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We have seen that those who suffer severe and protracted childhood trauma, particularly if their adverse childhood experiences have led them to develop such devastating psychological disorders as borderline personality disorder or complex post-traumatic stress disorder, are far more likely to experience intense feelings of stress in adulthood that are so tortuous that they are desperately compelled to try to alleviate them in ways that, in the long run, are dysfunctional and damaging. I consider some examples of such self-defeating behaviours below:
For example, let’s consider alcoholism:
Childhood Trauma And Alcoholism
When childhood trauma remains unresolved (i.e. it has not yet been worked through and processed with the help of psychotherapy), alcoholism may result (together, frequently, with aggressive behaviour).
Indeed, it has been suggested that unresolved traumatic events are actually the MAIN CAUSE of alcoholism in later life. The trauma may have its roots in:
– the child having been rejected by the parent/s
– too much responsibility having been placed upon the child
As would be expected, it has also been found that adult risk of both alcoholism and depression increases the greater the number of traumatic events experienced and the greater their intensity.
Children who grow up in alcoholic households have also been found to be at greater risk of becoming alcoholics themselves in adulthood, but this appears to be due to the fact that, as children with alcoholic parent/s, they are more likely to have experienced traumatic events than children of non-alcoholic parents, rather than due to them modelling their own behaviour regarding drinking alcohol upon that of their parent/s.
Furthermore, the more traumatic events experienced during childhood (of a physical, emotional or sexual nature), the more intensely symptoms of ANGER are likely to present themselves later on.
In research studies on childhood trauma, the degree of trauma experienced (and it is obviously not possible to quantify this with absolute precision) is often measured using the CHILDHOOD TRAUMA QUESTIONNAIRE (Fink et al., 1995) which identifies EMOTIONAL INJURIES and PARENTAL NEGLECT experienced during childhood and adolescence.
These view alcoholism as A MEANS OF COPING WITH ANXIETY. Studies suggest that an alcoholic adult is about ten times more likely to have experienced physical violence as a child and about twenty times more likely to have experienced sexual abuse. Lack of peace in the family during childhood is also much more frequently reported by adults suffering from alcoholism, as are: EMOTIONAL ABUSE, NEGLECT, SEPARATION AND LOSS, INADEQUATE (eg distant) RELATIONSHIPS and LACK OF PARENTAL AFFECTION.
IMPLICATIONS FOR THE TREATMENT OF ADULT ALCOHOLICS:
Psychotherapy to help the individual suffering from alcoholism resolve his/her childhood trauma may improve treatment outcomes and reduce the likelihood of relapse. Further research is being conducted to help to confirm this.
ALCOHOL DEPENDENCE :
There is no precise definition of ‘alcohol dependence’, but it is generally agreed between experts that it usually includes the following features:
– a pattern of daily drinking
– being aware of a compulsion to drink alcohol
– changes in tolerance to the amount of alcohol that can be consumed (in the first stage, tolerance increases, but, eventually, tolerance actually reduces again)
– frequent symptoms of withdrawal from alcohol (commonly referred to as a ‘hangover). Symptoms of this may include: nervousness, shaking, tenseness, agitation (or feeling ‘jittery’ and ‘on edge’), feelings of tension, feelings of sickness/nausea
– finding relief from some or all of the above symptoms by consuming more alcohol
– during any periods of abstinence, finding that the features of dependence on alcohol soon re-emerge
It should be noted that individuals who are considered to have become dependent on alcohol may not have all of the symptoms noted above; however, the more symptoms one possesses, the more seriously dependent upon alcohol one is likely to be. The intensity of these symptoms of alcohol dependence will also vary considerably between individuals.
STRATEGIES FOR THE REDUCTION OF ONE’S ALCOHOL INTAKE :
– cut out at least some drinking sessions (eg lunchtime drinking) and, ideally, find something else to occupy the time to act as a distraction (such as actually eating lunch!)
– during drinking sessions, alternate between soft drinks and alcoholic drinks
– avoid drinking environments / the company of people who may pressure you to drink, during periods that you have decided to stay alcohol-free
– if people who are likely to encourage you to drink cannot be avoided, plan how you will resist their influence
– add generous amounts of non-alcoholic mixers to alcoholic drinks where possible, but drink at the same speed as you would if the alcohol were less diluted (or slower!)
– avoid falling into social traps that tend to encourage drinking, such as participating in a large, hard-drinking group of people who are buying ’rounds’ for one another where a ‘group mentality’ is likely to predominate.
The experiment described below represents one theory about how childhood trauma (in this case, separation from the mother, may contribute towards a tendency towards violence in adult life.
A recent Swiss study by Marquez et al. (2013) has looked at the effects of trauma on ‘adolescent’ rats. It was found that those rats who were exposed to trauma (fear and stress-inducing stimuli) suffered adverse PHYSICAL EFFECTS ON THE BRAIN (specifically, the PREFRONTAL CORTEX). This, in turn, leads to them displaying significantly more aggressive behaviour than non-traumatized rats.
Effect Of Separation From Mothers :
A very similar effect has been found to occur in young rats SEPARATED FROM THEIR MOTHERS.
Furthermore, ‘adolescent’ rats exposed to trauma also develop ANXIETY and DEPRESSION type behaviours. They were found to also have increased activity in the brain region known as the AMYGDALA (which is linked to FEAR and VIOLENCE in humans). Additionally, they developed abnormally high levels of TESTOSTERONE ( a hormone which, in humans, is linked to AGGRESSION and VIOLENCE). Even the rats’ DNA was found to be affected by the trauma (specifically, MAOA genes). These genes act to break down SEROTONIN (a brain chemical, or neurotransmitter) and damage to it leads to too much serotonin being broken down which, in turn, leads to aggressive behaviour.
Comparison With Adult Rats :
However, ADULT RATS exposed to trauma did not undergo the same behavioural changes, so:
THE RESEARCH SUGGESTS IT IS TRAUMA IN EARLY LIFE, RATHER THAN IN ADULTHOOD, WHICH HAS ESPECIALLY DEEP EFFECTS ON THE CHEMISTRY AND PHYSICAL STRUCTURE OF THE BRAIN, THAT LEADS TO A PROPENSITY FOR AGGRESSIVE BEHAVIOR.
To what degree can we apply these findings to the effects of childhood trauma in HUMANS?
In fact, the findings I’ve outlined above mirror very accurately findings from studies on humans; this suggests that similar physiological processes are going on in both rats and humans as a result of early trauma.
Studies on non-human primates have also given rise to very similar findings.
It is hoped that such research showing that physiological effects of early trauma seem to underlie the development of a greater propensity towards violence and aggression will help lead to drugs being developed that can reverse these physiological effects and therefore reduce levels of aggression in individuals affected by early trauma. With this aim in mind, further human and non-human studies are being conducted.
Those who have suffered severe and chronic childhood trauma are at an increased risk of ending their lives by suicide than the average. Indeed, an astonishing ten per cent of those suffering from borderline personality disorder, or BPD (a severe mental illness linked to childhood trauma) die by their own hand.
I myself made a suicide attempt, at the peak (or should that be through?) of my illness which left me in a coma in intensive care for five days.
So, apart from those suffering from BPD, which other groups of individuals are at a heightened risk of committing suicide?
At greatest risk, as one would imagine, are individuals who are mentally ill – nine out of ten people who die by suicide are suffering from a diagnosable mental illness.
Of the mentally ill, those suffering from schizophrenia or bipolar disorder are especially at risk (like those suffering from BPD, one in ten with either of these mental health conditions eventually commits suicide).
Of course, whilst about ten per cent of those suffering severe mental illnesses such as BPD, bipolar disorder and schizophrenia end their lives by suicide, we need not be mathematical geniuses to deduce from this that 90℅ do not. So what tips people in these groups over the edge?
Research suggests that the main predictor of an individual with severe mental illness committing suicide is if they also experience a profound sense of hopelessness. Like me, when I made the suicide attempt I referred to above, they feel that their intolerable mental pain will never end, that every day will be a day of intense psychological suffering and turmoil, and that there is absolutely no way out whatsoever.
An aspect of the tragedy is, of course, that a person’s state of mind can make the individual believe 100℅ that things can never get better when, objectively, this is not the case. There are many who can vouch for this, happily, from their own former bitter experiences.
Feeling rejected by family, friends and society, in general, is another important predictor of suicide.
Whilst some suicide attempts are methodically planned (as my own was), others are made on impulse. It follows, of course, that those who have an impulsive type personality (impulsivity is often a feature of BPD) are also at higher risk.
About twice as many men die by suicide than women.
However, unsuccessful suicide attempts are approximately twice as likely to be made by females than by males.
The Paradox Of Getting ‘Better’:
Those suffering from severe depression, at their illest, may be so lacking in motivation, and so close to being in a catatonic state, that they wish to die but cannot muster the mental energy required to end their lives (they may, too, in such a state of illness, lack the requisite planning and decision-making abilities necessary). Paradoxically, it is sometimes only when such depressive symptoms start to lift slightly that they find themselves able to make a suicide attempt.
The Link Between Childhood Trauma and Future Suicide Attempts.: A Study
A particular study, carried out by Dube et al. (2001), which involved gathering data related to this issue, found that those most seriously affected by childhood trauma were a staggering 51 Xs (i.e. 5100%) at greater risk of suicide attempts as a teenager compared to those who had experienced a settled childhood. As an adult, they were found to be at 30Xs (i.e. 3000%) greater risk of attempting suicide compared to their more fortunate contemporaries.
Other findings in the study by Dube et al were that about 67% of adult suicide attempts were linked to the experience of childhood trauma, and, also, that about 80% of teenage suicide attempts were connected to the experience of childhood trauma.
THE SPECIAL ADVERSE EFFECT OF EMOTIONAL ABUSE :
The same study also found that the type of abuse that was most strongly predictive of the individual who experienced it making suicide attempts in later life was emotional abuse.
OTHER TYPES OF ABUSE FOCUSED UPON BY THE STUDY :
Dube et al. also found many other types of abuse to be powerfully correlated with an increased risk of suicide. These were :
– domestic violence
– loss of a parent (e.g through divorce or abandonment)
– a family member in prison
– parent with mental illness (e.g. depression
– parent with addiction
– physical neglect
– emotional neglect
– physical abuse
– verbal abuse
POSSIBLE ACTIONS TO TAKE IN LIGHT OF THE ABOVE FINDINGS :
Given the above facts, it is necessary to ask what may be done to address this tragic problem. I provide some suggestions below :
– more training for those who work with children about the effects of childhood trauma and how best to treat these effects
– more education to be given to the public in general about the effects of childhood trauma
– rather than expelling or suspending ‘difficult’ children, schools should keep them in education and provide the appropriate counselling and/or other professional support
– respond more sensitively and compassionately to ‘problem behaviour’ (or, ‘acting out’) by young people, both in schools and other application environments.
Those who sought to stigmatize the very serious and distressing psychological condition known as borderline personality disorder, or BPD, used to like (and perhaps still do) to put forward the theory that self-harming behaviour in those suffering from BPD is ‘merely attention-seeking’ (ridiculous when one considers the stark and brutal fact that one in ten people suffering from BPD end up dying by suicide; a statistic which is bewilderingly, and, in my view, disgracefully, often conveniently overlooked).
Clearly, suicide is the ultimate form of self-harm; however, at times of stress, those with BPD often engage in other forms of self-harm which include: cutting the skin, picking at skin to prevent healing, burning the skin with cigarettes/lighters/matches etc, hitting oneself, and even banging one’s head against a wall or jumping from dangerous heights.
Whilst the idea of self-harm is difficult for mentally healthy individuals to understand, science (see theory two, below) is now beginning to shed further light upon why BPD sufferers in distress may do it. I outline two of the theories which have been put forward below :
THEORY ONE – SELF-PUNISHMENT THEORY :
Those who have suffered severe childhood trauma, and have subsequently gone on to develop BPD, very often have been conditioned/brainwashed to view themselves as a ‘bad’ person.’ It is, therefore, possible that the self-harming behaviour which the majority of those who suffer from BPD sadly carry out may be DRIVEN BY AN INTERNAL, UNCONSCIOUS NEED TO PUNISH THEMSELVES DUE TO DEEP SEATED FEELINGS OF SELF-HATRED AND SHAME.
THEORY TWO – THE RELIEF FROM INTENSE EMOTIONAL PAIN THEORY :
When an individual inflicts physical harm upon him/herself, NEUROPEPTIDES are released in the brain (Stanley et al.); these are molecules that help neurons (brain cells) communicate with one another, and, in so doing, they influence our behaviours, thoughts and feelings. One important group of neuropeptides are OPIOIDS and these are thought to help explain why individuals might self-harm. But why should this be so?
The answer is that research has found that individuals who suffer from BPD tend to have ABNORMALLY LOW LEVELS OF BASELINE OPIOIDS. Because opioids act as natural pain-killers (in connection with both physical and emotional pain), and physical harm to the body causes more of them to be released, it is possible individuals in severe emotional pain self-harm to BOOST THEIR LEVELS OF OPIOIDS AND THUS REDUCE THE INTENSITY OF THE EMOTIONAL PAIN FROM WHICH THEY ARE SUFFERING.
Other neuropeptides released into the body as a result of self-harming behaviour, and which may also help explain why BPD sufferers are driven to inflict self-injury are oxytocin and vasopressin.
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