Childhood and adolescent trauma - Sue Bailey

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Professor Sue Bailey President of the Royal College of Psychiatrists, consultant child psychiatrist and adolescent forensic psychiatrist. Speaking on childhood and adolescent trauma – impacts on development, and on individual health across the lifecourse

Speaking at Beyond Youth Custody's conference: Childhood trauma and young people in the criminal justice system, 19 November 2013.

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Childhood and adolescent trauma - Sue Bailey

  1. 1. „Childhood and adolescent trauma – impacts on development, and on individual health across the lifecourse‟ Beyond Youth Custody 19 November 2013 Professor Sue Bailey OBE FRCPsych
  2. 2. What is “trauma”? – some definitions “Trauma is an emotional wound, resulting from a shocking event or multiple and repeated life threatening and/or extremely frightening experiences that may cause lasting negative effects on a person, disrupting the path of healthy physical, emotional, spiritual and intellectual development.” National Child Traumatic Stress Network (NCTSN)
  3. 3. “Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual's functioning and physical, social, emotional, or spiritual well-being. . . In short, trauma is the sum of the event, the experience, and the effect.” Substance Abuse and Mental Health Services Administration (SAMHSA)
  4. 4. Traumatic events  emotional, physical, and sexual abuse;  neglect;  assaults, bullying;  witnessing family, school, or community violence;  war;         racism; acts of terrorism; disasters; serious accidents; serious injuries; loss of loved ones; abandonment; separation
  5. 5. “A key condition that makes these events traumatic is that they can overwhelm a person‟s capacity to cope, and elicit intense feelings such as fear, terror, helplessness, hopelessness, and despair.” NCTSN
  6. 6. Not all traumatic events generate lasting damage - the impact of traumatic events is partly dependent on:  previous experience of trauma;  mental and emotional strengths & weaknesses (resilience);  what kind of support the individual has (at home or elsewhere)
  7. 7. Neuroscience – The brain has plasticity up until the late 30s and possibly beyond Nature Nurture „Change continues throughout the life cycle, but changes for better or worse are always possible. It is continuing potential for change that means that at no time is a person invulnerable to every possible adversity, and at no time is a person impermeable to favourable influence.‟ (Bowlby, 1965).
  8. 8. So what?  Why does it matter?
  9. 9. Domains of functioning, and impact on developmental stage of life:        Physical Affective Relationships (including attachment) Socialisation Personal/self system Cognitive Behaviour/psychopathology
  10. 10. Physical domain - Child Death Direct injury Disability
  11. 11. Brain:  HPA axis (corpus callosum) PA, Neglect, boys  Pituitary volume increase  Endocrine  Glucorticoid receptor sensitivity  Early menarche (CSA)  Growth reduction  Under immunisation
  12. 12. Physical - Adolescent  Risk taking behaviours  Early sexual partners  Pregnancy before 19  Drug and or alcohol use
  13. 13. Physical - adult              IHD (CSA) Cancer COPD (PA) IBS Arthritis Fibro myalgia Peptic ulcer Diabetes Auto immune diseases Chronic pelvic pain (SA) Dyspareunia (CSA) Thyroid disorder (CSA women) Stroke
  14. 14. Affective domain- Child           Emotional disorders Depression (PA) Aggression (neglect) Decreased emotional regulation (PA) Anger/Fear PTSD Paucity of positive effect (NEG) Decreased empathy (NEG) Hyper activity Lack of self control
  15. 15. Affective - adolescent  Depression  Panic disorder (CSA)  PTSD (CSA)
  16. 16. Affective - adult  Depression  Anxiety disorders
  17. 17. Relationships - child  Insecure attachment  Disorganised attachment  Attachment disorders
  18. 18. Relationships Adolescent  Maladaptive working models  Violence in romantic relationships  Victimisation in romantic relationships
  19. 19. Relationships - Adult  Relationship dissatisfaction and disruption  Insecure attachment with children  Intimate partner violence
  20. 20. Socialisation (including peer relationships) - Child  Withdrawal (NEG)  Poor social interactions (NEG PA)  Aggression (NEG)  Social information processing deficit
  21. 21. Socialisation Adolescent  Social withdrawal
  22. 22. Socialisation - Adult
  23. 23. Personal/self system domain Child       Delayed theory of mind Dissociation Shame (CSA) Reduced symbolic play Impaired self recognition Impoverished internal language
  24. 24. Personal/self system domain Adolescent Reduced self esteem Impaired perceived competence Continuing shame (CSA) Recklessness and risk taking behaviours  Self harm  External locus of control    
  25. 25. Personal/self system domain Adult  Pregnancy under 19 (PA with CSA)  Deliberate self harm
  26. 26. Cognitive - Child  Language delay  Educational delay  Cognitive delay (CSA, NEG)
  27. 27. Cognitive - Adolescent  Educational dropout  Educational underachievement
  28. 28. Cognitive - Adult  Illiteracy  Reduced employment opportunities
  29. 29. Behaviour/psychopathology - Child  Aggression  Conduct disorder  ADHD  OD
  30. 30. Behaviour - Adolescent        Antisocial behaviour Conduct disorder Heavy substance misuse School exclusion Aggression Bullying Depression
  31. 31. Behaviour/psychopathology - Adult       Substance abuse Personality disorder Eating disorder (CSA) Major Affective disorder Sleep disorder PTSD
  32. 32.  Recent advances in conceptualisation of emerging personality disorder – eg the CAPP  Comprehensive assessment of psychopathic personality (also version for borderline)
  33. 33.  Explication of construct of psychopathy and emerging psychopathy as a dynamic phenomenon and therefore open to positive and adverse influence
  34. 34. Domains Attachment  Attachment styles  Being uncommitted
  35. 35. Behavioural          Perseverance Conscientious Trustworthiness Opportunistic Restlessness Disruptive Disobedient Unmanageable Aggressiveness
  36. 36. Cognitive      Suspiciousness Hypervigilance Intolerance Inflexibility Stubbornness
  37. 37. Self  Self centredness  Self absorption  Self aggrandisement  Sense of vulnerability  Sense of being special
  38. 38. Emotional      Lacks Lacks Lacks Lacks Lacks anxiety pleasure emotional depth emotional stability remorse
  39. 39. Dominance        Antagonistic Domineering Deceptive Manipulative Insincere Superficial Garrulous
  40. 40. Contact Professor Sue Bailey at jmudd@rcpsych.ac.uk Ref: Child Mental Health – David Jones in Rutter Child and Adolescent Psychiatry - 2008

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