Connecting Externalizing and Internalizing Symptoms of Psychopathology in Adults with Childhood Experience of Domestic Violence and Abuse
Rodney L. Mulhollem
Domestic Violence has been around for centuries (Morgan, 2009). Externalizing and internalizing symptoms of psychopathology have been connected with domestic violence in children and early adolescents (Abell, 2008; Anderson, 2010; Bayarri, Ezpeleta, & Granero. (2011); Dehon & Weems, 2010; Fang & Corso, 2007; Huang, Wang & Warrener, 2010; Maikovich, Jaffee, Gallap & Odgers, 2008; Mass, Herrenhohl & Sousa, 2008; McPhedran, 2008; Moylan, Herrenkohl, Sousa, Tajima, Herrenkohl & Russo, 2010; Nguyen & Larsen, 2012; Tuyen & Larsen, 2012; Vega, Osa, Ezpeleta, Granero & Domenech, 2012; Yoo & Huang, 2012) and adult depression and anxiety for those currently experiencing domestic violence (Anderson, 2010; Dehon & Weems, 2010, Kuhlman, Howell & Grahm-Berman, 2012; Morgan & Freeman, 2009; Nguyen & Larsen, 2012; Vega, Osa, Ezpeleta, Granero & Domenech, 2012). However, limited research has been constructed to find a direct correlation between many adults experiencing externalizing and internalizing symptoms of psychopathology and childhood experience with domestic violence. The focus of this research is to perceive if there is a high correlation of adults suffering from these types of psychopathology with previous experience of domestic violence. Constructs considered in the definitions of domestic violence and abuse include physical violence, emotional abuse, coercion, verbal abuse, financial abuse, sexual abuse and domestic abuse. Since animal cruelty has also been highly correlated with domestic abuse, this construct is considered as well (Abell, 2008).
Keywords: physical violence, emotional abuse, coercion, verbal abuse, financial abuse, sexual abuse, domestic abuse, animal abuse, controlling behavior, internalizing symptoms, externalizing symptoms, depression, anxiety
Domestic violence can be traced back for centuries and it was originally encouraged for men to be involved with certain aspects of domestic violence in public (Morgan, 2009). In addition, the Biblical story of Cain and Abel can be viewed as a possible type of domestic violence as it resulted in one brother killing the other. Many types of externalizing and internalizing symptoms of psychopathology in preadolescents and adolescents are believed to be connected with different constructs of domestic violence experienced during early childhood (Abell, 2008; Anderson, 2010; Bayarri, Ezpeleta & Granero, 2011; Dehon & Weem, 2010; Fang & Corso, 2007; Kuhlman, Howell & Graham-Berman, 2012; Maikovich, Jaffer, Gallop & Odger, 2008; McPhedran, 2008; Miller & Mancaso, 2004; Morgan & Freeman, 2009; Moylan et al., 2010; Ngoyen & Larsen, 2012; Vega, Osa, Ezpeleta, Granero & Domenech, 2011; Yoo & Huang, 2012).
A broad scope of research has focused on two major aspects: domestic violence in connection with childhood and preadolescent struggles and psychopathology and adults who are either currently directly affected by domestic violence or those who are a participant in domestic violence. It is hypothesized that many types of externalizing and internalizing symptoms of psychopathology in adults can be shown to have a high correlation with at least one or more constructs of domestic violence experienced by the individual during childhood.
Those who experienced situations of domestic abuse or violence through single or multiple stages of their life were compared with those who never suffered from any type of domestic abuse or violence. Since many families consider animals to be family members, animal abuse was also considered a construct of domestic violence. Subjects of focus for this research include preadolescents, adolescents, young adults and adults. This allowed a conclusion to be established based upon a broad base of statistical information. The statistical information presented in this paper is a collection of research that is based upon a combination of over 160 different studies. These studies consisted of a mixture of longitudinal studies, single group designs and dual group designs that include controlled groups and single case designs. By connecting the research done, of different stages of life, of those who have or currently suffer from at least one construct of externalizing and/or internalizing symptoms of psychopathology, a connection was able to be established. These connections that spanned throughout subjects’ lives were found to highly correlate with one common factor: domestic violence.
Definitions of terms
With different perspectives, diverse definitions of terminology can be found. In reference to this research report, the following definitions will be used. Domestic violence can be defined as one or a combination of: physical violence, emotional abuse, coercion, financial abuse, sexual abuse, controlling behavior, and cyber stalking. (Finalaw, 2012). Physical violence can be defined as physically hurting another person with the intentions to cause harm or pain (Abell, 2008). In addition, the USDJ includes “denying someone medical treatment and forcing drugs/alcohol use on someone” (Findlaw, 2012). Emotional abuse can be defined as devaluating a person’s self-worth through avenues such as: constant criticism, destruction of relationships with children, constant denigration, and interfering with a person’s abilities. Coercion can be defined as forced seclusion, as well as threatening to harm oneself or another person (Abell, 2008). Financial abuse is the restraint of access to the family’s money or other financial constructs. Sexual abuse can be defined as a person trying to induce or force another person into sexual behavior or contact without their approval, sexually degrading, or telling sexual jokes with the intentions of hurting another person. Controlling behavior can be defined as restricting or preventing contact with another individual of the opposite sex (or of same sex in a homosexual relationship), showing anger when the partner speaks to another person of the opposite sex (or of the same sex in a homosexual relationship), limiting or forbidding contact with the partner’s family, lack of support for any type of activities outside of the home, destruction of property and tracking a spouse without their knowledge. In addition, the USDJ also incorporates cyber stalking into the definition of domestic violence (Findlaw.com, 2012). Cyber stalking is referred to as an action that is taken by a person to continuously connect with another person, through email or other online communication platforms, which causes substantial emotional distress to the recipient.
Psychological terminology includes internalizing symptoms and externalizing symptoms. Internalizing symptoms can include disorders whose most important constructs are mood and emotion. Examples of internal disorders include: certain kinds of anxiety disorders, such as general anxiety disorder, social phobias and other types of phobias, obsessive compulsive disorder and different types of anxiety, particularly separation anxiety, and depression. Externalizing symptoms can include disorders that are disruptive and are often aggressive. Examples of externalizing disorders include: attention deficit and hyperactivity disorder (ADHD), tic disorders, Tourette’s syndrome, oppositional defiant disorder, and conduct disorder.
When considering the definitions for depression and anxiety, the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) will be referenced. Depression, or what can also be referred to as major depressive disorder, is listed under the category of mood disorders in the DSM-IV-TR. The specific definition of major depressive disorder is “characterized by one or more Major Depressive Episodes (i.e., at least 2 weeks of depressed mood or loss of interest accompanied by at least four additional symptoms of depression)” (DSM-IV-TR, p. 345). The DSM-IV-TR lists 13 different types of anxiety disorders. The general definition of “a discrete period in which there is the sudden inset of intense apprehension, fearful, or terror, often associated with shortness of breath, palpitations, chest pain or discomfort, choking or smothering sensations and fear of going crazy or losing control are present” (DSM-IV-TR, p. 429).
Animal cruelty is not considered to be a type of domestic violence. However, animal cruelty has been found to highly correlate with many families who have a level of domestic violence (McPhedran, 2009). For the sake of this paper, animal cruelty will be defined as deliberately imposing pain and suffering and even death onto an animal with the goal of either hurting the animal and/or someone else.
Connecting the dots
Domestic violence can be viewed from a number of perspectives. One perspective could be from the perpetrator of the violence. Another perspective could be from the domestic partner who is on the receiving end of the domestic violence. Still, another perspective could be from the children whom are either witnessing, involved with, or the victim of domestic violence. Perspectives that will be considered include: domestic violence, family violence and psychopathology, domestic violence and alcoholism and drug abuse, domestic violence and animal abuse.
Domestic Violence, Family Violence and Psychopathology
Domestic abuse is a multifaceted construct imposing a multidimensional effect of damage on, not only the current family, but future families of those involved. The Department of Justice estimated up to 10 million children as being exposed to domestic violence annually (Klosterman & Kelley, 2009). Although domestic violence is not specific to women only, women are more commonly the victim. Children also suffer in multidimensional ways depending on the subtypes and level of domestic violence and abuse.
Children that come from homes that have a combination of both alcoholism and a violent level of child abuse and victimization are believed to struggle from developmental problems. These developmental problems are believed to be one of the major causes of adult alcohol problems, spousal abuse, and externalizing and internalizing types of psychopathology. However, terms of the definition of violent victimization versus victimization, and even the qualifications of victimization in general, differ within cultures and social constructs (Miller, & Mancuso, 2004). These multiple definitions and perspectives cause confusion as to which level of violence is being considered. For example, some research includes any type of “spanking” or “corporal punishment” of children to be types of domestic violence (Huang, Wang & Warrener, 2010, p.1318). Yet others look at these in a different perspective and do not consider certain levels to be domestic violence (Miller & Mancuso, 2004). A Number of studies also encapsulate corporal punishment as including spanking, slapping, beating and other physical interaction that would lead to severe injury. However, when considering childhood victimization in general, research shows that these rates have not changed dramatically from 1975 to 1985, with ratios of 630:1000 and 620:1000, respectively (Miller & Mancuso, 2004). With researchers giving different definitions of domestic violence and/or abuse, statistical data cannot be confirmed. Thus, it is uncertain if childhood victimization has really increased, decreased or stayed the same. No matter what the statistics show, it is important to remember that these statistics only represent those cases being reported.
Understanding these differences is important. What one culture may consider healthy discipline, another culture may consider domestic violence or even violent victimization. In addition, studies are showing very different results depending on the definitions of this terminology. For example, in terms of psychopathology, many studies show a direct connection between severe child victimization and externalizing symptoms. However, in reference to, what some may refer to as a lower level of victimization, which could include spanking, no symptoms exist (Maikovich, Jaffee, Gallap & Odgers, 2008; Bayarri, Ezpeleta, & Granero, 2011). Nevertheless, all studies do agree that empirical evidence clearly supports how important early childhood experiences are in terms of their continued psychological and physical development.
Children, in general, are affected by domestic violence both short term and long term. Long term can be identified as later in childhood and before adolescence, whereas short term is considered early childhood. Overall, children who experienced abuse were more likely to be under the age of three years old (Maas & Sousa, 2008). In addition, under the age of three, girls were slightly more likely to be abused than boys. When considering nationality and cultural differences and statistics of child abuse under the age of three, African Americans were rated highest followed by Pacific Islanders, Native Americans, European Americans, Hispanic/Latino Americans, and Asian Americans representing 19.9:1000, 17.6:1000, 15.5:1000, 10.4:1000 and 2.9:1000, respectively (Mass, Herrenhohl and Sousa, 2008).
When a child is subjected to harsh physical punishment, the common long term effects result in externalizing symptoms (Maikovich, Jaffee, Gallap & Odgers, 2008; Moylan, Herrenkohl, Sousa, Tajima, Herrenkohl & Russo, 2010). When a child witnesses domestic violence, the common long term effects result in internalizing symptoms. A study by Bayarri, Ezpeleta and Granero (2011) presented some startling new evidence reporting that boys who were victims showed more mood disorders than boys who were either involved with the abuse or only witnessed the abuse. An understanding of these results has not yet been calculated as the study has not had any kind of follow-ups or additional research. However, the results do show a distinct difference between being the victim of, being the witness to and being involved with harsh physical punishment.
When considering intimate partner violence, a type of domestic violence, girls and boys have different physical reactions. As psychological results show boys presenting more externalizing symptoms and girls presenting more internalizing symptoms, a different physical reaction would be expected. Just as high levels of normal internalizing stress and other negative factors can have a physical influence on adults, the same has been found in children. Since girls react more with internalizing reactions, emotional pain and suffering would build up internally as compared to boys being able to relieve some level of this stress through the externalizing symptoms. Kuhlman and Graham-Berman’s (2012) research included the physical health of preschool children exposed to intimate partner violence. Researchers caution that this is a new area of study and additional research needs to be conducted.
In addition to research focusing on the effects of imitate partner violence on children, Yoo and Huang (2012) have constructed a new study that takes a closer look at the effects of domestic violence on children’s behavior problems and comparing this with financial levels, marital status, and other factors. This five year longitudinal study included four waves. The focus of this study was to connect effects of “domestic violence towards mothers on children’s behavior problems varied by socioeconomic conditions such as poverty and marital status” (Yoo and Huang, 2012, p. 22).
In this study, children’s parental environments were considered at the ages of one, three, and five years. Children who presented externalizing problem behaviors at age five were compared to the environmental situations of other children who did not suffer from externalizing problems. When considering the marital status of these children’s mothers when the child was one year old, mothers who were not married had a significantly greater amount of domestic violence in their household, as compared to mothers who were married. In addition, when the child was three years old, unmarried mothers had a significantly higher rate of depression, as compared to married mothers. Thus, maternal mental health was found to both directly and indirectly affect their children’s behavior at the age of five. Also, from these results, it is concluded that the effects of domestic violence had an impact on the capability of the mother’s parenting ability. As these results were expected, other results were found to be perplexing. Results from the same study also showed that mothers and children living in poverty “were less effected by domestic violence than those not living in poverty” (Yoo & Huang, 2012, p.19).
Domestic Violence and Alcoholism and Drug Abuse
A great deal of research has been done on the connection between domestic violence and substance abuse. The term substance abuse represents either alcohol abuse, drug abuse, or a combination of both. General information has been pulled from two major studies that represent over 180 different studies on a type of substance abuse and/or connections with domestic violence. When considering general information regarding families with parental figures diagnosed with a type of substance abuse versus families with parental figures not diagnosed with any type of substance abuse, facts are startling.
When considering current adult substance abusers, research shows a strong connection between childhood abuse and domestic violence. Miller and Mancuso (2004) point out that 47% of female alcoholic’s studied across multiple studies were members of a home that displayed at least one type of domestic violence. In addition, this same study showed that, of the presented statistics, 66.3% of these women came from a home where they were personally victimized by a parent, care giver, or relative. Klostermann, Howell and Graham-Berman (2012) found, in their focused studies, that children who came from homes that involved domestic violence, particularly alcohol abuse, were more likely to develop externalizing symptoms, mostly conduct disorder, oppositional defiant disorder, delinquency, and attention deficit disorders. This same study also showed children from these family environments to be at a higher risk of depression (internalizing disorder) and anxiety (externalizing disorder).
Longitudinal studies followed a group of young adults from infancy to the age of 18 years of age. In this study, Miller (2004) came to the conclusion that a child who suffers from abuse at home (domestic abuse) was three time more likely to suffer from at least one type of substance abuse at the age of 18 years of age. The substance abuse most commonly found in this study was alcohol abuse.
Two different studies researched prisoners who were serving prison sentences for murdering their partners. In one of the studies, out of the inmates questioned, 75% of what was considered “aggressive inmates” were abused as children, as compared to 31% of the “non-aggressive inmates” were not abused as children (McPhedran, 2008). And in addition, 50% of the aggressive inmates came from homes that involved parental alcoholism and/or substance abuse.
Domestic Violence and Animal Abuse
Association between domestic violence and animal cruelty is well documented. Although there has been little empirical research on this subject matter, there is much qualitative review information. When connecting animal cruelty with domestic violence, research shows animal cruelty to be much higher in homes with domestic abuse in comparison to homes without any types of violence (McPhedran, 2008). In regards to types of animals most commonly abused, companion animals are on the top of the list.
Looking at the qualitative evidence, a multidimensional perspective can be found. First, is the connection of abused women and abused animals. Research shows 71% of women surveyed in a Utah shelter reported their partner had either threatened to hurt, harmed, or actually killed their pet (McPhedran, 2008). A similar study in a South Carolina women’s shelter found that 46.5% of battered women made the same claims as the Utah sheltered women (McPhedran, 2008). In addition, McPhedran (2008) found a study on a New York women’s shelter showing that 53% of the women claimed their partner had either abused or killed their personal pet. Reports in Australia also found similar results.
When considering children and pet abuse, the same research in Utah and New York concluded that “children of women in shelters were 20 times more likely to have witnessed animal abuse or killed companion animals” (McPhedran, 2008, p. 43). Of children in the Utah shelter, 32% of the women reported their child were currently or previously involved with animal cruelty.
A common connection has been established between children coming from homes that incorporate animal abuse with conduct disorder. McPhedran (2008) points to a prior study showing a good argument that “animal abuse may be one of the first symptoms of conduct disorder to appear in children” (p.45). Although the DSM-IV-TR does not include animal cruelty in its diagnosis with disorder conduct, much debate and discussion has been argued that a child committing animal abuse is one of the first signs of conduct disorder (McPhedran, 2008).
A common question arose as to why some children are abusive to animals and others are not, even though both come from homes with domestic violence. Where is the link connecting abuse with some children?
A common question is why is animal abuse so common in a home with domestic violence? McPhedran (2008) also suggests changing the focus of connecting animal abuse with domestic violence to finding the motivation of the animal abuse. In their studies, they found some very interesting results showing age in relationship to animal cruelty. Children who were able to understand domestic violence versus children who witnessed the actions, but were too young to understand, did not have the same negative impact. Children who were old enough to understand the abuse to their pets later showed signs of internalizing and externalizing symptoms. Thus, McPhedran concluded that it was not the action of the abuse itself that impacted the child, but the understanding of the action.
A Biblical Viewpoint of Domestic Violence
Domestic Violence is nothing new. When considering domestic violence, a number of constructs are consistently present. Due to the focus of this research, the constructs of animal abuse, sexual abuse, and physical violence are fixated on. In terms of physical violence, two major constructs researched included child abuse and spousal abuse. In addition, a theme that was found to be strongly correlated with domestic violence was substance addictions. Thus, these will be reviewed from a Biblical perspective.
The strongest and most dominant construct found was substance abuse. Although this is not considered part of the constructs of domestic violence, it appears to have a high correlation. When considering addictions and wine or alcohol from a Biblical perspective, the Hebrew words “shekar” and “cobe” are found in reference to addictions. “Shekar” refers to drunkards and “cobe” refers to a drunken state. When referencing a situation when Noah became drunk after the flood, the word “cobe” is used in the Old Testament. The complete definition would be to lose control and complete an act or deed that would not normally be done, resulting in negative consequences. When considering the New Testament or the Greek words used in reference to wine or alcohol, “parionos” is used throughout. This term is always used in a negative way and refers to someone that has a long history of drinking alcohol causing behavior that reaps negative consequences. In addition, the Bible also refers to this word when discussing leadership in the church. Leaders are not to be “parionos” or drunk, angry, and self-willed.
Anger can be an unhealthy desire that drives bitterness in the heart. The word desire can be found in the Old Testament in Proverbs 21:25 when talking about “avah” or having a desire that becomes controlling and self-destructive. Unhealthy sexual patterns can fall into this category including pornography, sexual abuse, and even anger and rage. Thus, “avah” can create a state of disequilibrium, creating an unhealthy pattern of abuse and even to the point of an addiction. In addition, there are two Greek words that are roots for the word desire. These include “epithymeo” and “aiter”. “Aiter” translates as a desire that has taken over a person. This desire has an addictive property of wanting to construct something evil to take over a person. “Epithymeo” can also be translated as the same addictive type of desire that takes over a person’s mind. However, the difference is the incorporation of lust. Both of the New Testament books of Acts and Roman’s refer to these root words with “epothymeo” talking about uncontrolled lust to the point of action. This could easily be viewed as a type of sexual abuse for either spouse or child. In reference to “aviter”, the book of Acts talks about the mentality of the Jews in their plt to kill Jesus. With this kind of controlling property, physical abuse, animal abuse, and physical violence could be interpreted here as well.
Lastly, the word “restraint” can be referenced in both the New and Old Testament with both the Greek and Hebrew using the same word “ma`tsore” or losing control. When referencing the Old Testament, Proverbs uses “ma`tsore” as something fools do. Conducting oneself in a careless and evil way or “ma`tsore” proves a person lacks wisdom. In a very different way, the New Testament refers to this same word in the relationship of the inability to escape from. The reference in Galatians 3:23 talks about how we, as Christians, are unable to be disconnected from the Law (of Moses) or the inability to escape from it.
Different aspects of domestic abuse were researched. Most of the current research on domestic abuse focused on physical abuse, sexual abuse and controlling behavior. Little research was found in regards to emotional abuse, coercion, financial abuse and cyber stalking. However, although these exact terms were not listed in the research, it could be fair to incorporate emotional abuse and coercion into this research due to evidence of the descriptions. Financial abuse and cyber stalking were not found in reference or theory in any of the studies used for the construction of this particular research paper.
Although animal abuse is not part of the technical definition included in domestic violence and abuse, research shows that animals that are considered family pets can, many times, also be considered as part of the family and by many, a family member (McPhedran, 2008). When considering specific research on the connection of domestic violence and animal abuse, links are made between the actions of the abuser to the animal in reference to similar or even the same tactics used on the human victims themselves. In addition, some types of animal abuse have been referenced as a tactic used by a domestic abuser to inflict power, control, and/or pain over their human victims (McPhedran, 2008).
This study dove deep into the understanding of not only how children react to domestic violence, but the victimized spouse or partner, as well. The longitudinal study conducted by Huang, Wang and Warrener (2010) showed direct connections between children who witnessed or were victims of domestic violence at the age of one and results of both the victimized parent and the child two and four years later. Studies presented by Miller & Manucuso (2004), Kuhlman, Howell & Grahm-Berman (2012) and McPhedran (2008) presented information on adults and psychopathology which included both externalizing and internalizing symptomology. And although Miller & Manucusso’s study was eight years old, it was the only study that could be found presenting empirical evidence connecting adults with certain types of psychopathology directly related to domestic violence and abuse, particularly physical abuse with terminology additionally describing controlling behavior, coercion, and emotional abuse.
When considering a Biblical aspect of this research, the Bible references six main Hebrew or Greek words in reference to addictive type properties and losing control. With any type of abuse, a level of loss of control is always present. In reference to relationships losing control with alcohol, “cobe” and “parionos” is used. In reference to being controlled by sex or lust, which can be one of the components included in sexual abuse, “avah” is used. Lastly, “aiter” is referenced as a desire to the point of losing control. Many times this desire can be fueled by hate, anger or lust. This is a key work in referencing many of the specific abuses listed in domestic violence, especially ones referenced to in Miller and Mancuso’s research.
Domestic Abuse has been around as long as the earliest records of mankind. The Bible talks about Cain taking his brother Able into the field and killing him out of anger (Gensis 4:5-8). This is an example of domestic abuse resulting in murder recorded in the very first family that lived outside of the Garden of Eden. Morgan (2009) discusses how domestic violence was, at one time, encouraged in a male dominated world, as men were not only encouraged, but expected to discipline their wives in public.
Even in modern history, with all of the newest research, educational opportunities, modern technology, and help available, domestic violence is still very common. In addition to domestic violence, research is showing a number of other constructs such as physical violence, emotional abuse, coercion, verbal abuse, financial abuse, sexual abuse, controlling behavior and some types of psychopathologies as either proven to be connected to or having a high correlation (Abell, 2008; Anderson, 2010; Dehon & Weem, 2010; Fang & Corso, 2007; Huang, Wang, Warrener, 2010; Klosterman & Kelly, 2009; Kuhlman, Howell & Graham-Berman, 2012; Maikovich, Jaffer, Gallop & Odger, 2008; Mass, Herrekohl & Sousa, 2008; McPhedran, 2008; Miller & Mancaso, 2004; Morgan & Freeman, 2009; Moylan et al., 2010; Ngoyen & Larsen, 2012; Yoo & Huang, 2012). In addition, the United States Department of Justice of Violence Against Women (USDJ) is “a pattern of abusive behavior in any relationship that is used by one partner to gain or maintain control over another intimate partner” (Findlaw, 2012).
When considering the research presented via the different types of studies, this author believes there is a clear linkage between childhood domestic violence and abuse and the externalizing and internalizing symptoms of psychopathology that many adults suffer from. In addition, cognitive maturity plays a key role in this factor. Considering longitudinal research conducted by Huang, Wang and Warrener (2010), the evidence shows results of these symptoms of psychopathology to only be present in children who witnessed a type of domestic violence or abuse once old enough to cognitively process the meaning behind the abuse. In addition, Miller’s research shows a strong correlation with inmates who committed murder in connection with childhood domestic violence or abuse. However, this does not give an excuse for the actions of the inmates. As adults we have a choice to change the world that was forced upon us as children. This does allow a deeper understanding of what these children go through and what they live with as they progress into the adult years.
New questions arise and encourage more research. First, not every adult that suffers from externalizing and internalizing symptoms of psychopathology suffered from childhood domestic violence and abuse. Not all children who suffered from domestic violence and abuse will suffer from externalizing or externalizing symptoms of psychopathology. More research in understanding the negative outcomes versus positive outcomes of children who experience domestic violence and abuse needs to be considered. This link can be a vital part of the process in helping people heal from these childhood experiences. In addition, more research from a Biblical perspective could be quite valuable. With research showing such negative results in some adults, the Biblical viewpoint of forgiveness, compassion and healthy love could be part of the equation to help those who suffer, as well as promote prevention. No research was found with studies incorporating a Biblical viewpoint.
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