A Beginner’s Guide To Childhood Trauma: Types, Effects And Treatments

Introduction

The Adverse Childhood Experiences Study And Types Of Interpersonal Trauma.

The best-known and most comprehensive study on the effects of adverse childhood experiences on later life was conducted by Felleti at Kaiser Permanente from 1995 to 1997 and is known as, not altogether inappropriately, THE ADVERSE CHILDHOOD EXPERIENCES STUDY, abbreviated to the ACE Study.

One of Feletti’s main aims in carrying out this study was to increase public and professional awareness of the enormous importance of the impact of childhood on adult lives and, therefore, of course, on society in general.

All too often individuals fail to identify the intimate connection between adult mental and physical problems and the adverse childhood experiences linked to these problems – this is also true of professionals who should know better; frequently, patients who present themselves to doctors and clinicians with conditions such as anxiety and depression are simply palmed off with medication (which often does not work and /or has unwanted side-effects) whilst the possible underlying cause, often a traumatic childhood, is utterly ignored.

Indeed, I know this from my own experience; I suffered severe anxiety and depression and for years and years and yet no clinician so much as enquired about my (highly unstable and traumatic) childhood; instead, I was given powerful medication (which, I later discovered, dramatically reduces life expectancy due to its toxicity) and even ECT (which did not work and was traumatic and frightening to undergo ; although it does work very well for some, according to the literature).

When considering the potentially damaging effects our traumatic childhoods may have had upon us, it is highly pertinent to consider the following questions:

1) How old we were when we experienced childhood trauma (for some, of course, sadly, this may encompass their entire childhoods). This is important as various traumatic experiences affect us differently depending upon our age at the time.

2) What support, if any, was there for us from any family members and/or caregivers not involved in causing the trauma?

This is important as the greater our level of emotional support at the time of our traumatic experiences, the more psychologically resilient we are likely to have been – thus potentially reducing the adverse effects of these traumatic events.

3) Was the person/s who caused our trauma-related to us and / or supposed to be our caregiver? In general terms, trauma induced by someone who is supposed to be our caregiver, particularly a parent, is very significantly more psychologically damaging to us than had the trauma been inflicted upon us by someone not falling within this category.

4) Did traumatic events occur to us that we do not remember? (For example, because we were so young or because these experiences were so emotionally painful that we have repressed them – i.e. blocked them out from our conscious awareness?). This is important as we may have been significantly psychologically damaged by events that are now not available to conscious access (however, any attempt to ‘recover buried memories’ must be undertaken with extreme caution as some so-called recovery techniques can lead to the creation of false memories).

Adverse childhood experiences (ACEs) have been split into three categories :

ABUSE
NEGLECT
FAMILY DYSFUNCTION

In the original ACE study (conducted by Kaiser Permanente and the Centers for Disease Control and Prevention between 1995 and 1997), these three categories were further broken down into :

ABUSE: Emotional; physical and sexual

NEGLECT: Physical; emotional

Family Dysfunction :

Witnessing domestic violence; person/s with depression / mental illness in the home; substance abuse in the home; loss of a parent (e.g. because of divorce/separation/death).

Of course, the child may suffer trauma in many other ways, but the above categories were focused upon in the original ACE study.

The original ACE study found that overall and on average, the greater the number of ACEs an individual had experienced during childhood, the more likely s/he was to suffer from the following problems later in life :

Psychiatric Problems :

alcoholism
depression
abuse of illegal drugs
sexually transmitted diseases
suicidal ideation

Physical Problems :

ischemic heart disease.
liver disease.
sexually transmitted diseases.
chronic obstructive pulmonary disease.

‘Life’ Problems :

health-related quality of life.
poor work performance.
financial stress.
risk for intimate partner violence.
promiscuity.
smoking/starting to smoke especially early in life.
unintended pregnancies.
poor academic performance.

In this book, I will examine more closely the nature of the association between the above symptoms, illnesses, difficulties and problems and childhood trauma. However, the above list is far from exhaustive, and other research, as we shall see, has linked childhood trauma to many other negative effects that can have on our adult lives and these links, too, will be further elucidated; they are as follows :

Arrested development; believing we are an ‘intrinsically bad’ person; how the feeling of being bad is perpetuated; anxiety; hypervigilance; being trapped in the fight/flight/freeze response; borderline personality disorder; complex PTSD; dissociation; problems with controlling intense emotions / dramatic mood swings (also referred to as emotional dysregulation) ; severe relationship difficulties; reduced life expectancy; difficulties managing stress; psychosis ; shame ; self-hatred; reduced life expectancy.

The Three Types Of Adverse Childhood Experiences: Abuse, Neglect And Family Dysfunction.

Abuse:

Child abuse can take on three main forms :

1) Emotional abuse

2) Physical abuse

3) Sexual abuse

In the past, it was generally agreed amongst clinicians that sexual abuse had the most significant adverse impact on the child’s subsequent development. However, it is important to point out that more up-to-date research shows emotional and physical abuse can be just as damaging (some children will experience a combination of two or more of the three types).

The exact nature of the abuse will be inextricably intertwined with the developmental problems which emerge in the individual as a result of it.

Neglect :

There is a problem, though, with the categorization method. This is because the three individual categories do not tend to take account of neglect. Neglect may involve a parent or carer doing nothing to intervene to prevent the child from being abused by someone else, or a parent burdening a young child with their own psychological problems which the child is not old or mature enough to cope with. A parent or carer might neglect a child knowingly or unknowingly.

How Common Is Child Abuse?

It is difficult to know the true figures as childhood abuse is often covered up or unreported. Also, accurate figures are hindered by the fact that childhood abuse cannot be precisely defined.

However, current estimates in the UK suggest about 12 % of children experience physical abuse and 11 % experienced sexual abuse.

So if you have been abused as a child, you are far from alone.

Personal Meaning :

Whilst it is impossible to precisely define child abuse, what is important is the PERSONAL MEANING the sufferer ATTACHES to it. In other words, recognizing the problems a person has developed as a result of the abuse and providing therapy to help the individual deal with those problems is more important than precisely defining the traumatic experience which caused the problems, and arguing about whether it technically qualifies as abuse or not.

Psychological Abuse May Be Most Damaging :

A major study (Spinazzola et al.) on the effects of child maltreatment provides strong evidence that the psychological maltreatment of children is the most harmful form of abuse.

The study analyzed a sample of 5616 young people who had histories of childhood trauma in the form of :

psychological maltreatment (i.e. emotional abuse / emotional neglect).
sexual abuse.
physical abuse.

Each young person who participated in the study was then assessed on whether or not he/she had experienced particular behavioural problems, symptoms and disorders (12 in all), a list of which I present below :

substance abuse.
alcohol abuse.
other forms of self-harm.
skipping school or daycare.
behaviour problems in the home.
criminal activity.
attachment problems.
academic problems.
running away.suicidality.
behaviour problems at school.sexualized behaviours.

Results Of The Study :

The researchers found that those young people who had a history of psychological maltreatment were more damaged by their adverse experiences (as measured by the extent to which they were affected by the above listed behavioural problems, symptoms and disorders) than were those who had suffered physical or sexual abuse.

More specifically, of the above 12 listed behavioural problems, symptoms and disorders, those who had suffered psychological maltreatment were equally likely, or more likely, than those who had suffered physical abuse to have been affected by :

substance abuse.
alcohol abuse.
other forms of self-harm.
skipping school or daycare.
behaviour problems in the home.
criminal activity.
attachment problems.
academic problems.
running away.
suicidality.behavior.
problems at school.

Furthermore, of the above 12 listed behavioural problems, symptoms and disorders, those who had suffered psychological maltreatment were equally likely, or more likely, than those who had suffered sexual abuse to have been affected by :

substance abuse.
alcohol abuse.
other forms of self-harm.
skipping school or daycare.
behaviour problems in the home.
criminal activity.
attachment problems.
academic problems.
running away.
suicidality.
behaviour problems at school.

Implications Of The Study :

In response to the above findings, the authors of the study emphasized the need for it to become a matter of public policy to develop and implement childhood trauma interventions in ways that recognize just what a devastating effect psychological maltreatment in one’s childhood can have upon a person’s quality of life.

They also drew attention to the need for the child welfare system to improve their ability to detect cases of child psychological maltreatment (which frequently occurs ‘under the radar’) so that effective interventions may be implemented.

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Different researchers tend to define emotional abuse, or, as it is referred to in the USA, ‘psychological maltreatment’ in different ways. The difficulties with precise definition arise from the fact that several variables need to be considered – including philosophical, scientific, cultural, political and legal factors (Hart et al., 2002).

For example, some researchers differentiate between emotional ABUSE and emotional NEGLECT. Also, whilst some researchers focus upon the ACTIONS OF THE PERPETRATOR (it should be pointed out that ‘actions’ in this context refer to both acts of COMMISSION and acts of OMISSION – or, to put it another way, both upon what the perpetrator does and FAILS TO DO), others focus more upon THE EFFECTS UPON THE CHILD. A third complicating factor is that there is often a significant delay between the abuse itself and the disturbed behaviour which results from that abuse.

In the USA, emotional abuse (or ‘psychological maltreatment’) is most frequently, formally defined in the following way :

‘ A repeated pattern of caregiver behaviour or extreme incidents that convey to children that they are worthless, flawed, unloved, unwanted, endangered or only of value in meeting the needs of another. It includes :

spurning

terrorizing

isolating

exploiting/corrupting

denying emotional responsiveness

neglecting mental health, medical needs and education

The above is the definition is from The American Professional Society on Abuse of Children (APSAC), 1995

Let’s look at what is meant by each of the six items on the above list.

1) SPURNING – this may be verbal or non-verbal and includes belittling, shaming or ridiculing the child, generally degrading him/her or rejecting/abandoning him/her.

2) TERRORIZING – this includes placing the child in danger, threatening him/her or generally creating a climate of fear.

3) ISOLATING – this can involve placing severe restrictions on the child, preventing developmentally appropriate social interaction and/or separating the child from the rest of the family.

4) EXPLOITING/ CORRUPTING – this includes encouraging the child to develop in inappropriate and/or antisocial behaviours and values, such as stealing, abusing others physically or verbally, breaking into houses etc.

5) DENYING EMOTIONAL RESPONSIVENESS – this involves being emotionally unavailable, ignoring the child, failing to express affection, and becoming distant physically and emotionally.

6) NEGLECTING MENTAL HEALTH, MEDICAL NEEDS AND EDUCATION – this involves failing to provide and attend to the psychological, medical, cognitive and mental needs of the child.

(1-6 above from Dorosa Iwaniec, 2006)

Why Is Emotional Abuse So Harmful?

Emotional abuse not only negatively affects the child at the time it is going on (by lowering his/her self-esteem and causing him/her to live in a constant state of uncertainty and fear, for example), but, if there is no therapeutic intervention, leads to deeply unhappy adulthood as well.

When a person has grown up in an environment which is emotionally abusive, his/her adult experiences will be viewed through the negative filter which was laid down during his/her childhood. This, in turn, is likely to lead to maladaptive (unhelpful) behaviours in adult life which may well jeopardize his/her career prospects, relationships and physical health, for example.

Effects Of Emotionally Unstable Environment On The Child :

If, as a child, an individual lives in an emotionally unstable environment, as I did with my mother until I was thirteen (when I was made to leave to go and live with my father and step-mother) s/he may, as I did, have felt that s/he was robbed of security and value.

As children, we desperately needed consistency and the knowledge that we were unconditionally accepted and valued by those who were supposed to deeply care for us. But, because an emotionally unstable environment is one which is devoid of consistency, children brought up in such a home never learn what to expect (their parents’ / carers’ behaviour can wildly fluctuate in unpredictable ways) they are never able to feel the environment is under control – they never know what might happen next or what lies ahead; there are constant uncertainty and fear about how they will be treated. Anything seems possible. There exists in such children a permanent state of nervous anticipation, if not outright terror.

Summary Of Main Adverse Effects Of Emotional Abuse :

a necessity to be in a state of constant hypervigilance; this will often lead to acute sensitivity and easily triggered hostility (attack, in this case, is a form of defence).
if, as children, we are constantly told we are in the wrong, this can lead to procrastination, indecision and inaction (we become constantly concerned anything we try will turn to disaster).
if we are constantly provoked, we may start reacting with outbursts of rage.
being constantly treated in an unfair way can lead us to become obsessed with getting justice.
the constant psychological strain can lead to a state of emotional exhaustion – this can easily result in apathy and depression (including losing motivation and an inability to derive any pleasure from activities or social interactions).
intense anger reactions following even minor provocations/outbursts of extreme rage easily triggered.
recurring feelings that life is not worth living given the intense emotional pain it entails.
feelings of being incapable of dealing with life’s relentless demands.
frequent and intense feelings of wanting to escape responsibilities.
regard other people’s opinions us far more important than our own (although may not show this on the surface; indeed, outward behaviour may suggest to others that the opposite view is held).
an intense desire to win the approval and admiration of others.
automatically self-blame when things go wrong.
inability to control our own emotions.
highly sensitive to others’ emotions.
fear of never being capable of living up to others’ expectations.
highly indecisive.
deep fear regarding what the future may hold / a constant sense of imminent doom / always expecting the worst possible outcome.
an inability to tolerate own failings and weaknesses.
a deep fear of taking risks that most people would regard as worth taking, resulting in not progressing at work, not daring to even attempt to form relationships etc.
Feelings of being undeserving of good things happen / feelings of guilt about indulging in pleasurable activities as believing we irrationally believe that we ‘don’t deserve them.’
when good things do happen, a feeling of suspicion emerges (e.g. ‘this is surely too good to be true / too good to last). For example, I used to think that if I won the lottery, it was overwhelmingly probable that I’d drop dead of a heart attack within a month (maximum!) of receiving my financial windfall.
difficulty keeping as a job (often, this may be due to problems interacting with authority figures / extreme difficulty accepting criticism).
fear of taking a challenging job due to intense concerns about failing at it, thus not fulfilling vocational potential.
derive comfort / ameliorate emotional pain from such things as cigarettes, drugs, alcohol, gambling, food, frequent casual sex etc. (in its intense form, such behaviour is referred to by psychologists as ‘dissociating’ (I will say more about ‘dissociation’ later on in this book). Also, a belief that it would be impossible to give up such activities as this would render life utterly intolerable.
indulgence in hedonistic behaviour as a way of compensating self for childhood suffering.
fear that, in a relationship, will be taken advantage of and exploited.
incomprehension regarding what others could possibly see in us, and, therefore, holding a kind of, ‘I wouldn’t want to join any club that would have me as a member’ (Groucho Marx) attitude – only applied to relationships (as expressed by Woody Allen in the opening sequence of his film Annie Hall).
prepared to tolerate being abused in a relationship due to a feeling of ‘deserving no better.’
feel a desperate need to be in a relationship with another person in order to feel ‘validated’ as an individual; this is linked to a poor sense of identity which may also result from having suffered childhood emotional abuse.
a feeling of having to hide ‘true self’ from others, as this ‘true self’ is ‘utterly unlovable.’
a feeling of constant physical malaise, but, also, a lack of motivation to do anything about it (e.g. taking more exercise, stopping smoking, eating more healthily etc.).
constant feelings of anxiety and/or frequent feelings of intense panic.
a deep sense that there must be something profoundly and irredeemably wrong with us.
being perpetually criticized can lead to feelings of insecurity, shame and guilt.

As one would expect, the worse one’s experience of childhood emotional abuse was, the more of the above symptoms one is likely to have, and the more intense such symptoms are likely to be (all else being equal).

Therapies such as cognitive behavioural therapy (CBT) and dialectical behavioural therapy (DBT) can significantly ameliorate such problems (we will look in greater detail at these therapies in Part 2).

The Dysfunctional Family :

A dysfunctional family is one that has at its core destructive and harmful parenting and a lack of concern for the child. The harmful effects on the child may go completely unacknowledged or be minimized. Often, little or nothing is done to rectify the situation nor to alleviate its adverse effects upon the child.

If the distress caused to the child is severe and long-lasting, s/he may develop a psychiatric condition such as complex posttraumatic stress disorder (complex PTSD) which, if not properly treated, may seriously adversely affect the rest of his/her life. (I will say more about complex PTSD later on in this book).

Types Of Dysfunctional Family :

1) A family in which the mother and/or father are addicted to drugs or alcohol (or who have another psychological addiction).

This may lead to the parent passing out, going missing for extended periods of time, behaving unpredictably, getting out of control or causing the family severe financial hardship.

Children who grow up in such families tend to grow up into distrustful adults who see others as being essentially unreliable.

2) A family in which violence and volatility predominates. Children from such families are at risk of becoming violent and volatile themselves, not least as a result of learned behaviour.

3) A family in which the child is forcibly removed from the parents’ care (e.g. due to being taken into care or being sentenced to a period of juvenile detention).

4) A family in which the child is used as a ‘pawn’ (e.g. divorcing parents each trying to turn the child against the other parent). This may include speaking ill of the other parent, limiting the child’s contact with the other parent, preventing the child from seeing the other parent at all or coercing them into rejecting a parent when this is not in the child’s interest.

5) A family in which a parent has a mental illness that adversely impinges upon the child’s own emotional development

6) A family in which the child is overly controlled and a parent makes excessive use of their power.

Adverse Effects Upon The Child :

Apart from the adverse effects upon the child already mentioned, children brought up in such dysfunctional families are also at risk of developing many other problems and difficulties, including depression, low self-esteem, anxiety, irrational self-blame and self-hatred, alcohol and/or drug dependency, an impaired, or even ruined, ability to both give and receive love.

Furthermore, the child may become rebellious and start to behave in anti-social ways; for example: getting into fights, vandalizing property, indulging in petty theft, committing arson, bullying others, dropping out of school.

They may also start behaving self-destructively, self-harm, develop life-long problems with interpersonal relationships, have an elevated risk of attempting suicide as well as lower life expectancy. Also, if they become parents themselves, they may develop their own parenting problems, thus perpetuating the dysfunctional family cycle.

Dysfunctional families which lead to the child having to take on the role of carer (e.g. before I was a teenager I cared for my mentally unstable mother after the divorce of my parents) can put him/her under extreme stress as s/he does not have the emotional maturity to cope. Such children, in effect, have their childhoods ‘stolen’ from them.

Children may also attempt to cope with the enormous stress of growing up in a dysfunctional family by becoming withdrawn. Compounding this problem, very sadly, they may also become the victims of bullies at school due to their vulnerability.

As a result of this, they may grow up to be ‘loners.’