psychology case study

psychology case study

The Impact of Childhood Trauma on Adult Mental Health

1. Introduction

Prior to the 1980s, and the dynamics of children witnessing intimate partner violence (IPV) between their parents, recognize children with a parent who is chronically abusing substances live in an environment that is predictably unpredictable. Along with physical, mental, and emotional damage, the home life of these children can be laden with role reversal, development of a parentified child, and distorted boundaries. A parentified child (PC) is a term that describes a specific and often unhealthy form of role reversal, where a child is inappropriately given the role as head of the household or expected to act as a responsible adult. Parentification can take place in both functional and dysfunctional manners, however it usually results in the loss of childhood for that individual. Children who are forced to be responsible for the addicts in their household often have to assume the role of a pseudo-spouse, it is common that these children feel forced to perform activities of daily living for their parents. In more severe cases, the PC may actually take on parenting responsibilities for their substance abusing parent. This role reversal can have predictably negative effects on a child. Distorted boundaries take place when there is a role reversal and the caretaker becomes dependent on the child. This is common in cases of substance abuse where the addicted individual may become reliant on the PC to provide care and often take on a childlike role themselves. All of these issues are expected to further damage the mental health of a child growing up in a substance abusing home.

2. Understanding Childhood Trauma

The child study movement, which can trace its roots to the beginning of the 20th century, has brought attention to the field of child psychology and the study of childhood traumatic experiences. A discourse was established and it is widely held in contemporary psychology that childhood traumas, like loss of a caretaker, emotional, physical or sexual abuse, and witnessing violence, constitute experiences which present significant risks to healthy child development. Trauma can be defined as experiences which are emotionally painful and distressing, and which overwhelm a child’s ability to cope, leaving them powerless. This definition distinguishes the deep sense of hurt and pain linked to traumatic events from other forms of stressful experience. Stress or challenges which do not overwhelm a child’s existing capacity to cope do not, by this definition, constitute traumatic experiences. This is a fundamental point, the effects of childhood traumas can be vastly different from experiences to which the word “trauma” is commonly associated, like role transitions such as starting school or adolescent rites of passage, events which are often mistakenly thought to be traumatic for children. The adverse effects of such real traumatic experiences may not become evident until years later, leading into a plethora of problems in adult mental health. A number of problems may occur in the wake of a traumatic experience and its effects are related to the character of the traumatizing event, salience of the event, and the nature of social support and other protective factors.

3. The Long-term Effects of Childhood Trauma

Trauma experienced in childhood increases the risk of the individual developing a wide range of mental health disorders and substance abuse issues. It is clear that the greater the severity of the trauma, the greater the risk will be for mental health issues to arise. The more types of trauma a child experiences, the higher the risk of mental and relational problems the child will have. People who have experienced childhood sexual abuse are four times more likely to experience PTSD throughout their life. A comprehensive assessment of childhood trauma history in patients with PTSD provides information that is of direct relevance to treatment planning and results in improved therapeutic alliance, reduction of early drop-out rate, and more rapid clinical improvement. PTSD is also a common outcome of physical abuse in childhood. Again, the likelihood of developing PTSD increases according to the severity of the abuse. This too is a problem as studies have shown that adults who have experienced PTSD are more likely to abuse their children. Depression is common in abused children and even more so in children who have experienced widespread abuse over a long period of time. Substance abuse is also a common problem seen in adults who were abused as children. It is a way of coping with the memories and trauma by blocking out feelings and awareness. The sedative properties of drugs relieve anxiety and depression and can be an escape from the bad memories of childhood trauma. Substance abuse and depression in abused individuals have led to difficulty with relationships and holding down employment, increasing the likelihood of the cycle of abuse being carried on to the next generation. Sufferers of these mental health disorders have a lower quality of life and lifespan, in particular those who have psychiatric disorders.

Childhood trauma has a broad range of negative effects on those who experience it. Long-term effects of childhood trauma are often diagnosed as general psychiatric disorders. A study of 32 adult patients (18 women and 14 men) who had been hospitalized for childhood abuse an average of 28 years earlier found that more than three fourths met the diagnostic criteria for at least one psychiatric disorder. While the patients reported a wide variety of psychiatric syndromes, the most commonly reported were substance abuse (61%), PTSD (48%), and depression (45%). Patients in this study reported 113 separate occurrences of physical or sexual abuse in their childhood. Childhood abuse has a 40% increased risk of major depression and a 30% increased risk of adult onset of a psychiatric disorder as shown in another study.

4. Case Studies: Examining the Psychological Consequences

Firstly, Bernstein and Fink (1998) interviewed 29 adult psychiatric inpatients, retrospectively asking them about their childhood exposure to traumatic events, finding that 93% had experienced at least one traumatic event in childhood. They did not have a control group in this study with other adult inpatients, and so they used a normative sample of 403 adults selected to represent the US population. They found that the number of traumatic events experienced in childhood was significantly higher among the psychiatric inpatients. A limitation of this study is that both the method of data collection and the findings are based on retrospective self-reporting, raising issues of recall bias and validity. This is because the adults may have failed to remember any events or may have distorted or denied them. They discussed this using research suggesting that some depressive patients recollect their past negatively and that some behaviors in the adult psychiatric inpatients like promiscuity, substance abuse, and self-destructiveness would be better explained in terms of traumatic experiences in childhood. A major strength of this study is that it was conducted in hospitals where a high proportion of psychiatric patients have experienced childhood traumatic events, and it is necessary to explore this further. Confidence in their findings is reinforced by the fact that the psychiatrists were consistent at diagnosing PTSD from listening to the patient accounts, showing good interrater reliability, and that both the patients and the normative adults involved a cross-cultural sample. Given the findings, a similar study on a larger scale, replacing the adults with other adult psychiatric inpatients, would be very beneficial.

A small-scale study using semi-structured interviews by Bernstein and Fink.

5. Conclusion: Promoting Healing and Resilience

The effects of childhood trauma can be damaging and enduring. Problems in health behavior and life circumstances affected by trauma could lead to negative effects on health. In fact, there are an abundance of studies being conducted that show the effects of adverse experiences on children and their health. Adverse childhood experiences (ACEs) and toxic stress across childhood have been linked with a wide range of medical and health problems, both acute and chronic. These effects can be direct through an individual’s efforts to cope with their trauma, or indirect through the life choices an individual makes during adolescence and adulthood. Some of the behavioral coping strategies for dealing with past trauma are considered risk factors for disease later on. These can include smoking, substance abuse, and overconsumption of food. But the effects mainly come from the perception an individual has of the world from their experiences. This can lead to a significant level of stress while striving for goals and higher status in life, which then affects the individual’s body and brain’s internal workings. This can cause ulcers, cardiovascular disease, an immune system that doesn’t function optimally. Other chronic diseases include cancer, chronic lung disease, skeletal fractures, and liver disease. All of which can decrease life expectancy. Childhood trauma increases the adult onset of psychological disorders, anxiety disorders, depression, and suicide. This shapes the types of social and economic situations these individuals will have, and therefore shape the health of their next generation. Another concern is that trauma has the potential to damage one’s mental state to the point where they themselves might commit acts of abuse or violence. This tour continues the cycle of trauma and further worsens adult and child health.