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The role of childhood trauma on health and diseases

Introduction
Traumatic events of the earliest years of infancy and childhood are not lost but, like a child’s footprints in wet cement, are often preserved lifelong. Time does not heal the wounds that occur in those earliest years; time conceals them. They are not lost; they are embodied. Only in recent decades has the magnitude of the problem of developmentally damaged humans begun to be recognized and understood.
The influence of childhood experience, including often-unrecognized traumatic events, is as powerful as Freud and his colleagues originally described it. That influence is long lasting, and the researchers describe the intermediary mechanisms, the neural pathways, that these stressors activate for their clinical manifestation. Unfortunately, and in spite of these findings, the biopsychosocial model and the biomedical models of psychiatry remain largely at odds rather than taking advantage of the new discoveries to reinforce each other.
Many of our most intractable public health problems are the result of compensatory behaviors such as smoking, overeating, promiscuity, and alcohol and drug use, which provide immediate partial relief from emotional problems caused by traumatic childhood experiences. That relationship is straightforward: early trauma to depression or anxiety, to obesity, to diabetes, to heart disease; trauma to smoking, to emphysema or lung cancer. But, apart from various common compensatory actions, the chronic life stress of the underlying developmental life experiences is generally unrecognized and hence unappreciated as a second and separate etiological mechanism underlying many biomedical diseases.

What is childhood trauma?
The National Institute of Mental Health (USA) defines childhood trauma as: “The experience of an event by a child that is emotionally painful or distressful, which often results in lasting mental and physical effects.” Childhood trauma can occur when a child witnesses or experiences overwhelming negative experiences in childhood. Many childhood experiences can overwhelm a child. This can happen in relationships e.g. abuse, neglect, violence. This is called interpersonal trauma. Children can also experience traumatic events. These include accidents, natural disasters, war and civil unrest, medical procedures or the sudden loss of a parent/caregiver.
Interpersonal trauma can be understood in this way:
1. Trauma from something done to a child:
– sexual, physical or emotional abuse at home or elsewhere
– witnessing or experiencing violence in family or home
– witnessing or experience violence in community e.g. civil unrest or war, refugee or asylum seeker trauma
2. Trauma from something that doesn’t happen e.g. child is not well nurtured:
– physical and emotional neglect
3. Trauma because a child’s parent or caregiver is affected by their own trauma. This can mean that they are unable to meet their child’s emotional needs. Often these parents have good intentions. Their own trauma stops them connecting securely to their child, which limits the child bonding or attaching securely:
– parental ill-health
– a parent who misuses substances e.g. alcohol or drugs- a parent put in prison
– separation of parents or divorce.

Early childhood trauma
Trauma in early childhood can be especially harmful. Early childhood trauma generally means trauma between birth and the age of six. A child’s brain grows and develops rapidly, especially in the first three years. Young children are also very dependent on the caregivers for care, nurture and protection. This can make young children especially vulnerable to trauma. When trauma occurs early it can affect a child’s development. It can also affect their ability to attach securely, especially when their trauma occurs with a caregiver.
The relationships between childhood trauma and aggressive behavior in adulthood are partially explained by the observation that traumatic stressors during early development may contribute to an impaired capacity for self-regulation in later life.15,16 This impaired capacity would explain the diffuse associations between childhood trauma and the number of reported aggressive behaviors in adulthood. However, our finding that specific forms of trauma (witnessing violence, emotional abuse) are associated with aggression scores is unexplained.
Although adults often say things like, “He was so young when that happened. He won’t even remember it as an adult,” childhood trauma can have a lifelong effect. And while kids are resilient, they’re not made of stone. That’s not to say your child will be emotionally scarred for life if he endures a horrific experience. With appropriate interventions, adults can help kids recover from traumatic experiences more effectively. But it’s important to recognize when your child may need professional help dealing with a trauma.
Post-Traumatic Stress Disorder
Many children are exposed to traumatic events at one point or another. While most of them experience distress following a traumatic event, the vast majority of them return to a normal state of functioning in a relatively short period of time.
But some children—between 3 and 15 percent of girls and 1 to 6 percent of boys—develop post-traumatic stress disorder (PTSD). Children with PTSD may re-experience the trauma in their minds over and over again. They may also avoid anything that reminds them of the trauma or they may re-enact their trauma in their play. Sometimes children believe they missed warning signs predicting the traumatic event. In an effort to prevent future traumas, they become hyper-vigilant in looking for warning signs that something bad is going to happen again.
Children with PTSD may also have problems with:
-Fear
-Depression
-Anxiety
-Anger and aggression
-Self-destructive behavior
-Feelings of isolation
-Poor self-esteem
-Difficulty trusting others
Even children who don’t develop PTSD may still exhibit emotional and behavioral issues following a traumatic experience. Here are some things to watch out for during the weeks and months after an upsetting event:
-Increased thoughts about death or safety
-Problems sleeping
-Changes in appetite
-Anger issues
-Attention problems
-School refusal
-Somatic complaints like headaches and stomach-aches
-Loss of interest in normal activities
-Irritability
-Sadness
-Development of new fears
-Effect on Long-Term Health
Traumatic events can affect how a child’s brain develops. And that can have lifelong consequences.
ALSO Studies show that the more adverse childhood experiences a person has, the higher their risk of health and wellness problems later in life. Childhood trauma may increase an individual’s risk of:
-Asthma
-Depression
-Coronary heart disease
-Stroke
-Diabetes
Additionally, a study published in 2016 in Psychiatric Times noted that the prevalence of suicide attempts was significantly higher in adults who experienced trauma, such as physical abuse, sexual abuse, and parental domestic violence, as a child.

How to Help a Child Who Has Been Traumatized?
Family support can be key to reducing the impact trauma has on a child. Here are some ways to support a child after an upsetting event:
-Encourage your child to talk about his feelings and validate his emotions.
-Answer questions honestly.
-Reassure your child that you’ll do everything you can to keep him safe.
-Stick to your daily routine as much as possible.
If your child has been exposed to traumatic circumstances and you’ve noticed changes in her mood or behavior, talk to her pediatrician. A physician can evaluate your child’s health and, if necessary, make a referral for mental health treatment.

Depending on your child’s age and needs, she may be referred for services such as cognitive behavioral therapy, play therapy, or family therapy. Medication may also be an option to treat your child’s symptoms.
Effects of Childhood Trauma on Adulthood life
Experiencing abuse or neglect as a child can have a significant impact on an adult’s quality of life. The impact can be felt across several areas, such as emotional health, physical health, mental health and personal relationships.

Emotional Health
Survivors of childhood abuse can often experience feelings of anxiety, worry, shame, guilt, helplessness, hopelessness, grief, sadness and anger.
Mental Health
Surviving abuse or trauma as a child has been linked with higher rates of anxiety, depression, suicide and self harm, PTSD, drug and alcohol misuse and relationship difficulties.
Physical Health
Children who are exposed to abuse and trauma may develop what is called ‘a heightened stress response’. This can impact their ability to regulate their emotions, lead to sleep difficulties, lower immune function, and increase the risk of a number of physical illnesses throughout adulthood.
How to deal with childhood trauma in adulthood
Trauma generates emotions, and unless we process these emotions at the time the trauma occurs, they become stuck in our mind and body. Instead of healing from the wounding event, the trauma stays in our body as energy in our unconscious, affecting our life until we uncover it and process it out. The healthy flow and processing of distressing emotions, such as anger, sadness, shame, and fear, is essential to healing from childhood trauma as an adult.
The healthiest response to childhood emotional wounds is also the rarest: When the trauma first occurs, we recognize the violation it has caused to our sense of self, feel the natural emotions that follow, and then realize that the violation doesn’t say anything about us personally — and thus we don’t make negative meaning of it and can let it go.
But because emotions like anger and sadness are painful — and because crying or confronting others is often not socially acceptable — this process doesn’t happen automatically. Instead, we may suppress our emotions, rather than feel and process them.

Trauma-Focused Cognitive Behavior Therapy

What Is Trauma-Focused Therapy?
As its name implies is a form of cognitive behavioral therapy that addresses the specific emotional and mental health needs of children, adolescents, adult survivors, and families who are struggling to overcome the destructive effects of early trauma. Trauma-focused cognitive behavioral therapy (TF-CBT) is especially sensitive to the unique problems of youth with post-traumatic stress and mood disorders resulting from abuse, violence, or grief. Because the client is usually a child, TF-CBT often brings non-offending parents or other caregivers into treatment and incorporates principles of family therapy.

What to Expect

TF-CBT is a short-term intervention that generally lasts anywhere from eight to 25 sessions and can take place in an outpatient mental health clinic, group home, community center, hospital, school, or in-home setting. Cognitive behavioral techniques are used to help modify distorted or unhelpful thinking and negative reactions and behaviors. At the same time, a family therapy approach looks at interactions among family members and other family dynamics that are contributing to the problem and aims to teach new parenting, stress-management, and communication skills.

How It Works
The trauma-focused approach to psychotherapy was first developed in the 1990s by psychiatrist Judith Cohen and psychologists Esther Deblinger and Anthony Mannarino, whose original intent was to better serve children and adolescents who had experienced sexual abuse. TF-CBT has expanded over the years to include services for youths who have experienced any form of severe trauma or abuse.
Early trauma can lead to guilt, anger, feelings of powerlessness, self-abuse, acting out behavior, and mental health issues, such as depression and anxiety. Post-traumatic stress disorder, which affects children and adults, can manifest in a number of ways, such as bothersome recurring thoughts about the traumatic experience, emotional numbness, sleep issues, concentration problems, and extreme physical and emotional responses to anything that triggers a memory of the trauma. By integrating the theories and techniques of several therapeutic interventions, TF-CBT can address and improve the symptoms of post-traumatic stress in youth.

Gathering & compilation
Marzieh Ahankoob,PhD (Clinical Psychologist)

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