Childhood trauma has profound psychological, physiological, and sociological impacts and can have negative, lasting effects on health and well-being. Referred to in academic literature as adverse childhood experiences (ACEs), childhood trauma ranges from sexual abuse to neglect to living in a household where a parent or sibling is treated violently or there is a parent with a mental illness. Kaiser Permanente and the Centers for Disease Control and Prevention's 1998 study on adverse childhood experiences determined that traumatic experiences during childhood are a root cause of many social, emotional, and cognitive impairments that lead to increased risk of unhealthy behaviors, risk of violence or re-victimization, chronic health conditions, low life potential and premature mortality. As the number of adverse experiences increases, the risk of problems from childhood through adulthood also rises. Nearly 30 years of study following the initial study has confirmed this. Many states, health providers, and other groups now routinely screen parents and children for ACEs.
Traumatic experiences during childhood causes stress that increases an individual’s allostatic load and thus affects the immune system, nervous system, and endocrine system. Childhood trauma is often associated with adverse health outcomes including depression, hypertension, autoimmune diseases, lung cancer, and premature mortality. Effects of childhood trauma on brain development includes a negative impact on emotional regulation and impairment of development of social skills. Research has shown that children raised in traumatic or risky family environments tend to have excessive internalizing (e.g., social withdrawal, anxiety) or externalizing (e.g., aggressive behavior), and suicidal behavior. Recent research has found that physical and sexual abuse are associated with mood and anxiety disorders in adulthood, while personality disorders and schizophrenia are linked with emotional abuse as adults.
Childhood trauma can increase the risk of mental disorders including posttraumatic stress disorder (PTSD), attachment issues, depression, and substance abuse. Sensitive and critical stages of child development can result in altered neurological functioning, adaptive to a malevolent environment but difficult for more benign environments.
Child abuse can leave tracks, not only physically and emotionally, but also in the form of epigenetic marks on a child's genes. Although these epigenetic marks do not cause mutations in the DNA itself, the chemical modifications-including DNA methylation-change gene expression by silencing (or activating) genes. This can alter fundamental biological processes and adversely affect health outcomes throughout life. A 2013 study found that people who had experienced childhood trauma had different neuropathology than people with PTSD from trauma experienced after childhood. Another recent study in rhesus macaques showed that DNA methylation changes related to early-life adversity persisted into adulthood.
Socioeconomic costs of childhood traumaEdit
The social and economic costs of child abuse and neglect are difficult to calculate. Some costs are straightforward and directly related to maltreatment, such as hospital costs for medical treatment of injuries sustained as a result of physical abuse and foster care costs resulting from the removal of children when they cannot remain safely with their families. Other costs, less directly tied to the incidence of abuse, include lower academic achievement, adult criminality, and lifelong mental health problems. Both direct and indirect costs impact society and the economy.
People can pass their epigenetic marks including de-myelinated neurons to their children. The effects of trauma can be transferred from one generation of childhood trauma survivors to subsequent generations of offsprings. This is known as transgenerational trauma or intergenerational trauma, and can manifest in parenting behaviors as well as epigenetically. Exposure to childhood trauma, along with environmental stress, can also cause alterations in genes and gene expressions. A growing body of literature suggests that children's experiences of trauma and abuse within close relationships not only jeopardize their well-being in childhood, but can also have long-lasting consequences that extend well into adulthood. These long-lasting consequences can include emotion regulation issues, which can then be passed onto subsequent generations through child-parent interactions and learned behaviors. (see also behavioral epigenetics, epigenetics, historical trauma, and cycle of violence)
Exposure to maltreatment in childhood significantly predicts a variety of negative outcomes in adulthood. However, not all children who are exposed to a potentially traumatic event develop subsequent struggles with mental or physical health. Therefore, there are factors that reduce the impact of potentially traumatic events and protect an individual from developing mental health problems after exposure to a potentially traumatic event. These are called resiliency factors.
Research regarding children who showed adaptive development while facing adversity began in the 1970s and continues to this day. Resilience is defined as “the process of, capacity for, or outcome of successful adaptation despite challenging or threatening circumstances." The concept of resilience stems from research that showed experiencing positive emotions had a restorative and preventive effect on the experience of negative emotions more broadly with regards to physical and psychological wellbeing in general and more specifically with reactions to trauma. This line of research has contributed to the development of interventions that focus on promoting resilience as opposed to focusing on deficits in an individual who has experienced a traumatic event. Resilience has been found to decrease risk of suicide, depression, anxiety and other mental health struggles associated with exposure to trauma in childhood.
When an individual who is high in resilience experiences a potentially traumatic event, their relative level of functioning does not significantly deviate from the level of functioning they exhibited prior to exposure to a potentially traumatic event. Furthermore, that same individual may recover more quickly and successfully from a potentially traumatic experience than an individual who could be said to be less resilient. In children, level of functioning is operationalized as the child continuing to behave in a manner that is considered developmentally appropriate for a child of that age. Level of functioning is also measured by the presence of mental health disorders such as depression, anxiety, posttraumatic stress disorder, and so on.
Factors that affect resilienceEdit
Factors that affect resilience include cultural factors like socioeconomic status, such that having more resources at one’s disposal usually equates to more resilience to trauma. Furthermore, the severity and duration of the potentially traumatic experience affect the likelihood of experiencing negative outcomes as a result of childhood trauma. One factor that does not affect resilience is gender, with both males and females being equally sensitive to risk and protective factors. Cognitive ability is also not a predictor of resilience.
Attachment has been shown to be one of the most important factors to consider when it comes to evaluating the relative resilience of an individual. Children with secure attachments to an adult with effective coping strategies were most likely to endure adverse childhood experiences (ACEs) in an adaptive manner. Secure attachments throughout the lifespan (including in adolescence and adulthood) appear to be equally important in fostering and maintaining resilience. Secure attachment to one’s peers throughout adolescence is a particularly strong predictor of resilience. Within the context of abuse, it is thought that these secure attachments decrease the extent to which children who are abused perceive others as being untrustworthy. In other words, while some children who are abused might begin to view other people as being unsafe and unable to be trusted, children who are able to develop and maintain healthy relationships are less likely to hold these views. Children who experience trauma but also experience healthy attachment with multiple groups of people (in essence, adults, peers, romantic partners, etc.) throughout childhood, adolescence, and adulthood are particularly resilient.
Personality also affects the development (or lack of development) of adult psychopathology as a result of childhood abuse. Individuals who scored low in neuroticism exhibit fewer negative outcomes, such as psychopathology, criminal activity, and poor physical health, after exposure to a potentially traumatic event. Furthermore, individuals with higher scores on openness to experience, conscientiousness, and extraversion have been found to be more resilient to the effects of childhood trauma.
One of the most common misconceptions about resilience is that individuals who show resilience are somehow special or extraordinary in some way. Successful adaptation, or resilience, is quite common among children. This is due in part to the naturally adaptive nature of childhood development. Therefore, resilience is enhanced by protecting against factors that might undermine a child's inborn resilience. Studies suggest that resiliency can be enhanced by providing children who have been exposed to trauma with environments in which they feel safe and are able to securely attach to a healthy adult. Therefore, interventions that promote strong parent-child bonds are particularly effective at buffering against the potential negative effects of trauma.
Furthermore, researchers of resilience argue that successful adaptation is not merely an end result but rather a developmental process that is ongoing throughout a person’s lifetime. Thus, successful promotion of resilience must also be ongoing throughout a person’s lifespan.
Trauma affects all children differently (see stress in early childhood). Some children who experience trauma develop significant and long-lasting problems, while others may have minimal symptoms and recover more quickly. Studies have found that despite the broad impacts of trauma, children can and do recover, and that trauma-informed care and interventions produce better outcomes than “treatment as usual”. Trauma-informed care is defined as offering services or support in a way that addresses the special needs of people who have experienced trauma.
Medical trauma, sometimes called "pediatric medical traumatic stress" refers to a set of psychological and physiological responses of children and their families to pain, injury, serious illness, medical procedures, and invasive or frightening treatment experiences. Medical trauma may occur as a response to a single or multiple medical events.
Separation trauma is a disruption in an attachment relationship that disrupts neurological development and can lead to death. Chronic separation from a caregiver can be extremely traumatic to a child.
Treatment for Childhood TraumaEdit
The effects of childhood trauma can be mitigated through care and treatment. Early intervention has significant impact. Trauma-informed treatment modalities treat the whole person, recognizing the impact of trauma on physical, psychological, and social health.
Reducing stress hormones (cortisol, adrenaline, testosterone) is a vital early for step effective treatment of complex childhood trauma.
- "The Adverse Childhood Experiences (ACE) Study". Centers for Diesase Control. Retrieved 6 June 2017.
- Brown DW, Anda RF, Felitti VJ, Edwards VJ, Malarcher AM, Croft JB, Giles WH (January 2010). "Adverse childhood experiences are associated with the risk of lung cancer: a prospective cohort study". BMC Public Health. 10: 20. doi:10.1186/1471-2458-10-20. PMC 2826284. PMID 20085623.
- Dube SR, Fairweather D, Pearson WS, Felitti VJ, Anda RF, Croft JB (February 2009). "Cumulative childhood stress and autoimmune diseases in adults". Psychosomatic Medicine. 71 (2): 243–50. doi:10.1097/PSY.0b013e3181907888. PMC 3318917. PMID 19188532.
- Taylor SE, Lerner JS, Sage RM, Lehman BJ, Seeman TE (December 2004). "Early environment, emotions, responses to stress, and health". Journal of Personality. 72 (6): 1365–93. CiteSeerX 10.1.1.324.5195. doi:10.1111/j.1467-6494.2004.00300.x. PMID 15509286.
- Motzer SA, Hertig V (March 2004). "Stress, stress response, and health". The Nursing Clinics of North America. 39 (1): 1–17. doi:10.1016/j.cnur.2003.11.001. PMID 15062724.
- Chapman DP, Whitfield CL, Felitti VJ, Dube SR, Edwards VJ, Anda RF (October 2004). "Adverse childhood experiences and the risk of depressive disorders in adulthood". Journal of Affective Disorders. 82 (2): 217–25. doi:10.1016/j.jad.2003.12.013. PMID 15488250.
- Murphy MO, Cohn DM, Loria AS (March 2017). "Developmental origins of cardiovascular disease: Impact of early life stress in humans and rodents". Neuroscience and Biobehavioral Reviews. 74 (Pt B): 453–465. doi:10.1016/j.neubiorev.2016.07.018. PMC 5250589. PMID 27450581.
- Aron EN, Aron A, Davies KM (February 2005). "Adult shyness: the interaction of temperamental sensitivity and an adverse childhood environment". Personality & Social Psychology Bulletin. 31 (2): 181–97. doi:10.1177/0146167204271419. PMID 15619591.
- Norman RE, Byambaa M, De R, Butchart A, Scott J, Vos T (2012). "The long-term health consequences of child physical abuse, emotional abuse, and neglect: a systematic review and meta-analysis". PLoS Medicine. 9 (11): e1001349. doi:10.1371/journal.pmed.1001349. PMC 3507962. PMID 23209385.
- Sachs-Ericsson NJ, Sheffler JL, Stanley IH, Piazza JR, Preacher KJ (October 2017). "When Emotional Pain Becomes Physical: Adverse Childhood Experiences, Pain, and the Role of Mood and Anxiety Disorders". Journal of Clinical Psychology. 73 (10): 1403–1428. doi:10.1002/jclp.22444. PMC 6098699. PMID 28328011.
- Carr CP, Martins CM, Stingel AM, Lemgruber VB, Juruena MF (December 2013). "The role of early life stress in adult psychiatric disorders: a systematic review according to childhood trauma subtypes". The Journal of Nervous and Mental Disease. 201 (12): 1007–20. doi:10.1097/NMD.0000000000000049. PMID 24284634.
- Mehta D, Klengel T, Conneely KN, Smith AK, Altmann A, Pace TW, Rex-Haffner M, Loeschner A, Gonik M, Mercer KB, Bradley B, Müller-Myhsok B, Ressler KJ, Binder EB (May 2013). "Childhood maltreatment is associated with distinct genomic and epigenetic profiles in posttraumatic stress disorder". Proceedings of the National Academy of Sciences of the United States of America. 110 (20): 8302–7. doi:10.1073/pnas.1217750110. PMC 3657772. PMID 23630272.
- Provençal N, Suderman MJ, Guillemin C, Massart R, Ruggiero A, Wang D, et al. (October 2012). "The signature of maternal rearing in the methylome in rhesus macaque prefrontal cortex and T cells". The Journal of Neuroscience. 32 (44): 15626–42. doi:10.1523/JNEUROSCI.1470-12.2012. PMC 3490439. PMID 23115197.
- "Social and Economic Consequences of Child Abuse and Neglect". Child Welfare Information Gateway. U.S. Department of Health and Human Services. This article incorporates text from this source, which is in the public domain.
- "The Estimated Annual Cost of Child Abuse and Neglect". Prevent Child Abuse America.
- Fox M (2 May 2016). "Poor Parenting Can Be Passed From Generation to Generation". NBC News. Retrieved 2017-03-16.
- "Childhood trauma compromises health via diverse pathways". The Blue Knot Foundation. Retrieved 2017-03-16.
- "Adverse Childhood Experiences (ACEs): Mental Illness of a Parent". Crow Wing Energized. Retrieved 2017-03-16.
- Roth TL (November 2013). "Epigenetic mechanisms in the development of behavior: advances, challenges, and future promises of a new field". Development and Psychopathology. 25 (4 Pt 2): 1279–91. doi:10.1017/S0954579413000618. PMC 4080409. PMID 24342840.
- Feder A, Nestler EJ, Charney DS (June 2009). "Psychobiology and molecular genetics of resilience". Nature Reviews. Neuroscience. 10 (6): 446–57. doi:10.1038/nrn2649. PMC 2833107. PMID 19455174.
- Tyrka AR, Ridout KK, Parade SH (November 2016). "Childhood adversity and epigenetic regulation of glucocorticoid signaling genes: Associations in children and adults". Development and Psychopathology. 28 (4pt2): 1319–1331. doi:10.1017/S0954579416000870. PMC 5330387. PMID 27691985.
- Kaplan SJ, Pelcovitz D, Labruna V (October 1999). "Child and adolescent abuse and neglect research: a review of the past 10 years. Part I: Physical and emotional abuse and neglect". Journal of the American Academy of Child and Adolescent Psychiatry. 38 (10): 1214–22. doi:10.1097/00004583-199910000-00009. PMID 10517053.
- "Maternal early-life trauma and affective parenting style: the mediating rol...: EBSCOhost". web.a.ebscohost.com. Retrieved 2017-10-04.
- Arnow, B. A. (2004). "Relationships between childhood maltreatment, adult health and psychiatric outcomes, and medical utilization". Journal of Clinical Psychiatry. 65: 10–15.
- Collishaw, Stephan; Pickles, Andrew; Messer, Julie; Rutter, Michael; Shearer, Christina; Maughan, Barbara (March 2007). "Resilience to adult psychopathology following childhood maltreatment: Evidence from a community sample". Child Abuse & Neglect. 31 (3): 211–229. doi:10.1016/j.chiabu.2007.02.004. ISSN 0145-2134.
- Masten, Ann S. (2001). "Ordinary magic: Resilience processes in development". American Psychologist. 56 (3): 227–238. doi:10.1037//0003-066x.56.3.227. ISSN 0003-066X.
- Masten, Ann S.; Best, Karin M.; Garmezy, Norman (October 1990). "Resilience and development: Contributions from the study of children who overcome adversity". Development and Psychopathology. 2 (4): 425–444. doi:10.1017/S0954579400005812. ISSN 1469-2198.
- "Cultivating positive emotions to optimize health and well-being". Prevention & Treatment. 3: np. 2000. doi:10.1037//1522-3736.3.0001a. ISSN 1522-3736.
- Tugade, Michele M.; Fredrickson, Barbara L.; Feldman Barrett, Lisa (2004). "Psychological Resilience and Positive Emotional Granularity: Examining the Benefits of Positive Emotions on Coping and Health". Journal of Personality. 72 (6): 1161–1190. doi:10.1111/j.1467-6494.2004.00294.x. ISSN 0022-3506. PMC 1201429. PMID 15509280.
- Roy, Alec; Carli, Vladimir; Sarchiapone, Marco (2011). "Resilience mitigates the suicide risk associated with childhood trauma". Journal of Affective Disorders. 133 (3): 591–594. doi:10.1016/j.jad.2011.05.006. ISSN 0165-0327.
- Wingo, Aliza P.; Wrenn, Glenda; Pelletier, Tiffany; Gutman, Alisa R.; Bradley, Bekh; Ressler, Kerry J. (2010). "Moderating effects of resilience on depression in individuals with a history of childhood abuse or trauma exposure". Journal of Affective Disorders. 126 (3): 411–414. doi:10.1016/j.jad.2010.04.009. ISSN 0165-0327. PMC 3606050. PMID 20488545.
- Poole, Julia C.; Dobson, Keith S.; Pusch, Dennis (2017). "Childhood adversity and adult depression: The protective role of psychological resilience". Child Abuse & Neglect. 64: 89–100. doi:10.1016/j.chiabu.2016.12.012. ISSN 0145-2134.
- Poole, Julia C.; Dobson, Keith S.; Pusch, Dennis (2017). "Anxiety among adults with a history of childhood adversity: Psychological resilience moderates the indirect effect of emotion dysregulation". Journal of Affective Disorders. 217: 144–152. doi:10.1016/j.jad.2017.03.047. ISSN 0165-0327.
- Watson, David; Hubbard, Brock (1996). "Adaptational Style and Dispositional Structure: Coping in the Context of the Five-Factor Model". Journal of Personality. 64 (4): 737–774. doi:10.1111/j.1467-6494.1996.tb00943.x. ISSN 0022-3506.
- Campbell-Sills, Laura; Cohan, Sharon L.; Stein, Murray B. (2006). "Relationship of resilience to personality, coping, and psychiatric symptoms in young adults". Behaviour Research and Therapy. 44 (4): 585–599. doi:10.1016/j.brat.2005.05.001. ISSN 0005-7967.
- Yates, Tuppett M.; Egeland, Byron; Sroufe, L. Alan (2003), "Rethinking Resilience: A Developmental Process Perspective", Resilience and Vulnerability, Cambridge University Press, pp. 243–266, doi:10.1017/cbo9780511615788.012, ISBN 9780511615788, retrieved 2018-11-20
- "Chapter 3, Understanding the Impact of Trauma.". Trauma-Informed Care in Behavioral Health Services. Trauma-Informed Care in Behavioral Health Services (Treatment Improvement Protocol (TIP) Series. 57. Rockville (MD): Center for Substance Abuse Treatment (US). 2014.
- SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach. Rockville, MD: Substance Abuse and Mental Health Services Administration. 2014.
- Marsac ML, Kassam-Adams N, Delahanty DL, Widaman KF, Barakat LP (December 2014). "Posttraumatic stress following acute medical trauma in children: a proposed model of bio-psycho-social processes during the peri-trauma period". Clinical Child and Family Psychology Review. 17 (4): 399–411. doi:10.1007/s10567-014-0174-2. PMC 4319666. PMID 25217001.
- Thomas C (2016). "Symbolization of early separation traumas and the formation of new representations. Experiences from the analysis of a former institutionalized child". Psyche. 70 (11). doi:10.21706/ps-70-11. ISSN 0033-2623.
- Ward MJ, Lee SS, Lipper EG (2000). "Failure-to-thrive is associated with disorganized infant-mother attachment and unresolved maternal attachment". Infant Mental Health Journal. 21 (6): 428–442. doi:10.1002/1097-0355(200011/12)21:6<428::aid-imhj2>3.0.co;2-b.
- Muñoz-Hoyos A, Augustin-Morales MC, Ruíz-Cosano C, Molina-Carballo A, Fernández-García JM, Galdó-Munoz G (November 2001). "Institutional childcare and the affective deficiency syndrome: consequences on growth, nutrition and development". Early Human Development. 65 Suppl: S145–52. doi:10.1016/s0378-3782(01)00216-x. PMID 11755045.
- Cook A, Spinazzola J, Ford J, Lanktree C, Blaustein M, Cloitre M, DeRosa R, Hubbard R, Kagan R (2005-05-01). "Complex Trauma in Children and Adolescents". Psychiatric Annals. 35 (5): 390–398. doi:10.3928/00485713-20050501-05.
- Kinzie JD, Sack WH, Angell RH, Manson S, Rath B (1986). "The Psychiatric Effects of Massive Trauma on Cambodian Children: I. The Children". Journal of the American Academy of Child Psychiatry. 25 (3): 370–376. doi:10.1016/s0002-7138(09)60259-4.
- "A paradigm shift in responding to children who have experienced trauma: The Australian treatment and care for kids program". Children and Youth Services Review. 94: 525–534. 2018-11-01. doi:10.1016/j.childyouth.2018.08.031. ISSN 0190-7409.
- Black, Melissa; Hitchcock, Caitlin; Bevan, Anna; Leary, Cliodhna O; Clarke, James; Elliott, Rachel; Watson, Peter; Lafortune, Louise; Rae, Sarah (2018-04-24). "The HARMONIC trial: Study protocol for a randomised controlled feasibility trial of Shaping Healthy Minds – a modular transdiagnostic intervention for mood, stress and anxiety disorders in adults". dx.doi.org. Retrieved 2019-01-10.
- "Trauma-Informed Care | ATTC Network". attcnetwork.org. Retrieved 2019-01-10.
- Gustaffsson, Per E. "Diurnal cortisol levels, psychiatric symptoms and sense of coherence in abused adolescents". Nordic Journal of Psychiatry. 71 (4): 324–324. doi:10.1080/08039488.2017.1301704. ISSN 0803-9488.