Abuse

Abuse refers to a pattern of harmful behaviour — physical, sexual, emotional, psychological, financial, spiritual, or technological — directed at another person within a relationship of trust, dependence, or unequal power. Survivors of abuse are at elevated risk for trauma-related, mood, anxiety, and substance-use conditions.

Overview

Abuse encompasses a range of patterned harmful behaviors directed at another person, typically within a relationship characterized by trust, dependency, or unequal power. Forms recognized in clinical and legal literature include physical abuse, sexual abuse, emotional and psychological abuse, financial abuse, spiritual or religious abuse, technological abuse, and neglect. Abuse may occur in childhood (by caregivers, family members, authority figures) or in adulthood (by intimate partners, family members, caregivers, employers, institutions).

Abuse is a leading cause of trauma-related morbidity worldwide. The Adverse Childhood Experiences (ACE) study (Felitti et al., 1998) and decades of subsequent research have established robust dose-response relationships between childhood abuse and adult outcomes including depression, anxiety, complex PTSD, substance use disorders, eating disorders, autoimmune conditions, cardiovascular disease, and premature mortality. Adult abuse, including intimate partner violence, produces substantial direct injury and elevated rates of PTSD, major depression, suicidal behaviour, and chronic pain.

Population data from Statistics Canada indicate that approximately 1 in 3 women and 1 in 8 men experience some form of intimate partner violence in their lifetime; approximately 1 in 4 girls and 1 in 6 boys experience sexual abuse before age 18. Rates are substantially higher in Indigenous communities, sexual and gender minority populations, people with disabilities, and other historically marginalized groups.

Survivors of abuse frequently delay seeking help — often for years or decades — due to shame, fear of disclosure consequences, distrust of institutions, ongoing contact with the abuser, or coercive control that suppresses help-seeking. Effective trauma-informed care recognizes these barriers and centers safety, agency, and pacing rather than disclosure-on-demand or rapid memory work.

Recovery is possible. Trauma-focused therapies have substantial evidence supporting symptom reduction, post-traumatic growth, and restored capacity for relationships, work, and meaning. Survivors are not defined by what was done to them, and treatment increasingly focuses on identity reclamation rather than exclusively on symptom management.

Signs and symptoms

Intrusive memories or flashbacks — Unwanted, vivid recollections of abusive events; sensory or physical re-experiencing.
Hyperarousal and hypervigilance — Persistent scanning for threat, exaggerated startle, sleep disturbance, irritability, difficulty concentrating.
Avoidance — Patterned avoidance of people, places, conversations, or internal experiences associated with the abuse.
Negative alterations in cognition and mood — Persistent negative beliefs about self, others, or the world; pervasive shame, guilt, hopelessness, anhedonia.
Dissociative symptoms — Depersonalization, derealization, or dissociative amnesia for parts of the abusive experience or aftermath.
Difficulties with emotion regulation — Rapid mood shifts, difficulty calming down once activated, persistent low-grade dysregulation.
Difficulties with interpersonal relationships — Patterns of avoidance, reactivity, mistrust, or repeating dynamics from the abusive relationship in new contexts.
Negative self-concept — Persistent shame, sense of being permanently damaged or different, unable-to-be-loved beliefs.
Self-harm or suicidal ideation — Self-injurious behaviour or suicidal thoughts, particularly during periods of acute remembering or relational crisis.
Somatic symptoms — Chronic pain, gastrointestinal distress, headaches, fatigue, and other persistent physical symptoms without identified medical cause.

Causes and risk factors

“Causes” of abuse-related symptoms refer to the abuse itself — symptoms are reactions to abnormal events, not signs of pre-existing disorder. Risk factors discussed here are those that affect vulnerability to abuse exposure and severity of post-abuse symptoms:

Vulnerability to exposure:

Childhood: parental mental illness, parental addiction, family poverty, social isolation, prior history of family violence, age (younger children at higher risk), and presence of disability.
Adulthood: prior abuse history (childhood abuse strongly predicts adult revictimization), social isolation, dependent housing or financial relationships, immigration status, and membership in marginalized populations.

Severity of post-abuse symptoms:

Earlier age at onset, longer duration, and greater severity of abuse.
Abuse by a caregiver, attachment figure, or trusted authority — produces more severe symptoms than abuse by a stranger because of the betrayal-trauma dimension (Freyd, 1996).
Lack of safe, supportive disclosure when first reaching out; institutional or familial denial.
Prolonged exposure to the abuser after the abuse begins (e.g., remaining in the home, ongoing contact required).
Co-occurring stressors and lack of supportive resources during recovery.

Protective factors that reduce post-abuse symptom severity include early validation by at least one supportive adult or peer, access to safe housing and financial resources, trauma-informed care, and a strong sense of cultural identity or community belonging.

Typical treatments

Trauma-focused, evidence-based psychotherapies are the foundation of treatment. International guidelines (ISTSS, NICE, APA) consistently recommend the following:

Cognitive Processing Therapy (CPT): 12-session structured CBT focused on identifying and modifying “stuck points” — beliefs that prevent recovery (e.g., “it was my fault,” “I should have known”). Strong evidence base for adult sexual assault and childhood sexual abuse survivors.

Prolonged Exposure (PE) therapy: structured 8-15 session protocol involving repeated imaginal exposure to the trauma memory and in vivo exposure to avoided situations. Strong evidence base for PTSD across trauma types.

Eye Movement Desensitization and Reprocessing (EMDR): trauma-processing modality using bilateral stimulation. Strong evidence base; accepted by WHO and major guideline bodies as first-line treatment for PTSD.

Trauma-Focused Cognitive behavioural Therapy (TF-CBT): developed for children and adolescents who have experienced abuse. Strong evidence base; involves caregiver participation.

Phase-oriented treatment for complex trauma: three-phase approach (stabilization, processing, integration) recommended by ISTSS for individuals with complex PTSD or substantial dissociative features. Particularly important for childhood abuse survivors with extensive trauma history.

Sensorimotor Psychotherapy and Somatic Experiencing: body-oriented approaches that target trauma-related dysregulation through interoceptive awareness and structured movement. Growing evidence base; often integrated with cognitive approaches.

Dialectical behaviour Therapy (DBT): first-line for survivors with co-occurring borderline features or chronic suicidality; provides skills-based stabilization before or in parallel with trauma processing.

Group therapy and survivor-led communities provide validation, reduce isolation, and offer models of recovery. They complement individual therapy rather than replacing it.

Pharmacotherapy: SSRIs (paroxetine, sertraline) are FDA- and Health Canada–approved for PTSD. Prazosin is used for trauma-related nightmares. Other agents target specific co-occurring conditions (depression, anxiety, sleep disturbance). Benzodiazepines are generally avoided in PTSD due to evidence of poorer long-term outcomes.

Treatment of co-occurring conditions — substance use disorders, eating disorders, dissociative disorders — is essential for sustained recovery.

When to seek help

If you are in immediate danger now, contact emergency services: dial 911. If you are unable to speak safely on the phone, text-based crisis services are available below.

If you are experiencing or recently experienced abuse — including emotional, psychological, financial, or technological abuse — and are not in immediate physical danger, consider reaching out to one of the following 24-hour Canadian resources:

9-8-8 — Suicide Crisis Helpline (call or text). Free, 24/7, available across Canada.
1-833-456-4566 — Talk Suicide Canada (call); text 45645, 4 PM–midnight ET.
1-866-863-0511 — Assaulted Women’s Helpline (Ontario; multilingual; 24/7).
1-800-668-6868 — Kids Help Phone (under 20; call or text CONNECT to 686868; 24/7).
1-866-925-4419 — Indian Residential Schools Crisis Line (24/7).
1-855-242-3310 — Hope for Wellness Helpline (Indigenous-led; counselling in English, French, Cree, Ojibway, and Inuktitut; 24/7).
1-800-363-9010 — ShelterSafe / Canada-wide Shelter Network (online directory at sheltersafe.ca).
211 — connects to local social services across Canada.
811 — Health Link (Alberta and most provinces) for non-emergency mental-health support.

If you are an adult processing childhood abuse, professional support is indicated when:

Memories or feelings about past abuse are intruding on daily life, sleep, or relationships.
You are experiencing patterns from the abusive relationship in adult relationships.
You are using substances, food, sex, or other coping strategies in ways that are harming you.
You are experiencing depression, anxiety, suicidal ideation, or self-harm urges.
You are considering reporting historical abuse and need support thinking through the decision.

Disclosure to a therapist is confidential, with two well-defined exceptions: (1) imminent risk to self or others, and (2) reasonable suspicion that a child is currently being abused (mandatory reporting laws apply to clinicians in all Canadian provinces). Survivors of historical abuse are not required to report and do not lose confidentiality by discussing past events.

Frequently asked questions

How do I know if what happened to me was abuse?

Abuse is a pattern of harmful behaviour in a relationship of trust, dependence, or unequal power. It does not require physical injury. Emotional, psychological, financial, sexual, and spiritual abuse are all recognized forms. If you are uncertain, a single confidential conversation with a trauma-informed clinician can help you sort through your experience without committing to disclosure or reporting.

Is it too late to start therapy if the abuse was decades ago?

No. Trauma-focused treatments are effective regardless of how long ago the abuse occurred. Many survivors enter treatment 20, 30, or 40+ years after the events. Recent research on post-traumatic growth shows that meaningful recovery and even thriving are possible at any life stage.

Will I have to talk about all the details?

No. Trauma-focused therapy is paced according to your readiness. Stabilization comes before processing, and processing is structured to avoid retraumatization. You retain control over what you share and when.

Will the therapist have to report what I tell them?

For adult survivors of historical abuse, no. Mandatory reporting in Canada applies to (1) imminent risk to yourself or others, and (2) ongoing or recent abuse of a child. A clinician can answer specific questions about reporting at the start of treatment.

Is medication necessary?

Not always. Medication is one option, particularly for severe PTSD, major depression, or sleep disturbance. Many survivors recover with psychotherapy alone. Decisions are individualized.

Will I ever feel "normal" again?

Many survivors achieve full symptom remission and report improved functioning, relationships, and sense of self after treatment. Recovery is not return to a pre-abuse self — it is the building of a new, more integrated self that includes the experience without being defined by it.

References

Felitti, V. J., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258.
International Society for Traumatic Stress Studies. (2018). Posttraumatic Stress Disorder Prevention and Treatment Guidelines.
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.). APA.
Herman, J. L. (1992). Trauma and Recovery: The Aftermath of Violence. Basic Books.
van der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking.
Statistics Canada. (2023). Family Violence in Canada: A Statistical Profile.

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The ShiftGrit Clinical Editorial Team combines the insight of registered psychologists, provisional psychologists, and trained writers to create accessible, evidence-informed therapy resources. All content is clinically reviewed by a Registered Psychologist.