Australian Social Work

Vol. 63, No. 4, December 2010, pp. 391
403

Impact of Childhood Abuse: Biopsychosocial Pathways Through

Which Adult Mental Health is Compromised
Dominiek Coates
Adults Surviving Child Abuse (ASCA), Kirribilli Neighbourhood Centre, Sydney, New South Wales

Abstract
The relationship between childhood abuse and adult mental and physical health
problems is well documented. Over the lifespan of victims of child abuse, social,
psychological and biological consequences of abuse interact in complex ways.
A biopsychosocial model is applied to the experiences of adult victims of child abuse to
make sense of the complex and varied impacts of child abuse. The long-term difficulties
experienced by adult victims of child abuse are discussed in relation to the neurobiological impacts of child abuse on the childs developing brain. The impact of child
abuse on neuro-endocrine functioning and the structure of the brain, in particular on the
amygdala, hippocampus, left hemisphere, and corpus callosum are explored. A number of
implications for social work practice are outlined.
Keywords: Biopsychosocial Model; Child Abuse; Child Neglect; Neuro-biology; Trauma
The association between child abuse and neglect, and adult mental health problems
has been well-established (Briere, 2002, 2004; Briere & Scott, 2006; Draper et al., 2008;
Harper, Stalker, Palmer, & Gadbois, 2008; Palmer, Brown, Rae-Grant, & Loughin,
2001; Spila, Makara, Kozak, & Urbanska, 2008). A number of research studies have
examined the relationship between traumatic experiences in childhood and later
health concerns and have found that a range of problems, including depression,
anxiety disorders, addictions, personality disorders, eating disorders, sexual disorders,
suicidal behaviour, and physical health problems can be, but are not necessarily,
associated with childhood experiences of abuse (Draper et al., 2008; Spila et al.,
2008). The long-term impact of child abuse is far reaching, with some studies
highlighting that the effects of childhood abuse can last a lifetime (Draper et al.,
2008).
Despite these findings, we still hear the saying What doesnt kill you makes you
stronger and Time heals all wounds. This common wisdom implies that traumatic
experiences, once overcome, result in greater levels of psychological, physical, and

AQ1

Correspondence to: Dominiek Coates, Research and Program Manager, Adults Surviving Child Abuse (ASCA),
Kirribilli Neighbourhood Centre, 16
18 Fitzroy St, Sydney, New South Wales 2061, Australia. Email:
dcoates@psrc.com.au
Accepted 19 March 2010
ISSN 0312-407X (print)/ISSN 1447-0748 (online) # 2010 Australian Association of Social Workers
DOI: 10.1080/0312407X.2010.508533

392 Dominiek Coates

emotional wellbeing. The impact of traumatic events on infants and young children is
often minimised in this way. Although trials and tribulations can build character, they
can also cause biological, neurological, and psychological compromise (Cozolino,
2002). It is ironic that greater resilience is often presumed during infancy and
childhood, a time of greatest vulnerability to the effects of trauma (Perry, Pollard,
Blakely, Baker, & Vigilante, 1995). The effects of early and severe trauma are
widespread, devastating, pervasive, and often difficult to treat (Cozolino, 2002, 2008;
Draper et al., 2008; Giarratano, 2004).
We know that our first intimate or loving relationship with our primary caregiver
informs our expectations and patterns of behaviour (Harlow, 1958). Most social
workers are familiar with attachment theory, a theory of personality development
emanating from John Bowlbys work (1969, 1973, 1980, 1988), which highlights the
relationship between patterns of attachment formed in childhood and patterns of
intimate relationships in adulthood. Attachment theory proposes that the negative
core schema determined by first attachment relationships can fundamentally affect an
individuals capacity to establish and sustain significant attachments throughout life.
Attachment theory suggests that early childhood relationships are internalised and
inform an internal working model of the self, others, and relationships and thus,
influence the pattern of relationships and attachment styles in adult life (Alexander &
Anderson, 1994; Carnelley, Pietromonaco, & Jaffe, 1994). Attachment theory posits
that difficulties associated with abuse-related attachment interact with the childs
biopsychosocial development and are mirrored in relationships throughout a childs
life.
Childhood trauma can have a profound impact on the emotional, behavioural,
cognitive, social, and physical functioning of children (Perry et al., 1995), with the
impacts of child abuse continuing into adulthood (Briere, 2002; Draper et al., 2008;
Perry et al., 1995; Van Der Horst, LeRoy, & Van Der Veer, 2008). However, it should
be noted that the extent and nature of the impact of child abuse and neglect varies
from person to person. A number of reviews have estimated that between a third and
half of individuals who have experienced sexual abuse do not experience adult
psychiatric or psychological problems (Fergusson & Mullen, 1999; McGloin &
Widom, 2001). A variety of factors may influence if and how abuse has an impact,
including the gender of the victim and perpetrator, the type and severity of the abuse,
the duration of and time since the abuse, genetic variations, biopsychological factors,
family reactions and background, and perceived social support (Collishaw et al.,
2007; Futa, Nash, Hansen, & Garbin, 2003; McClure, Chavez, Agars, Peacock, &
Matosian, 2007; Ullman, Filipas, Townsend, & Starzynski, 2007). In addition to a
number of variables that moderate the impact of abuse Rutter (2007) stressed the
important role of the of gene-environment interaction in understanding the
heterogeneity in outcome of childhood adversity and the resilience of the child.
To help make sense of the repercussions of child abuse in adulthood, an
understanding of the effects of child abuse and neglect on a childs biopsychosocial
development is necessary. Therefore, the model adopted to understand the pervasive

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impact of child abuse in the present paper is the biopsychosocial model, which holds
to the idea that illness and health are the result of an interaction between biological,
psychological, and social factors (Alonso, 2004; Suls, 2004). The primary questions
explored are:
.

How does the quality of the attachment relationship with the primary caregiver
impact on a developing childs physiology?
What are the implications in terms of social work practice with adults who have
experienced child abuse?

A review of the relevant research, with a focus on the biological impacts of child
abuse, is used to explore these questions.
Regulating Stress: Impact of Abuse on Neuro-endocrine Systems
Brain development is affected by stress early on in ones life. Early severe stress and
abuse produces a cascade of neurobiological events that have the potential to cause
enduring changes in brain development, with these neurobiological sequelae, in turn,
playing a significant role in the emergence of psychiatric disorders (Teicher, 2002;
Teicher et al., 2003).
Safety and security are considered crucial factors in early brain organisation. A safe
environment with a caring primary caregiver helps moderate the potentially negative
impact stress places on the developing brain (Gunnar, 1998). It is often suggested that
the role of a primary caregiver is to provide the child with environments that are
stimulating, while at the same time being consistently available to help regulate the
childs physiological arousal and ensure the child does not become overwhelmed. In
secure environments, stressed children seek and receive comfort from the primary
caregiver, which regulates their arousal response and enables them to return to
exploratory activity away from the caregiver (Streeck-Fischer & van der Kolk, 2000).
By providing a balance between soothing and stimulation, and helping the child
regulate and moderate his or her physiological arousal, the primary caregiver helps
the child to develop a biological framework for dealing with future stress (Schore,
1994). Children who are not provided with a secure base, and who cannot rely on
their primary caregiver for comfort, become incapable of calming themselves down
when threatened, and struggle to develop a biological framework for regulating stress.
The main biological system involved in regulating stress is the neuro-endocrine
system.
Extensive research into the neuro-biology of stress has established the link between a
history of childhood abuse and neglect, and neuro-endocrine impacts (Hertsgaard,
Gunnar, Erickson, & Nachmias, 1995; Neigh, Gillespie, & Nemeroff, 2009). The neuroendocrine system refers to the system of interaction between the brain, nervous
system, and hormones; with one of its primary roles the regulation of moods,
emotions, and stress response. Any disruption to the neuro-endocrine system affects a
range of basic psychological and physiological functions. Research suggests that many
of the long-term impacts of child abuse result from the chronic neuro-endocrine

394 Dominiek Coates

dysregulation caused by prolonged exposure to abuse and violence (Kendall-Tackett,

2001). For example, studies have found that child abuse and neglect alters a major part
of the neuro-endocrine system involved in the regulation of stress, called the
hypothalamic-pituitary-adrenocortical (HPA) axis (Neigh et al., 2009).
Even in utero foetuses can experience dysfunctional stress (Cozolino, 2002). Tests
have found that foetuses express a biological response indicative of a stress response
well before birth (Gunnar, 1998). The nervous systems of children who are abused
run on a constant high, because they are constantly anticipating further danger. Their
bodies are flooded with fight
flight hormones such as cortisol (Cozolino, 2002).
A number of studies have identified alterations in cortisol production in both
children and adults who experienced childhood abuse (Carpenter et al., 2007; Joyce
et al., 2007; Linares et al., 2008; Murray-Close, Han, Cicchetti, Crick, & Rogosch,
2008). Alteration in cortisol levels, either an increase or decrease, can cause a number
of long-term physical and psychological health concerns. The more a child is in a
state of hyper-arousal, the more likely he or she is to have neuropsychiatric symptoms
following trauma (Perry et al., 1995).
For many victims of child abuse this state of chronic hyper-arousal persists
throughout the adult years. Even when the abuse is over and the environment is
safe, many adults with a history of child abuse still perceive the threat as present; their
fear is maintained and becomes pathological (Briere & Scott, 2006). The hyper-arousal
response to threat impacts on the childs developing brain, and the bodies of children
who are being abused adapt to their unpredictable dangerous environments (Perry
et al., 1995). Stress can set off a ripple of hormonal changes that permanently wire a
childs brain to cope with a malevolent world (Teicher, 2002). Through this chain of
events, violence and abuse pass from generation to generation (Teicher, 2002).
Neuro-biological Impact of Abuse: The Impact of Abuse on the Developing Brain
An estimate of 70% of human genetic structure is added after birth (Schore, 1994).
While the fundamental neuro-anatomical structure of the brain is genetically
determined, the templates determining the categorisation and interpretation of
experience within the limbic system and frontal lobes develop gradually as a child
grows. Developmental experiences shape the structure in which the brain is being
organised (Perry et al., 1995; Streeck-Fischer & van der Kolk, 2000). A childs
interaction with the outside environment causes connections to form between brain
cells (McLean Hospital, 2000).
Studies suggest that child abuse and neglect impact on a childs developing brain,
in particular on the limbic system which includes the amygdala (Teicher et al., 2003;
Teicher, Glod, Surrey, & Swett, 1993) and hippocampus (Gould & Tanapat, 1999;
Stein, 1997); the cerebral cortex (Arnsten, 1999; Ito, Teicher, Glod, & Ackerman,
1998) and corpus callosum (De Bellis et al., 1999; Ito et al., 1998). To appreciate the
significance of the findings of these studies, an understanding of how the brain
responds to threat is necessary.

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The Brains Response to Threat

The limbic system is a network of brain cells sometimes called the emotional brain.
It controls many of the most fundamental emotions and drives pertinent to survival
(McLean Hospital, 2000). The limbic system, which includes the amygdala and
hippocampus, initiates the fight, flight, or freeze responses in the face of threat
(Teicher et al., 2003). The cortex, the more rational, outer-layer of the brain and the
seat of our thinking capacity is in constant communication with the amygdala and
the hippocampus (the limbic system). The frontal lobes in the cortex are responsible
for learning and problem solving. The capacity to learn from experience requires
events to be registered in the prefrontal cortex, compared with other experiences, and
evaluated (Streeck-Fischer & van der Kolk, 2000). When children feel they are being
threatened, the fast tracts of the limbic system are likely to be activated before the
slower prefrontal cortex has a chance to evaluate the stimulus (Streeck-Fischer & van
der Kolk, 2000). Only a state of non hyper-arousal allows the activation of the
prefrontal cortex needed for learning and problem solving.
The amygdala processes emotions before the cortex registers an event. For example,
on registering the sound of a loved ones voice the amygdala generates an emotional
response (e.g., pleasure) by releasing hormones. When someone is threatened, the
amygdala perceives danger and releases a series of hormones causing the defensive
responses of fight, flight, or freeze. As the amygdala is immune to the effects of stress
hormones it may continue to sound an alarm inappropriately, and this is considered
to be a possible link to subsequent post traumatic stress disorder (PTSD) reactions
(Rothschild, 2003, 2004).
The hippocampus helps to process information and lends time and spatial context
to memories and events. It also assists the initial transfer of information to the cortex.
However, the hippocampus is vulnerable to stress hormones, in particular the
hormones released by the amygdalas alarm. When these hormones are heightened,
they suppress the activity of the hippocampus, and it loses its ability to function. As a
result, information that would enable the differentiation between a real and an
imagined threat never reaches the cortex and a rational evaluation of the information
is not possible (Rothschild, 2004). If a stimulus is misinterpreted as a threat, this leads
to immediate fight
flight
freeze responses (to nonthreatening stimuli). This causes
the limbic system to respond to minor irritations in a totalistic manner (StreeckFischer & van der Kolk, 2000).Thus, children who are abused go immediately from
(fearful) stimulus to fight or flight responses without learning from the experience,
because they cannot grasp what is happening when the prefrontal cortex is not
activated (Streeck-Fischer & van der Kolk, 2000).
Impact of Child Abuse on the Limbic System
Studies indicate that child abuse impacts on limbic system functioning. The amygdala
and hippocampus are main parts of the limbic system. The amygdala plays an
important role in the fight
flight response and is central to fear conditioning and
the control of aggressive, oral, and sexual behaviour (Teicher et al., 2003).

396 Dominiek Coates

The hippocampus plays a critical role in the encoding and retrieval of information
(Desgranges, Baron, & Eustache, 1998), and is implicated in the generation of
dissociative states (Mesulam, 1981), anxiety, and panic disorders (Gray, 1983).
A study by Teicher et al. (1993), using a questionnaire designed to test limbic system
dysfunction in adults, found that adult psychiatric outpatients with a history of
childhood physical or sexual abuse had a significantly higher score, indicating limbic
system dysfunction. This study found a 38% increase in limbic abnormalities
following physical abuse, 49% after sexual abuse, and 113% following more than one
type of abuse.
Hippocampal volume has also been found to decrease after exposure to
environments of extreme stress, especially in childhood (Gould & Tanapat, 1999).
Decreased hippocampal volume has been associated with poorer declarative memory,
increasing the risk of developing PTSD-like symptoms, depression, and physical
inflammations (Danese, Pariante, Caspi, Taylor, & Poulton, 2006).
Impact of Child Abuse on the Cerebral Cortex
Studies have found that child abuse and neglect impact on the development of the
cortex, in particular on the left hemisphere and corpus callosum. A study by Ito et al.
(1998) at McLean Hospital found that children with histories of abuse were twice as
likely as nonabused children to have abnormal electroencephalographs (EEGs). In a
group of 115 psychiatric inpatient children, a significant association was shown
between a history of child physical, sexual, or psychological abuse, and EEG
abnormalities in the left side of the frontal and temporal region of the brain.
Furthermore, this study revealed impaired development of the left brain in abused
patients, suggesting increased activity of the right hemisphere than in healthy
individuals. The right hemisphere of abused subjects had developed to the same
degree as the right hemisphere of controls, while the left hemisphere of the abused
subjects lagged substantially behind the left hemisphere of healthy controls. The left
hemisphere is usually dominant in a variety of tasks, and deals with perception and
expression of language and logical analytical thought. The right hemisphere deals
with the perception and expression of emotions, particularly unpleasant emotions
(Ross, Thompson, & Yenkosky, 1997). Similarly, a study by Choi, Jeong, Rohan,
Polcari and Teicher (2009) found that exposure to parental verbal abuse affects the
integrity of left hemisphere pathways involved with processing language, as well as
fiber tracts involved in emotional regulation. This study highlighted the potential
negative effect of ridicule, humiliation, and disdain on brain connectivity.
The corpus callosum has also been found to be affected by child abuse. The two
hemispheres need to interact closely with each other and are connected through the
corpus callosum (Teicher et al., 2004). Early stress exerts a strong effect on the
degree of right
left hemispheric integration, with a number of studies having found
that the corpus callosum is smaller in abused children than in healthy children
(De Bellis et al., 1999; De Bellis et al., 2002; Teicher et al., 2004; Teicher, Ito, Glod, &
Andersen, 1997). Furthermore, McLean Hospital (2000) found that abused patients

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shifted the degree of activity between the two hemispheres to a much greater extent
than normal. They theorised that a smaller corpus callosum leads to less integration
of the hemispheres. This can lead to dramatic shifts in mood or personality.
Impact of Child Abuse on Gene Expression
A study by McGowan et al. (2009) has shown that abuse in early childhood can
dramatically alter the way the brain copes with stress in adulthood. The study
examined samples from the hippocampal region of the brain of 36 people


12 suicide victims with a history of childhood abuse, 12 suicide victims without a
history of childhood abuse, and 12 people who had died suddenly of accidental
causes. While studying the hippocampus region of the brain, the team found that a
gene called NR3C1, which influences the brains susceptibility to stress hormones was
less likely to be activated in people who had been abused. Hence, this study found
that childhood abuse or neglect can alter the function of a gene that controls the
brains response to stress. While child abuse and neglect has previously been shown to
affect brain structure, the study is the first to demonstrate a genetic process that
appears to underlie such changes.
Implications for Social Work Practice
It is clear that early patterns of attachment have powerful effects across the lifespan,
and children who experience child abuse adapt to survive in a dangerous world.
Developmental modifications resulting from excessive stress are designed to help the
individual adapt to high levels of lifelong stress. However, these alterations are not
optimal for survival in a more benign environment (Teicher et al., 2003). Considering
the extent of the biopsychosocial impact of child abuse, therapeutic interventions that
are aimed at assisting individuals who have adapted to a dangerous world to survive
in a safe, or at least safer, world may be appropriate. The question of how social
workers can best assist victims of child abuse, whose brains have developed to survive
in a dangerous world, to adapt to life in comparatively safe environments needs to be
posed. Before outlining some recommendations, the plasticity of the brain needs to
be stressed. As outlined in this paper, there is significant evidence that shows that the
brain is plastic and changes in response to the environment. However, the plasticity of
the brain is not restricted to childhood, but continues throughout adult life. Studies
suggest that the adult brain is almost as malleable and plastic as the childs. (See
Doidge, 2007, for a study of brain plasticity). In a similar way to how the childs brain
adapts to survive in an abusive environment, the adult brain can change and adapt to
living in a safe world.
Teach Your Client Arousal Reduction Strategies
To survive in a dangerous world, victims of abuse learn to react instead of respond. In
times of danger, the emotional part of our brain (limbic system) becomes activated
and produces fight
flight
freeze hormones to enhance survival before the slower
cortex becomes activated. When under attack, instinctive reactions are more
important in terms of survival than a carefully deliberated response. As discussed,

398 Dominiek Coates

the hippocampus, responsible for transferring an instinctual emotional response from

the amygdala to the cortex where it can be processed, is sensitive to stress hormones
and malfunctions when under continuous stress. Human physiology adapts to
surviving in a dangerous world and reacting becomes a more adaptive response
than (the slower) responding. This is a pattern that often continues into adulthood,
even when there is no apparent danger present (Cloitre, Cohen, & Koenen, 2006).
Studies show that adult victims of child abuse have a tendency to respond to minor
triggers with a range of catastrophic reactions (Streeck-Fischer & van der Kolk, 2000).
As explained, victims of child abuse become excessively responsive to relatively
minor stimuli as a result of decreased frontal lobe functioning (cognitive understanding of events) and increased limbic system sensitivity (impulsiveness) (StreeckFischer & van der Kolk, 2000). A cognitive understanding of events helps modulate
emotions and is important in responding rather than reacting to situations. In other
words, adult victims of child abuse may have histories of reacting impulsively and
potentially making crisis situations worse, rather than formulating flexible responses.
Difficulties in formulating flexible responses in situations of stress can be best
understood in light of the shutting down of an already malfunctioning hippocampus in response to the over-production of fight
flight
freeze hormones. Therefore, in
terms of practice implications, safe and successful therapy needs to maintain stress
hormone levels low enough to keep the hippocampus functioning (Rothschild, 2004).
However, maintaining low stress hormone levels can be challenging for victims of
child abuse and is likely to require a dedicated commitment by both client and
therapist. As explained, the normal development of neuro-endocrine systems that
regulate stress, in particular the HPA axis, is negatively impacted by child abuse.
Thus, significant difficulties in emotional self-regulation are commonly observed in
victims of child abuse and neglect (Cozolino, 2002). Without adequate affectregulation skills, even small amounts of distress can be overwhelming (Briere, 2004).
Considering the importance in keeping the hippocampus functioning, and in turn
the prefrontal cortex required for learning and problem solving, teaching clients with
histories of abuse arousal reduction strategies and other affect regulation skills is
paramount to recovery (Briere, 2004; Linehan, 1993; Saakvitne & Pearlman, 1996).
Victims of child abuse need tools to help them contain reactions to triggers and to
halt the out-of-control acceleration of hyper-arousal (Rothschild, 2003).
A useful arousal reduction strategy to encourage victims of child abuse to try is
breathing exercises (Briere, 2002, 2004; Briere & Scott, 2006; Rothschild, 2003).
Increased respiration is one of the bodys fight
flight responses, with many victims of
child abuse, whose fight
flight response often fires too rapidly, chronically overbreathing. Breathing at the correct rate slows the bodily processes, lowers arousal,
and in turn reduces tension and stress. Slowing the breathing rate is an effective
method of turning off the fight
flight response. An in-depth overview of affect
regulation and arousal reduction strategies is not within the scope of this work, and
dialectical behaviour therapy as developed by Linehan (1993) and trauma therapy as
developed by Briere (2002) are recommended for further information.

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Teach Your Clients Strategies that Strengthen the Corpus Callosum

Another area of therapeutic work could be enhancing the communication between
the left and right hemispheres by teaching clients strategies that strengthen the corpus
callosum. As noted, a smaller corpus callosum has been found to be the result of child
abuse and appears to relate to dramatic shifts in mood or personality (McLean
Hospital, 2000). A number of exercise programs have been specifically designed to
strengthen left
right hemisphere integration and other areas of the brain (Blakemore
& Frith, 2005; Cohen & Goldsmith, 2002; Dennison & Dennison, 1985; Hannaford,
1995; Parlette, 1997). Even though the effectiveness of such programs is underresearched and does not hold a strong scientific basis, studies indicate that more than
half of teachers who have adopted such programs found the techniques helpful
(Howard-Jones & Pickering, n.d.). Despite a need for further scientific evidence,
some of the physical exercises developed to strengthen the corpus callosum maybe
helpful (for more information see the work of Dennison & Dennison, 1985, and
Hannaford, 1995).
Assist Your Client in Developing Social Skills and New Relationships
As outlined, neural development and social interactions are inextricably intertwined.
The human brain adapts to surviving in danger when environments are experienced
as dangerous; similarly the human brain adapts to survive in safety when
environments are experienced as safe. This suggests that once primed to survive in
a dangerous world, individuals may be more likely to continue living in a dangerous
world, even when safety could be available to them (Siegel & Geller, 2000).
As explained, victims of child abuse are vulnerable to hyper-arousal which makes
tolerating uncertainty difficult (Streeck-Fischer & van der Kolk, 2000). Sensitivity to
hyper-arousal makes victims of child abuse more likely to avoid novelty, including
new social settings and relationships. Therefore, they are more likely to avoid exactly
what is needed for recovery: resocialisation in safe environments where safe
relationships are the norm.
Difficulties in establishing relationships in adulthood link childhood abuse and its
negative health outcomes. The association between dysfunctional relationships and
adverse mental and physical health outcomes has been frequently reported (Draper
et al., 2008). Two-thirds of the long-term negative mental health effects of child abuse
are related to poor educational and work choices, and deficiencies in intimate
relationships (Schilling, Aseltine, & Gore, 2007). Unable to regulate their feelings,
victims of child abuse are more prone to scaring away other children and, in time,
other adults (Streeck-Fischer & van der Kolk, 2000). Victims of child abuse often do
not know how to enlist other people as allies. People are perceived as sources of terror
or gratification, but rarely fellow human beings with their own sets of needs and
desires (Streeck-Fischer & van der Kolk, 2000). Consequently, child abuse not only
traumatises children, but also deprives them of healing interactions (Cozolino, 2002).
Therefore, assisting clients with histories of child abuse build supportive social
relationships and networks is paramount to recovery. Studies have found that

400 Dominiek Coates

developing strong social supports is an important factor in ameliorating the impacts

of child abuse (Lauterbach, Koch, & Porter, 2007; Schilling et al., 2007).
Conclusion
The impact of extreme and chronic stress on the developing child as experienced in
environments of abuse is profound. Evidence shows that prolonged abuse of the
child impacts upon the childs developing brain and neuro-endocrine system,
priming the child to survive in a dangerous world. Being socialised in environments
of abuse impact on the developing brains structure and has significant
biopsychosocial impacts into adulthood. Living in relative safety can be challenging
for victims of child abuse primed to survive in danger. Recommendations for social
work practice focus on breaking the cycle of violence and abuse by helping victims
build new and safe social relationships and networks. Effective arousal reduction
strategies are vital to successfully transitioning from a dangerous world to a world
of relative safety. In time, and with dedicated effort, the victim will become
resocialised and new neural pathways will form; living in safety will no longer be
difficult but become the norm.
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