Childhood Trauma

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Dr. Matthew Kerr, Psychologist at The Royal, spoke about Childhood Trauma and it's long term effects on your mental health.

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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
  • 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)
  • 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.
  • Childhood Trauma

    1. 1. An Unwanted Legacy: Long-term effects of chronic childhood trauma Matthew Kerr, Ph.D. C.Psych. October 5, 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? 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)
    4. 4. What is trauma? • 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 • Post Traumatic Stress Disorder (PTSD) Symptoms • Intrusion (re-experiencing) • Avoidance • Hyperarousal • Negative alterations in thoughts and mood
    5. 5. What is trauma? Chronic Developmental Trauma – Repeated psychological trauma from very early childhood to pre/early adolescence – Also experienced by the child: • unhealthy parenting • lack of security • Poor caretaking • aka Complex Trauma
    6. 6. 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%
    7. 7. 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 (3.8%) – About 1.9% of Canadian children age 15 and under experienced substantiated childhood 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)
    8. 8. How common is it? • The impact of chronic developmental traumatization poses a significant public health risk “Dealing with the effects of trauma is a health- care priority; it is as serious as any major medical illness” (US Surgeon General, 1999)
    9. 9. Why is chronic childhood trauma so damaging?
    10. 10. 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
    11. 11. Why is chronic childhood trauma so damaging? • Neurophysiological development – Over development of the survival brain at the expense of the learning brain – Stress response system • Reduces immune system activity • Interferes with more complex brain function – Learning, making conscious judgements, planning – Particularly sensitive periods are around age 2 and late pre-adolescence/early adolescence
    12. 12. Why is chronic childhood trauma so damaging?
    13. 13. Why is chronic childhood trauma so damaging? • Relational development – Attachment Theory (John Bowlby) • Stable/predictable caregivers = stable patterns of relating in child • Inconsistent parents or those who cause pain/trauma yield a disorganized attachment style in child
    14. 14. What is the lasting impact of these experiences? • Disrupted psychobiological/Interpersonal functioning in the following domains: – Emotion and impulse regulation – Biological self-regulation – Attention or consciousness – Perception of perpetrators (and/or dangerous others) – Self-perception – Capacity for relationships (Trust)
    15. 15. 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
    16. 16. What is the lasting impact of these experiences? • Mental Health – Depression – Anxiety – Psychosis – Substance use/abuse – Eating disorders – Personality disorders – Dissociative symptoms/disorders & Somatoform disorders – Suicidality and/or self-injury • Physical Health – Coronary artery disease – Liver disease – Chronic obstructive pulmonary disease – Autoimmune disease – Chronic pain – Overutilization of emergency medicine / underutilization of routine healthcare
    17. 17. 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
    18. 18. 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 of traumatic material
    19. 19. 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 (list not exhaustive)
    20. 20. 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/post- traumatic-stress-disorder-ptsd/nimh_ptsd_booklet.pdf • http://www.cmha.ca/mental_health/post-traumatic-stress- disorder/#.UaOOE9Ksg6Y • http://www.nami.org/factsheets/ptsd_factsheet.pdf • http://www.isst-d.org/default.asp?contentID=13
    21. 21. Discussion and Questions?

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