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


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By Dr. Matthew Kerr

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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 Family Services of Ottawa Sexual Assault Support Centre of Ottawa Ottawa Rape Crisis Centre Catholic Family Services of Ottawa Jewish Family Services of Ottawa
    23. 23. Web resources • • • • • • •
    24. 24. Discussion and Questions?