Final Literature Review

The effects of childhood trauma in adolescence and adulthood

Abstract

The impacts of childhood trauma on cognitive function, self-reflection, psychological disorders and recurrence of victimization were studied for individuals during adolescence and adulthood in order to understand the long-term influences on these individuals. Various studies were gathered for each category and combined to establish general trends and associations. The majority of individuals who experienced childhood trauma also experienced impaired cognitive function, poorer self-esteem, psychological disorders and/or more severe symptoms, as well as an increased risk of recurrence within their family. The findings demonstrate a lack of programs and treatment available for childhood trauma victims to avoid complications during adolescence and adulthood.

1. Introduction

All professionals involved in the treatment of individuals with psychological disorders as well as childhood trauma would be able to gather further insight as to the importance of treatment and early intervention of these victims. Childhood trauma and its long-term effects on victims are constantly overlooked and lack research. It is also unclear if individuals being treated for psychological disorders are also being seen for coping with the trauma experienced. Understanding the effects of childhood trauma in adolescence and adulthood allows for early intervention and treatment programs to be developed in order to decrease the number of individuals developing psychological disorders and the number of children experiencing traumatic events. This information can be gathered to answer the following research question: What psychological disorders are associated with adolescents and adults who have experienced childhood trauma and what cognitive limitations are they more likely to experience?

1.1  Methods

Research for this article was conducted through the University of Nevada, Reno Knowledge Center database. Key words for the search included childhood trauma, psychological disorders, mental disorders, adolescence, and social behavior. A total of 10 articles were gathered and all articles used were found no later than March 3, 2017 using three different criteria. The criteria consisted of observational studies on brain activity, social behavior, and factors contributing to psychological disorders, peer-reviewed journal articles published within the last 10 years, and comparisons with individuals who did not experience childhood trauma with variations in age of participants.

The first section consists of impaired cognitive function due to childhood trauma exposure. Understanding prevalence of psychological disorders and re-victimization requires understanding how the brain is influenced by the trauma, which is why cognitive function is discussed first. The second section focuses more on self-reflection and understanding how individuals with childhood trauma exposure view themselves and how this influences their mental health in adolescence and adulthood. The third section delves into the psychological disorders associated with childhood trauma along with the increased severity of symptoms. The final section is regarding recurrence of childhood trauma among individuals and generations. In order to understand why psychological disorders are common among individuals with childhood trauma exposure and the lifelong impacts, readers will need to understand cognitive function as it connects to every section.

2. Outcomes of childhood trauma exposure

            2.1. Impaired cognitive function and reactions
            Regarding storage and responses of memories, a series of interviews took place with individuals who survived the Holocaust and the genocide in Rwanda in 1994 by Kaplan (2006). Kaplan studied the interviews for indicators of how these individuals processed the traumatic event(s) as well as how they address the recurring memories through images and objects. The concept of space creating was present among the individuals interviewed, explaining how individuals who have experienced childhood trauma are able to get through the event(s). Space creating is when an individual creates a space or individual in their mind that captures their life before the traumatic experience (Kaplan, 2006). Those interviewed used space creating in order to mentally remove themselves from the terrifying surroundings and produce an exciting or positive experience.
            A pilot study of 47 healthy adults assessed how different types of childhood trauma exposure influence memory in adulthood by conducting several memory tests. Randomly selected participants from a population were assessed for current and past medical and psychological concerns, eliminating the possibility of other influencing factors (Majer, Nater, Lin, Capuron, & Reeves, 2010). The study found a correlation between childhood trauma exposure and altered memory in adulthood, with type of memory related to type of childhood trauma exposure. Participants who experienced higher rates of physical neglect had longer delays during the Pattern Recognition Memory task, which assesses long-term memory (Majer, et al., 2010). Participants with higher rates of emotional abuse produced more errors during the Spatial Working Memory task, demonstrating poorer working memory (Majer et al., 2010).
            Psychological disorders are known to be associated with cognitive function, and in this case, the cognitive ability for improvement is impacted due to childhood trauma exposure. In regards to improvement rates of psychological disorders with individuals who have experience childhood trauma, Aas et al. (2016) conducted a study including 96 participants with first-episode psychosis gathered from several in and out patient hospitals along with 264 healthy individuals. All participants were assessed within the first year of treatment as well as one year after treatment. Individuals with childhood trauma exposure who were also being treated for first-episode psychosis presented poorer functioning and more severe clinical symptoms at the start of their treatment as well as one year after the treatment (Aas et al., 2016). More individuals reported experiencing childhood trauma in the psychosis group as well. The study found depression to be the most strongly associated with childhood trauma along with suicide attempts, which delayed improvements (Aas et al., 2016).
            2.2. Altered self-reflection

On the subject of physical and mental health, Tanaka, Wekerle, Schmuck, & Paglia-Boak (2011), studied self-compassion as influenced by childhood maltreatment. Participants consisted of adolescents between the ages of 16-20 receiving child protection services and were randomly selected. Child maltreatment was studied using the Childhood Trauma Questionnaire upon starting the study and were then assessed on mental health, substance use, suicide attempt, as well as self-compassion after two years (Tanaka et al., 2011). Participants with higher rates of emotional abuse and neglect, and physical abuse also demonstrated lower self-compassion. Emotional abuse presented the most significant association with low self-compassion. The study found adolescents with lower self-compassion were at an increased risk for psychological disorders, substance use, and serious suicide attempts (Tanaka et al., 2015). Measuring self-compassion is an important tool to better understand the impact of childhood trauma on adolescence.

Model-of-self is influenced by cognitive distortion in a poor manner due to childhood trauma exposure. Browne and Winkelman (2007) researched if adult attachment and cognitive distortion influence psychological adjustment. 219 participants were recruited from undergraduate psychology courses in Australia and were questioned on the type of childhood trauma experienced as well as the prevalence of trauma symptoms from the past 6 months. The study resulted in low levels of childhood trauma but emotional abuse and neglect occurred the most (Browne & Winkelman, 2007). Model-of-self reflected cognitive distortion, which was highly related to trauma symptoms. In other words, model-of-self is related to cognitive distortion but not trauma symptoms. Model-of-self is a cognitive creation negatively influenced by exposure to childhood trauma and is thus maintained by negative experiences, surroundings and exposures (Browne & Winkelman, 2007). This model-of-self persists into adulthood because it has been established since childhood, even if the environment has changed.

            2.3. Prevalence and severity of psychological disorders among victims

A study conducted by Ballard et al. (2015), delves into the latent classes of childhood trauma exposure before age 13 as well as using this information to predict negative behavior development in adolescence and young adulthood. 1,815 randomly selected first graders of elementary schools in an urban Detroit community completed comprehensive psychiatric assessments as well as upon entering young adulthood. One latent class of childhood trauma exposure, consisting primarily of women who were sexually assaulted, demonstrated higher rates of psychiatric issues in young adulthood (Ballard et al., 2015). A second latent class, predominantly male, had experienced violence and resulted in increased rates of post-traumatic stress disorder as well as antisocial personality disorder. The last class made up 84% of the participants and had low rates of childhood trauma exposure (Ballard et al., 2015). Different classes of childhood trauma exposure are indicators of specific psychiatric and behavioral outcomes, evident during adolescence and young adulthood.

Individuals with bipolar disorder are often found to have childhood trauma exposure. Watson el al. (2014) ran a randomized placebo-controlled study of mifepristone treatment in bipolar depression in colleges in England and New Zealand. 115 participants were randomly selected from outpatient clinics between ages 18-65, stable with medication for at least 4 weeks, and able to adequately understand English. Those abusing substances, pregnant, or suffer from a significant mental illness affecting safety were excluded from the trial. Participants with bipolar I and bipolar II disorder scored higher for childhood trauma exposure than the healthy control group. The trial concludes emotional neglect to be the most influential for individuals diagnosed with bipolar I and II disorder (Watson et al., 2014). Although the trail was relatively small, decreasing the reliability of the findings, Etain et al. (2013), also researched the influence of childhood trauma exposure on bipolar disorder. The study including 587 patients with bipolar disorder from France and Norway. Participants completed the Childhood Trauma Questionnaire and those who scored higher on the CTQ experienced earlier onset of bipolar disorder, suicide attempts, and increased depressive episodes (Etain et al., 2013). Etain et al. (2013), found consistent associations between childhood trauma and severe symptoms of bipolar disorder.
            The study conducted by Aas et al. (2016), did not necessarily have results indicating increased chances of experience psychotic episodes for individuals who experienced childhood trauma, but rather those with psychosis experienced much more severe characteristics during and after their first year of treatment. The study demonstrates various how influences of childhood trauma exposure can increase the severity of psychosis, a large portion probably due to the cognitive development (Aas et al., 2016).

2.4. Recurrence of victimization among individuals and generations
            Regarding environmental influences on psychological disorders, Catalan et al. (2017), researched the rate of childhood trauma depending on parental rearing styles with individuals with borderline personality disorder, first episode psychosis, and healthy individuals. The relationship between childhood trauma, parental rearing style, and presence of psychological disorder symptoms was also studied. A relationship between childhood trauma and affectionless parenting style is present, along with a correlation between participants with trauma exposure and poorest parenting style (Catalan et al., 2017). Participants who experienced emotional trauma demonstrated high levels of emotional expression and excessive overprotection in hopes of avoiding recurrence with their children. Overall, women with higher rates of childhood trauma are more likely to portray psychotic symptoms, and are therefore have poorer parenting styles. Children who are raised with more optimal rearing styles have a lower chance of experiencing psychotic symptoms in adulthood (Catalan et al., 2017). The environment these individuals are surrounded by affect the severity of any possible psychological disorders, it is not just the traumatic event.
            A study conducted by Wearick-Silva et al. (2014) includes 41 mothers of sexually abused children and 82 mothers of non-sexually abused children, all completing a questionnaire on childhood trauma, specifically for sexual abuse, to predict the likelihood of having a sexually abused child.  The participants were from Brazil and the mothers of sexually abused children scored higher on this questionnaire, indicating women who sexually abused as children are more likely to have children who will also experience sexual abuse (Wearick-Silva et al., 2014). Recurrence of childhood sexual abuse among subsequent generations can result from maternal psychopathology and/or distress, inconsistent maternal care, and negative family and romantic relationships (Wearick-Silva et al., 2014).

3. Discussion

Based on gathered research covering various life aspects influenced by childhood trauma exposure, these individuals tend to be cognitively impacted for the duration of their life. The research does not go to say these individuals cannot learn how to manage cognitive limitations or psychological disorders, but the research does clearly demonstrate the strong association with childhood trauma exposure. The gathered research can be grouped into four major themes: cognitive function, self-reflection, prevalence and severity of psychological disorders, and recurrence of victimization.

Research regarding cognitive function demonstrates an important cognitive function is altered or impacted by childhood trauma exposure and that is memory. The way in which the brain chooses to store experiences, emotions, and information is different for many of the individuals in adolescence and adulthood who experience childhood trauma by either making it difficult to retrieve the memories or by completely altering the memory itself. This may be a coping mechanism or a way to prevent the individual from re-experiencing the trauma. There is also research-providing information on how self-reflection and esteem is impacted. The research presents the idea that many who experience childhood trauma have lower self-esteems and a poorer model-of-self, meaning the trauma experienced influenced them enough to begin believing in the verbal and physical abuse endured as having occurred for a reason. Through this research, it can be suggested these individuals are less likely to take care of themselves mentally, emotionally, physically, and in many other forms, which could contribute to the increased risk of developing a psychological disorder in adolescence and adulthood.

What is of particular interest is the research is beginning to make connections between types of psychological disorders and types of childhood trauma. Multiple articles have presented a high rate of individuals being treated for bipolar disorder having experienced childhood trauma. Often times these individuals have more severe cases of bipolar disorder and slower progression rates. While there are some mixed results regarding prevalence of psychological disorders among individuals with childhood trauma exposure, the research does demonstrate the severity of symptoms is higher for this demographic. Research gathered regarding recurrence of childhood trauma demonstrate a strong indication that individuals who experienced childhood trauma are more likely to experience another form of trauma in adulthood as well as more likely to have children who will experience childhood trauma. Family characteristics are difficult to break from, especially when all four themes presented are interrelated. All four themes influence and feed from one another, making it difficult for the impacted individuals to re-establish themselves and truly recover from the traumatic experience.

Cognitive function decreases in individuals with childhood trauma exposure and are more likely to return to a non-existent world throughout adulthood. Psychological disorders are a strong possibility due to the changes and variations in cognitive development and function. On top of being at a higher risk for developing psychological disorders, there is also a likelihood of experiencing more severe symptoms if a psychological disorder develops. Childhood trauma exposure does not end with childhood, it continues to influence the relationships established in adulthood with friends and family. Without getting the appropriate assistance, there is a high chance that impacted individuals will have children who will experience similar trauma. The impacts of childhood trauma are becoming clearer but more research is required for properly understand how these individuals are impacted as well as how to assist them.

4. Conclusion

            Based on the gathered research regarding psychological disorders and cognitive function in individuals with childhood trauma exposure, it can be concluded that a large portion of this population will develop a psychological disorder by the time they enter adulthood. It can also be concluded that cognitive function is often altered by traumatic exposure in childhood, which carries into adolescence and adulthood. Psychological disorders are more prevalent in individuals who have experienced childhood trauma and often they experience more severe symptoms of the disorder. This could be a result of the combination of decreased self-esteem, altered cognitive function and the environment as all aspects build from one another and have the opportunity to inhibit progress. Recognizing the connection between types of psychological disorders and types of childhood trauma is important for understanding cognitive development as well as treatment for individuals exposed to childhood trauma.

While there is research demonstrating the increased rates of psychological disorders within this community, more research is required in order to study treatment methods and to discover whether individuals being treated for psychological disorders are also being treated for the childhood trauma. Research demonstrating an association between specific psychological disorders and types of childhood trauma is also necessary to obtain a deeper understanding of the impact of childhood trauma in adolescence and adulthood and would provide great insight on appropriately treat for these patients. Further research is also required to better understand the extent to which memory is impacted as well as to uncover and other possible cognitive functions impaired by childhood trauma.