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.

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. 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. “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. Traumatic events
 emotional,
physical, and
sexual abuse;
 neglect;
 assaults, bullying;
 witnessing family,
school, or
community
violence;
 war;
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racism;
acts of terrorism;
disasters;
serious accidents;
serious injuries;
loss of loved ones;
abandonment;
separation

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. 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. 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. So what?
 Why does it matter?

9. Domains of functioning, and
impact on developmental stage
of life:
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Physical
Affective
Relationships (including attachment)
Socialisation
Personal/self system
Cognitive
Behaviour/psychopathology

10. Physical domain - Child
Death
Direct injury
Disability

11. Brain:
 HPA axis (corpus callosum)
PA, Neglect, boys
 Pituitary volume increase
 Endocrine
 Glucorticoid receptor sensitivity
 Early menarche (CSA)
 Growth reduction
 Under immunisation

12. Physical - Adolescent
 Risk taking behaviours
 Early sexual partners
 Pregnancy before 19
 Drug and or alcohol use

13. Physical - adult
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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. Affective domain- Child
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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. Affective - adolescent
 Depression
 Panic disorder (CSA)
 PTSD (CSA)

16. Affective - adult
 Depression
 Anxiety disorders

17. Relationships - child
 Insecure attachment
 Disorganised attachment
 Attachment disorders

18. Relationships Adolescent
 Maladaptive working models
 Violence in romantic relationships
 Victimisation in romantic
relationships

19. Relationships - Adult
 Relationship dissatisfaction and
disruption
 Insecure attachment with children
 Intimate partner violence

20. Socialisation (including
peer relationships) - Child
 Withdrawal (NEG)
 Poor social interactions (NEG PA)
 Aggression (NEG)
 Social information processing deficit

21. Socialisation Adolescent
 Social
withdrawal

22. Socialisation - Adult

23. Personal/self system domain Child
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Delayed theory of mind
Dissociation
Shame (CSA)
Reduced symbolic play
Impaired self recognition
Impoverished internal language

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
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25. Personal/self system domain Adult
 Pregnancy under 19 (PA with CSA)
 Deliberate self harm

26. Cognitive - Child
 Language delay
 Educational delay
 Cognitive delay (CSA, NEG)

27. Cognitive - Adolescent
 Educational dropout
 Educational underachievement

28. Cognitive - Adult
 Illiteracy
 Reduced employment opportunities

29. Behaviour/psychopathology
- Child
 Aggression
 Conduct disorder
 ADHD
 OD

30. Behaviour - Adolescent
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Antisocial behaviour
Conduct disorder
Heavy substance misuse
School exclusion
Aggression
Bullying
Depression

31. Behaviour/psychopathology
- Adult
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Substance abuse
Personality disorder
Eating disorder (CSA)
Major Affective disorder
Sleep disorder
PTSD

32.  Recent advances in
conceptualisation of emerging
personality disorder – eg the
CAPP
 Comprehensive assessment of
psychopathic personality (also
version for borderline)

33.  Explication of construct of
psychopathy and emerging
psychopathy as a dynamic
phenomenon and therefore open
to positive and adverse influence

34. Domains
Attachment
 Attachment styles
 Being uncommitted

35. Behavioural
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Perseverance
Conscientious
Trustworthiness
Opportunistic
Restlessness
Disruptive
Disobedient
Unmanageable
Aggressiveness

36. Cognitive
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Suspiciousness
Hypervigilance
Intolerance
Inflexibility
Stubbornness

37. Self
 Self centredness
 Self absorption
 Self aggrandisement
 Sense of vulnerability
 Sense of being special

38. Emotional
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Lacks
Lacks
Lacks
Lacks
Lacks
anxiety
pleasure
emotional depth
emotional stability
remorse

39. Dominance
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Antagonistic
Domineering
Deceptive
Manipulative
Insincere
Superficial
Garrulous

40. Contact Professor Sue Bailey at
jmudd@rcpsych.ac.uk
Ref: Child Mental Health – David Jones in Rutter
Child and Adolescent Psychiatry - 2008