The effect of parental emotional abuse on the severity and treatment of PTSD symptoms in children and adolescents

Types of childhood maltreatment as predictors of posttraumatic stress disorder severity and complex posttraumatic stress disorder in patients with substance use disorders

Background: Childhood maltreatment (CM) can be divided into: emotional abuse (EA), physical abuse (PA), sexual abuse (SA), emotional neglect (EN), and physical neglect (PN). CM is associated with (Complex)Posttraumatic stress disorder (PTSD/CPTSD) and substance use disorder (SUD).Objective: This cross-sectional study examined the relationships between CM-subtypes with PTSD-severity and CPTSD in patients with SUD-PTSD.Method: Participants (N = 209) were treatment-seeking SUD-PTSD patients who completed the Childhood Trauma Questionnaire-short form, the Clinician-Administered PTSD Scale for DSM-5 and the International Trauma Questionnaire. Regression analyses and a model selection procedure to select an optimal model were used to examine CM-subtypes as predictors of (C)PTSD, adjusted for sex and age.Results: Total CM and all CM-types significantly predicted PTSD-severity in the univariate regression analysis, with EA begin the strongest predictor. In the multiple regression only SA predicted PTSD-severity. Subsequently, model selection indicated that the optimal model to predict PTSD-severity included EA and SA. In the univariate analyses total CM, EA, and PN significantly predicted CPTSD-classification, and total CM and all CM-types significantly predicted CPTSD-severity. In the multiple regression for CPTSD-classification only EA and PA were significant predictors and for CPTSD-severity EA, PA and SA were significant predictors. In post-hoc multiple regression analyses, only EA was a significant predictor of CPTSD-classification and CPTSD-severity. Finally, in the model selection the most parsimonious model only included EA for both CPTSD-classification and CPTSD-severity. Sex was not a moderator in the relationship between CM and PTSD, nor in CM and CPTSD.Conclusions: These findings indicate that for SUD-PTSD patients, several CM-types have predictive value for (C)PTSD-severity, however SA and especially EA appear to contribute to these complaints. Since EA does not constitute an A-criterion, it is generally more overlooked in PTSD treatment. Its impact should therefore be underlined, and clinicians should be attentive to EA in their treatment.

Interpersonal trauma, shame, and substance use: A systematic review

BACKGROUND

Interpersonal trauma is a risk factor for a wide array of adverse mental health outcomes, including substance use. Research has begun investigating the role of shame in the intersection between substance use and interpersonal trauma. The current systematic review summarizes the existing literature documenting the relation among shame, substance use, and interpersonal trauma.

METHOD

Articles were collected using a Boolean search strategy of terms related to interpersonal trauma, substance use, and shame across six databases. Independent search and screening by three researchers led to a final review of 27 articles, 15 of which were qualitative studies.

RESULTS

Findings highlight robust associations among shame, interpersonal violence, and substance use across varied samples. Findings emphasize that increased shame is associated with greater substance use among survivors of interpersonal violence and elevated shame and greater interpersonal violence are present among individuals who use substances given the high prevalence rates. Burgeoning research suggests that shame mediates the relationship between interpersonal violence and substance use.

CONCLUSION

Results from our review suggest that shame may be an important treatment target for individuals presenting with substance use and a history of interpersonal violence. Future studies, with longitudinal designs, are needed to parse out the temporal relation among shame, substance use, and interpersonal violence.

Do dimensions of childhood adversity differ in their direct associations with youth psychopathology? A meta-analysis

Growing evidence supports the unique pathways by which threat and deprivation, two core dimensions of adversity, confer risk for youth psychopathology. However, the extent to which these dimensions differ in their direct associations with youth psychopathology remains unclear. The primary aim of this preregistered meta-analysis was to synthesize the associations between threat, deprivation, internalizing, externalizing, and trauma-specific psychopathology. Because threat is proposed to be directly linked with socioemotional development, we hypothesized that the magnitude of associations between threat and psychopathology would be larger than those with deprivation. We conducted a search for peer-reviewed articles in English using PubMed and PsycINFO databases through August 2022. Studies that assessed both threat and deprivation and used previously validated measures of youth psychopathology were included. One hundred and twenty-seven articles were included in the synthesis (N = 163,767). Results of our three-level meta-analyses indicated that adversity dimension significantly moderated the associations between adversity and psychopathology, such that the magnitude of effects for threat (r's = .21-26) were consistently larger than those for deprivation (r's = .16-.19). These differences were more pronounced when accounting for the threat-deprivation correlation. Additional significant moderators included emotional abuse and youth self-report of adversity. Findings are consistent with the Dimensional Model of Adversity and Psychopathology, with clinical, research, and policy implications.

Investigating Trauma Symptomology as a Mediator of the Relationships Between Childhood Maltreatment and Sexual and Non-Sexual Delinquency

Maltreatment is a risk factor for both sexual and non-sexual delinquency. Little is known about how specific forms of maltreatment relate to the distinct offending outcomes. Though trauma symptoms have been associated with maltreatment and delinquency, the intervening role of trauma symptoms in pathways from maltreatment to offending is not well understood. The goal of the current study was to test social learning and general strain theory explanations for sexual and non-sexual delinquency in adolescence, exploring trauma symptoms as a mediator between the four major types of maltreatment and offending outcomes. Data were collected via surveys of 136 incarcerated youth at seven residential treatment and community corrections facilities in a Midwestern state. Confirmatory factor analysis (CFA) was used to establish a measurement model, and structural equation modeling was employed to test direct and indirect pathways from maltreatment to offending. Individual forms of maltreatment had differential relationships with offending outcomes, with neglect having a significant association with non-sexual delinquency, and sexual abuse having a significant direct relationship with sexual delinquency. Trauma symptomology did not mediate these relationships. Future research should explore developmentally appropriate proxies for measuring childhood trauma. Practice and policy should consider the role of maltreatment victimization history in the inception of delinquency behaviors, prioritizing therapeutic alternatives to detention and incarceration.

[Emotional Maltreatment of Children and Adolescents - Definitions, Prevalences, Risk Factors and Psychological Consequences]

The aim of this article is to provide an introductory overview of the phenomenon of emotional maltreatment of children and adolescents by presenting national and international literature and, in particular, to illustrate the consequences for the mental health of those affected. First, relevant definitions are made and forms of appearance of emotional child maltreatment are presented. A comparison of national and global prevalences shows that emotional child maltreatment is one of the most prevalent forms of child maltreatment. There are different risk factors that can exist at the level of the parents as well as at the level of the children or the environment. The risk that children and adolescents who have experienced emotional violence will have experienced other forms of childmaltreatment is high.There aremultiple consequences for victims of emotional child maltreatment which can result in different, longterm participatory impairments. Especially the psychological and somatic consequences of emotional childmaltreatment can be compared to the consequences of child sexual abuse and physical child maltreatment. Nevertheless, the significance of emotional maltreatment for affected children and adolescents is still underestimated in practice. Often, the effects of emotionalmaltreatment on those affected are not visible. Froma child and adolescent psychiatric/ psychotherapeutic perspective, the psychological consequences must therefore be clearly stated. Finally, there is a need for a broader understanding of emotional child maltreatment that also includes peer and sibling violence.

Stress and strain: a qualitative study into the impact of having relatives with addiction problems on students' health and daily lives

PURPOSE

To explore the impact of having relatives with addiction problems on students' health, substance use, social life, and cognitive functioning, and to establish possible contributions of the participants' gender, type of relationship, and type of addiction of the relative(s).

METHODS

A qualitative, cross-sectional study of semi-structured interviews with thirty students from a University of Applied Sciences in the Netherlands who had relatives with addiction problems.

RESULTS

Nine major themes were identified: (1) violence; (2) death, illness, and accidents of relatives; (3) informal care; (4) perception of addiction; (5) ill health, use of alcohol and illegal drugs; (6) financial problems; (7) pressured social life; (8) affected cognitive functioning, and(9) disclosure.

CONCLUSIONS

Having relatives with addiction problems severely affected the life and health of participants. Women were more likely to be informal carers, to experience physical violence, and to choose a partner with addiction problems than men. Conversely, men more often struggled with their own substance use. Participants who did not share their experiences reported more severe health complaints. It was impossible to make comparisons based on the type of relationship or type of addiction because participants had more than one relative or addiction in the family.

Cumulative trauma, adversity, and loss among juvenile justice-involved girls: Implications for health disparities

Adverse childhood experiences (ACEs) are social determinants of health that increase morbidity and mortality and are prevalent among juvenile justice-involved (JJI) youth. ACEs drive health-risk behaviors (e.g., substance use) that reflect maladaptive coping, increase arrest risk, and overlap with posttraumatic risk-seeking theoretically and reckless/self-destructive behaviors diagnostically. However, little is known, especially among girls, about cumulative developmental adversity burden distress (i.e., total cumulative/lifespan stressor reactivity, grief-specific and adversity-related symptoms, and adversity-driven maladaptive coping strategies by age 18) and associated health risk impacts. Therefore, we assessed (a) developmental adversity burden indicators capturing expanded ACEs (E-ACEs; reflecting cumulative losses and traumatic events), cumulative distress, and risk characteristics; (b) potential racial/ethnic differences in developmental adversity burden; and (c) predictors of maladaptive coping among 223 JJI girls. Participants averaged 15 E-ACEs, endorsing 61.0% of stressor reactivity reactions, 58.4% of cumulative grief-specific symptoms, 55.7% (avoidance) to 73.2% (arousal) of adversity-related symptoms, and 45.0% of adversity-driven maladaptive coping strategies. White JJI girls endorsed significantly higher stressor reactivity and maladaptive coping than Latina girls (e.g., 38.8% vs. 14.6% suicide attempts), ds = 0.56-0.71. Adaptive LASSO analyses of maladaptive coping highlighted primary contributions from stressor reactivity, arousal alterations (excluding reckless/self-destructive behaviors), and cognition/mood alterations but not E-ACEs, grief, avoidance, or intrusions. Participants reported high levels of all cumulative developmental adversity burden indicators (e.g., 81.6% reported reckless/self-destructive behaviors). Results support cumulative, adversity-informed, universal precautions and assessments. Further, emotion regulation interventions targeting stressor reactivity, cognition/mood alterations, and/or arousal alterations may be useful for JJI youth with maladaptive coping.

Complex post-traumatic stress disorder (CPTSD) of ICD-11 in youths with childhood maltreatment: Associations with age of exposure and clinical outcomes

BACKGROUND

Exposure to childhood maltreatment (CM) increases the risk of psychiatric morbidity in youths. The new Complex Post-Traumatic Stress Disorder (CPTSD) diagnosis captures the heterogeneity and complexity of clinical outcomes observed in youths exposed to CM. This study explores CPTSD symptomatology and its association with clinical outcomes, considering the impact of CM subtypes and age of exposure.

METHODS

Exposure to CM and clinical outcomes were evaluated in 187 youths aged 7-17 (116 with psychiatric disorder; 71 healthy controls) following the Tools for Assessing the Severity of Situations in which Children are Vulnerable (TASSCV) structured interview criteria. CPTSD symptomatology was explored by confirmatory factor analysis, considering four subdomains: post-traumatic stress symptoms, emotion dysregulation, negative self-concept and interpersonal problems.

RESULTS

Youths exposed to CM (with or without psychiatric disorders) showed greater internalizing, externalizing and other symptomatology, worse premorbid adjustment and poorer overall functioning. Youth with psychiatric disorder and exposed to CM reported more CPTSD symptomatology, psychiatric comorbidity and polypharmacy and earlier onset of cannabis use. Different subtypes of CM and the developmental stage of exposure differentially impact CPTSD subdomains.

LIMITATIONS

Small percentage of resilient youths was studied. It was not possible to explore specific interactions between diagnostic categories and CM. Direct inference cannot be assumed.

CONCLUSIONS

Gathering information on type and age of exposure to CM is clinically useful to understand the complexity of psychiatric symptoms observed in youths. Inclusion of the CPTSD diagnosis should increase the implementation of early specific interventions, improving youths' functioning and reducing the severity of clinical outcomes.

Eye movement desensitization and processing for adolescents with major depressive disorder: study protocol for a multi-site randomized controlled trial

BACKGROUND

Major depressive disorder (MDD) is one of the most common mental disorders in adolescence carrying a serious risk of adverse development later in life. Extant treatments are limited in effectiveness and have high drop-out and relapse rates. A body of literature has been published on the association between distressing/ traumatic experiences and development and maintenance of MDD, but the effectiveness of a trauma-focused treatment approach for MDD has hardly been studied. This study aims to determine the effectiveness of eye movement desensitization and reprocessing (EMDR) therapy as stand-alone intervention in adolescents diagnosed with MDD.

METHODS

This study will be a randomized controlled trial with two conditions: (1) EMDR treatment (6 sessions) and (2) waiting list condition (WL: 6 weeks, followed by EMDR treatment). First, participants receive a baseline measure after which they will be randomized. Participants will be assessed post-intervention after which the WL participants will also receive six EMDR sessions. Follow-up assessments will be conducted at 3 and 6 months follow-up.

STUDY POPULATION

In total, 64 adolescents (aged 12-18) diagnosed with a major depressive disorder (DSM-5) and identified memories of at least one distressing or traumatic event related to the depressive symptomatology will be included. Main study parameters/endpoints: Primary outcome variables will be the percentage of patients meeting criteria for MDD classification, and level of depressive symptoms. Secondary outcome measures include symptoms of PTSD, anxiety, and general social-emotional problems. At baseline, family functioning and having experienced emotional abuse or neglect will be assessed to explore whether these factors predict post-treatment outcome.

DISCUSSION

With the present study, we aim to investigate whether EMDR as a trauma-focussed brief intervention may be effective for adolescents with a primary diagnosis of MDD. EMDR has been proven an effective treatment for traumatic memories in other disorders. It is hypothesized that traumatic memories play a role in the onset and maintenance of depressive disorders. Particularly in adolescence, early treatment of these traumatic memories is warranted to prevent a more chronic or recurrent course of the disorder.

TRIAL REGISTRATION

International Clinical Trial Registry Platform (ICTRP): NL9008 (30-10-2020).

Physical and social trauma: Towards an integrative transdiagnostic perspective on psychological trauma that involves threats to status and belonging

Current theories of psychological trauma assume that posttraumatic symptoms originate from stress reactions caused by extremely adverse life experiences. Since the diagnosis of PTSD is restricted to events that involve threats to the physical or sexual integrity of a person, such as accidents and physical and sexual violence, these theories are not well suited to explain the psychopathological consequences of severe violations of one's social integrity, such as emotional abuse and bullying. However, it is evident that social threats contribute to a broad range of mental disorders and increase symptom severity in patients with posttraumatic stress disorder. The aim of the Physical and Social Trauma (PAST) framework is to extend current memory theories of psychological trauma to incorporate threats to a person's social integrity. Within this perspective, the harmful effects of events that involve social threats result from violations of core social motives such as the need for status and belonging that bring about intense affective reactions, including despair and defeat. Within associative threat structures, these emotions are tied to the stimulus characteristics of the experiences and can be re-activated in social situations. The resulting psychopathology transcends PTSD criteria and other current classifications and suggests a transdiagnostic perspective of psychological trauma. Implications for treatment and further directions for research are discussed.

Psychotherapeutic Change Mechanisms and Causal Psychotherapy: Applications to Child Abuse and Trauma

The study of change mechanisms in psychotherapy needs to be integrated with the causality of behavior, which leads to the concept of causal psychotherapy. Causal psychotherapy is posited as a useful adjunct to standard, evidence based psychotherapies for child and youth victims of abuse and trauma. The article illustrates six processes that could be involved in causal psychotherapy in this context, from the distal to the proximal. They include the distal mechanism of activation-inhibition coordination. The most proximal one relates to executive function. The intermediate levels include ones related to co-regulation (e.g., self control), analysis-synthesis, objectivity-subjectivity, and psychological reserve, which is a new concept in the domain of psychological change mechanisms. Each of the variables can vary from high to low, with the low end being more problematic. Psychotherapy can aim to bring the patient toward adaptive levels. The literature review focuses on psychotherapeutic change mechanisms, and standard psychotherapies for child/youth abuse/trauma, especially trauma-focused cognitive behavior therapy (TF-CBT). Then, it considers causal aspects of child/youth abuse and trauma, including PTSD. The discussion relates causal therapy to the question of unifying psychology and psychotherapy under the rubric of causality as a core integrative mechanism.

Differences in developmental problems between victims of different types of child maltreatment

This study examined differences in developmental problems between children who were victims of two child maltreatment dimensions: abuse versus neglect, and physical versus emotional maltreatment. Family demographics and developmental problems were examined in a clinical sample of 146 Dutch children from families involved in a Multisystemic Therapy - Child Abuse and Neglect treatment trajectory. No differences were found in child behavior problems within the dimension abuse versus neglect. However, more externalizing behavior problems (e.g., aggressive problems) were found in children who experienced physical maltreatment compared to children who experienced emotional maltreatment. Further, more behavior problems (e.g., social problems, attention problems, and trauma symptoms) were found in victims of multitype maltreatment compared to victims of any single-type maltreatment. The results of this study increase the understanding of the impact of child maltreatment poly-victimization, and highlight the value of classifying child maltreatment into physical and emotional maltreatment.

Association Between Early Trauma and Ideal Cardiovascular Health Among Black Americans: Results From the Morehouse-Emory Cardiovascular (MECA) Center for Health Equity

BACKGROUND

Early trauma (general, emotional, physical, and sexual abuse before age 18 years) has been associated with both cardiovascular disease risk and lifestyle-related risk factors for cardiovascular disease, including smoking, obesity, and physical inactivity. Despite higher prevalence, the association between early trauma and cardiovascular health (CVH) has been understudied in Black Americans, especially those from low-income backgrounds, who may be doubly vulnerable. Therefore, we investigated the association between early trauma and CVH, particularly among low-income Black Americans.

METHODS

We recruited 457 Black adults (age 53±10, 38% male) without known cardiovascular disease from the Atlanta, GA, metropolitan area using personalized, community-based recruitment methods. The Early Trauma Inventory was administered to assess overall early traumatic life experiences which include physical, sexual, emotional abuse, and general trauma. Our primary outcome was the American Heart Association Life's Simple 7, which is a set of 7 CVH metrics, including 4 lifestyle-related factors (smoking, body mass index, physical activity, and diet) and three physiologically measured health factors (blood pressure, total blood cholesterol, and blood glucose). We used linear regression models adjusting for age, sex, socioeconomic status, and depression to test the association between early trauma and CVH and tested the early trauma by household income (<$50 000) interaction.

RESULTS

Higher levels of early trauma were associated with lower Life's Simple 7 scores (β, -0.05 [95% CI, -0.09 to -0.01], P=0.02, per 1 unit increase in the Early Trauma Inventory score) among lower, but not higher, income Black participants (P value for interaction=0.04). Subtypes of early trauma linked to Life's Simple 7 were general trauma, emotional abuse, and sexual abuse. Exploratory analyses demonstrated that early trauma was only associated with the body mass index and smoking components of Life's Simple 7.

CONCLUSIONS

Early trauma, including general trauma, emotional abuse, and sexual abuse, may be associated with worse CVH among low-, but not higher-income Black adults.