How can childhood trauma affect health?
We have all heard: "What doesn't kill you makes you stronger" and "time heals all wounds". Adversity can build character. Children trauma however affects our health as an adult, sometimes seriously. Infants and young children are the most vulnerable to trauma. The brain is developing in childhood, especially early. Severe trauma, early in childhood can have widespread impacts (Cozolino, 2002; Giarratano, 2004a). It can affect many systems of the body. These include the hormone, endocrine and immune systems. Trauma interrupts the ways these systems work together. This can make the child, and the adult very sensitive to later stress.
A number of pathways link childhood trauma and child abuse with adult health issues.
Safe and nurturing environments help children bond to their caregivers. This helps protect the child’s developing brain from stress. This is called secure attachment. Secure attachment with a caregiver help regulate a child’s level of arousal. This provides a balance between soothing and stimulation. Stimulation occurs during play, learning and exploration (Streeck-Fischer & van der Kolk, 2000). When secure, a stressed child can be comforted by their caregiver. This settles them so they can go off to learn and explore. This helps the child develop a framework for dealing with future stress.
Children who don’t have a secure base, learn that they can’t rely on their caregiver for comfort. This means that they struggle to calm themselves when threatened. If a child can’t regulate their emotional states, or rely on others to help them, their biological fight/flight/freeze response is repeatedly triggered.
When a child understands events, they can learn to regulate their emotions and respond flexibly. This involves both cognition (thought and understanding) and emotions. Our first caregiver relationship informs our expectations and patterns around behaviour. When our primary attachment is negative, it creates a negative model for relationships. This can affect a survivor's capacity to establish and sustain significant attachments throughout life.
Secure infants learn to rely on their emotions and thoughts. Children in abusive environments may learn to ignore what they feel (emotion) or perceive (cognition) (Streeck-Fischer & van der Kolk, 2000).
The following attachment styles are a guide. They occur in different combinations. They help explain the challenges child and adult survivors can have in relationships.
The caregiver of a child who is securely attached is consistent and responsible. This helps the child to feel safe and secure. They come to see other people as positively available. These children see themselves as lovable, valued and socially effective (Bowlby,1988). Adults with secure attachments can generally regulate their emotions and form and maintain ‘healthy’ relationships.
Children with ‘ambivalent attachments’ experience inconsistent, unreliable and emotionally neglectful parenting. This can cause the child to feel rejected and abandoned. The child often clings to their caregiver. They will sometimes exaggerate their emotions to connect to their caregiver at the times they are responsive. As an adult they may become clingy, jealous, obsessive, dependent and self-sacrificing. They are often very sensitive to being abandoned, rejected or isolated (Bowlby,1988).
Children who have ‘avoidant attachments’ experience hostile, rejecting and controlling parenting. They receive little warmth or love. This means that their emotional needs remain largely unmet. Their parents aren’t consistently rejecting. In fact they may respond positively to their child’s achievements. However they are often cold and unresponsive when the child needs help and nurture. The child holds back when they need something to avoid being rejected. This can make them overly self-reliant. As an adult they may struggle with intimacy. That’s because are not confident that the person will be available for them. The adult can be fiercely self-reliant. They can appear hostile and easily frustrated. Despite being anxious and distressed, they often deny their issues.
The primary caregiver of a child with disorganised attachment tends to be frightening and/or frightened with the child. This means the child is dependent on the person who is the source of their anxiety and fear. The child can’t regulate their emotions. They may dissociate when interacting with the parent. As adults they may see themselves as bad and flawed. They blame themselves for their trauma. They may experience significant distress, depression, and poor social adjustment.
Behavioural pathways link childhood trauma and adult health through behaviours. These include smoking, substance misuse, overeating, high-risk sexual behaviour, and suicidal behaviour (Draper et al., 2007). High-risk behaviours that are damaging to their health are common.
These high risk behaviours can be understood as 'coping strategies'. They are adopted in childhood, to manage rejection, betrayal and trauma. They are protective at first. Some become risky, and can damage health over time. The Adverse Childhood Experiences (ACE) Study showed the relationship between childhood coping strategies and the ‘symptoms’ of poor health later in life.
`(F)or example, those who experienced four or more types of adverse childhood experiences were more than seven times more likely to consider themselves to be an alcoholic, almost five times more likely to have used illicit drugs, and more than ten times more likely to have injected illicit drugs’ (Felitti et al, 1998, in Banyard et al, p.141)
`Symptoms’ can be understood as the offshoots of coping strategies. Much chronic disease and ill-health has roots in our development. It is important to recognise the short and medium term benefits of ‘risky behaviours in trauma survivors. The focus currently is often on the long term health impacts of problematic behaviours. This misses the importance of coping strategies to trauma.
The ACE Study `found a strong graded relationship between the numbers of different adversities experienced in childhood and every health risk behaviour studied, including cigarette smoking, obesity, physical inactivity, alcoholism, drug abuse, depression, suicide attempts, sexual promiscuity, and sexually transmitted diseases’ (Banyard et al, p.141) Some coping strategies are socially sanctioned e.g. rigorous exercise routines and extreme sports. They are still coping strategies.
Cognitive pathways include our beliefs and attitudes. These influence our daily lives. As children, survivors of childhood trauma have often been betrayed, manipulated and silenced by ‘trusted’ adult/s. This can affect their patterns of knowing, perceiving and reasoning.
Children who experienced serious trauma or abuse in childhood will often see themselves negatively (Ayoub et al, 2006). They might blame themselves for their trauma. They can also internalise abusive behaviours. These can become patterns of thinking, reasoning and perception into adulthood. They can affect self-esteem and identity (van Loon & Kralik, 2005b).
Cognitive pathways work with biological pathways. Children who have experienced trauma often have fight/flight responses to a threat. Because of the effects of trauma on higher brain function, they often can’t grasp what is happening. This means that can’t learn from the experience.
Childhood trauma and abuse can mean survivors expect or perceive the negative. This can relate to safety, trust, esteem, intimacy and control. Everyday interactions can set off the negative (Henderson, 2006).
People affected in this way can struggle to understand themselves and others. This can make it hard for them to get other people on side. They can see people in black and white - either as the source of terror or pleasure. They struggle to see that other people have their own needs and desires. Because they struggle to regulate their feelings, they often scare other children (and in time adults) away. This prevents them having interactions which could help them heal (Cozolino, 2002).
Because survivors are often hyperaroused they can struggle with uncertainty. They can avoid novelty, as flexibility is difficult. They often avoid social contact. This often miss developing the social skills contact can bring.
We develop seventy percent of our genetic structure after birth (Schore, 1994; cited in Cozolino, 2002). Experience shapes the structure of the brain. The brain organizes and internalizes new information when it needs to (Streeck-Fischer & van der Kolk, 2000, Perry et al., 1995). A child's interaction with the world facilitates connections between brain cells (McLean Hospital, 2000). The more often a child is hyper-aroused or dissociated, the greater the impact on the structure and function of the brain. Chronic fatigue syndrome (Heim et al., 2006), fibromyalgia and other chronic pain syndromes (Imbierowicz and Egle, 2003; Heim et al., 1998), functional gastrointestinal disorders (Drossman et al., 1990), and cardiovascular disease (Dong et al., 2004) are all associated with childhood trauma.