An Unwanted Legacy:
Long-term effects of chronic
childhood trauma

Matthew Kerr, Ph.D. C.Psych.
June 13, 2013
Where we are headed…
•
•
•
•
•

What is trauma?
How common is childhood trauma?
Why is chronic childhood trauma so damagin...
What is trauma?
• ISTSS

– “Traumatic events are shocking and emotionally
overwhelming situations that may involve actual ...
What is trauma?
• Post Traumatic Stress Disorder (PTSD)
Symptoms
•
•
•
•

Intrusion (re-experiencing)
Avoidance
Hyperarous...
What is trauma?
• Some adverse childhood experiences do not coincide
with diagnostic definitions of trauma
Psychological T...
What is trauma?
Chronic Developmental Trauma
– Repeated adverse, traumatic
experiences/psychological trauma during the ver...
How common is it?
• National (U.S.) Comorbidity Study –
Replication (2010)

• Surveyed 3019 women and 2673 men
• Inquired ...
How common is it?
• Canadian Incidence Study of Reported Child Abuse
and Neglect (CIS):
– In 2003, an estimated 235,315 ch...
How common is it?
• The impact of chronic developmental
traumatization poses a significant public
health risk
“Dealing wit...
Why is chronic childhood trauma so
damaging?
Why is chronic childhood trauma so
damaging?
• Often this trauma involves:
•
•
•
•

Contextual factors
A betrayal of trust...
Why is chronic childhood trauma so
damaging?
• Neurophysiological development
– Learning brain:

• engaged in exploration,...
Why is chronic childhood trauma so
damaging?
• Neurophysiological development
– Stress response system
• Reduces immune sy...
Why is chronic childhood trauma so
damaging?
Why is chronic childhood trauma so
damaging?
• Relational development
– Attachment Theory (John Bowlby)
• In times of stre...
What is the lasting impact of these
experiences?
• Disrupted psychobiological/Interpersonal functioning
in the following d...
What is the lasting impact of these
experiences?
• Self-blame, felt sense of being
bad/defective/evil/deserved what happen...
What is the lasting impact of these
experiences?
• Mental Health correlates to complex trauma
–
–
–
–
–
–
–
–

Depression
...
What is the lasting impact of these
experiences?
• Physical Health correlates of complex trauma
– Coronary artery disease
...
What do I do about it?
• Get more education about trauma and its impact
• See web resource list

• Know that the trauma is...
What do I do about it?
• Trauma-based psychotherapy
– 3 stages:
• Stabilization
• Processing of Traumatic Memories
• (Re-)...
Community resources (free or low fee)
Centre for Treatment of Sexual Abuse and Childhood Trauma
www.centrefortreatment.com...
Web resources
•
•
•
•

http://www.sidran.org/sub.cfm?sectionID=4
http://www.trauma-pages.com/trauma.php
http://www.istss.o...
Discussion and Questions?
An Unwanted Legacy: Long-term effects of chronic childhood trauma
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  • Include clinical example of neglect
  • Canadian/Ontario data is very similar
    Numbers likely to be higher if age range raised to 18
  • Disrupted development of affect regulation system, little capacity for self-soothing (a learned process)
    Disorganized attachment
    “…in human children is characterized by a chaotic mix of excessive help seeking and dependency, social isolation and disengagement, impulsiveness and inhibition, and submissiveness and aggression.” (Lyons-Ruth et al., 2006)
  • Clinical examples of affect regulation – vomiting, burning, cutting, substance us
    Self-Perception – limitations of child brain to hold conflicting views of parent/abuser, often reinforced by abuser, or family
    Capacity for relationships – Trust is undermined
  • View of world – clinical example – everyone as abuser or survivor
  • Point prevalence of PTSD in those with severe mental illness is about 45% (MDD, BD, Schiz)
  • Stabilization: Education, affect regulation, grounding, stress management/tolerance
    Processing: related to trauma memory content specifically, and also shifting the meaning of the events
    Integration: learning how to live in the world without the trauma-filters that existed previously.
  • An Unwanted Legacy: Long-term effects of chronic childhood trauma

    1. 1. An Unwanted Legacy: Long-term effects of chronic childhood trauma Matthew Kerr, Ph.D. C.Psych. June 13, 2013
    2. 2. Where we are headed… • • • • • What is trauma? How common is childhood trauma? Why is chronic childhood trauma so damaging? What is the lasting impact of these experiences? What do I do about it?
    3. 3. What is trauma? • ISTSS – “Traumatic events are shocking and emotionally overwhelming situations that may involve actual or threaten death, serious injury, or threat to physical integrity.” – ISTSS • PTSD Criterion A (DSM-5) – “Exposure to actual or threatened death, serious injury, or sexual violence in one of the following ways:” • Direct experience, witnessing, learning about, repeated or extreme exposure to aversive details
    4. 4. What is trauma? • Post Traumatic Stress Disorder (PTSD) Symptoms • • • • Intrusion (re-experiencing) Avoidance Hyperarousal Negative alterations in thoughts and mood • At times, the definition of trauma has been too focused on identifying specific events
    5. 5. What is trauma? • Some adverse childhood experiences do not coincide with diagnostic definitions of trauma Psychological Trauma: “…the unique individual experience, associated with an event or enduring conditions, in which the individual’s ability to integrate affective experience is overwhelmed or the individual experiences a threat to life or bodily integrity…” (Pearlman & Saakvitne, 1995)
    6. 6. What is trauma? Chronic Developmental Trauma – Repeated adverse, traumatic experiences/psychological trauma during the very early childhood to pre/early adolescence – Accompanied by significant disruptions to healthy parenting, the provision of security, and caretaking experienced by the child • aka Complex Trauma
    7. 7. How common is it? • National (U.S.) Comorbidity Study – Replication (2010) • Surveyed 3019 women and 2673 men • Inquired about numerous adverse life experiences prior to age 13 • Rape – 5.9% • Sexual assault/molestation – 9.8% • Any sexual violence – 13.1% • Any assaultive violence – 25.5% • The NCS-R did not consider many nonCriterion A trauma, including those that would contribute to a complex traumatization
    8. 8. How common is it? • Canadian Incidence Study of Reported Child Abuse and Neglect (CIS): – In 2003, an estimated 235,315 child maltreatment investigations were conducted in Canada – About 3.8% of Canadian children age 15 and under • Approximately 1.9% of Canadian children experienced substantiated abuse – Many cases are never reported. • 5.1% of those with history of childhood physical abuse • 8.7% with a history of childhood sexual abuse (MacMillan, Jamieson, & Walsh, 2003)
    9. 9. How common is it? • The impact of chronic developmental traumatization poses a significant public health risk “Dealing with the effects of trauma is a healthcare priority; it is as serious as any major medical illness” (US Surgeon General, 1999)
    10. 10. Why is chronic childhood trauma so damaging?
    11. 11. Why is chronic childhood trauma so damaging? • Often this trauma involves: • • • • Contextual factors A betrayal of trust Inadequate parenting Disrupted neurophysiological and social development • 50 to 75%+ of children experiencing complex and chronic trauma will develop PTSD (and other difficulties) in adulthood • Compared to 18-25% of those traumatized as adults • As the number of adverse childhood experiences increases, so does the risk for various psychological and medical disorders
    12. 12. Why is chronic childhood trauma so damaging? • Neurophysiological development – Learning brain: • engaged in exploration, searches for balance between novelty and familiarity • Involved in more complex adaptations to the environment – Anterior cingulate cortex, insula, prefrontal cortex, hippocampus – Survival brain: • anticipate, prevent, or protect against real or imagined dangers, motivated to identify threats and conserve internal resources to be able to respond to them • Depends on rapid automatic processes involving basic brain structures – Brainstem, midbrain, parts of the limbic system (amygdala)
    13. 13. Why is chronic childhood trauma so damaging? • Neurophysiological development – Stress response system • Reduces immune system activity • Interferes with more complex brain function – Learning, seeking rewards, managing distress, making conscious judgements, planning – Particularly sensitive periods are around age 2 (language development) and late preadolescence/early adolescence
    14. 14. Why is chronic childhood trauma so damaging?
    15. 15. Why is chronic childhood trauma so damaging? • Relational development – Attachment Theory (John Bowlby) • In times of stress/distress, humans are wired to seek a safe haven for safety and protection • In times of reduced stress, humans use attachment figures as a secure base for play and exploration • Developing a stable pattern of relating to caregivers depends on them having stable/predictable behaviour – Results in a secure or insecure attachment, both are relatively stable with stable patterns of soliciting or responding to support • Inconsistent parenting, or parents who are the source of pain/trauma yields a disorganized attachment style
    16. 16. What is the lasting impact of these experiences? • Disrupted psychobiological/Interpersonal functioning in the following domains: – – – – – – Affect and impulse regulation Biological self-regulation Attention or consciousness Perception of perpetrators (and/or dangerous others) Self-perception Capacity for relationships (Trust)
    17. 17. What is the lasting impact of these experiences? • Self-blame, felt sense of being bad/defective/evil/deserved what happened • Fear of strong emotion (especially anger) • Fear that one is like their abuser • See world as a dangerous place
    18. 18. What is the lasting impact of these experiences? • Mental Health correlates to complex trauma – – – – – – – – Depression Anxiety Psychosis Substance use/abuse Eating disorders Personality disorders (e.g. BPD) Dissociative symptoms/disorders & Somatoform disorders Suicidality and risk-taking behaviour
    19. 19. What is the lasting impact of these experiences? • Physical Health correlates of complex trauma – Coronary artery disease – Liver disease – Chronic obstructive pulmonary disease – Autoimmune disease – Chronic pain – Overutilization of emergency medicine / underutilization of routine healthcare
    20. 20. What do I do about it? • Get more education about trauma and its impact • See web resource list • Know that the trauma is/was not your fault • Trauma-related symptoms are treatable • See community resource list • Tell your (mental) health care provider • Advocate for yourself
    21. 21. What do I do about it? • Trauma-based psychotherapy – 3 stages: • Stabilization • Processing of Traumatic Memories • (Re-) Integration – Often movement back-and-forth between first two stages – Gradual exposure to sharing for traumatic material
    22. 22. Community resources (free or low fee) Centre for Treatment of Sexual Abuse and Childhood Trauma www.centrefortreatment.com Family Services of Ottawa http://familyservicesottawa.org Sexual Assault Support Centre of Ottawa www.sascottawa.org Ottawa Rape Crisis Centre www.orcc.net Catholic Family Services of Ottawa www.cfsottawa.ca Jewish Family Services of Ottawa www.jfsottawa.com/TheCounsellingGroup/site
    23. 23. Web resources • • • • http://www.sidran.org/sub.cfm?sectionID=4 http://www.trauma-pages.com/trauma.php http://www.istss.org/ForthePublic.htm http://www.nimh.nih.gov/health/publications/posttraumatic-stress-disorder-ptsd/nimh_ptsd_booklet.pdf • http://www.cmha.ca/mental_health/post-traumatic-stressdisorder/#.UaOOE9Ksg6Y • http://www.nami.org/factsheets/ptsd_factsheet.pdf • http://www.isst-d.org/default.asp?contentID=13
    24. 24. Discussion and Questions?

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