Trauma

Importance of Social Relationships in Mental Health

• Social relationships are essential for mental well-being.
• Maltreatment disrupts a child's ability to form and maintain relationships, leading to increased stress and loneliness.

How Trauma Affects a Child's Social World

• Maltreated children often experience social difficulties like peer rejection and bullying.
• They often have fewer social connections in childhood and adulthood.
• Maltreated children have a higher likelihood of stressful, conflict-prone relationships.
• The impacts of trauma can create a cycle of isolation and stress, increasing vulnerability to mental health disorders.

Two Pathways to Mental Health Problems

• Maltreated children are more likely to experience social stress like bullying and relationship conflicts.
• Learned responses to stress may unintentionally escalate conflicts.
• Social Thinning*
• Over time, maltreated individuals have fewer social connections and less support.
• Loneliness and isolation further increase mental health risks.

The Role of the Brain in Social Relationships

• Childhood trauma alters key brain systems that regulate social interactions.
• Threat System*
• The threat systems become overactive, leading to hypervigilance and misinterpretation of social cues as threats.
• Reward System*
• The reward systems become underactive, reducing motivation to seek positive social interactions.
• Memory System*
• Overgeneralized memory makes it harder to learn from past social experiences.
• These changes make social interactions more stressful and reinforce patterns of isolation.

Building a Supportive Social World for Children

• Changing Systems Around the Child*
• Schools and social services should prioritize stable relationships.
• Support systems for caregivers are essential.
• Children should have a voice in shaping their social environments.
• Changing Adult Thinking & Behavior*
• Recognize that a child's social difficulties stem from brain adaptations to trauma.
• Respond with curiosity and patience rather than frustration.
• Helping the Child Help Themselves*
• Teaching social skills can help children.
• Helping children process social experiences can help children.
• Supporting emotion regulation strategies can help children.

The Importance of Trust

• Maltreated children often struggle to trust others due to their past experiences hindering the ability to form supportive relationships.
• Maltreated children are more likely to perceive strangers as untrustworthy.
• Rebuilding trust is key to helping them develop healthier relationships.

Conclusion

• Childhood trauma disrupts social development and increases mental health risks.
• Brain changes are not fixed, and positive social environments can promote recovery.
• A coordinated effort across caregivers, educators, and policymakers is needed to support affected children.
• Relationships play a critical role in buffering trauma's effects and shaping long-term mental health outcomes.

Types of Trauma

• Traumatic Events*
• Involve actual or threatened physical/psychological harm to oneself or others, ranging from miscarriage to murder, divorce, violence, accidents, or medical treatments.
• Can include incidents where people instigate, perpetrate, fail to prevent, or witness actions violating their moral code.
• Type I Trauma*
• Single, well-defined, public traumatic incidents like natural disasters.
• Also referred to as "Simple Trauma”, “Single incident trauma”, “Acute Trauma"
• Type II Trauma*
• Series of related, sequential traumata like neglect, maltreatment, and sexual abuse, often carried out in secret by caregivers.
• May result in impaired personality development and heterogeneous psychopathological symptoms like dissociation and low self-efficacy.
• Also referred to as “Complex Trauma”, “Chronic Trauma”, “Developmental Trauma", "Attachment Trauma"
• Acute Trauma*
• A single traumatic event limited in time, such as a car accident or a single sexual assault.
• Chronic Trauma*
• The experience of multiple traumatic events like intimate partner violence or domestic violence.
• Complex Trauma*
• Exposure to chronic trauma and its impact on an individual.
• Common with early childhood experiences like physical or verbal abuse.
• Historical/Circumstances*
• Multi-generational trauma and communities experiencing oppression
• Can also include settings that systematically disempower individuals or include incarceration.

Situations, Contexts of Trauma

• Adverse Childhood Events (ACEs)
• Single Incident Trauma
• Chronic / Prolonged Trauma
• Repeated Trauma

Adverse Childhood Experiences (ACEs)

• The prevalence of Childhood Maltreatment and Household Challenges is common and they usually co-occur.
• Abuse*
• Type of ACE that includes: physical, emotional, and sexual abuse
• Neglect*
• Type of ACE that includes: physical and emotional neglect
• Household Dysfunction*
• Type of ACE that includes: mental illness, mother treated violently, divorce, incarcerated relative, and substance abuse

ACEs (Adverse Childhood Experiences)

• ACEs are associated with physical and mental health outcomes
• Behavior Outcomes*
• These include: lack of physical activity, smoking, alcoholism, drug use, and missed work
• Physical & Mental Health Outcomes*
• These include: severe obesity, diabetes, depression, suicide attempts, STDs, and heart disease

Trauma-Related Disorder

• Can be defined as a broad disorder relating to direct/indirect experiences of traumatic events.
• It can include distressing emotional, cognitive, and physiological reactions to an experience.
• It may mean the inability to cope effectively with one's own distressing reactions.
• It is related to a wide range of mental health difficulties including mood and conduct disorders or personality disorders.

Childhood PTSD

• Diagnosis is based on the same key symptom clusters as adult PTSD:
• Intrusion
• Avoidance
• Negative alterations of mood and cognition
• Hyperarousal (Fight/Flight mode)
• The majority of children and adolescents experience at least 1 traumatic event by adulthood
• However only a minority develop subsequent PTSD
• Symptoms may manifest differently for children than adults:
  • Intrusions: for children these may be present in play, including dissociative reactions → e.g. trauma re-enactment during play)
  • Dreams: there may be distressing dreams / nightmares but may not be possible to ascertain if content is related to trauma
  • Less focus on items requiring description of subjective experience
• Child's age and developmental stage, temperament, relationships, and cultural/social contexts are also important in determining the presence of a trauma.

Risk of PTSD Varies with Type of Trauma

• High degree of threat to life is most likely to trigger PTSD (natural disasters, traffic accidents, terror attacks, school shootings. (Metaanalysis (Trickey et al, 2012)
• Interpersonal violence, including rape, sexual assault and physical abuse by caregivers or romantic partners have highest risk of developing PTSD- between 30 to 70%.
• Exposure to war and conflict- 46%
• High rates for children displaced and living as refugees with child soliders

Child and Family Characteristics of Child/Family

• Girls are two to three times more likely to develop PTSD
• Children with history of other mental health difficulties are more likely to develop PTSD after a traumatic event
• Poor family functioning is a risk factor for PTSD
• Significant association between parent PTSD symptoms and child PTSD symptoms
• Children with great social support are less likely to develop PTSD.

Developmental Trauma

• Individuals who experience multiple traumas in childhood often do not meet criteria for PTSD
• Looked after children may not seek or receive diagnosis or service without recognition
• The use of Strengths and Difficulties Questionnaire can identify treatment needs

DTD - a new diagnosis

• Term defined to specify impact of multiple childhood traumas noting that the difficulties (and perhaps treatments required) differ from that following single traumatic incident.
• Included emotional and physiological dysregulation along with problems with conduct and attention.
• DTD was rejected for inclusion in the DSM-V
• However DTD concept has beenhugely influential
• It challenged the tradition of diagnostic categories being purely descriptive

Current Status of Developmental Trauma

• Widely used by CAMHS and Social Care professionals
• Tendency to favour trauma explanations over others?
• I.e. Neurodevelopmental?
• Popular and acceptable to advocacy and activist groups