When someone leaves an abusive environment, it’s common for those around them to assume their problems will lessen. If you leave an undesirable situation for something better, you should in turn feel better… right? The harsh reality is that trauma can follow you. This doesn’t mean a survivor chooses to allow trauma to linger, but more so that the events they underwent had a direct impact on their developmental arc. Extensive research into the future health consequences of child maltreatment has continuously shown a close association to mental illnesses such as depression, anxiety, personality disorders, and other mental health conditions.
The first step in understanding the health consequences of child maltreatment (CM) is recognizing what it encompasses. Emotional neglect, emotional abuse, physical neglect, physical abuse, and sexual abuse are all considered different forms of CM. Often overlooked are non-physical forms of abuse such as what fall under the concept of psychological abuse. Though not spoken of nearly enough, psychological abuse has been documented as one of the most prevalent forms of child abuse. It has been known to be developmentally damaging, and can bring about negative features such as helplessness, aggression, emotional unresponsiveness and neuroticism (Rizvi and Najam, 2014).
Before we go more in depth, let’s take a look at some facts about CM in general. According to the World Health Organization, about 3 in 4 children between the ages of 2-4 regularly suffer through physical and psychological violence. In addition, 1 in 5 women and 1 in 13 men report being sexually abused between the ages of 0-17. The World Health Organization notes that consequences of CM can include impairments mentally and physically as well. Not only that, but they mention that the social and occupational outcomes that stem from CM can even slow a country’s economic and social development.
The effects of this type of abuse extend far beyond the perceived average scope that society itself faces the long-term repercussions. With that being said, consider how impactful this type of behavior can be to one person, especially a child whose brain is still developing.
Mental Illness Symptoms and Childhood Adversity
Mental illness does not have one extreme. There is no formula to how mental illness manifests itself through a survivor of any form of abuse. The outcomes that come from wrongful childhood treatment are individual and can shift depending on the person. Even two people who experience similar instances of CM can have two entirely different mental health outcomes. Analyzing the relationship between mental health complexities and childhood adversity produces better insight into mental illness and its individuality.
Depression, Anxiety, and Bipolar Disorder
Early childhood adversity may make someone more prone to depressive behavior and overall mood disorders. In fact, there has been a definitive link found between CM and major depressive disorder. If you weren’t already aware, the experience of any form of child abuse more than doubles the risk of developing a depressive disorder (Klumparendt and Nelson et al, 2019).
A research article published by BMC Psychiatry ran a study aimed to find the relationship between CM and major depressive disorder. 1,027 participants between the ages of 18-65 with no bipolar or psychotic symptoms completed a childhood trauma questionnaire including a self-report questionnaire that analyzed four different mediators used to account for the association between the two. These included emotional regulation, attachment, attribution style, and post-traumatic stress disorder (Klumparendt and Nelson et al, 2019).
The sample results published by BMC Psychiatry provided a plethora of findings. 16.3% of participants met criteria for experiencing a current major depressive episode. A whopping 48.8% of participants were suffering from mild to severe depressive symptoms, and 12.2% scored above the cut-off value for showing potential indicators of post-traumatic stress disorder. After looking at these statistics, it was unsurprising to find that nearly half of the entire sample (48.7%) reported at least one former episode of a depressive disorder (Klumpared and Nelson et al, 2019).
BMC Psychiatry later published a study that was more focused on social anxiety in adulthood from those who have experienced a form of CM. The reason behind the analysis was to see how evident social anxiety was in abuse survivors, and to examine how common other mental disorders were among the sample. 1,091 participants who were all treatment seeking outpatients were assessed with a childhood trauma questionnaire as well as a questionnaire on stressful social experiences.
The study found that patients with social anxiety and depression reported significantly more severe cases of emotional abuse in their questionnaires. Second most common was physical abuse followed by sexual abuse, emotional neglect, and lastly victimization from their peers. The effects of CM were proven to extend past social anxiety, and indicated potential in bringing about varying types of anxiety and other depressive disorders overall (Bruhl and Kley et al, 2019).
Yet another mental health outcome that can be seen in suvivors of child abuse is manic depression, also known as bipolar disorder. Although bipolar disorder is a known mental illness that can severely affect one’s mood, many people are not aware of the link between manic depression and childhood adversity. To get a firmer grasp on the significance of these adverse experiences and bipolar disorder it’s essential to understand how it can present itself.
The International Journal of Bipolar Disorders published an article in 2020 on a project conducted at the clinic of the Ruhr-University Bochum in Germany. The study lasted 2 years and consisted of 48 men and 86 women with the average age being 24 years old. The study utilized self report scales and assessments such as the Beck Depression Inventory II (BDI) which is a 21 item assessment for the severity of depression, the Hypomania Checklist 32 (HCL) which is intended to serve as a measurement for hypomanic symptoms, a three part questionnaire that had the participants recall memories of CM, the Altman Self-Rating Mania Scale (ASRM) where respondents were asked to complete a five item scale ranging from 0-4, and the Bochumer Screeningbogen Bipolar (BSB) which is a German self-report scale with 17 items that examined hypomania, depressive symptoms, and general symptoms such as anxiety and emotional instability.
The outcome of this research proved there was a connection between bipolar disorder and CM but in specific ways. It was concluded that manic and hypomanic symptoms were not directly associated with recalling past abusive experiences, but depressive symptoms in bipolar disorder were clearly higher among those who reported some form of abuse in early life. Interestingly so, it was found that participants with reports of emotional abuse in childhood had high depression scores with women being the gender most affected (Haussleiter and Neumann et al, 2020).
The Biological Component of Bipolar Disorder and Sleep Disturbances
Now that we’ve touched base on some studies that demonstrate the relationship between different mood disorders and childhood trauma, we’ll go a little bit further into the biological component of it all. There are various biological factors that play in tandem between mood disorders and CM. So many in fact that it would be virtually impossible to discuss all of them unless you’re willing to read through another twenty to thirty pages or so. So in regard to diligent research, scientific backing, and time sensitivity, let’s go over a couple of them.
Neuroplasticity mechanisms such as BDNF are responsible for the growth and differences of neurons during brain development. If you didn’t know, BDNF stands for brain-derived neurotrophic factor. BDNF is pivotal when it comes to the reorganization and growth of neurons, so much so that it plays a key role in memory and learning (Bathina and Das, 2015). There has actually been shown to be a reduction in BDNF for those who were exposed to traumatic events with bipolar disorder (Aas and Henry et al, 2016).
Sleep disturbances have also been observed in people diagnosed with bipolar disorder. The International Journal of Bipolar Disorders has stated that in the general public, child abuse in all its forms is a risk factor for adult sleep disorders. This is explained by the circadian system’s biological response to stress and stimuli (Aas and Henry et al, 2016).
PTSD, Memory, and Dissociation
Child maltreatment in every one of its forms is a risk factor for developing mental and cognitive conditions that can negatively impact the psyche. A disorder commonly seen in survivors is post-traumatic stress disorder (PTSD). The American Psychiatric Association defines PTSD as a psychiatric disorder that causes flashbacks, nightmares, or overwhelming feelings of emotions after experiencing a traumatic event. To give you a better idea of its prominence in relation to CM, 22% to 49% of those who report childhood abuse fulfil criteria for a lifetime diagnosis of PTSD (Oprel and Hoeboer, 2018).
To dive back into the biological component even more, there are some things to be considered while looking at the association between CM and the development of PTSD. What we’ll be focusing on here is child sexual abuse (CSA). What many people don’t know is that there are biological changes in the brain that can become physically apparent after repeated sexual abuse.
To further elaborate, a number of neurohumoral and neurotransmitter effects can be triggered which can then produce a multitude of alternations in the function and structure of the brain. The areas that are mainly affected by this mechanism include the hippocampus, amygdala, corpus callosum, cerebral cortex and cerebellar vermis. This can explain the difficulty in memory recollection that survivors may face considering the reduced number of synapses (a synapse is a junction of nerve cells where signals are relayed to one another) in the hippocampal region (the hippocampus is where memories are stored in the brain) (Wiesel and Bechor, 2018).
This type of brain alteration can also explain the dissociative symptoms survivors of CSA may endure. In case you didn’t know, dissociative symptoms can include amnesia, depersonalization, derealization, identity confusion, and identity alterations (Sar, 2014). It’s not unheard of for these symptoms to be found in survivors of CM. Additionally, the excessive amygdala activation (the amygdala is situated in the temporal lobe and is where emotions are given meaning) which may occur from these brain alterations is found to be crucial in the development of PTSD (Wiesel and Bechor, 2018).
Why It Matters
The trauma doesn’t end when a survivor ages or leaves an abusive situation. It’s normal, and even likely that the experiences they lived through will leave imprints of the past. Sometimes those imprints carry into the mental well being of a survivor, and bring forth new trials and tribulations not easily seen at a simple glance.
Our purpose here at The Humanity Preservation Foundation is to bring light to the abuse that is far too common, while also bringing light to the potential after-effects it may cause. By no means is everything mentioned above all-inclusive. There are varying ways child maltreatment can express itself in adulthood. Although some survivors show no severe lasting effects from prior abuse, others experience mental symptoms more sinister. In some cases survivors may even exhibit symptoms of eating disorders and substance abuse.
This is the relentless truth survivors face in the wake of their trauma. Their mental states are always valid even when they are no longer living in direct abuse. Consider checking back soon to learn more about how food disorders and substance use can be related to adverse childhood experiences. By educating one another on these essential topics we make the world a more compassionate, open, and accepting place for all survivors to become thrivers.
Resources
Aas, M. A., Henry, C. A., Andreassen, O. A., Bellivier, F. A., Melle, I. A., & Etain, B. A. (2016). The Role of Childhood Trauma In Bipolar Disorders. International Journal of Bipolar Disorders, 4. doi:10.1186/s40345-015-0042-0
Bathina, S. N., & Das, U. N. (2015). Brain-Derived Neurotrophic Factor and Its Clinical Implications. Archives of Medical Science, 11(6), 1164-1178. doi:10.5114/aoms.2015.56342
Brühl, A., Kley, H., Grocholewski, A., Neuner, F., & Heinrichs, N. (2019). Child Maltreatment, Peer Victimization, and Social Anxiety In Adulthood: A Cross-Sectional Study In A Treatment-Seeking Sample. BMC Psychiatry, 19. doi:10.1186/s12888-019-2400-4
Child Maltreatment. (2020, June 8). Retrieved March 15, 2021, from https://www.who.int/news-room/fact-sheets/detail/child-maltreatment
Haussleiter, I. S., Neumann, E. S., Lorek, S. S., Ueberberg, B. S., & Juckel, G. S. (2020). Role Of Child Maltreatment and Gender For Bipolar Symptoms In Young Adults. International Journal of Bipolar Disorders, 8. doi:10.1186/s40345-019-0173-9
Iram Rizvi SF & Najam, N. (2014). Parental Psychological Abuse Toward Children and Mental Health Problems In Adolescence. Pakistan Journal of Medical Sciences, 30(2), 256-260. PMID: 24772122; PMCID: PMC3998989
Klumparendt, A., Nelson, J., Barenbrügge, J., & Ehring, T. (2019). Associations Between Childhood Maltreatment and Adult Depression: A Mediation Analysis. BMC Psychiatry, 19. doi:10.1186/s12888-019-2016-8
Lev-Wiesel, R., Bechor, Y., Daphna-Tekoah, S., Hadanny, A., & Efrati, S. (2018). Brain and Mind Integration: Childhood Sexual Abuse Survivors Experiencing Hyperbaric Oxygen Treatment and Psychotherapy Concurrently. Frontiers in Psychology, 9. doi:10.3389/fpsyg.2018.02535
Oprel, D. A., Hoeboer, C. M., Schoorl, M., Kleine, R. A., Wigard, I. G., Cloitre, M., Van Minnen, A., Van Der Does, W. (2018). Improving Treatment For Patients With Childhood Abuse Related Posttraumatic Stress Disorder (IMPACT study): Protocol For A Multicenter Randomized Trial Comparing Prolonged Exposure With Intensified Prolonged Exposure And Phase-Based Treatment. BMC Psychiatry, 18(385). doi:10.1186/s12888-018-1967-5
Şar, V. (2014). The Many Faces of Dissociation: Opportunities for Innovative Research in Psychiatry. Clinical Psychopharmacology and Neuroscience, 12(3), 171-179. doi:10.9758/cpn.2014.12.3.171
Torres, F. (2020, August). What Is Posttraumatic Stress Disorder? Retrieved March 15, 2021, from https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd
website URLS
https://www.who.int/news-room/fact-sheets/detail/child-maltreatment
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343339/
https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-019-2400-4
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4697050/
https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-015-0042-0
https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-018-1967-5
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4293161/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3998989/
https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd
Leave A Comment