Lecture 5: physical health consequences of child abuse and neglect Flashcards
Pathways by which abuse can influence health
- Behavioural pathways (harmful activities)
- Social pathways (attachment, stressful reactions)
- Cognitive pathways (maladaptive schema’s)
- Emotional pathways (depression, anxiety PTSD)
(1) Behavioural pathway
Abuse –> harmful activities .
Early life stress can cause the reward system to change or te be left undeveloped. This is a circuit that is involved in self-regulation and malfunction of this area can lead to impulsive behaviour (fastfood, drinking, smoking) and drugs use.
Mechanism: ELS –> low responsiveness to reward –> impulsivity –> unhealthy life-style —> negative health outcomes.
(2) Social pathway
Childhood abuse is related to increased stress response in social situation and to an avoidant attachment style, which can also cause social problems. This can lead to difficult social relations, less social support etc., which can influence physical health.
Social support: is a key buffer against stress.
Being married or cohabitating (social pathway)
Was correlated with:
- Lower morbidity and mortality rates.
- Lower cortisol response in stressful situations.
Study Trier Social Stress Test:
- Men showed lower cortisol response being supported by their spouse or just an other women.
- Women showed an increased cortisol response when verbally supported by their spouse, but not phyisically.
Soothing system of affective touch
Parenting is a very physical job and physical touch can help to sooth a child. There is a direct link of touch to the reduced activity of the amygdala (reduced stress response).
A massage can release oxytocin, which relieves stress.
Experiment: stroking a child with different paces. The heart-rate of the child was measured and it only decreased in the ‘regular’ stroking pattern. When people experience neglect, this system of affective touch may not be developed normally and they can be very unhabitated to touch.
(3) Cognitive pahtway
Maltreated people can develop maladaptive cognitive pathways, which can automatically get activated again in later life. Negative cognitions can be directly supplied to the child by the abuse (“you are worthless”) or indirectly (through for example sexual abuse).
Buffer to maladaptive cognitive pathways
Buffer: parental support can help to form healthy cognitive pathways, based on optimism, self-esteem mastery etc. When they experience a stressful event later in life, these positive cognitive pathways will be activated and can help in a stressful situation.
The nun study (optimism & longevity)
This study looked into nun’s positive emotions in early life and longevity (how long they lived), based on a writing when they started being a nun. The people who experienced the most positive emotions lived the longest.
(4) Emotional pathway
Mental disorders by themselves also increase the risk for physical illnesses.
- Depression predicts coronary heart disease and mortality due to an infarct.
- Anger predicts coronary heart disease and hypertension.
- The link between PTSD and depression may be mediated by: increased stress response, impact on immune system, poor self-regulation , and lack of sleep.
Early life stress and immune dysregulation (Danese & Lewis)
When a child grows up in a stressful environment, the HPA axis wil be programmed to be more prone to stressful situations in later life. This can lead to an overly activated immune system (and infection).
Indicators of an overly active immune system
- Higher levels of systemic inflammation (IL-6, TNF-a)
- Larger acute stress-induced increase in inflammatory markers and pro-inflammatory responses to microbial challenges.
- Resistance to inhibitory mechanisms designed to dampen inflammation.
These effects are increased by:
- Risk behavours
- Hormonal dysregulation of the HPA axis
- Negative social interactions
Telomeres
Protect the end of the chromosome from deterioration. Chromosome-ends shorten over time (everytime they duplicate due to aging).
Telomeres and stress
The more early life stress someone experiences, the shorter their telomeres are. Shorter telomeres is linked with a range of diseases:
- Cardiovascular diseases
- Heart diseases
Mediator of telomere length (in the study)
- Time may be a mediator. The longer the measurement was between the ELS and the measurement of telemore lengt, the smaller the effect –> time can have a mediating effect.
- Endurance of the ELS: was also found to be a mediator, with enduring stress (like enduring abuse) having the most profound effects on telomere length.
Positive early life experiences
Can potentially protect against telomere shortening and possibly also lengthen telomere length. These positive experiences can be:
- Sense of security
- Strong relationships with caregivers
- Having access to learning opportunities
- Felling loved and encouraged
