An Unwanted Legacy: Long-term effects of chronic childhood trauma. Matthew Kerr, Ph.D. C.Psych. June 13, 2013

Transcription

1 An Unwanted Legacy: Long-term effects of chronic childhood trauma Matthew Kerr, Ph.D. C.Psych. June 13, 2013

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 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 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 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 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 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 non- Criterion A trauma, including those that would contribute to a complex traumatization

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 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 Why is chronic childhood trauma so damaging?

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

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13 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)

14 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

15 Why is chronic childhood trauma so damaging?

16 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

17 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)

18 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

19 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

20 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

21 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

22 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

23 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

24 Web resources

25 Discussion and Questions?