الفهرس 
Child AbuseOnly 14 pages are availabe for public view
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Abstract
Introduction
It is difficult to assess the impact of childhood traumatic events on the psychiatric disorders in adulthood, as neither prospective research studies, nor experimental approaches are possible. Nevertheless, an increasing number of retrospective reports suggest that psychiatric disorders may be related to childhood psychological traumas.
Cases of child abuse represent the “tip of the iceberg” of the real phenomenon, where only a small proportion would be seen ”above the surface”. There is incomplete and inconsistent information on the prevalence of maltreatment, its sociodemographic risk factors, and its relationship to future health
The impact of child abuse and neglect is often discussed in terms of physical, psychological, behavioral, and societal consequences. In reality, however, it is impossible to separate them completely. Physical consequences (such as damage to a child’s growing brain) can have psychological implications for example: cognitive delays or emotional difficulties. Psychological problems often manifest as high-risk behaviors. Depression and anxiety, may make a person more likely to smoke, abuse alcohol or illicit drugs.
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Early psychoanalytic formulations postulated that drug users, in general, suffered from either a special form of affective dysregulation (tense depression) that was alleviated by drug use or from a disorder of impulse control in which the search for pleasure was dominant. More-recent formulations postulate ego defects, which are evinced by the addict’s inability to manage painful affects (guilt, anger, anxiety) and to avoid preventable medical, legal, and financial problems. The newer formulations postulating ego defects are to some degree the older formulations with a modest change in terminology that gives greater weight to the inability to cope with painful affects than to the intensity or abnormality of the affects per se. It is postulated that some substances pharmacologically and symbolically aid the ego in controlling those affects and that their use can be viewed as a form of self-medication.
Review of literature
The theoretical part of this thesis involves two chapters:
Chapter one:
This chapter provided contemporary definitions of child abuse, various patterns of child abuse with etiological models and epidemiology of child abuse
Chapter two:
This chapter provided an understanding of theoretical perspectives about adolescent substance use. The causes of substance use are complex and multifaceted. The data
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gathered from the literature suggest that substance use cannot be caused by a single particular factor, but by a combination of different aspects such as individual, family, peer, cultural and community factors. The prevalence of substance use, substances used, theoretical perspectives about the origin of substance use, effects of substance.
Aim of the work:
Identify the possible relationship between history of childhood abuse and the current substance use disorder and severity of associated complications
Subjects:
Subjects were divided into two groups. group (A) the patient group and group (B) the control group
Study design:
Case control study
Sample Size: After consultation of a statistician who recommended a sample size of 60 cases for each study group.
Sampling technique:
Stratified sampling method, Addiction unit of psychiatric hospitals in Great Cairo has been stratified into two major
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categories private & public. A random sample from both public units and private units were sampled to respect all different socioeconomic standards in the sample. Data About psychiatric hospitals were collected and hospitals were chosen according to the number of patients in addiction ward and rate of flow of patients in each psychiatric hospital.
Private Psychiatric hospitals chosen were: Al Mashfa Psychiatric Hospital, Dr. Gamal Mady Abou Elazayem Psychiatric Hospital and Dar El Mokattam Mental Health Hospital
Public Psychiatric Hospitals Chosen were: Ain Shams Psychiatric Institute, Abbassia Psychiatric Hospital and Psychological Medicine Hospital Heliopolis )Almatar(
20 patients were selected from each hospital after fulfilling the inclusion & exclusion criteria’s
Patients (group A):
60 male substance use disorder patients with history of childhood abuse.
Patients must fulfill the following:
Inclusive criteria:
Age between 18-50
Able to read and write to fulfill self-applied questionnaire
Fulfill the criteria of substance use disorder
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according to SCID-I.
Written consent
History of Childhood Abuse (using the Childhood Trauma Questionnaire)
Exclusive criteria:
Other Axis I Psychiatric Disorder
Diagnosis of Organic brain Syndrome
Medical condition that would interfere with the assessment (delirium)
Control (group B):
60 male substance use disorder patients with NO history of childhood abuse
Same inclusive and exclusion criteria as group A except for History of Childhood Abuse (using the Childhood Trauma Questionnaire)
Methods:
Both groups were subjected to the following assessment procedures:
Consent:
Each subject was informed with the study nature and aim with the right to participate or refrain. Written consent and verbal one were taken from each subject in
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the study. Strict confidentiality was offered to all subjects as regards joining the study and the results of the questionnaire.
Psychometric Procedures for both groups:
A) Structured Clinical Interview for DSM-IV (SCID- I) (First et al. 1995)
B) Structured Clinical Interview for DSM-IV (SCID II) (First et al. 1997)
C) Addiction Severity Index (ASI) (McLellan et al. 1985)
D) Childhood Trauma Questionnaire (CTQ) (Bernstein & Fink, 1998; Bernstein et al. 1994)
E) Familial Socioeconomic Status Scale (El-Shakhs, 1995)
Results
There is a direct correlation between childhood abuse and early age of onset of substance use disorder
More Single patients was found in private hospitals than in public hospitals in the opposite more married patients was found in the public hospitals. Divorce rate in public hospitals is much higher than private hospitals
Cluster B was the predominant personality disorder
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Patients who experienced child abuse are now scoring higher scores in drug use, alcohol use and family relationship subscales on the addiction severity index compared with those who did not experience child abuse.
Emotional neglect and physical neglect Scored the most type of abuse in the thesis sample
Children who experience childhood abuse were more likely to develop personality disorder (cluster B) as they grow up