Summaries per article with of Psychological and Neurobiological Consequences of Child Abuse at Leiden University 21/22
Article summary with Child maltreatment and risk for psychopathology in childhood and adulthood by Jaffee - 2017
...........Read moreArticle summary with Paradise Lost: The Neurobiological and Clinical Consequences of Child Abuse and Neglect by Nemeroff - 2016
...........Read moreArticle summary with Maltreatment in childhood substantially increases the risk of adult depression and anxiety in prospective cohort studies: Systematic review, meta-analysis, and proportional attributable fractions by Li a.o. - 2015
...........Read moreChild abuse is associated with an increased risk of developing various psychological problems, including major depressive disorder. There is evidence for a strong association between child abuse and major depressive disorder. It is important to note that child abuse not only increases the risk of developing a major depressive disorder, but that it also affects the severity and course of the disorder. It is important to gain a better understanding of the processes that mediate the link between child abuse and depression. To date, few studies have looked at psychological processes that mediate associations between child abuse and depression. This study examines three potential mediators:
Problems with emotion regulation
Attachment
Attributional style
The variables are chosen based on the following criteria:
Proof of a relationship with child abuse
Proof of a relationship with depression
Existing theoretical explanation for the variable as a mediator
Suitable for online assessment
There are increasing indications that support the role of emotion regulation as a mediator between child abuse and the onset of depression. There is also indirect evidence for that child abuse leads to problems with emotion regulation, such as problems with understanding and naming affective states, low emotional acceptance and the use of inappropriate emotion regulation strategies.
There are indications of a relationship between child abuse and unsafe attachment in adulthood. There are two unsafe attachment styles: avoidance and fear. Avoiding consists of a tendency to avoid closeness and intimacy in relationships, while fear refers to feelings of insecurity and a lack of close relationships.
Experiences of hopelessness can lead to depressogenic inferential styles that are characterized by the tendency to attribute negative life events to internal, stable and global causes. This attribution style is a cognitive risk factor that interacts with acute stressors, which reliably predict depressive reactions after a stressful event.
In this study, the mediators described above were studied simultaneously in a group of people with a depressive disorder. Three hypothesis have been drawn up:
The severity of child abuse is accompanied by the severity of depression and more depressive episodes
Severity of child abuse, the severity and course of depression are associated with the mediators described
There is an indirect effect of the mediators on the relationship between child abuse and depression on the one hand and the number of depressive episodes on the other hand
Participants were acquired through online forums and self-help organizations for people with depression. 340 participants took part in the study, who spoke fluent German, were between 18 and 65 years old and had a (suspected) diagnosis of major depressive disorder. The PHQ-9 was used to screen the diagnoses of major depressive disorder and to assess the severity of the symptoms. Child abuse has been established by means of a shortened version of CTQ. Emotion regulation was measured using the Difficulties in Emotion Regulation Scale (DERS). The attachment was determined by ECR, the depressive attribution style was measured by Depressive Attributions Questionnaire (DAQ) and lastly traumatic experiences were measured using The Posttraumatic Diagnostic Scale.
As predicted in the first hypothesis, the severity of child abuse (measured with the CTQ) is significantly correlated with the severity of depression and the number of depressive episodes. In addition, the CTQ scores were significantly associated with all proposed mediators, as predicted in hypothesis two. In addition, scores on the DERS, ECR subscale avoidance and DAQ were significantly correlated with the severity of depression and the number of depressive episodes. However, scores on the ECR anxiety subscale were not significantly associated with the number of depressive episodes. As a result, hypothesis three is not fully confirmed, so mediator attachment 'anxiety' is not associated with a connection between child abuse and depression on the one hand and the number of depressive episodes on the other.
This study has shown that the severity of child abuse is associated with the severity of depression and the number of depressive episodes. This involved research into the role of problems with emotion regulation, attachment and attribution style as possible mediators. Child abuse had a significant association with all proposed mediators.
Found result possibly caused by other, not investigated, factors
Study is primarily based on self-reports, which means that reliability and validity are unclear
Not known if the sample collected online is representative
Despite a number of limitations, this study provides new evidence for the role of emotion regulation problems, avoidant attachment, depressive attribution style and PTSD as a mediator between the relationship of child abuse and depression.
Neglect, physical -and sexual abuse are known as adverse childhood experiences (ACE). In Europe, community surveys show high rates of emotional, sexual and physical abuse. However, most cases are still underreported. ACE’s frequently play a massive part in the development of long-lasting adverse effects on the brain, but also on mental and physical health. This is because they influence cognitive -and affective processing. ACE’s influence brain processes in the amygdala, hippocampus and anterior cingulate cortex (ACC) that regulate emotional, cognitive -and affective processing. The current review presents the literature on the influence of adverse childhood experiences on mental health, neurobiology and somatic health later in adulthood. The study reviewed several articles on the influence of ACE on adulthood neurobiology, somatic -and mental health.
ACE’s can alter sensitivity to stress -and emotion regulation. The hippocampus and amygdala are vulnerable to ACE because of the high density of glucorticoids that can cause damage to dendritic atrophy and neurogenesis suppression. Several neuroimaging studies found that the size of the hippocampus is reduced of individuals that experienced ACE. Furthermore, the amygdala consists of pyramidal cells that are highly susceptible to the effects of stress. Stress stimulates the process of dendritic arborization which causes an increase of the size of the amygdala. However, this is almost always related to only physical neglect. On the other hand, people suffering form bipolar disorder show an increased volume of the amygdala.
The exposure to specific types of childhood experiences affect certain sensory systems. These sensory systems are involved with trauma. Domestic violence for example, targets the inferior longitudinal fasciculus that interconnects the limbic and visual systems. The effect of domestic is most critical when it happens between the age of 11-13 years. For sexual abuse however, the most susceptible age is between 3-5 years.
Functional neuroimaging studies show the functional brain alterations. The amygdala is critically involved in processing and detecting salient stimuli. The amygdala is hyperactive when exposed to danger or emotional stimuli. This hyperactivity is associated with a greater risk for posttraumatic stress disorder (PTSD), anxiety -and mood disorders. Besides the amygdala, the anterior insula is hyperactive in individuals with ACE while exposed to emotion -and attention stimuli. This hyperactivity could be an adaptive ability in the context of childhood abusive experiences.
There are many effects of ACE on the development of different clinical profiles in adulthood. Somatic -and mental disorders can co-occur in posttraumatic stress disorder, depression, borderline personality disorder, obesity and diabetes. The risk for developing a mental illness after ACE is the highest for PTSD, depression, borderline and substance abuse. People with mental disorders with ACE are less likely to respond to standard treatments. Some ACE’s have a bigger effect on mental health than others. A general effect of stress was found on neural alterations and development of disorders.
The innate immune system seems to be a biological mediator between ACE and diseases in adulthood. This is true for obesity, Crohn disease and diabetes. An association between an increase of pro-inflammatory markers and ACE was found. This is also true for C-active -and other proteins. ACE are known to be associated with chronicity of low back pain, pain sensitivity and enhanced temporal summation of pain.
There is a role of type of ACE and timing that should be considered in the prevention and treatment of ACE-related mental -and somatic illnesses. During the vulnerable development stages of childhood, the risk of getting a ACE-related condition increases. There are sensitive periods that correlate with a specific type of ACE. During these periods, people are prone to develop neural alterations and functional changes in the amygdala and hippocampus. However, there is a mediating effect of familiar support in the development of a disorder even when exposed to ACE.
There are more longitudinal studies needed to research the complex and ACE-related characteristics and mechanisms relevant for mental -and somatic disorders by the integration of fitting knowledge and methods. Psychological treatment options can be improved by a better identification and validation of psychosocial and somatic risk factors and diagnostic markers.
Article summary with Childhood maltreatment, latent vulnerability, and the shift to preventative psychiatry - the contribution of functional brain imaging by McCrory a.o. - 2017
...........Read moreUnfavorable childhood conditions lead to an increased risk of developing various psychiatric disorders and medical illnesses in later life. A clinical consequence of sexual abuse in childhood is the development of sexual dysfunction. Examples of this are anorgasmia, no experienced pleasure in sexuality and / or chronic genital pain or pelvic pain in adulthood. Various studies state that the human brain is plastic (= cortical / neural plasticity). This means that the brain adapts to the environment as a reaction to certain (life) events. There may be either an enlargement or a reduction in cortical areas and it is known that events that are not good for development can cause cortical areas to shrink and that enriching events can cause cortical areas to enlarge. In the case of shrinkage of cortical areas, this means that the brain tries to limit the harmful effects of the negative experiences and tries to protect itself against this. This is the case with sexual abuse during childhood. In this study, the cortical thickness was analyzed by MRI (magnetic resonance imaging).
51 healthy African-American, white and other women participated in this study. Among them there were women with and without a history of abuse and / or neglect before puberty and with and without depression. All women had a normal menstrual cycle, had no medical illnesses and did not use any medication. Women with a history characterized by psychosis, bipolar disorder, substance abuse, or alcohol abuse were excluded from this study.
The Childhood Trauma Questionnaire (CTQ) was used in this study. The CTQ is a form of self-report that assesses emotional, sexual and physical abuse and emotional and physical neglect. The five subscales each contain five items and a positive score on a subscale means that events are most often answered as 'true'. This showed that moderate to severe mistreatment occurred in 28 women and that 23 women experienced little to no abuse.
A semi-structured clinical interview was also used to map the starting age and duration of the trauma, and this correlated highly with the CTQ. To map the current mental health, the Structured Clinical Interview for DSM-IV-TR was conducted. This revealed that twelve women were depressed during the study and that nine women suffered from post-traumatic stress disorder.
MRI: a 3D MRI technique was used.
Cortical thickness analysis: an analysis of cortical thickness was also performed.
Statistical analysis: cortical thickness was used in the statistical analysis as a dependent variable with respect to the total CTQ score as an independent variable. Furthermore, the age of the start of the abuse and the duration thereof were also taken into account.
A regression analysis was conducted to compare cortical thickness to the total CTQ score. This analysis showed that people who had experienced difficulties during childhood, had cortical shrinkage. This was most visible in the lateral somatosensory cortex located in the left hemisphere. This area is connected to the female clitoris, the genital area and the area around the mouth. The same was true for the anterior cingulate gyrus, the precuneus and the gyrus parahippocampalis (also known as seahorse winding). These are cortical areas that play a role in emotion regulation, self-awareness and the coding of memories.
The effects were less clear for the right hemisphere. However, a maximum was found in both the lateral area of the right motor cortex, as well as in the gyrus parahippocampalis and in the central area of the posterior cingulate cortex. A separate analysis for the effect of experiences with sexual abuse on cortical shrinkage revealed a shrinkage of the somatosensory cortex. This area is associated with the female clitoris and with the area around it in the left hemisphere. Furthermore, the gyrus parahippocampalis appeared to be affected by sexual abuse in both hemispheres.
There also appeared to be an effect of emotional abuse on cortical shrinkage. This was seen in the left and right precuneus and in the left anterior and posterior cingulate cortex. These areas are important for self-reflection, self-awareness, and one's own perspective of the self. At an earlier start of the abuse / abuse, effects of cortical shrinkage were found in the right temporal strain, the left parietal lobe, the left frontal lobe and the right frontal strain. These areas are important in autobiographical memory. Finally, there was also a shrinkage of the anterior cingulate cortex. This provides an explanation for the phenomenon that people who have been abused in their youth often cannot remember this afterwards. No effects were found for the duration of the abuse.
This research has shown that childhood abuse causes changes or adaptations in the brain. This often involves cortical shrinkage and there appears to be a specific effect for each area as a result of a specific type of abuse. This is the result of a protection mechanism of the brain.
Different mechanisms can explain the changes in brain structures. The shrinkage of the primary somatosensory cortex observed in this study would be the result of both top-down and bottom-up mechanisms. Cognitive adjustment plays a role in the top-down mechanism. This is explained on the basis of an example about pain perception. Several studies showed that by diverting attention from the painful stimuli, attention to experiencing the pain and thus the activation of the somatosensory cortex was reduced. It is stated that if this same mechanism comes into effect during the development and formation of the synapses, as is the case in childhood, the final formation of the synaptic compounds in the neocortex will be significantly less. The bottom-up mechanism assumes that physical and sexual abuse during the synapse period can lead to inhibition and that this could reduce the number of synapses in the somatosensory cortex.
Inadequate development of the genital somatosensory region in the brain could lead to reduced sexual perception and / or sexual dysfunction in later life. Women who have experienced sexual abuse in childhood will probably have a lower pain threshold due to the reduced thickness of their somatosensory cortex. This will cause them to experience more genital and pelvic pain. In the case of poor development of the precuneus and the cingulate cortex, which play a role in emotion regulation, there is likely to be cognitive avoidance and inhibition of emotional processes. Studies conducted into childhood trauma showed that in this case there was a reduced volume of the anterior cingulate cortex, but there was no distinction made between the different types of trauma.
An alternative explanation is that people who are sexually abused in childhood are more likely to avoid sexual activity in adulthood. This can lead to a reduced size of the somatosensory cortical area. Emotional abuse in childhood would ensure that these children would later become refusal-sensitive adults who avoid assessment situations and thus use this cortical area too little, which in turn will lead to shrinking of this area. There was no longitudinal MRI and behavioral data in this study, so this hypothesis could not be tested. Another limitation of this investigation is that retrospective self-reporting has been used. Issues such as forgetting childhood events can yield bias. However, meta-analysis has shown that this would lead to false-negative rather than false-positive self-reporting.
Article summary with Emotion Modulation in PTSD: Clinical and Neurobiological Evidence for a Dissociative Subtype by Lanius a.o. - 2010
...........Read moreRelatively little is known about neurobiological changes caused by stressors during childhood, even though it is associated with an increased risk of developing psychopathology in later life. A widely used method to investigate the risks of stressors in childhood is to study children who were adopted from orphanages. However, these studies cannot indicate whether the results found are only associated with the upbringing in orphanages or if they have to do with prenatal factors. Little is also known about the long-term effects of stressors during childhood. The current study looks at a rodent model of stressors in childhood. The outcome measurements are in line with the human paradigm, and are therefore generalizable to human behavior.
Many animal studies have focused on the effects of stress in adulthood or the consequences of childhood stressors in adult life. Adult stressors have been shown to reduce PFC (prefrontal cortex) and hippocampal dendritic complexity and volume, but this is effect is reversible. Childhood stressors lead to problems in hippocampal dependent memory in adulthood and inconsistency in anxious behavior.
This study looked at the type of stressor and its timing. To compare mice to humans (who had been adopted from orphanages), mice were used that were still drinking milk from the mother. To create "an orphanage situation", nesting opportunities were kept to a minimum and the mother was interrupted in her care practices. The anxiety response was measured when the mice reached preadolescent, adolescent, and adult age. Two hypothesis have been formed based on previous literature. The first hypothesis is that the childhood stressor would affect the regulation of anxiety (which is measured as the ability to suppress anxiety in order to achieve a goal). The second hypothesis is that this behavior is parallel to an increased activity of the amygdala.
A go-no-go task was used to measure the suppression of anxiety. The analysis show that childhood stressors influence the ability to suppress anxiety responses in order to perform targeted behavior and that these effects persist into adulthood. To measure neural activity, the basolateral amygdala and the c-fos gene were examined. This gene is associated with anxiety-related systems. The results showed that there were stronger responses in mice who were exposed to childhood stressors. These results are generalizable to humans.
The results are therefore in line with previous research and show that disorganized interrupted care in orphanages influences emotional and behavioral regulation in humans which persist into adulthood.The type of stressor experienced and its timing (in what period of one's life) also affect the outcome. Chronic stressors at an early age have stronger effects than short stressors later in life. These effects remain even after the stressor is gone.
During early childhood, mental and neurocognitive illnesses are highly prevalent. To understand these illnesses, researchers have to know things about genetics and about environmental factors that influence the brain. This article discusses the existing knowledge about maternal care and mother-child interactions. The research question in the article is: Do fragmentation and unpredictability of maternal cues during fetal and early postnatal life contribute to unfavorable cognitive and emotional outcomes and to changes in underlying brain structures?
The literature, which is strongly influenced by Bowlby's research, suggests that the quality of the parent-child relationship affects developmental outcomes of the child. Research by Bowlby also shows that the child's relationship with the parents and especially the relationship with the mother at a young age is an important predictor for the extent to which the child individual develops cooperative relationships, trusts someone and safely attaches to someone. Children who develop a secure attachment are often children with a history of sensitive (accurate responses to children's signals) and responsive (consistency of responses to the child's signals) parents. A secure attachment style offers is also a predictor for higher independence, better emotional regulation skills and better social adjustment. Children with unsafe bonding due to poor maternal care quality are more vulnerable to risk factors and suffer from poorer mental health.
Certain research cannot be done with humans. This is why researchers test on animals. The influence of maternal behavior on offspring has been investigated during animal studies. Studies with rodents support Bowlby's assumption that sensory signals from mothers are one of the mechanisms by which the environment influences brain development. The environment influences maternal behavior and maternal behavior influences the brain. A stressful environment for the mother not only leads to stress, but also to abnormal parenting behavior towards their offspring. The timing of the abnormal signals and the sex of the offspring also influence the outcomes.
Both quantitative and qualitative aspects of maternal care have been validated as important frameworks that can change brain function in offspring. Increasing quantitative maternal care leads to attenuation of the stress hormone gene expression, a reduced stress response and more resilience, while minimal care leads to cognitive and emotional problems. Maternal sensitivity and responsiveness are determinants of the quality of maternal care.
In human behavior, fragmented behavior is behavior that consists of many consecutive simple patterns. In rodents, fragmentation focuses on the extent to which care behavior occurs in numerous short episodes. For both humans and rodents, unpredictable maternal behavior focuses on patterns of behavior and measures the occurrence of consistent compared to inconsistent prevention of behavior.
It is not yet fully understood how sensory input is transmitted from the mother to the fetus. Recent research shows that a consistent emotional state of the mother leads to better mental development in children who are one year of age. It might be that the mother passess on emotional information to her fetus through physical parameters such as hormone levels or heart rate, but this has not yet been proven.
With the help of video recordings, specific sensory signals from the mother to the child have been identified. Qualitative and quantitative aspects in rodents have been evaluated by reducing a group's nesting material (this is a simulation of poverty). Fragmentation of maternal care causes cognitive and emotional problems in puppies, of which the consequences become visible later in life and persist into middle age. Learning difficulties were associated with loss of hippocampal synapses and dendrites. Emotional problems resulted in anxious behavior and increases the vulnerability to depression. If predictable and consistent sensory input from the mother diminishes excitement and gene expression, it seems likely that fragmentary and unpredictable sensory signals have the opposite effect.
The patterns and especially the degree of fragmentation and unpredictability of maternal signals have an important influence on the neuropsychiatric outcomes of the child, both pre- and postnatally. Little is known yet about how maternal care affects the brain of the fetus and about the mechanisms by which these influences take place.
Article summary with Genetic sensitivity to the environment: the case of the serotonin transporter gene and its implications for studying complex diseases and traits by Caspi a.o. - 2010
...........Read moreArticle summary with Self-reported impulsivity in women with borderline personality disorder: the role of childhood maltreatment severity and emotion regulation difficulties by Krause-Utz a.o. - 2019
...........Read moreThe amygdala is very important for recognizing emotional stimuli and for regulating behavioral alertness and physiological reactions in response to environmental challenges. Studies have shown that increased amygdala activity and a larger amygdala (in volume) occurs when children experience acute stress during adulthood. Because the amygdala develops rapidly during childhood, researchers have indicated that childhood to adolescence is a critical period in which the amygdala is sensitive to stress. These results state that exposure to stress, especially during childhood, leads to increased amygdala activation which can cause psychopathology.
One of the primary functions of the glucocorticoid receptor is to normalize brain activity through negative feedback inhibition of the HPA axis. There is a common polymorphism (rs5522) within exon 2 of the mineralocorticoid receptor gene (NR3C2), which results in the replacement of isoleucine (Iso / A) for valine (Val / G). Because Val is associated with a reduction in cortisol binding that inhibits the HPA-axis function, it is not surprising that it is associated with increased stress reactivity. The fall is also associated with depressive symptoms.
The aim of this study was to assess the direct biological effects of the mineralcorticoid receptor iso / val polymorphism at the level of threat-related amygdala reactivity and to investigate the interactions between the mineralcorticoid receptor iso / val polymorphism and emotional neglect during childhood.
Children and adolescents (N = 279) aged 11 to 15 were randomly selected from the general population. The study was designed to find out how genes, environment and neural systems contribute to adolescent psychopathology.
The Childhood Trauma Questionnaire is used to classify exposure to abuse into five categories: emotional and physical abuse, sexual abuse, and emotional and physical neglect.
A challenge paradigm was used to elicit robust amygdala reactivity. The fMRI was also used. Multiple regression analysis investigated how emotional neglect and the mineralcorticoid receptor influenced genotype independent and interactive threat-related amygdala reactivity.
In line with previous findings, the main effects of the analysis revealed robust left and right amygdala reactivity. Regression analysis predicted threat-related amygdala reactivity throughout the sample. The analysis provide a positive association between emotional neglect and threat-related amygdala reactivity in iso homozygotes, but not in trap.
There are three major findings in this study:
Extreme forms of emotional neglect increase the threat-related amygdala reactivity
The fall was associated with increased threat-related amygdala activation
An interaction between the mineralcorticoid receptor genotype and a history of emotional neglect has been observed such that a positive association between emotional neglect and threat-related amygdala reactivity was found in iso homozygotes
Stress in the early years of life is one of the strongest predictors of the development of emotional, cognitive and behavioral problems. Emotional neglect in interaction with mineralcorticoid receptor genotype was associated with right amygdala reactivity.
No neuroendocrine measurements have been conducted and research into emotional neglect was dependent on retrospective self-reporting.
Article summary with Childhood Maltreatment, Borderline Personality Features, and Coping as Predictors of Intimate Partner Violence by Krause-Utz a.o.
...........Read moreArticle summary with Using Principles of Behavioral Epigenetics to Advance Research on Early-Life Stress by Conradt - 2017
...........Read moreArticle summary with Non-suicidal Self-Injury in Adolescence by Brown & Plener - 2017
...........Read moreDNA methylation is an epigenetic process in which a methyl group is added to a histone within the DNA molecule. This changes the structure of the DNA, creating tissue-specific DNA methylation patterns. DNA methylation plays a crucial role in determining tissue-specific patterns of gene expression.
The fact that DNA methylation plays an important role in the specification of specific cell type programs, implies that DNA methylation is preserved during the lifetime of the tissue. Because of this, it is assumed that DNA methylation patterns are highly resistant to physical tissue. Data have shown that DNA methylation could be involved in providing specific DNA exposure and that these DNA methylation differences are associated with stable phenotypes. This idea is of particular importance for mental health care and behavioral biology. Here, gene-environment interactions have been recorded and the impact of the external social environment on the behavior and development of the brain has been extensively determined.
Working hypothesis: DNA methylation is a potential genomic mechanism for adapting sustainable genome analysis programs of the social environment.
An important part of human and animal development are external environmental signals (stimuli from the environment). In particular, the development of: mental functions, behavior, immunity, inflammation and healthy metabolism. As a result, it is stated that DNA methylation has its share in the form of genome function in response to signals from the environment. Especially the early years of life are important. Social and physical environmental signals in these early years will have an impact on the rest of one's life. So, growing up in an unfavorable environment leads to worse immunity, mental responses and heart responses. These responses in turn change DNA methylation in various physiological systems such as the brain and the peripheral systems.
Maternal care plays a crucial role for the future well-being of her offspring. In this study, it was studied whether natural variations in maternal care just after birth lead to differences in DNA methylation that may lead to observed phenotypic differences between the offspring in adult life. These adult offspring experienced either High Licking (HL) and High Grooming (HG) maternal care or Low licking (LL) and Low Grooming (LG) maternal care. The offspring that received LL maternal care showed an increased level of glucocorticoid in their stress response. It has been shown that variations in maternal care lead to differences in epigenetic programming. These differences remain visible in adulthood. It was also examined whether the change in DNA methylation was reversible, but this was not the case. Early stress in mice causes persistent DNA hypomethylation in an important regulatory region of the arginine vasopressin gene, which plays a role in aggression, blood pressure regulation and body temperature.
This article suggests that DNA methylation is a mechanism that is dependent on external experiences and changes gene function and phenotype in a stable way. These reactions are visible throughout the system and not just in the brain, since social distress has important physical consequences. Because it can affect the entire system, DNA methylation has important practical consequences.
Survivors of child abuse often suffer from health problems that come to light long after the abuse has stopped. The percentage of health problems with a background of abuse is much higher than with people who have not been abused. This article examines why this is the case.
Behavior has often been investigated. Anyone familiar with child abuse is not surprised to hear that adults survivors of child abuse are more likely to participate in harmful activities.
Child abuse survivors have an increased risk of alcohol and drug abuse.
People who have been abused have an increased risk of being overweight. In addition, some studies show that sexual abuse is associated with eating problems in women.
There is an increased risk of suicide attempts and ideas about suicide.
Risky sexual behavior is the most documented form of harmful behavior as a result of abuse. A study of risky sexual behavior in four different countries shows that young women with a history of sexual abuse were previously sexually active, more likely to have teenage pregnancy, often had more bed partners and had more unsafe sex. Men and women who had experienced four or more types of family mistreatment were more likely to have 50 or more bed partners and sexually transmitted diseases.
Problems in family functioning lead to a greater risk of smoking.
Sufficient sleep is essential for good health. Sleep is not really a form of behavior, but the effects do occur in behavior. People with a history of child abuse often have problems with sleep. People who are chronically deficient in sleep are more vulnerable to infections and diseases and are more likely to have accidents. It can also give an increased chance of severe and chronic depression.
The ability to form social relationships is essential to people's health. The ability to develop and maintain a relationship is also influenced by abuse in youth. These people often have fewer relationships and are more likely to get divorced.
Survivors of mistreatment often have an avoiding or intrusive (intrusive) style. Avoidance is characterized by low dependence and low heat. Intrusiveness is related to an extreme need for proximity to people. People without social support participated less often in health promotion activities and were more likely to have irregular sleep times. Social support also appears to be important for people with a lower income, because the social support amounts to better health.
Being victims again reflects a problem with social connections and occurs regularly with survivors of child abuse. It is also more common in clinical groups. A study of 290 patients with borderline shows that half are victims as adults. The trauma affects health. It also increases the risk of sexually transmitted diseases and chronic stress.
Homelessness is another example of what can be the result of poor social networks. It seems to be related to a history of abuse. Homeless women more often had trauma and a history of abuse than women of equal SES who did have a place of residence. Family violence creates social isolation which makes women more vulnerable to homelessness. Being homeless has health effects. You can become malnourished, exposed to bad weather, have no hygiene and no medical care. It is also a risk for substance abuse.
The internal work model refers to a mental framework with which a person interprets stressful events and motives and actions of others. The model also responds to people's beliefs about how much power they have in situations and what they can do to help themselves. The working model is related to depression, health perception and self-motivation. Research by Briere and Elliot shows that abused children develop an internal work model in which they see the world as a dangerous place. The children will overestimate danger and as adults underestimate themselves. They will also have chronic perceptions of helplessness, danger and powerlessness, which can lead to emotional problems and a risk of depression. These negative ideas can also affect health. The amount of confidence that someone has in themselves can even influence how long they live.
Health perceptions concern why someone considers themselves healthy. The observation that someone has about their health can be a predictor of illness and death.
Depression is one of the most preventable consequences of abuse. Survivors of abuse are four times more likely to develop depression compared to people without a history of abuse. Some wonder whether child abuse causes mental health problems or whether depression is caused by poor family functioning that makes abuse possible. Depression has consequences for health. Depression is associated with not having breakfast, irregular sleep times, not using a belt and missing physical activity. Women with depression also have an increased risk of heart disease.
PTSD is also a common consequence of abuse and it has a serious impact on health. Many victims of sexual abuse do not fully meet the criteria for PTSD, more than 80% have PTSD related symptoms such as hyper vigilance, intrusive thoughts and flashbacks of the experience. Child abuse makes people vulnerable to the development of PTSD when exposed to a current stressor. PTSD is often co-morbid with depression, anxiety disorder, smoking and substance abuse. PTSD gives an increased chance of divorce and family problems, stopping education, thoughts about suicide and sleeping problems such as nightmares.
Health depends on a complex web of behaviors, thoughts, emotions and social connections. These not only influence each other, but also health. Abuse can affect health and these four components. To improve health outcomes, clinicians need to look at all avenues that can affect the health of the victim.
Article summary with Psychoneuroimmunology of early-life stress: the hidden wounds of childhood trauma? by Danese & Lewis - 2017
...........Read moreArticle summary with Sexual problems and post-traumatic stress disorder following sexual trauma: A meta-analytic review by O'Driscoll & Flanagan - 2015
...........Read moreArticle summary with The Sexual Well-Being of Women Who Have Experienced Sexual Abuse During Childhood by Lemieux & Byers - 2008
...........Read moreThe short and long-term effects of sexual abuse involve a wide range of mental disorders, such as: PTSS, depression, anxiety, aggression and substance abuse. However, not everyone suffers from a psychiatric disorder after they experienced sexual abuse. Some people maintain a normal level of functioning. These people are seen as being 'resilient', which is defined as being able to positively adjust during and after a (major) setback. To date, there has been no consensus on the operationalization of the concept of 'resilience'. The majority of the studies included in this study define resilience as adaptive functioning or as the absence of psychopathological symptoms.
Protective factors are related to resilience and refer to the buffers of an individual. Research into sexual abuse in general has found empirical evidence for both individual and environmental protective factors. Individual protective factors include personal characteristics such as: openness, extraversion, agreeableness, having an internal locus of control, optimism, etc. Environmental protective factors associated with resilience are: receiving social support from family, colleagues, teachers or other significant others.
This systematic study of the literature has four goals:
Providing an overview of the protective factors associated with the resilience specific to a particular form of sexual abuse
Determining outcomes and protective factors of different developmental stages
Estimating and emphasizing the level of resilience of child abuse survivors
Evaluating the quality of the included studies on the basis of a quality assessment and view methodological issues in the discussion
The following criteria have been applied in this study:
Studies must be published in English, German or French that comply with peer review policy
Studies looked at resilience after the occurrence of sexual abuse
Resilience is defined in as adaptive functioning or the absence of psychological symptoms
The most important outcomes were assessed on the basis of standardized tests
Only quantitative studies were included
The sample consists of at least twenty participants
Studies were included if they measured both short-term resilience during childhood and adolescence as well as long-term resilience in adulthood
Studies using different characteristics were included
Two methods have been used to record relevant studies. First, the database was searched with certain combinations of search terms. Second, a snowball technique was applied, in which the reference lists of all relevant studies were reviewed to note further studies.
According to various researchers, protective factors can be divided into three broad categories.
Internal factors of the victim
External factors of the victim's family
External factors related to the broader social environment of the victim
Furthermore, a distinction has been made between three different age groups. Participants under the age of ten were categorized as children. Adolescents were defined as participants from 11 to 17 years of age and starting from 18 years of age the participants were categorized as adults.
The study looked at protective factors that are related to resilience after being sexually abused. The following results are a summary of the studies included in this review.
A study found that in adolescents, both hope and expectations, predicted resilience. In adults, optimism and hope appeared to play a protective role in HIV-infected adults who were sexually abused.
In a longitudinal study of sexually abused adolescents, a greater sense of empowerment was associated with resilience. In adults, having an internal locus of control was characterized as a protective factor for mental health and self-esteem. Having an external locus of control, on the other hand, was characterized as a risk factor for drug addiction.
To blame others instead of blaming yourself, or externalizing guilt, was associated with resilience.
In children, avoidance behavior was on the one hand associated with fewer behavioral problems, but on the other hand it was associated with more sexual anxiety in some studies. For adolescents, the use of an avoidance strategy proved to be a risk factor for negative results.
Those who had more certainty about their plans for education achieved a stronger academic performance and had more positive feelings about education compared to those with lower certainty. Academic performance proved to be a protective factor for self-esteem in adults. It was also found that obtaining a diploma in high school was significantly correlated with resilience.
Understanding and dealing with emotions, which is defined as emotional intelligence, proved to be a protective factor for adolescents against suicidal thoughts and suicide attempts. Furthermore, interpersonal and emotional competence was associated with lower levels of recall of sexual events. In adults, interpersonal competence was predictive of resilience.
Higher emotional attachment in one's own family proved to be protective among female students, but not among male students. Secure attachment in parent-child relationships proved to be protective against the negative effects of sexual abuse.
A sense of self-esteem predicted subjective health among female victims and appeared to be protective against interpersonal problems, being sexual and taking sexual risk behavior.
A personal high SES proved to be protective against psychopathology. Furthermore, current job was positively associated with self-esteem, but not with psychopathology.
For children, the support from the father, support from both parents and the emotional support from counselors served as a protective factor. In adolescents, parental care, family connectedness, parenting support, caregiver support, and emotional support from counselors served as a protective factor. For adults, family support, social support satisfaction, mother care, nature and quality of family relationships, paternal support childhood and partner support were found to be protective factors.
Various forms of social support at the community level have been associated with resilience. Satisfaction with the social support of the community turned out to be a protective factor for women who were sexually abused in their childhood. The nature and quality of the relationship with peers in adolescence was also associated with a resilient outcome at the age of 18.
Participation in club activities was associated with less recall of sexual events. However, this only applied to those who experienced a lower level of abuse, not to those who experienced a high level of abuse.
Research into resilience in the aftermath of sexual abuse can be valuable because it can provide valuable information about protective factors. In turn, this information can be used to design interventions and prevention programs to help those people who have experienced sexual abuse. Strong evidence was found for individual factors such as education, interpersonal and emotional competence, control beliefs, active coping, optimism, social attachment and the appointment of external culprits. In addition, there is considerable empirical evidence for both the importance of social support for the family and social support at the environmental level.
Knowledge about resilience can guide the development of treatment and prevention programs
The best supporting protective factors are education, interpersonal and emotional competence, control beliefs, social support of the family and the broader social environment
Level of resilience among participants who were sexually abused turned out to be between ten and 53 percent
Preventive and clinical interventions must make use of psychoeducation and cognitive strategies. This must be adjusted to the level of development of victims
Future research should focus on the mechanisms that underlie an effective and healthy adaptation after sexual abuse. A longitudinal study would be best, since resilience is a dynamic process with different levels in different contexts
Depressions have major consequences for health and cause a high economic burden for society. Because of this, it is important to study the risks of developing recurrent and severe depression and inadequate responding to treatment.
Child abuse predicts an unfavorable course of depression and leads to unfavorable treatment outcomes. People who have experienced child abuse have a high risk on developing depression.
This article describes a meta-analysis that examines the relationship between child abuse and an increased risk of depression and negative treatment outcomes. For people with depression and a history of child abuse, it was checked whether there were recurrent depressive periods and persistent depressive symptoms. The relationship between child abuse and various treatments was also examined. The types of treatment considered are psychological and pharmacological (medication) treatments and a combination of the two.
Literature has been used that describes the relationship between child abuse and disease progression (such as recurrence and persistence) and treatment outcomes in depression. Recurrence was defined in terms of the number of depressive periods. Persistence was defined as the duration of the current depression. Treatment outcome was defined in terms of treatment response and remission (reduction or disappearance of symptoms of depression).
A meta-analysis among these studies showed that people with a history of child abuse were twice as likely to have an unfavorable course of depression than people without a history of child abuse.
The results showed that people with a history of child abuse suffered twice as often from recurrent depressive periods compared to people without a history of child abuse. The severity and persistence of depressive symptoms was also investigated in the group with a history of child abuse. This group also appeared to suffer twice as often from more severe and persistent depression periods.
The results of the meta-analysis showed that people with a history of child abuse were more likely to respond poorly to treatment compared to people without a history of child abuse. In psychotherapy, people who had been abused, did not significantly respond poorly to treatments. For pharmacology, a significantly higher risk was found for poor treatment outcomes in people with a history of child abuse. The group of abused persons also appeared to achieve a worse treatment result when in combined (psychological and pharmacological) treatment.
This meta-analysis showed that people with a history of child abuse had recurrent and persistent depressive symptoms twice as often as people without a history of child abuse. This group of abused persons also appeared to benefit less from treatments. This in turn is a risk factor for recurrent and persistent depressive periods. In the context of depression, early prevention of child abuse is important for improving health and reducing the economic burden.
Schema therapy is a treatment that revolves around cognitions, behaviors, experiences and psychodynamics. It is used for clients who have a chronic psychological disorder. It has been shown to be effective in people with borderline personality disorder and for people who are paranoid, narcissistic and theatrical. Positive effects have also been found in people with personality disorders and depression. The question is whether schema therapy is also effective when someone is chronically depressed. Chronic depression has stronger negative consequences on the quality of life, results in more suicide attempts and admissions and leads to higher economic costs compared to depressive episodes.
Most treatments for chronic depression involve antidepressants, cognitive therapy, cognitive behavioral psychotherapy or a combination of psychotherapy and medication. There is also emotion-focused therapy in which a client is helped to identify his or her emotions and behavior. Because of the fact that in many forms of therapy the effects are only temporarily effective. Therefore, there often have to be subsequent, maintaining treatments.
According to the original schema therapy model, early maladaptive schemas (EMS) are at the core of psychopathology. These schemas are seen as stable and long-term beliefs of oneself and of the world. These schemas remain hidden until they are triggered by a life event that causes a powerful emotional response. Given that the EMS are the core of psychopathology, a therapy would be to make these schemas more adaptive.
Clients with strong EMS develop dysfunctional coping strategies for dealing with negative emotions. There are three types of coping associated with these schemas, namely avoidance behavior (behaviors to avoid activation of the schema), surrender (behaviors that match the schema) and overcompensation (behaviors that are opposite of the schema).
It is likely that chronic depression is caused by multiple interacting factors. There are four risk factors for chronic depression which are empirically supported. These factors are: early adverse life events, personality, cognitive factors, and interpersonal factors. The effect of distant risk factors (early adverse life events and personality) on chronic depression affects the proximal (nearby) risk factors (EMS and dysfunctional attitudes). The nearby risk factors are triggered by recent life events and are maintained by avoidant coping strategies and by interpersonal behavior related to avoidance of social situations. This creates a shortage of social support and this ensures that depression is maintained. A recent life event can therefore activate an EMS and this can lead to a chronic depression. Figure 1 in the article shows the cognitive schema model of chronic depression.
Early adverse life events represent the experiences that one experiences as a child, such as abuse or neglect. In other studies it has been shown that the more often someone has experienced such events in his or her childhood, the greater the chance on depression. However, this does depend on the way in which a child cognitively generates an event (so creates a schema of it). So, EMS mediates between early adverse life events and the depression and therefore the treatment should focus on these EMS. Schema therapy can help with this, because this therapy causes the client to imagine the traumatic experience and thus to relive the trauma. This reduces the impact of the trauma on the client.
People with depression have been shown to have dysfunctional thoughts. These thoughts come up automatically. It has also been found that people with chronic depression have worse EMS and that these schemas remain fairly stable during outpatient treatment for their depression. Schema therapy ensures that these negative thinking patterns are broken. The ultimate goal is then to reduce the schematic processes that are dominated by the EMS. With the use of cognitive and emotional techniques, the patient will come to see that their schemas are false.
In the group of people with chronic depression there is more comorbidity of a personality disorder and chronic depression than within the group with episodic depression. Schema therapy has been developed specifically for clients with a chronic problem, often with a personality disorder. It has been shown that there is a positive effect for people with borderline personality disorder and Cluster-C personality disorder if it occurs together with chronic depression.
Depressed clients are described as socially avoidant and inassertive. Because they are socially avoidant, they receive less social support from others. These people also avoid conflict. Schema therapy ensures that these patterns are broken, so that the client will no longer avoid conflicts. This is reached through certain techniques that allow the client and the therapist to identify the EMS that leads to these unhealthy interpersonal thougts and behaviors.
Schema therapy uses many techniques that are also used with other therapies. Schema therapy is based on cognitive therapy and schema therapy used the cognitive techniques from it. There are also differences between these two therapies. In addition to cognitive techniques, schema therapy includes experiential techniques to identify schemas and modify schemas. This is not what cognitive therapy does. Schema therapy is used to change the schemas from different perspectives. Schema therapy is about past events and cognitive therapy is about present events.
Schema therapy leads to that a link is made between past events and recent problems. This is not what cognitive therapy does.
Schema therapy for the chronically depressed people can be divided into three phases. In the first two phases the sessions are weekly and in the last phase the frequencies of the sessions are reduced and the client gains more autonomy and responsibility.
In this phase, there are three goals. First, the client must understand the concept of schemas and look for the most dominant scheme. The client shows the relationship between the most dominant schema, the problems and the history. The therapist helps the client to experience the feeling associated with the schema through techniques.
The client has to tell about an event from his or her youth and the therapist watches for affective reactions of the client. Then, general images are used and these images become progressively more specific. In this phase, unlike phase 2, no rewriting of the images is needed.
In this phase, the goal is to change the EMS, to change emotional experiences and to change dysfunctional behavior. There are four different techniques used for these goals:
Cognitive techniques: The cognitive techniques are used to ensure that the client becomes more rational and objective about the world and about his or herself.
Experiential techniques: The experiential techniques are used to work on emotional experiences. A distinction can be made between imagery and chair dialogue. In imagery, the intention is that the client will take different perspectives in the event of problems. The client will learn to cope with experiences of despair and disability and will be able to better express what he or she wants. The other technique is the chair dialogue. Each chair represents a different 'I' for the client.
Therapeutic alliance: The therapist confronts the client with the behavior that the client shows during the sessions created by the underlying EMS through the empathic confrontations. This allows the client to learn to take different positions. The therapist then looks at how the client has fallen short in his or her youth and then the therapies tries to compensate for this. However, in this phase the therapists needs to be aware of independence.
Behavioral techniques: Behavioral techniques involve role play and assertiveness training. With behavioral techniques, the client learns to turn cognitions and emotions into action.
During this phase, the client and the therapist make plans to prevent relapse in the future. They analyse situations that could trigger a relapse and make a plan how to deal with it.
There is no empirical evidence for that schema therapy is effective for clients with chronic depression. It has been shown that it addresses the underlying risk factors of chronic depression. It is likely that the effects are positive and long-lasting.
PTSD is a common negative consequence of child abuse that many adults who have experienced child abuse suffer from. This makes it important to study how people who suffer from PTSD can be treated best. The tricky part here is that the people who suffer from PTSD treatment are underrepresented in many effect studies. There is currently no consensus in the literature as to whether the current interventions of PTSD as a result of trauma during adulthood also apply to PTSD as a result of trauma during childhood. This study therefore focuses on the effectiveness of PTSD treatments in adult victims of child abuse.
There is extensive evidence that people who have been victims of child abuse exhibit a high degree of complex symptoms of PTSD. Many researchers confirm this finding, but the jury does not yet agree that a different approach to treatment is required for this group.
There is consistent evidence that trauma-focused treatments lead to a significantly greater effect than non-trauma-focused treatments. Interventions that focus on trauma related memories have the greatest effect, since memory processes play a role in PTSD during development. However, victims of child abuse with PTSD are underrepresented in most studies. As a result, it remains unclear whether trauma-oriented treatments also have an effect on this specific group. One of the main objectives of this meta-analysis was to study whether the general findings of the literature on PTSD treatment can be replicated.
The first aim of the study was to assess the effectiveness of psychological interventions for PTSD in adult victims of child abuse. It was expected that psychological treatments would have a medium to substantial effect size in this group. Secondly, an attempt was made to study whether trauma-centered treatments differed from non-trauma-centered treatments with regard to relative efficacy. A higher return was expected for trauma-oriented treatments. Finally, the relative efficacy of individual treatments versus group treatments was examined. The expectation was that individual treatments would have a larger effect.
The following criteria were used in this meta-analysis:
Randomized trial, with at least one control condition and one experimental condition (active treatment)
PTSD symptoms are the most important target in the treatment
Participants are at least 18
At least 90% of the sample is a victim of child abuse or similar trauma
Outcome measures included the severity of PTSD symptoms
At least 10 participants per condition
Published in a peer review
Active treatments have been shown to lead to a considerably higher effect compared to a control group. It has also been found that a follow-up within five months showed a significantly larger pre-follow-up effect size compared to when the follow-up took place after more than six months. There was also a medium to large effect in the after treatment of the active treatments, compared to a placebo after treatment in the control groups.
The results showed that the outcomes of trauma-focused treatments had a significantly higher effect size than non-traumatic treatments. However, this effect was only visible when a placebo treatment was used in the control group. So not when a similar treatment was used.
Individual treatments were found to have a considerably higher effect size than group treatments. Here, the effect applied only when the control group used a placebo treatment.
This meta-analysis showed that psychological interventions for PTSD are effective in adult victims of child abuse. For all active treatments, a moderate to high effect size has been found for the reduction of PTSD and the severity of symptoms. In addition, trauma-oriented treatments were found to lead to a significantly higher effect size than non-trauma-oriented treatments. These findings are in line with current treatment guidelines. The importance of processing trauma related memories is emphasized in a PTSD treatment. The effectiveness of PTSD treatments depends on the extent to which the treatment helps to process the memory of the traumatic event. Furthermore, individual treatments proved to be more effective than group treatments.
The methodological quality of the included studies varied per study
There was a higher heterogeneity in the trauma-focused treatment groups than in the non-trauma-focused treatment groups. As a result, there was not enough statistical power to draw conclusions about this.
No research has been done on the effect of different PTSD treatments on different types of trauma, only on one type of trauma: child abuse during childhood
There was a large publication bias, so effect sizes may be overestimated
Despite the limitations present, the current findings prove that PTSD can be treated effectively in adult victims of child abuse. In addition, the results suggest individual trauma-focused treatments as first-line interventions for PTSD in this specific group. However, this meta-analysis also showed that the results of the research into the treatment of PTSD as a result of child abuse are lagging behind the general PTSD treatment. As a result, more research is needed to increase the knowledge about providing the right treatment for this specific group of people.
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