There is a particular kind of wound that doesn’t show up on an X-ray. It doesn’t bleed, and it rarely announces itself in the emergency room. Yet it reshapes the architecture of the brain, rewrites a person’s sense of self, and — if left unaddressed — echoes from one generation into the next. This is the wound left by abuse and violence.

As clinical psychologists, we are often the first professionals to hear these stories. And one of the most important things research keeps reminding us is this: we must listen not just to the event, but to the entire ecology in which it occurs.

Defining the Landscape: What Do We Mean by Abuse and Violence?

Abuse and violence are not monolithic constructs. They span a wide, complex spectrum that includes physical, sexual, emotional, and psychological harm, as well as neglect and economic control. The World Health Organization (WHO) estimates that up to 1 billion children aged 2–17 years have experienced some form of violence or neglect in just the past year alone — a figure that is both staggering and sobering (Stoltenborgh et al., 2015, as cited in Child Abuse & Neglect, 2025).

Intimate partner violence (IPV) — one of the most studied forms — encompasses physical violence, sexual coercion, psychological abuse, and controlling behaviors directed at a current or former partner (Oram et al., 2022). Globally, about 1 in 3 women has been subjected to violence by a current or previous intimate partner, and approximately 38% of women who are murdered are killed by intimate partners (World Health Organization, 2024). The economic toll is equally alarming: estimates suggest it would cost a country like the United States approximately $3.6 trillion to effectively address the lifetime economic consequences of IPV (Peterson et al., 2018).

Yet despite these figures, a critical insight from recent research is that the most prevalent form of abuse in intimate relationships is not physical — it is emotional. Psychological abuse is pervasive, insidious, and often unrecognized both by victims and by clinicians (Oram et al., 2017). Survivors frequently describe feeling confused, degraded, fearful, hopeless, and trapped — without always being able to name what is happening to them (Engel, 2023; Walby & Towers, 2018). Importantly, the intensity of emotional abuse can range from microaggressions to severe harm that precipitates suicidal ideation and attempts (Wolford-Clevenger et al., 2017).

The Neuroscience of Harm: What Abuse Does to the Developing Brain

To truly understand the consequences of abuse, we must go beneath behavior and into biology. The developing brain is particularly vulnerable.

During childhood, the brain undergoes a period of heightened neuroplasticity — an extraordinary capacity to form new connections in response to its environment. This is what makes early experience so formative. But this same plasticity makes the brain exquisitely sensitive to harm. When a child is repeatedly exposed to abuse or neglect, neuroplasticity can become maladaptive: it restructures the brain around threat rather than growth (Cimeša et al., 2023).

Research published in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging (2024) found that children who had experienced trauma displayed disrupted activity in two critical brain networks — the default mode network (DMN), which governs self-concept and introspection, and the central executive network (CEN), which supports emotional regulation, memory, and decision-making (Ireton, Hughes, & Klabunde, 2024). These are not peripheral systems. They are the networks that allow a person to feel safe in their own skin and to navigate relationships.

Structurally, childhood trauma is linked to decreased hippocampal volume — the region most responsible for memory and stress regulation — as well as overactivation of the amygdala, the brain’s alarm system (Cimeša et al., 2023). The result is a nervous system perpetually braced for danger, even when the danger has passed. This is the neurobiological substrate of Post-Traumatic Stress Disorder (PTSD), which childhood maltreatment significantly increases the risk of developing.

Perhaps most troublingly, research now shows that childhood adversity does not merely shape the brain during development — it continues to affect how the brain responds to future trauma in adulthood. A 2025 longitudinal study found that childhood maltreatment was associated with white matter changes in the brain following adult trauma exposure, which in turn predicted more severe PTSD symptoms six months later. In other words, early abuse sensitizes the neural architecture to subsequent harm, compounding vulnerability over a lifetime.

The Cycle That Didn’t Have to Repeat: Intergenerational Transmission of Violence

One of the most profound — and, in clinical practice, most emotionally complex — findings in this field is that violence travels through families like an underground river: invisible to many, but shaping everything above it.

The intergenerational transmission of family violence (ITFV) refers to the process by which violent behaviors and experiences are repeated from one generation to the next (Widom et al., 2015). Exposure to child maltreatment, parental IPV, or sibling violence in early life is consistently linked to a significantly elevated risk of perpetrating IPV in adult relationships (Meinck et al., 2023). A 2023 scoping review confirmed that children whose parents had adverse childhood experiences (ACEs) — including family violence — face an elevated risk of both exposure to violence and later perpetration.

But it is essential to name what is happening without sliding into determinism. The cycle of violence is a risk factor, not a destiny. Most people who experience childhood abuse do not go on to perpetrate abuse. What the research helps us understand are the mechanisms through which transmission occurs — and therefore where intervention can interrupt it.

Three mechanisms emerge consistently in the literature:

1. Normalization: When violence is modeled in the home, it can become normalized — absorbed as an ordinary feature of relationships. Research confirms that endorsement of IPV myths mediates the relationship between victims’ past psychological abuse and their continued acceptance of psychological aggression in future relationships (Frontiers in Psychology, 2023). In short, what we grow up believing is “normal” shapes our tolerance thresholds.
2. Emotion dysregulation: Children who grow up in abusive environments often do not learn healthy emotion regulation skills, because those skills are modeled through safe, consistent caregiving relationships they never had. Research shows that violence exposure reduces impulse and anger control (Neilson et al., 2023), creating a vulnerability to reactive aggression in adulthood.
3. Traumagenic dynamics: Theoretical frameworks such as the traumagenic dynamics model (Finkelhor & Browne, 1985) propose that early abuse distorts a child’s self-concept and interpersonal boundaries, increasing susceptibility to further victimization. This helps explain why, particularly among women, adverse childhood experiences are linked to a greater risk of revictimization in adult intimate relationships — a pattern compounded by gendered socialization and systemic power imbalances (Corbett et al., 2023).

The Invisible Architecture: Psychological and Cognitive Consequences

The psychological sequelae of abuse are wide-ranging and do not resolve simply because the abuse has ended.

Research exploring the consequences of gender-based violence (Lausi et al., 2024, Frontiers in Psychology) found that victims of complex, multi-type victimization experienced significantly worse outcomes across both psychological wellbeing and cognitive functioning compared to those who experienced single-type abuse. Symptoms’ severity appears to be related to individuals’ capacity to suppress painful content and regulate decision-making — abilities that abuse directly erodes.

Studies further show that adults with PTSD who also experienced childhood sexual abuse demonstrate significantly poorer performance on measures of memory, language, and attention compared to PTSD patients without a childhood abuse history (NCBI, 2020). This has profound implications for how we approach assessment and therapy: we may be working with clients whose cognitive architecture has been genuinely compromised — not through lack of effort or motivation, but through the documented neurological impact of their histories.

Beyond cognition, the emotional landscape of abuse survivors is often marked by chronic shame, dissociation, distorted self-worth, hypervigilance, and profound difficulties in trust and attachment. The experience of being hurt by someone who was supposed to protect you — a parent, a partner, a caregiver — creates a particular kind of betrayal trauma that cuts at the very foundations of how we relate to others.

What Clinical Evidence Tells Us About Effective Intervention

Understanding the problem is only part of our responsibility. As practitioners, the question is always: what actually helps?

The evidence points to several converging principles:

• Trauma-informed care is not a luxury — it is the baseline. Effective clinical work with survivors of abuse must begin with an understanding that many presenting symptoms (aggression, dissociation, avoidance, substance use, self-harm) are not pathological character traits but adaptive responses to overwhelming experiences. Reframing symptoms in this way changes the therapeutic relationship fundamentally.
• Cognitive-Behavioral Therapy (CBT) remains one of the most robustly evidenced approaches for addressing the distorted cognitions that develop in the context of abuse — particularly beliefs about self-blame, worthlessness, and the perceived normality of harmful relationships (Butler et al., 2006). CBT-based interventions work to identify and restructure the cognitive distortions that sustain emotional distress long after the abusive environment is gone.
• Mindfulness-based interventions have demonstrated effectiveness in reducing symptoms of depression and anxiety in survivors, partly by increasing self-awareness and disrupting the ruminative thought patterns that often accompany trauma (Evans et al., 2008; Piet & Hougaard, 2011).
• Motivational approaches, such as Motivational Interviewing, are particularly valuable when working with survivors who remain ambivalent about leaving abusive relationships — or when working with perpetrators. These approaches build intrinsic motivation for behavioral change in a way that directive methods often cannot (Rollnick & Miller, 1995).
• For perpetrators of domestic abuse, structured programs modeled on accountability and behavioral change — such as the Duluth Model and newer evidence-informed frameworks — have shown promise. Project Mirabal, which evaluated 11 such programs across multiple domains, demonstrated significant reductions in various forms of abuse and a 51% increase in women’s perceived safety 12 months after program completion (Verney, 2022).
• On the prevention side, the WHO’s INSPIRE framework emphasizes targeting gender norms at the societal level and creating positive relational models — particularly from early primary school age — as a means of interrupting the normalization of violence before it takes root (WHO, 2016).

A Note on Survivors: Resilience Is Real

It would be a disservice to end without naming something the research also affirms: human beings are remarkably resilient. The same neuroplasticity that makes us vulnerable to harm in childhood is also the mechanism through which healing becomes possible. Trauma-informed therapy, stable and safe relationships, and access to appropriate resources can meaningfully alter the trajectories set in motion by abuse.

Post-traumatic growth — the experience of meaningful psychological transformation in the aftermath of adversity — is well-documented. Survivors do not merely survive. Many develop extraordinary capacities for empathy, advocacy, and insight that become integral to who they are.

As clinical psychologists, we hold a privileged position in this journey. Every time a client shares their story in our office, they are doing something profoundly courageous. Our role is not simply to reduce symptoms, but to help restore what abuse seeks to take away: dignity, agency, and the felt sense of being worthy of care.

References

• Corbett, A., et al. (2023). Gendered socialization and revictimization pathways. Journal of Interpersonal Violence.
• Engel, B. (2023). Escaping Emotional Abuse. Citadel Press.
• Evans, S., et al. (2008). Mindfulness-based cognitive therapy for generalized anxiety disorder. Journal of Anxiety Disorders.
• Finkelhor, D., & Browne, A. (1985). The traumatic impact of child sexual abuse. American Journal of Orthopsychiatry, 55(4), 530–541.
• Ireton, R., Hughes, A., & Klabunde, M. (2024). A functional MRI meta-analysis of childhood trauma. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 9(6), 561–570.
• Lausi, G., et al. (2024). Consequences of abuse on psychological wellbeing and cognitive outcomes in victims of gender-based violence. Frontiers in Psychology, 15. https://doi.org/10.3389/fpsyg.2024.1367489
• McCloud, B., & Abdullah, A. (2025). Theoretical analysis of the cycle of intimate partner violence. Trauma, Violence, & Abuse. https://doi.org/10.1177/15248380241301781
• Meinck, F., et al. (2025). What are the mechanisms underpinning intergenerational transmission of violence perpetration? A realist review. Trauma, Violence, & Abuse. https://doi.org/10.1177/15248380251361468
• Neilson, G., et al. (2023). Impulse control and violence exposure. Aggression and Violent Behavior.
• Oram, S., et al. (2017). Prevalence of experiences of domestic violence among psychiatric patients. Social Psychiatry and Psychiatric Epidemiology.
• Oram, S., et al. (2022). The Lancet Psychiatry Commission on intimate partner violence and mental health. The Lancet Psychiatry.
• Piet, J., & Hougaard, E. (2011). The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder. Clinical Psychology Review.
• Peterson, C., et al. (2018). Lifetime economic burden of intimate partner violence among U.S. adults. American Journal of Preventive Medicine.
• Rollnick, S., & Miller, W. R. (1995). What is motivational interviewing? Behavioural and Cognitive Psychotherapy, 23(4), 325–334.
• Stoltenborgh, M., et al. (2015). The prevalence of child maltreatment across the globe. Child Abuse Review.
• Verney, J. (2022). Project Mirabal: Evaluating perpetrator programmes. Journal of Family Violence.
• Widom, C. S., et al. (2015). The intergenerational transmission of violence. In Violence and Mental Health: Its Manifold Faces. Springer.
• Wolford-Clevenger, C., et al. (2017). Psychological abuse and suicidal ideation. Partner Abuse.
• World Health Organization. (2024). Violence against women: Key facts. https://www.who.int/news-room/fact-sheets/detail/violence-against-women