|Great Attachment Debate Mary Jo Barrett Community of Excellence Symposium 2012 William Doherty Trauma Diets Anxiety Narcissistic Clients David Schnarch Future of Psychotherapy Etienne Wenger Couples Therapy Ethics Brain Science Attachment Theory Challenging Cases Gender Issues Alan Sroufe Mind/Body Couples Attachment Clinical Mastery Men in Therapy CE Comments Linda Bacon Clinical Excellence Wendy Behary The Future of Psychotherapy Mindfulness|
|The Long Shadow of Trauma - Page 5|
The ACE Studies
Since DSM-IV, a massive body of neurobiological research has accumulated revealing how protracted childhood abuse and neglect can cause pervasive, devastating, and lasting biological and psychological harm. Researchers in developmental psychopathology have shown that childhood maltreatment and neglect are associated with structural and functional abnormalities in different brain areas, including the prefrontal cortex (logic and reasoning), corpus callosum (integrating the right and left hemisphere), amydgala (fear and facial recognition), temporal lobe (hearing, verbal memory, language function), and hippocampus (memory). Last year, for example, researchers found a reduction in the visual cortex of young women sexually abused as children (but not in controls), which may help explain why abused children are quicker to recognize and stare at angry faces than non-abused kids, and why they pick up anger even in faces with ambiguous expressions, while missing other emotions. Abuse also disrupts the neuorendocrine system, altering the production of the stress-regulating hormone cortisol and neurotransmitters like epinephrine, dopamine, and serotonin—chemicals affecting mood and behavior. Chronic trauma weakens the immune system and sets up children for illness far down the road. The Centers for Disease Control has recently reported, for instance, that trauma's disruption of cortisol levels leaves abused children vulnerable to chronic fatigue syndrome later in life.
Some of the most astonishing and far-reaching evidence for the lifelong and malign repercussions of childhood trauma has come not from the mental health field, but from the study of epidemiology. In 1995, internist Vincent Felitti, a preventive medicine specialist with California-based HMO Kaiser Permanente, and Robert Anda, an epidemiologist with the Centers for Disease Control began the Adverse Childhood Experiences (ACE) Study to track the relationship between childhood maltreatment, neglect, and other family loss or dysfunction and adult mental and physical health. Drawing data from an extensive and detailed survey of 17, 337 Kaiser members undergoing standard yearly physical exams, this unprecedented study (and more than 60 others by numerous researchers based on the same data) found that a majority of the participants surveyed had experienced some form of serious family dysfunction, emotional, physical, and/or sexual abuse and neglect. Not only that, but the studies showed direct correlations with these "adverse experiences" and a remarkably large proportion of all the physical, mental, and social ills that beset society.
It's by now glaringly obvious to mental health professionals that child abuse significantly increases the risk for mental and emotional disorders—and associated risks for alcoholism, drug abuse, and smoking—though the ACE Studies nail the case beyond denial. Who knew, however, that childhood adversity was major risk factor for many of society's most prevalent biomedical illnesses and causes of death—heart and lung disease, diabetes, liver and kidney disease, some cancers, sexually transmitted diseases (including HIV), and autoimmune diseases, for example? Or that being abused or neglected as a child increased the likelihood of being arrested as a juvenile by 59 percent, as an adult by 28 percent, and for committing a violent crime by 30 percent? The total direct and indirect costs of child abuse—hospitalization and mental health care for children, as well as increased health care costs for adults who were abused as children, child welfare services, law enforcement, special education, juvenile justice system, criminal justice system, and lost productivity—amounted to $103 billion in 2007 in conservative estimates. In light of all this, it's been asserted that child abuse is the largest single public health issue in America.
In order to study the symptomatology of the children seen within the NCTSN, van de Kolk and his colleague Joseph Spinazzola organized a complex trauma task force. Between 2002 and 2003, they conducted a survey (via clinician reports) of 1,700 children receiving trauma-focused treatment at 38 different centers across the country. They found more evidence of what two decades of research had already revealed: nearly 80 percent of the surveyed kids had been exposed to multiple and/or prolonged interpersonal trauma, and of those, fewer than a 25 percent met the diagnostic criteria for PTSD.