Investigating the Relationship between Symptoms of Histrionic Personality Disorder and Experiences of Child Abuse among Students of Tabriz Islamic Azad University

The present study attempts to investigate the relationship between symptoms of histrionic personality disorder and experiences of child abuse among students of Tabriz Islamic Azad University in 2013-2014. The general aim of this study is to predict histrionic personality disorder in adulthood based on child abuse experiences during childhood. The population of this study include 19599 people among whom 377 were selected through simple random sampling. The instrument of this study includes Millon-3 CASRS questionnaire and child abuse questionnaire. The data was analyzed by Pearson correlation coefficient and multiple regression. The obtained results revealed that there is significant relationship between histrionic personality disorder (independent variable) and dimensions of child abuse (dependent variable) that includes emotional, neglect, physical, and sexual child abuse. Considering different dimensions of child abuse, neglect of child and sexual child abuse have the most and the least contribution in predicting symptoms of histrionic personality disorder in adulthood. In addition, the results showed that all four dimensions of child abuse can predict symptoms of histrionic personality disorder in adulthood, but ignorance or neglecting child has the most effect and sexual dimension has the least effect in the prediction.


Introduction
Family is the most basic institution for socializing children, especially in critical early years of life.Family prepares children in proper conditions to identify their potential abilities and accept useful roles as adults in the society (Sotoudeh, 2001).Almost two decades ago, it was assumed that family is the best place to live for adults and best place for emotional and physical growth and development of children and teenagers because of intimate and loving relationships within the family; however, surprisingly, the results of research revealed that not only "problematic" families, but also families who are seemingly normal or desirable may behave abusively toward their children (Azazi, 2001).
Family and parents have the most important social relationships with the children.They can establish discipline and take care of children in different ways.Good and worthy parents help their child's development in various ways and coordinate their needs and expectations with the needs and capabilities of children.Of course, as normal human beings parents may sometimes punish and reprimand their children and ignore children's needs.In fact, the assertive behaviors that are associated with expressing verbal emotions are necessary for child discipline.Finally, those parents who violate children's needs and misuse the child dependence in different physical, sexual, and emotional manners, actually have abnormal and annoying behaviors; similarly, failure to respond to the needs of children is the cornerstone of a child's personality problems.Generally, child abuse is the biggest failure for the child in his environment.Abusive families fail to prepare most of the expected emotional and physical needs of the child and they do not provide proper conditions for self-expression and compatibility with the environment for the child.There is not any definite and clear border between normal and abnormal behavior, but awareness of right and wrong behavior can have a significant impact on the prevention of mistreatment (Mash, 1999).

Statement of the Problem
Children for various reasons, including young age and lack of sufficient skills are always the most vulnerable people of society.They cannot protect themselves and need adults' support, especially, the support of their parents.Incompetent and unworthy parents create different problems and issues like child abuse.Child abuse is one of the greatest social issue that can be found in developed and developing countries (Naghavi, 2005).Child abuse is the problem of million families and children that is occurred in every society.The effects of this problem are remarkable among children of every race, color, social class, religion and different age groups (before the birth, infancy, childhood, adolescence, etc.) (Burnet, 2000).Child abuse includes any kind of physical, psychological, sexual, violent and neglecting behaviors toward individuals younger than 18, which are committed by people who are responsible for comfort, and welfare of children.In this case, the health and welfare of children will be damaged and jeopardize.Death of children who have been abused is the most unfortunate and tragic outcome of child abuse, however, it has other consequences that influence childhood and adulthood of abused children.Child abuse is a major threat to children's health, so, it is necessary to implement preventing and supporting programs in order to address this social disease.In this regard, research and studies provide the required knowledge about the essence and prevention way of the violence that affects children (Hazard, 1988).
Neglect can be divided into three types: physical, educational, and emotional.Physical neglect includes lack of health care, abandonment, inadequate supervision, poor nutrition, inappropriate clothing and sanitation, etc. Educational neglect includes allowing children to escape from school regularly and not enrolling them in schools.Emotional neglect includes lack of emotional security, putting children at risk of spouse violence and abuse, allowing children to use drug and alcohol, and lack of psychological care (Marvasti, 2000).Emotional annoyance includes numerous verbal threats, ridicule, humiliating ideas, scapegoating the child, refrain from providing food, shelter, sleeping and other necessities for the child deliberately, and economic exploitation of children (Marvasti, 2000).Physical abuse includes injuries such as stroke, burns, head stroke, fractures, internal injuries, trauma and other forms of physical damage that is sustained for at least 48 hours.

Significance of the Study
Children who are the victims of abuse and violence will experience uncontrollable and spreading consequences; these outcomes are not compatible with their natural growth and they threaten children's psychological wellbeing.Children are not only forced to face with their parent's unpredictable and horrible betrayal, but also they must match themselves with their surrounding and the conditions that are not compatible with their natural growth.
However, child abuse like other problems of life and childhood injuries do not affect all children in a similar way.The effect of abuse not only depends on the severity of abuse but also it depends on individual characteristics of the child and his family.In other words, the effect of every stressful factor, including violence depends mostly on individual characteristics of the ones facing these tensions.Children may encounter different types of risk and stress that some of them are sever; however, they learn how to overcome these conditions through different methods and techniques.Younger children may pass the early stages of natural growth but the influence of hard and sever violence and stress may decrease this process; consequently, the main stages of development will be disturbed and create emotional and behavioral problems like delay in speaking and criminal acts (Naghavi, 2008).
Mortality of the children who are abused is the most unfortunate consequence.The studies revealed that basic depression, sensory disorder, alcohol dependence, conduct disorder, posttraumatic stress disorder, separation anxiety, borderline personality disorder, antisocial personality disorder and suicidal behaviors are more evident among abused people (McMillan & Munch, 2001).
Child abuse is a major threat to children's health.In addition, the outcomes of abuse can have sever negative and at times irreversible effect on physical and psychological health of children and their psychological system in adulthood.Therefore, it is necessary to implement prevention and support programs in order to address this social disease (Visa, 2008).The present study attempts to investigate the relationship between child abuse and histrionic personality disorder in adulthood.

Theoretical Foundation of the Study
Although there is no definite theory about child abuse, there are some arguments in scholars' viewpoints that are related to child abuse.In the following section, we will consider theories related to the relationship between parent and child, such as biological theories, psychoanalytic theory, the object relationship, Adler, Ericson, Maslow, Allport, and Horney theory, and the most important one belonging theory of Bowlby (Naghavi, 2008).
Sigmund Freud is a scientist who devoted his entire life to the scientific excavations.Not everyone who turns to psychology can ignore the effect of Freud's thoughts.He believed that humans' personality is formed and founded during the first five years of life.According to Freud from the birth moment children are influenced by permanent social trainings and make them as a part of their personality.From birth onward human beings move in a course that is more or less specific and certain.The way we pass our childhood has important effect on our personality in adulthood.According to Freud, factors such as maternal kindness deprivation, lack of child care, parents with inequalities, excessive aggression and strictness lead to neurotic states.Generally, Freud believed that abusing child by the parent, especially in the first five years of life causes psychological disorders in adults (Naghavi, 2008).
Klein is a theorist of object relationship that concentrates on pathological structures within families, relationship of children with each other and with parents, and the problems arising from these exchanges.According to Klein, adult's personality is based on created relationship in few month of life.Lack of safe relationship creates personality problems (Naghavi, 2008).
Mahler is another theorist of object relationship.He initially concentrates on the process of psychological separation of child from mother.If mother hastes in directing the child toward independence, this process will be impaired.The development of personality depends on the support that the child receives from his parents.Supportive parents with trust and comfort can provide safe and healthy environment for development of the child "himself", in this case, a healthy child will be fostered.
Erikson believed that human beings have the potential to solve their conflicts; by solving crises that occur in each particular life stages, competent performance will be established.He divided life into eight stages.In the first stage (trust against distrust), child is dependent entirely on his mother for survival and feeling secure.The relationship between mother, child and surrounding has both biological and social aspects.The interaction between mother and child determines whether the child will look to the world with the eyes of trust or mistrust.If mother shows repulsive, unnoticed, and unstable behavior, the child will have mistrusted attitude and will become 3 3 T suspicious, fearful, and anxious.According to Erikson, mistrust is also created when mother does not pay special attention to the child.It is possible to have distrust model in other stages of development.For example, when the relationship between mother and child is at high level and the child trusts his mother, if he loses his mother or if she leaves him, this sense of trust will be destroyed.Investigating the children between 12 to 18 months revealed that after three years those children, who have trusted their mothers and established trustful relationships with them, were at high level of social and emotional level.
Children, who have formed good sense of trust, are more adorable and curious; those who have low trust are deprived emotionally and socially, they are not interested and curious to play with other children and they are not successful in attaining their goals 3 3 T (Naghavi, 2008).Horowitz (2001) examined the effect of child abuse and neglect on adulthood health.The findings showed that men who were victims of child abuse and neglect are depressed and have antisocial personality disorders in comparison with control group; however, they do not have alcohol problems.Women who were victims of child abuse are also depressed and have antisocial personality disorders in comparison with control group; however, in comparison with men, they have many alcohol problems.

Physical Child Abuse
Physical abuse means hurting child by someone who takes care of him/her and harming children deliberately and intentionally by adults; these injuries are resulted from sever and unjustified physical punishments.Also, physical abuse includes deliberate and conscious attack toward child, like burning, biting, cutting parts of body, pushing, harming organs, torture, beatings, wounds and fracture (Seifi, 2010).

Emotional Child Abuse
Emotional abuse means any type of improper behavior that have negative effect on behavioral, cognitive, emotional, and physical performance of children, such as verbal and non-verbal harassment, blaming and degrading, insulting, mocking, strict regulations and control, irrational and unpredictable responses of parents that lead to uncertainty and changes in children (Moharami, 2011).

Sexual Child Abuse
According to conceptual definition, sexual abuse means using, implementing, and forcing children to engage in any clear sexual behavior, rape, sexual contact, prostitution and any form of sexual exploitation of children in order to satisfy sexual desires and for pleasures (Moharami, 2011).

Neglect Child Abuse
Neglect means failure to meet the child's basic needs, including food, clothing, protection, support and training (Hobbs & Hank, 1998).Neglecting and ignoring child means failure in providing basic needs of child (Peterson, 1998).

Personality Disorder
A personality disorder is a stabile pattern of inner experience and behavior that is considerably incompatible with cultural expectations, it is comprehensive and inflexible, it begins in adolescence and early years of adulthood that becomes stable over time and leads to distress or impairment.

Histrionic Personality Disorder
The main feature of histrionic personality disorder is attention-seeking behavior and excessive and pervasive emotionality.The people who have this problem will feel upset and lack of

Research Hypotheses
In the present study Pearson correlation coefficient and stepwise regression were used to examine hypotheses.For predicting criterion variable (histrionic personality disorder) based on predicting variable (components of child abuse) stepwise multiple regression model was used.Table 2 shows the results of Kolmogorov-Smirnov Test in order to assess the normal distribution of data.Accordingly, the significance level of all variables is more than 0.05.
Thus, it can be concluded that all variables are distributed normally.The studied variables are close to normal distribution.3 shows the matrix of the correlation between child abuse components and histrionic personality disorder.Based on the findings there is significant relationship between components of child abuse and histrionic personality disorder with 99% level of insurance (0.001).
Step 1) predictor variable: physical abuse 2 3 B Step 2) predictor variable: physical abuse, neglect 2 4 B Step 3) predictor variable: physical abuse, neglect, emotional abuse 2 5 B Step 4) predictor variable: physical abuse, neglect, emotional abuse, sexual abuse Criterion variable: histrionic personality disorder Table 4 shows the results of stepwise regression analysis related to histrionic personality disorder (criterion variable) based on components of child abuse (predictor variable).
Accordingly, regression has moved four steps; in the first step physical abuse, in second step neglect, in third step emotional abuse, and in the fourth step sexual abuse are entered.Based on the results regression amount in final step is 0.766.In other word, the amount of multiple correlation between physical, neglect, emotional and sexual abuse and histrionic personality disorder is 0.766.Thus, 58 percent of histrionic personality disorder variance can be predicted by physical, neglect, emotional and sexual abuse.Variance analysis has two main functions in regression analysis.First, it shows that the relationship between predictor variable and criterion variable is linear and second it shows that the obtained regression is significant.Thus, according to the results of Table 5 the relationship between predictor variable and criterion variable based on variance analysis of regression equation is linear in all steps and multiple regression amount is significant (=0.001).The effects of emotional abuse can be classified in this way: disability in learning, disability in creating and maintaining interpersonal relations, inappropriate feeling and behavior with conditions, depressed mood and physical symptoms.
Child abuse in cognitive dimension affects brain and reduces the size of some parts of the brain that are responsible for learning and memory, causing impairment in these activities.On average, abused children gain lower score in all cognitive dimensions and have lower academic achievement than their normal peers.As mentioned earlier, most of the studies in line with the present research show the relationship between types of child abuse experience and personality disorder.Accordingly, it can be mentioned that each of psychologists emphasizes the effect of child abuse on personality development, for example, Freud believed that deprivation of motherly warmth, lack of childcare and excessive aggression is causing neurotic states; also, Klein claimed that lack of safe relationship between mother and child leads to problems in child's personality in future.One of the most important theories in this field is related to Bowlby; this theory emphasizes mother's behavioral style in early years of child's life.Bowlby believed that future behaviors of the child depends on his attachment method to his mother.Children with safe attachment to their mothers are happy and compatible.But, insecure attachment provides emotional and social maladjustment.
Finally, considering the results obtained from this study and other studies it can be argued that there is relationship between types of child abuse experience and symptoms of personality disorders.That is to say, experiencing abuse during childhood creates the potential of psychological complaints like personality disorders.Of course, we cannot claim that having abuse background in childhood necessarily leads to personality disorder, but this experience can significantly predict the possibility of personality disorders among these kinds of people.
Considering the above-mentioned ideas, the research hypotheses attempted to find out whether dimensions of child abuse can be used to predict symptoms of histrionic personality disorder in adulthood.The results of this study demonstrated that all four dimensions of child abuse can predict symptoms of histrionic personality disorder in adulthood, however, neglect and ignorance dimension has the largest effect and sexual dimension has the least effect in this prediction.
Tyrka et al. (2009) investigated the effects of abuse types on symptoms of personality disorders; they found out that each type of physical, sexual, and emotional abuses are resulted from neglect and they are related to three main symptoms of personality disorder.Abuse is especially related closely to main symptoms of some personality disorders like paranoid personality disorder, borderline, avoidant, dependent, and obsessive-compulsive personality disorder.In a study conducted by Harter and Taylor in 2005 people with abuse background in childhood answered the child abuse questionnaire.The paranoid and psychotic symptoms were more common among them than others, also sexual and physical abused ones have symptoms of obsession, anxiety and somatization.Eating disorders and obesity are common among abused children.In a study, 131 patients with rape experience by their relative were examined; 60 percent of them were 50 pounds and 25 percent of them were overweighed for more than 100 pounds.Kendall and Tacket (2002) examined 290 patients with borderline personality disorder; according to the results, 33 percent of them have one annoying friend, 31 percent were raped, 21 percent were raped by a familiar person, 11 percent of them were raped several times, and 19 percent were beatend and raped.Harter and Taylor (2000)  studied parents' alcohol dependence, child abuse and adaptability in adulthood; according to the results somatization, obsessive-compulsive and anxiety among victims of sexual and physical abuse, interpersonal sensitivity, pessimism, depression and psychosis among victims of emotional, sexual and physical abuse, and hostility and fear among victims of sexual abuse are significant.Children being abused in school show problems in their workplace and in relationships with others.Other results showed that abused children are more affected by alcohol.Wallery et al. (2003)  examined the relationship between several forms of mistreatment during childhood and psychological health in adulthood.The results revealed that any kind of abuse in childhood with all dimensions decreases the scores of psychological health, significantly and high number of abuse will have devastating impact.Draper et al. (2008)  investigated the long-term effects of child abuse on life quality and psychological health of adults victimized by child abuse.The findings showed that physical and sexual abuse seriously undermines physical and psychological health of victimized children in adulthood and influence their life quality undesirably.

Table 1 .
Statistical Description of Histrionic Personality Disorder, Child Abuse and itsTable1shows statistical description of histrionic personality disorder, child abuse and its components.Based on the results, among child abuse components, neglect has the most mean score and sexual abuse has the least mean score.Skewness and kurtosis are normal which reveals that distribution of variables is close to normal.

Table 2 .
Results of Kolmogorov-Smirnov Test in order to assess the Normal Distribution of

Table 3 .
Matrix of the Correlation between Child Abuse Components and Histrionic Personality Disorder

Table 4 .
Results of Stepwise Regression Analysis: Histrionic Personality Disorder (Criterion Variable) based on Components of Child Abuse (Predictor Variable)

Table 5 .
Variance Analysis of Stepwise Regression of Histrionic Personality Disorder based

Table 6 .
Regression Coefficient for Predicting Histrionic Personality Disorder based on

Table 6 shows
Regression Coefficient for Predicting Histrionic Personality Disorder based onComponents of Child Abuse.If value of tolerance for a specific variable is 0.01 or less than this, and VIF is more than 10, there would be multicollinearity.Based on the results tolerance and VIF are in desirable domain; this shows that there is no multicollinearity between and neglect component has the highest mean score and sexual abuse has the lowest mean score.Neglect means failure in providing basic needs of the child like food, clothing, protection, support, and educational facilities.Harassment means "committing" an intended act.Neglect means "deleting" a considered action.Neglect and ignorance are the most common types of mistreatment with children.70 percent of reported abuses is related to neglect.
ConclusionBased on the results obtained from hypotheses analysis it can be concluded that all dimensions of child abuse (emotional, neglect, physical, and sexual) can predicts the symptoms of histrionic personality disorder; accordingly, all four hypotheses of the research are accepted