Lecture 7: psychological effects of childhood abuse (and neglect): diagnosis and treatment in adults

Question 1

Transdiagnostic perspective on the consequences of childhood maltreatment

Answer 1

Childhood maltreatment has varied symptoms:
- Under or over-regulation of affect
- Cognitive problems
- Interpersonal relationships problems
- Self-image problems
- Negative cognitions
- Somatisation

Question 2

Prevalence of PTSD

Answer 2

About 70% op people experience trauma in their lifetime, but only 7-9% develop PTSD. In childhood trauma this is higher:
- 50-80% of people who experienced childhood sexual abuse develop PTSD.
- 22-50% of the people who experienced childhood abuse develop PTSD.

Question 3

PTSD DSM criteria:

Answer 3

A. Experiencing a traumatic event
B. Reliving (key-symptom)
C. Avoidance
D. Negative thoughts and mood
E. Hyperactivity

Question 4

4 subtypes of PTSD

Answer 4

1. Hyperaroused PTSD
2. Dissociative PTSD
3. Delayed expression PTSD (takes a long time to develop symptoms after the traumatic event).
4. Complex PTSD: all normal symptoms + emotions regulation problems, interpersonal problems, negative self-concept.

Question 5

Comorbidity of PTSD

Answer 5

There is a lot of overlapt between PTSD and:
- Depressive disorders (50%)
- Anxiety disorders
- Substance abuse (20-40%0
- Personality disorders

Question 6

Emotional Processing Theory (Foa)

Answer 6

PTSD is developed to escape danger/ to anticipate on the current threat. This can be functional in the current environment. Fear is a cognitive structure that includes:
- Fear responses (physical)
- Meaning of stimuli (‘men are dangerous’)
- Cognitive responses (‘my increased heart-rate means that i’m afraid’)
This causes you’re brain to make certain associations (men = danger) because you are constantly alert to new dangers.

Question 7

Major depressive disorder (DSM-5 criteria)

Answer 7

A. Sadness or anhedonia (numbness of joy)
B. Loss of interest or pleasure
C. Other symptoms:
- Changes in appetite
- Changes in weight
- Sleep disturbances
- Fatigue
- Feelings of worthlessness or guilt
- Difficulty concentration

Question 8

Cognitive Model of Depression (Beck)

Answer 8

Depression is related to a cognitive vulnerability, which is related to negative schema’s about the world or the self. These negative cognitive thoughts are activated every time a person encounters a stressful life event, and can then cause negative self-inferences, dysfunctional attitudes and low self-worth. This can lead to symptoms of depression and anxiety.

! This is especially the case in emotional maltreatment, because negative cognitions are directly supplied to them.

Question 9

Shared etiology of different disorders related to childhood maltreatment

Answer 9

Comorbidity of disorders related to childhood maltreatment van be explained by:
- Genetic dispositions
- Neurobiological dispositions
- Psychological dispositions
- Environmental factors
This can lead to PTSD, which can then lead to cognitive and emotional processing problems, which can lead to comorbid disorders.

Dissociation is also often a comorbidity.

Question 10

Dissociation

Answer 10

Feelings of derealisation (not feeling connected to the outside world) and depersonalisation (not feeling connected to yourself). Dissociation can be a functional reaction to an overwhelming experience. But it can become a problem later in life.

Question 11

Diagnostics in clinical practice

Answer 11

Starts with case conceptualisation: a model that the psychologist makes for every patient, including:
1. History of the traumatic event
2. Underlying traits
3. Context (social)
4. Symptoms (in clusters)
5. Hypothesis about etiology

Question 12

How you start a conversation with your patients

Answer 12

You first look at:
1. Structural vulnerability: genetics, history, trauma, childhood.
2. Convictions/ beliefs/ personal characteristics: image of self/other, coping mechanisms, world view.
3. Problem selection: the consequences of the stress.

Question 13

Trauma-focused treatment

Answer 13

A lot of evidence for therapy was conducted with participants who didn’t experience childhood trauma, because it was a too complex group. Now there is growing evidence of trauma-focused therapy in patients with CA-PTSD.

Question 14

Prolonged exposure therapy

Answer 14

Focusses on the inhibition of the associations to the trauma, and learning new associations. The aim is to:
- Expose people to trauma memories and anxious sensations
- Challenge negative cognitions
- Learn new healthy associations
- Stop avoidance behaviours
- Violence harm expectancy (what you think will happen when you encounter a traumatic trigger).

–> Works through the anxiety network.

Question 15

Treatments of PTSD

Answer 15

• Exposure
• Virtual reality therapy
• Mindfulness
• MDMA

Question 16

Patients perspective and implementation

Answer 16

• Treatment options for seriously traumatised victims fall short.
• Only 39% of patients with PTSD receive TFT (trauma-focused-therapy?)
• Patients prefer TFT.
• Implementation research is sorely needed.