Although there is now a vast amount of research that has been conducted on the link between childhood trauma and the later development of non-psychotic disorders, the amount of research that has been conducted on the link between childhood trauma and the later development of psychotic conditions has been rather less plentiful; however, increasingly, researchers are focusing on this, so far, less studied link and in this article, I will review some of what is currently known or theorized about the association.
CHILDHOOD TRAUMA AND PSYCHOSIS:
‘The psychiatric profession is about to experience an earthquake that will shake its intellectual foundations…there is tectonic, plate-shifting evidence'[for the environmental basis of psychosis]’
-Oliver James (leading UK psychologist). Comment in relation to the now overwhelming evidence that psychosis is strongly related to childhood trauma and the need to stop over-focusing on biological causes.
There is now extremely strong research evidence showing the link between childhood trauma and the affected individual’s likelihood of developing PSYCHOTIC ILLNESS in later life.
It is, of course, already well-established that there is a powerful link between childhood trauma and psychiatric illness which include depression, anxiety, substance abuse, eating disorders, complex post-traumatic stress disorder, sexual dysfunction, borderline personality disorder, dissociation and suicidal ideation. Now, however, it is becoming increasingly apparent that there is also a strong link with psychotic conditions such as BIPOLAR DEPRESSION and SCHIZOPHRENIA.
An ever-increasing body of evidence is now demonstrating the very high prevalence of experiences of severe childhood trauma in psychiatric patients who are suffering from psychotic illnesses
Indeed, many leading psychologists are arguing that researchers have neglected the importance of childhood experiences in relation to psychotic illness in the past. Here, then, I present some recent research which helps to redress the balance:
– Read et al. reviewed 51 previous studies on causes of psychotic illness and found that 69% of female psychotic patients and 59% of male psychotic patients had suffered severe childhood trauma. It was also pointed out by the researchers that these figures, although already extremely high, may be UNDERESTIMATES due to the fact that experiences of child abuse are well known to be under-reported.
– Bebbington et al. : these researchers, examining data generated from 8500 individuals, found that those suffering from psychosis were approx. 15 times more likely than the mentally well to have suffered severe childhood trauma.
– A Dutch study of 4000 patients found that those who had suffered severe childhood trauma were approx. 11 times more likely to have developed psychotic conditions in later life.
– A Californian study found that those who had suffered severe childhood trauma were 5 times more likely to have gone on to experience HALLUCINATIONS in later life.
HOW IS CHILDHOOD TRAUMA THOUGHT TO LEAD TO PSYCHOSIS?
– COGNITIVE THEORY: Due to adverse childhood experiences, the individual develops what is called a NEGATIVE COGNITIVE TRIAD of beliefs; these are:
– a negative view of self
– a negative view of others
– a negative view of the world in general
More specifically, beliefs such as the following are likely to develop:
– I am vulnerable
– others cannot be trusted
– the world is dangerous
Such beliefs can become so ingrained and severe that they eventually manifest themselves in the guise of psychotic symptoms e.g PARANOIA.
– EFFECT OF CHILDHOOD TRAUMA ON THE BRAIN: Research is showing that extreme stress in childhood can adversely affect the physical development of vital brain regions responsible for emotional control (e.g the AMYGDALA) which can lead to extreme emotional dysregulation (INABILITY TO CONTROL STRONG EMOTIONS) and concomitant over-sensitivity and emotional over-reactivity. If the problem becomes sufficiently intense psychotic conditions may result.
It is thought a new, over-arching theory of the causes of psychosis (known in scientific circles as a PARADIGM SHIFT) is likely take root in the field of psychiatric research – namely one that emphasizes the enormous importance of adverse childhood experiences.
It is argued that patients who present with psychotic symptoms should ROUTINELY undergo DETAILED ASSESSMENTS relating to their childhood experiences and that there should be a much greater emphasis upon the importance of psychological therapy (as opposed to drug therapy- so popular up until now- based upon theories of the biological origins of psychotic conditions).
EARLY SIGNS OF PSYCHOSIS:
Usually, a person does not suddenly become psychotic. Instead, the onset of psychosis is often a gradual process and sometimes individuals may start to show possible signs of incipient psychosis in their teens.
So what are the early warning signs? I provide a list based on the most current research in this area below. However, it is important to realize these symptoms are NOT specific to psychosis, they may also be due to numerous other conditions or set of personal psychosis. Anyone worried they or someone else may be psychotic or may be developing psychosis should seek an expert opinion and NOT attempt an amateur diagnosis based on the symptoms that follow.
These signs may be split into six categories as follows:
1) Cognitive symptoms
2) Neurotic symptoms
3) Changes in mood
4) Changes in volition
5) Behavioural symptoms
6) Physical symptoms
Let’s look at each of these six categories below:
– problems with concentration/attention/mental focus
– frequent daydreaming/ retreating into fantasy worlds
– thought blocking (a sudden lapse into silence during conversation due to the mind ‘going blank’. This most frequently occurs when the individual is asked about something that is, consciously or unconsciously, psychologically disturbing to him/her. It is a psychological defence mechanism and form of repression.)
– reduced ability to think in abstract terms
– restlessness / agitation
Changes in Mood:
– suicidal ideation
– mood swings
– anhedonia (an inability to derive pleasure from people, events or circumstances – a feeling of emptiness, flatness and numbness)
Change in Volition:
– loss of drive
– loss of interest in events, activities and people that used to interest one
– feelings of apathy and fatigue and a general lack of energy
– social withdrawal
– drop in standard of school/college work
– increase in impulsivity
– increasingly odd/strange behaviour
– weight loss
– poor appetite
– sleep problems
MAIN TYPES OF PSYCHOTIC DELUSION:
Psychotic delusions can occur in two conditions linked to childhood trauma :
A) DEPRESSION WITH PSYCHOTIC FEATURES
WHAT IS A ‘PSYCHOTIC DELUSION?’
A PSYCHOTIC DELUSION results from a THOUGHT DISORDER that gives rise to BLATANTLY FALSE BELIEFS. Whilst the belief is clearly and obviously false, the person who holds it has an UNSHAKEABLE BELIEF that the belief is true, even in the face of utterly overwhelming evidence to the contrary.
Classification of delusions:
Delusions can be classified as follows:
They can be:
A) Bizarre or non-bizarre
B) Mood-congruent or mood- incongruent
I define these classifications below:
BIZARRE – extremely strange and odd beliefs that are CLEARLY IMPOSSIBLE. For example, a belief that the birds’ singing is really Morse code and they are communicating with each other in such code in order to form a plot to take over the world.
NON- BIZARRE – the belief held is still clearly wrong but, theoretically, not totally impossible. For example, a belief that the government has placed listening devices in every room of one’s house.
MOOD – CONGRUENT – the delusion is in line with the mood the person manifests as a result of his/her condition. For example, a depressed individual who believes that aliens have removed the part of his/her brain the used to give rise to the experience of pleasure. Or, a person who is manic may believe s/he has supernatural powers
MOOD – INCONGRUENT – the delusion is not obviously in line with the individual’s prevailing mood (eg. a newsreader on the TV is talking about him/her. These are sometimes referred to as ‘mood-neutral’ delusions
Within these classification groups, delusions can also be of a specific type. I list these types below:
– Delusions of jealousy: an all-consuming obsession that one’s partner is being unfaithful when there is no evidence this is the case and there is no objective reason for suspicion.
– Delusions of nihilism: the belief that oneself, other people or the world do not really exist
– Delusions of grandeur: a belief one is a person of massive importance such as Jesus, Emperor of the World etc. Or the belief one has made a great achievement (that the world refuses to recognise) such as a belief one has written plays vastly superior to those of Shakespeare when, in reality, they are barely literate.
– Delusions of control: a belief that one is having one’s thoughts and behaviour controlled by an external force e.g. by aliens
– Delusions of reference: a clearly false belief that people are talking about one or making reference to one when they are not e.g. a belief that the newsreader on the radio is always referring to one in a or a coded or indirect manner
– Delusions of guilt: a false belief one is responsible for some terrible event (such as a belief one is personally responsible for all the starving people in the world
– Erotomania: the belief a famous person or person of high status (normally a person the sufferer of the delusion has never met) is deeply and passionately in love with one.
– Delusions of mind-reading: the belief that others are reading one’s mind
– Delusions of persecution: the belief that others are conspiring against one ( e.g trying to poison or drug one)
– Religious delusions: Delusions with a religious theme e.g .that one is a human incarnation of God
– Somatic delusions: these are delusions about one’s body ( e.g. that ants are crawling under one’s skin)
David Hosier BSc Hons; MSc; PGDE (FAHE).
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