Breaking news: Invisible injuries can hurt for real

Compared to experiencing physical and/or sexual abuse, experiencing psychological abuse is associated with later problems at equal or higher rates, according to a relatively recent research article that I read this morning (Spinazzola et al., 2014). Reading this made me feel better, for a brief moment, and I had to think about why that might be. Certainly this isn’t good news, or even “new” news. But I think at least for me, part of the cruelty of psychological abuse is the ability of the perpetrator and everyone else to claim that no “real” abuse is taking place.

When I was first hospitalized in the late 1980s, I faced pressure from my treatment team to recall repressed memories of sexual abuse, and I consider myself extremely lucky that I was unable to come up with any. During these years, the idea that patients with symptoms like mine would have had to have been sexually abused — and could only really recover if they remembered and told the stories of what had happened to them — contributed to unprecedented frequency and severity of accusations, retractions, and lawsuits that tore families and individuals apart. Therapists of this period were making a well-intentioned over-correction for the long history of ignoring sexual abuse in the field and in broader society, but lacking sufficient understanding of how suggestion can influence memories, they harmed patients in the process. Notably, alongside this trend was the fundamental assumption that in the absence of any physical/sexual events, psychological abuse alone could not explain severe symptoms like mine.

Consistent with this assumption, I meet all the diagnostic criteria for PTSD except for one really crucial one. According to official diagnostic rules, psychological abuse without a physical or sexual component does not “count” as a trauma. Though I otherwise appear to have PTSD, I’ve never experienced a qualifying ‘T,’ so I don’t. It took me years to realize that I was being (psychologically) abused  and (small ‘t’) traumatized. It took me even longer to stop feeling like too much of an exaggerator/impostor to use those words in describing my own life.

What I felt this morning suggests that to some extent I still do feel like an exaggerator/impostor when using those words. Because after all this time it somehow meant a lot to me to hear that a research study confirmed what I’ve always known but not always been able to defend:  psychological abuse can hurt for real.


Spinazzola et al.(2014):

Another new study on this topic:

Vachon et al. (2015):

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