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ADVERSE CHILDHOOD EXPERIENCES, POST-TRAUMATIC STRESS DISORDER (PTSD) AND MENTAL HEALTH

ADVERSE CHILDHOOD EXPERIENCES, POST TRAUMATIC STRESS DISORDER (PTSD) AND MENTAL HEALTH

Introduction

Trauma is any occurrence, usually not any ordinary that harms the spirit, self and body. It covers a wide range of experiences that are hurtful, including the traumas that has emotional, mental, sexual and physical realm of our being (Blackburn et al 2012p.18). There are different forms of traumas that regularly occur and these are called Adverse Childhood Experiences (ACE). According to Felitti et al (1998p.249), the largest study of Adverse Childhood Experiences (ACE) ever done to examine the economic, social and medical effects of Adverse Childhood Experiences over the lifespan of children. The number of participants in the study was 18,000. Mendelsohn et al (2011p.77) pointed out the components of Adverse Childhood Experiences. These include the childhood emotional, sexual and physical abuse and neglect. Similarly, another component is a child growing up with substance abuse, domestic violence, crime or even parental loss.

From the study conducted by Felitti et al (1998p.246), the study findings reveal that Adverse Childhood experiences in life affect adults in different ways. To begin, the burden of the disease and the costs of medical care to the adult, Adverse Childhood Experiences affect adults in wellbeing, increases the suicide rates and depression. Moreover, drug abuse and alcoholism is common to adults who are affected by Adverse Childhood Experiences. Other effects on adults include disability and job performance and finally effect on the subsequent generations.

According to Schiraldi (2000 p.102), Adverse Childhood Experiences are linked to the ten most death causes in United States. The top ten risk factors include a history of sexually transmitted diseases, over fifty sexual partners, injected drug use, illicit drug use, alcoholism, suicide attempts, depression, physical inactivity, severe obesity and smoking.

According to Thomas (2008 p.113), if the trauma is accepted by the people as real and the survivors or victims experiences is validated and its expression supported its short term effects also referred to as  acute traumatic stress, can be processed, expressed, metabolized or ameliorated in a healthy way so that no or few lasting detrimental effects eventually remain. However, if traumatic experience reality is invalidated or denied by the victim, important or by close others such as family, assisting professionals, friends, and then the individual may not be able to completely heal from the traumatic adverse effects. If the trauma persists, with no support and validation in expressing its related pain, it may grow into Post Traumatic Stress Disorder (PTSD), that Van (1998p.97) believe is the main disorder among the trauma survivors who are unrecovered.

To get healed from trauma, the person who has experience trauma has to be able to mourn the related pain. To mourn, the individual must remember well enough the trauma and accurately name it. Whitfield (1997p.331) pointed out that remembering and mourning a trauma of the past may be difficult since there exist many roadblocks compared to the others. For instance, many people refuse to believe that a parent or a relative could or would neglect or abuse their own child or a relative child. Perhaps this forms the basis for the plethora of support and disbelief in the court systems and the media n favor of the accused charged with abusing or molesting their child or the ones close to them. Brandyberry et al (1998p.271) observed that it is common knowledge that over 90% of the people who abuse a child knows well the child before abusing them, and most of them are related to the children.

Blackburn et al (2012p.56) observed the psychological sequelea or the pathological results of Adverse Childhood Experiences. The symptoms of Post Traumatic Stress Disorder (PSTD) or DSM IV include traumatic event exposure, are experiencing, hyper arousal, numbing/avoidance and functional impairments. Similarly the complex Post Traumatic Stress Disorder or the extreme stress disorders include; alterations in affective arousal regulations, alterations in consciousness and attention, somatisation, characterological changes that are chronic and finally systems of meaning alterations.

Felitti et al (1998p.109) observed that in addition to Post Traumatic Stress Disorder, early life trauma is linked with impaired self awareness, sense of self and significant disturbance in regulation of emotion and interpersonal functioning. The prevalence of Post Traumatic Stress Disorder related to trauma of early life can be gauged by the study by Felitti et al (1998p.109). the DSM-IV field trials Post Traumatic Stress Disorder identified the Post Traumatic Stress Disorder prevalence in a clinical sample and combined community as 77% for sexual abuse on children and 45% for physical abuse of children and 85% for people with sexual and physical abuse (Mendelsohn et al 2011p.87).Moreover, in the mental healthcare settings, the prevalence of childhood abuse reported a rate ranging from 35% to 50%, depending on the service (Mendelsohn et al 2011p.89).

The factors increasing a person’s vulnerability to Post Traumatic Stress Disorder include the female gender, genetic vulnerability, psychiatric illness history such as anxiety and depression, repeated or prolonged exposure to trauma, poor social system of support and childhood trauma. However, the protective factors against Post Traumatic Stress Disorder as observed by Schiraldi (2000p.329) include; the early care givers of a child which play a very crucial role in buffering the child against the stressful situations impact, and more importantly, assist build resilience against adverse experiences in the future. Additionally, the presence of early attachments that are secure is a protective factor.

The neurobiology of Post Traumatic Stress Disorder related to early life trauma is explained in studies by Thomas (2008 p.137). The study shows that Post Traumatic Stress Disorder involves both emotional under modulation and emotional over modulation in a bid to restrict emotional experiences that are unwanted. The emotional under modulation includes hyper arousal, re-experiencing, anger and fear states. However emotional over modulation includes analgesia, numbing and states of dissociation.

Van (1998p.24) asserted that the interpersonal dysfunction includes; sensitivity to criticism, social isolation, revicimization such as domestic violence, physical assaults and adult rape, difficulty in standing for oneself, functioning problems and child rearing difficulties. The social emotions are elicited by social interactions and also involve language, social intentionality and meaning. However, the non social emotions according to Blackburn et al (2012p.226) emerge as a result of a posing stimulus to direct physiological relevance such as fleeing, fighting and food.

In analyzing the self reflection and sense of self in Post Traumatic Stress Disorder related to trauma of early life, Felitti et al (1998p.252) asserted that sense of self is the ability to make a reflection upon oneself. This requires a sense of self that is robust, which has been given a description as a schemata collection regarding the ability of a person, attitudes and traits that guides people’s behaviors, social interactions and choices

The study conducted by Mendelsohn et al (2011p.67) found out that the second most common adverse child experience or trauma was the overt sexual abuse on children, reported in 22% out of the 9508 of the medically evaluated adults. Furthermore, Schiraldi (2000 p.73) observed that for the past few years, a number of their accused molesters of children have cried of false memory when finally their victims recovered and revealed their adverse child experiences to others. According to Thomas (2008 p.186), child molesters usually try to silence by violence or threats their victims, and this could be an explanation why some of the victim never talk to others about their adverse experienced to others. May be Post Traumatic Stress Disorder is likely to be their main disorder, and traumatic amnesia in people with Post Traumatic Stress Disorder is common, no matter what their core trauma was.

From clinical observation of the trauma survivors, they tend to possess many disorders or diseases at a higher prevalence compared to the general population. These conditions and disorders include addictions, dissociative disorders, suicide attempts, depression, somatizatin, borderline personality disorder, Post Traumatic Stress Disorder, psychosis, self harming behaviors, prostitution, violent behaviors and pedophilia. Hence, the trauma survivors are frequent among the general medical populations as well as psychological and psychiatric outpatient and inpatient practices and clinics Van (1998p.104).

These diagnoses and the determination of the potential causal connection to the trauma of the child require skillful taking of history, and dealing with painful materials for the patient to disclose to the clinician. Whitfield (1997p.375) asserted that it is time for the public health and the general medical communities to directly begin to address the occurrences of adverse child experiences in combination to their long term effects instead of relegating the duty to the social services, psychologists, psychiatrists and trauma specialists whose number is too small compared to the huge number of survivors of trauma.

According to Brandyberry et al (1998p.296), the unrecovered survivors of trauma tend to exhibit behavior of high risk such as excessive risk taking, alcohol, tobacco and other drugs. By engaging in these behaviors of high risk, the trauma survivor, the trauma survivor is not acting antisocially or crazy, but rather re enacting aspects unconsciously of their original trauma for them to master it and eventually heal from it hopefully.

The study by Blackburn et al (2012p.32) provide more circumstantial and direct evidence that a substantial portion of the psychological and medical illnesses may be trauma based in large part. This implies that the health professionals allowing people to work to name, identify and mourn of their past traumas have a likelihood of contributing to their ability to heal from some of the diseases, problems and disorders that are associated with trauma. These lessen the impact of these associated problems and illnesses, and the final higher costs of not treating them in t5hos manner.

Mendelsohn et al (2011p.47) have also shown that some of the common organic diseases often trace their origins not from merely childhood, but in the unprocessed childhood traumatic emotional experiences. The manner in which these grief that are unhealed translates into organic diseases forms the large part of the results of the different behavioral coping mechanisms employed to gain some relief such as drugs, smoking, promiscuity, excess drinking, overeating, violence and toxic relationships. Mendelsohn  et al (2011p.53) elaborated that these mechanisms of self medication usually work to a certain degree for some time, and their risks also seems too remote, that they are actually seductive when the relief need is acute. It is not a surprising that Adverse Childhood Experiences have long term psychological effects that are prominent. Decades later, what is unexpected is an association of the adverse childhood experiences with the common organic diseases.

Over the past decades, the twelve step self help recovery fellowships at the grass root like Al-Anon, AA, Co-Dependence Anonymous and Adult Children of Alcoholics have noticed some of the Adverse Childhood Experiences and several of their connections. These effective but inexpensive groups have form part of the recovery movements during the 1980’s and the 90’s. Most of their members have also utilized the use of bibliotherapy in the form of selected books for self help that simplify some of the more principles of recovery and psychology which are effective. Some examples of such organizations include American Coalition for Abuse Awareness (ACAA), American Professional Society on the Abuse of Children (APSAC), One Voice, and The International Society for the Study of Dissociation (ISSD), The Sidran Foundation in Baltimore, the National Centre for Prosecution of Child Abuse and The International Society for Traumatic Stress Studies (ISTSS)(Schiraldi 2000p.343).

The AA twelve steps, now being used by over 100 other self help groups and fellowships have added a dimension of spirituality to the recovery. The spirituality in this scenario is defined as having to do with the relationships with self and universe in deeper dimensions.

These self help grass root fellowships and other aids for recovery have also assisted many healthcare professionals, many of whom posses a personal history of more or one Adverse Childhood Experiences or traumas, in working a program that is effective of their own recovery. By doing that way, they have surpassed the more conventional medicine, psychology and psychiatry limitations with success. These health professionals who are now recovered are able in turn to offer their clients and patients a wide range of therapeutic choices to use in their work of recovery. By doing so, they are improving and expanding the care standard for most of their patients (Thomas 2008p.142).

In the prevention of the Adverse Childhood Experiences from afflicting people, Van (1998p.89) suggested that the problem can only be limited by people’s own creativity. For example, the organizations of health professionals should consider addressing the mental and physical health of their professional members, as well as their recovery from the effects of any Adverse Childhood Experiences that is harmful. Similarly, other journals should encourage and give consideration to more clinical and basic research on trauma for publication. Alternatively, healthcare organizations and managed companies for care should pay for long term and short term appropriate treatment of the adverse effects of Adverse Childhood Experiences in survivors of trauma, which in the long run will save them money. Moreover, each training program for professionals of health should have information on trauma effects, such as child abuse or other Adverse Childhood Experiences, how to ask them about, and what to do with a trauma patient who has experienced it.

Another suggestion as elaborated by Whitfield (1997 p.542) include stopping treating children as though they are the property. People should treat children with love and compassion, and not with fear or shame. More parenting programs that are effective have been in existence for many years. These skills should be incorporated and be taught in the schools. Brandyberry  et al (1998p.107) noted that some communities have seen excellent results in child neglect and abuse elimination by establishing centers for parenting that visit weekly every new parent and child for the first two years. The training of every professionals of health should include Adverse Childhood Experiences recognition and techniques to treat and manage their long term effects.

Another suggestion proposed is giving more political and monetary support to organizations that work in child abuse prevention, such as councils of child abuse and services of child protection. Therefore, people should look to the selected state and national organizations for guidance and training. Lastly, people should support groups such as the Healthy Families America and Alliance for Children which are creatively working to improve child rearing and parenting and child maltreatment prevention (Blackburn et al 2012p.117). The federal organizations could also double their funding and efforts for health improvement and children well being.

The treatment that targets symptoms of Post Traumatic Stress Disorder, emotion, self dysregulation and interpersonal is elaborated by Felitti et al (1998p.255). Training skills in interpersonal and affective regulation plus exposure treatment prolonged specifically developed for Post Traumatic Stress Disorder related to child abuse. Furthermore, skills training in emotion, self and interpersonal regulation plus and exposure that is prolonged, has been shown to reduce impairment that are related to childhood abuse Post Traumatic Stress Disorder and its associated interpersonal, emotion and self dysregulation.

Conclusion

In conclusion, in all generations, the current generation is the first in history to understand and recognize the child abuse and neglect ravages and begin to do something tangible about it. Moreover, this is the first generation to start healing the people psychologically and physically from the harmful effects of Adverse Childhood Experiences. Through trial and error and several researches and publications and subsequent dissemination to the wider public, the people can apply constructively the knowledge and skills to the children. Some suggestions have been that if one generation can be raised of healthy children, humanity can go far in eradication of war, social violence and many other worldly problems. Through research, humanity can develop significant new knowledge that when executed, promise to foster the future generations of healthy adults, children and societies.

The following articles give more information on adverse childhood experiences, post traumatic stress disorder and mental health

  1. Blackburn Knight, R., & Falstein, M. (2012) A Man’s Recovery from Traumatic Childhood Abuse The Insiders. Hoboken, Taylor and Francis. Retrieved from http://www.UCM.eblib.com/patron/FullRecord.aspx?p=1047009.

In intimate and candid words, the author elaborates his courageous and long fight to overcome the sadistic ravages of child abuse. The author makes the reader see, feel and hear its horrors, unvarnished and raw. Instructive to both victims and therapists, the content gives techniques and hope to the healing people. Accompanied by long years of research on dissociation literature, the author tried many different approaches to treatment. He finally uncovers “the insiders” through hypnoanalytic procedures, the unconscious ego that represented the memories of his betrayal at childhood. This literature is good for therapists and many others who are seeking to heal and understand the child abuse horrors.

  1. Felitti Vj, Anda Rf, Nordenberg D, Williamson Df, Spitz Am, Edwards V, Koss Mp, & Marks Js. (1998) Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine. 14, 245-58.

This article repot on different common trauma forms that regularly occur in different countries. They call these traumas as the Adverse Childhood Experiences (ACEs)

  1. Mendelsohn, M., Herman, J. L., Schatzow, E., Coco, M., Kallivayalil, D., & Levitan, J. (2011) The trauma recovery group: a guide for practitioners. New York, Guilford Press.

Written with an expert, it offers practical guidance for therapists. The book presents a group treatment approach that is based on evidence for interpersonal trauma survivors. This treatment that is limited to time is designed patients that has achieved basic stability and safety in the present life, and is ready to work more on enduring ways that trauma has affected their relationship and self perception.

  1. Schiraldi, G. R. (2000) The post-traumatic stress disorder sourcebook a guide to healing, recovery, and growth. Los Angeles, Calif, Lowell House. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&scope=site&db=nlebk&db=nlabk&AN=23967.

The book explains that trauma manifest in many forms, from surviving a disaster or witnessing a very violent crime with the effects of rape, abuse, alcoholism or combat. The deep emotional wounds may look as if they will not heal. The book offers remarkable wide range of management and treatment alternatives and techniques. This shows the survivors that growth and recover is the other side of pain

  1. Van Der Kolk, B. A. (1998) Trauma and memory. Psychiatry and Clinical Neurosciences. 52, S52-S64.

Taking a deep examination at the most recent memory research on traumatic events, the book has sate of the art data covering the controversial areas of the repressed memory. The author and other contributors integrated multi disciplinary findings into a coherent treatment proposal, and social and legal practices and policies.

  1. Thomas, P. (2008) Post traumatic stress disorder. Farmington Hills, MI, Lucent Books.
  1. Whitfield, C. I. M. (1997) Traumatic amnesia: The evolution of our understanding from a clinical and legal perspective. Sexual Addiction & Compulsivity. 4, 107-135.
  2. Brandyberry Lj, & Macnair-Semands Rr. (1998) Examining the validity and reliability of childhood abuse scales: putting The Courage To Heal to the test. Child Abuse & Neglect. 22, 1253-63.

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