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Childhood trauma

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.[1] 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.


Health outcomesEdit

Lasting effects of Adverse Childhood Experiences

Traumatic experiences during childhood causes stress that increases an individual’s allostatic load and thus affects the immune system, nervous system, and endocrine system.[2][3][4][5] Childhood trauma is often associated with adverse health outcomes including depression, hypertension, autoimmune diseases, lung cancer, and premature mortality.[2][4][2][6][7] Effects of childhood trauma on brain development includes a negative impact on emotional regulation and impairment of development of social skills.[4] 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.[4][8][9] 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.[10][11]

Psychological impactEdit

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.[12] Another recent study in rhesus macaques showed that DNA methylation changes related to early-life adversity persisted into adulthood.[13]

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.[14][15]

Transgenerational effectsEdit

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.[16][17][18] Exposure to childhood trauma, along with environmental stress, can also cause alterations in genes and gene expressions.[19][20][21] 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.[22] These long-lasting consequences can include emotion regulation issues, which can then be passed onto subsequent generations through child-parent interactions and learned behaviors.[23] (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.[24] However, not all children who are exposed to a potentially traumatic event develop subsequent struggles with mental or physical health.[25] 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.[26] Resilience is defined as “the process of, capacity for, or outcome of successful adaptation despite challenging or threatening circumstances."[27] 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.[28][29] 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.[26] Resilience has been found to decrease risk of suicide, depression, anxiety and other mental health struggles associated with exposure to trauma in childhood.[30][31][32][33]

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.[27] 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.[27] 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.[26] Level of functioning is also measured by the presence of mental health disorders such as depression, anxiety, posttraumatic stress disorder, and so on.[25]

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.[26] Furthermore, the severity and duration of the potentially traumatic experience affect the likelihood of experiencing negative outcomes as a result of childhood trauma.[25][31] One factor that does not affect resilience is gender, with both males and females being equally sensitive to risk and protective factors.[25] Cognitive ability is also not a predictor of resilience.[25]

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.[25] Children with secure attachments to an adult with effective coping strategies were most likely to endure adverse childhood experiences (ACEs) in an adaptive manner.[26] Secure attachments throughout the lifespan (including in adolescence and adulthood) appear to be equally important in fostering and maintaining resilience.[25] Secure attachment to one’s peers throughout adolescence is a particularly strong predictor of resilience.[25] 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.[25] 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.[25]

Personality also affects the development (or lack of development) of adult psychopathology as a result of childhood abuse.[25] 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.[25] 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.[34][35]

Enhancing resilienceEdit

One of the most common misconceptions about resilience is that individuals who show resilience are somehow special or extraordinary in some way.[26] Successful adaptation, or resilience, is quite common among children.[26] 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.[26] 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.[36] Therefore, interventions that promote strong parent-child bonds are particularly effective at buffering against the potential negative effects of trauma.[36]

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.[36] 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.[37] 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.[38]


Medical traumaEdit

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.[39]

Separation traumaEdit

Separation trauma[40] is a disruption in an attachment relationship that disrupts neurological development and can lead to death.[41][42] Chronic separation from a caregiver can be extremely traumatic to a child.[43][44]

Treatment for Childhood TraumaEdit

The effects of childhood trauma can be mitigated through care and treatment. Early intervention has significant impact[45][46]. Trauma-informed treatment modalities treat the whole person, recognizing the impact of trauma on physical, psychological, and social health[47].

Reducing stress hormones (cortisol, adrenaline, testosterone) is a vital early for step effective treatment of complex childhood trauma[48].


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