Life adversities and Trauma Flashcards
What are the 2 ways to define trauma?
1) A distressing reaction
2) Exposure to events and circumstances
Trauma is a distressing reaction. What does this mean?
A distressing reaction resulting from adverse life experiences that exceed the person’s ability to cope in the short and long term
e.g. symptoms of ‘post-traumatic stress and related forms of psychological distress
Trauma is exposure to events and circumstances. What does this mean?
Exposure to events and circumstances that are experienced as harmful or life-threatening and that have lasting impacts on mental, physical, emotional and/or social well-being (and development in children/adolescence)
What are the 6 main types of trauma?
1) Big T traumas
2) Small t traumas
3) Childhood trauma (type 1 and type 2)
4) Complex childhood and developmental traumas
5) Social trauma
6) Historical trauma
What are Big T traumas?
Traumas involving major distressing life events, experiences of interpersonal violence
e.g. trauma from rape or domestic violence
What are small t traumas?
Traumas involving more common events that still have the potential to negatively impact individuals’ mental health and wellbeing
What is childhood trauma type 1?
Trauma involving witnessing or experiencing a single event such as a serious accident or rape
What is childhood trauma type 2?
Trauma resulting from repeated exposure to extreme external events, such as ongoing sexual abuse
What are childhood and developmental trauma?
Trauma resulting from bullying, gang culture, sexual assault, homicide, war, abuse, neglect, abandonment and family separation
What is social trauma?
Trauma involving inequality, marginalisation, racism and poverty
What is historical trauma?
Trauma resulting from violence committed against entire groups, including slavery, genocide and the Holocaust
True or False?
Trauma can only be a single event
False
Trauma can be a single event or multiple events occurring over time
Traumas involving major distressing life events, experiences of interpersonal violence
e.g. trauma from rape or domestic violence
This is known as…?
Big T traumas
Traumas involving more common events that still have the potential to negatively impact individuals’ mental health and wellbeing
This is known as…?
Small t traumas
Trauma in childhood involving witnessing or experiencing a single event such as a serious accident or rape
This is known as…?
Type 1 childhood trauma
Trauma resulting from repeated exposure to extreme external events, such as ongoing sexual abuse
This is known as…?
Type 2 childhood trauma
Trauma resulting from bullying, gang culture, sexual assault, homicide, war, abuse, neglect, abandonment and family separation
This is known as…?
Complex childhood and developmental traumas
Trauma involving inequality, marginalisation, racism and poverty
This is known as…?
Social trauma
Trauma involving violence committed against entire groups, including slavery, genocide and the Holocaust
This is known as…?
Historical trauma
What are the 4 factors that could contribute to the development of mental health difficulties?
1) Traumatic experiences are repeated or prolonged
2) When traumatic experiences are difficult or impossible to escape
3) When traumatic experiences are interpersonal (they involve people close to the person or meaningful others)
4) When one experiences multiple traumatic experiences (different adverse life experiences) or when traumatic experiences occur at critical stages of development (e.g. childhood, adolescence and ‘life transitions’)
What happened in the study on Romania’s abandoned children?
1) Under Ceausescu’s rule, contraception and abortion for women under the age of 45 were banned
2) Ceausescu demanded a minimum of five children per family to boost Romania’s population and fuel the economy
3) This led to huge numbers of abandoned children
4) In January 1990, reporters covering the collapse of the communist regime in Romania stumbled across a long-hidden story: 600 state-run orphanages, filled with abandoned children (around 100.000 children)
5) In the hope of joining the EU, in 2006/2007 Romania began closing orphanages or turning them into smaller foster homes
Who investigated the lasting impact of neglect?
Fox et al.
What did Fox et al. do in their study of investigating the lasting impact of neglect?
1) Project assessed 136 children (age from 6 months to 3 years) who had been living in Bucharest’s institutions from birth
2) Then they randomly assigned half of the children to Romanian foster families, and the other half remained in care as usual
3) They also evaluated a control group of local children who had never lived in an institution
What did Fox et al. discover about the lasting impact of neglect?
1) Institutionalized children had delays in cognitive function, motor development and language. They showed deficits in socio-emotional behaviours and experienced more psychiatric disorders. They also showed changes in the patterns of electrical activity in their brains (as measured by EEG)
2) While children in foster homes achieved notable improvements, they still lagged behind the control group of children who had never been institutionalized.
3) Those removed from the institutions before age 2 made the biggest gains; highest chance of improving their cognitive abilities (brain plasticity)
4) When children were moved into foster care before their second birthdays, by age 8 their brains’ electrical activity looked no different from that of community controls
Who investigated the neurodevelopmental impact of neglect in childhood?
Perry
What is the difference between a 3-year-old with severe sensory deprivation neglect’s brain and a healthy 3-year-old’s brain?
The child with severe sensory deprivation has a brain that is significantly smaller (3rd percentile) than average (50th percentile) and has enlarged ventricles and cortical atrophy.
Sensory neglect in early childhood is associated with…?
Abnormal brain development
Children were placed in foster care at different ages (ages 8 months to 5.7 years) and one year later re-evaluated.
Their frontal-occipital circumference was measured and compared to same-aged norms
What happened to their improvement after a year of foster placement?
It started to decrease such that children removed after four years in the neglectful setting had no statistically-significant improvement one year later
The degree of recovery over a year period was proportional to the age at which the child was removed from the neglecting caregivers
True or False?
False
The degree of recovery over a year period was inversely proportional to the age at which the child was removed from the neglecting caregivers
The earlier in life and the less time in the sensory-depriving environment, the (………) the recovery
More robust
A set of 10 traumatic events or circumstances occurring before the age of 18 is known as?
Adverse Childhood Experiences (ACE)
What is Adverse Childhood Experiences (ACE)?
A set of 10 traumatic events or circumstances occurring before the age of 18
Experiencing Adverse Childhood Experiences (ACE) results in…?
Increasing the risk of adult mental health problems and debilitating diseases
There are 10 total ACE categories.
5 are known as …? and the other 5 are known as…?
5 ACE categories are forms of child abuse and neglect (known to harm children and are punishable by law)
The other 5 represent forms of family dysfunction that increase children’s exposure to trauma
What are the 10 categories of ACEs?
- physical abuse
- sexual abuse
- psychological abuse
- physical neglect
- psychological neglect
- witnessing domestic abuse
- having a close family member who misused drugs or alcohol
- having a close family member with mental health problems
- having a close family member who served time in prison
- parental separation or divorce on account of relationship breakdown
Who conducted the ACE study?
Felitti et al.
What did Felliti et al. do in the ACE study?
Presented a connection between adverse childhood experiences and experiences in adulthood
9,508 Americans completed an ACE questionnaire as part of routine medical evaluation
7 categories of ACE were studied (psychological, physical or sexual abuse, violence against the mother, or living with family members who were substance abusers, mentally ill or suicidal, or ever imprisoned)
What did Felliti et al. discover in the ACE study?
1) More than half of respondents (52%) experienced at least 1 category of adverse childhood experiences
2) Approximately a quarter reported at least two ACE exposure
3) 6.2% of respondents reported ≥ 4 exposures
To conclude = The more traumatic adverse childhood experience one has, the more difficult one’s adulthood seemed to be
Adverse childhood effects are associated with what?
Associated with a graded/dose response to many adverse health outcomes
A relationship that suggests that for
each increase in the ‘dose’ of a risk factor, there is a corresponding increase in the probability of developing a certain condition or problem
This is known as…?
Graded / dose-response relationship
What is graded / dose-response relationship?
A relationship that suggests that for
each increase in the ‘dose’ of a risk factor, there is a corresponding increase in the probability of developing a certain condition or problem
When is graded / dose-response relationship important?
When we are trying to establish potentially causal relationships
Many studies have shown that people with greater ‘doses’ of ACE (e.g. > 4) are …?
At considerable heightened risk for a range of health outcomes
How common are adverse (potentially traumatic) childhood life experiences in England?
The English Adverse Childhood Experiences (ACE) study by Bellis et al conducted a national household survey with nearly 4,000 participants (aged 18-69 years) from across England in 2013
Results:
- Nearly half (47%) of respondents reported at least 1 adverse childhood life experience
- Approximately 1 in 10 people (9%) reported four or more adverse childhood life experience
How common are adverse (potentially traumatic) childhood life experiences in Wales?
The Welsh Adverse Childhood Experiences (ACE) study by Public Health Wales presented a representative survey of Welsh households with 2000 participants (aged 18-69 years) with comparable results to the English ACE study
Results:
- Nearly half (47%) of respondents reported at least 1 adverse childhood life experience
- 13% report four or more adverse childhood life experience
What are the 3 factors that impact adverse experiences/circumstances?
1) Biological
2) Psychological
3) Social
The impact of adverse experiences/circumstances can be biological. What does this mean?
- ACE can impact one’s sensitivity to stress
- ACE can affect your biological makeup due to stress and stop your natural growth/development and biological processes to prepare for a fight or flight response
- ACE can also impact key brain areas involved in emotion and stress regulation (frontal cortex, amygdala) and memory (hippocampus) etc
The impact of adverse experiences/circumstances can be psychological. What does this mean?
- ACE may lead to negative beliefs about self, others and the world
- ACE may lead to one’s sense of threat
- ACE may lead to ‘Maladaptive’ thinking styles (rumination and worry) etc
The impact of adverse experiences/circumstances can be social. What does this mean?
- ACE may lead to difficulties in relationships
- ACE may lead to a lack of social support
- ACE may lead to reduced access to opportunities (education, work etc.) etc
What have governments done to aid individuals with ACEs?
Governments have increased their investment in activities aimed at preventing or reducing ACEs
What has the US state of California recently done to aid individuals with ACEs?
The US state of California has recently (2020) committed $ 95 million to implement state-wide ACE screening through GP services.
What is the UK planning to do to aid individuals with ACEs?
In the UK, the government is implementing training in trauma-informed care for a wide variety of frontline workers
In the UK, the government is implementing training in trauma-informed care for a wide variety of frontline workers
What is this for?
To understand where one’s difficulties started from
Healthcare professionals aim to consider the childhood backgrounds of individuals when diagnosing them rather than just their symptoms
What did the UK house of commons propose in 2018 to aid individuals with ACEs?
House of Commons science and technology committee inquiry was held to examine the evidence linking ACEs to poor adult outcomes and to consider the role of early intervention in preventing and reducing ACEs
House of Commons science and technology committee inquiry was held to examine the evidence linking ACEs to poor adult outcomes and to consider the role of early intervention in preventing and reducing ACEs
What did the committee conclude?
There was a clear correlation between suffering adversity in childhood and experiencing further negative outcomes in later life
True or False?
There is a clear correlation between suffering adversity in childhood and experiencing further negative outcomes in later life
True
In 2018, the house of commons science and technology committee concluded that there was a clear correlation between suffering adversity in childhood and experiencing further negative outcomes in later life
What did they recommend the government to do?
They recommended that the government ensure that it is making the most of the opportunity for early intervention to effectively and cost-effectively address childhood adversity and trauma, and the long-term problems associated with such experiences
Why is it important to identify and tackle Adverse Childhood Experiences early?
To prevent or reduce difficulties in later life and to minimise the effect of ACEs in adulthood
True or False?
Exposure to 4 or more adverse childhood experiences significantly decreases the likelihood of a person engaging in health-harming behaviours
False
Exposure to 4 or more adverse childhood experiences significantly increases the likelihood of a person engaging in health-harming behaviours
Who claimed that exposure to 4 or more adverse childhood experiences significantly increases the likelihood of a person engaging in health-harming behaviours?
Felitti et al.
How many times more likely will exposure to 4 or more adverse childhood experiences result in engaging in sexual risk behaviours and having sexually transmitted infections?
2.5x more likely
How many times more likely will exposure to 4 or more adverse childhood experiences result in attempted suicide?
12 x more likely
How many times more likely will exposure to 4 or more adverse childhood experiences result in becoming addicted to alcohol?
7x more likely
How many times more likely will exposure to 4 or more adverse childhood experiences result in using illicit drugs?
5 x more likely
ACEs are associated with physical health and leading causes of mortality (Felitti et al 1998). They are associated with the increased risk of…? (List 5 physical health problems)
1) Physical inactivity and severe obesity
2) Ischemic heart disease
3) Cancer
4) Chronic lung disease
5) Skeletal fractures
True or False?
Increased risk of physical health problems is due to engaging in high-risk behaviours only
False
Increased risk of physical health problems is due to a combination of engaging in high-risk behaviours but also physiological responses to chronic stress (especially at key stages of development)
How many times more likely are people more likely to be smokers if they had been exposed to 4 or more ACEs?
3x more likely
How many times more likely are people likely to binge drink and have a poor diet if they had been exposed to 4 or more ACEs?
2x more likely
How many times more likely are people likely to engage in sex before age of 16 years old if they had been exposed to 4 or more ACEs?
5x more likely
How many times more likely are people likely to have had or caused an unplanned teenage pregnancy if they had been exposed to 4 or more ACEs?
6x more likely
How many times more likely are people likely to have been involved in violence in the past year if they had been exposed to 4 or more ACEs?
7x more likely
How many times more likely are people likely to have used heroin/crack or been incarcerated if they had been exposed to 4 or more ACEs?
11x more likely
6 ACEs can lead to premature morbidity of (….) years
20
Are coping strategies for ACEs good for the most part?
Only good in the short-term as coping strategies are developed to relieve distress temporarily (eg, smoking, drugs and alcohol)
But repeated use becomes health-harming and the disease burden increases.
What happens when we repeatedly use coping strategies of ACEs?
Repeated use of coping strategies becomes health-harming and the disease burden increases.
Repeated use of coping strategies becomes health-harming and the disease burden increases
Why is this?
The brain adapts to the threat and fear in the environment
Learning at school becomes impossible due to heightened physiological arousal and hypervigilance to threat
The brain adapts to the threat and fear in the environment
What systems does this impact?
This has a cumulative impact and leads to an excessive load on the immune and hormonal systems
It leads to uninterrupted exposure to toxic stress in childhood
Describe the 6 stages of the ACEs Life Course pyramid
1) ACEs- Adverse Childhood Experiences
2) Impact on nervous, hormonal and Immune function/development
3) Develop Social, Emotional and Learning Problems
4) Adopt Health Harming Behavior’s and Crime
5) Non-Communicable Disease, Disability, Social Problems, Low Productivity
6) Reduced lifespan
True or False?
Anyone exposed to or experiencing ACE will engage in these health-harming behaviours.
False
There are ways to remove children from harmful environments early
Also, each person has their own coping mechanism and deals with traumatic childhood experiences differently; one might cope better than others
True or False?
The majority of individuals with experience of ACE can adapt and cope quite well with these experiences
True
Do ACEs have weak associations or strong associations with the risk of developing ‘common’ mental health difficulties?
Strong associations
What are “common” mental health difficulties associated with ACEs?
- Anxiety
- Depression
- Suicidality
- Self-harm
- Drug and alcohol addictions
- EDs
True or False?
Exposure to life adversities in childhood increases the risk for psychosis
True
On average, people exposed to childhood adversities are (…..) times more likely to develop psychosis, but the risk (decreases/increases) if they have experienced multiple life adversities
1) 3 times
2) Increases
What further increases the development of psychosis, other than childhood adversities?
If one has experienced multiple life adversities
Up to (…….) of cases of psychosis could be attributable to the impact of childhood adversities
a. 1/2
b. 1/4
c. 1/3
d. 1/5
c. 1/3
What are psychiatrical views on the relationship between ACEs and the risk of developing severe mental health difficulties?
Psychiatry has been very resistant about the idea that there is a link between ACE and trauma and the risk of developing severe mental health difficulties such as psychosis.
People exposed to 1 type of childhood trauma (e.g. sexual abuse) were (…..) times more likely to have experienced psychosis
2.5x more likely
People exposed to 5 types of childhood trauma (e.g. sexual abuse, physical abuse, neglect) were (…….) times more likely to have experienced psychosis
53x more likely
The relationship between childhood adversities and psychosis is weak
True or False?
False
The relationship between childhood adversities and psychosis is as strong as the link between smoking and lung cancer
People with bipolar disorder are (…..) more likely than “controls” to report (……….) in general
1) 2.5x
2) Childhood adversities
People with bipolar disorder are (……..) more likely to report childhood emotional abuse
4x
People with borderline personality disorder are (…….) more likely than “controls” to report (……) in general
1) 13x
2) Childhood adversities
People with borderline personality disorder are (…….) more likely to report childhood emotional abuse and sexual abuse
38x
Unfair treatment or negative attitudes towards different categories of people (based on age, gender, race, religion, disability, sexual orientation, amongst others)
This is known as…?
Discrimination
Define discrimination
Unfair treatment or negative attitudes towards different categories of people (based on age, gender, race, religion, disability, sexual orientation, amongst others)
Which type of discrimination abuse affects mental health?
Overt abuse (e.g. racial abuse; hate crimes) and also more ‘subtle’ (implicit bias) but damaging forms of singling out members of minorities (e.g. limited access to social resources)
True or False?
Individuals belonging to a majority group have an elevated risk for mental health difficulties
False
Individuals belonging to minority groups have an elevated risk for mental health difficulties
Exposure to discrimination is linked with (……………..) in minority groups
Many physical and mental health conditions
(Lower/Higher) rates of psychosis have been consistently found among minority groups such as immigrants, ethnic minorities and non-heterosexual individuals
Higher
Why are minority groups more likely to experience an increased risk for psychosis?
Due to greater levels of life adversities that members of these groups face in their daily lives (and the inability to access mainstream assistance due to discrimination)
A review of 24 different studies found that minority discrimination is linked to (decreased/increased) risk for psychosis, with stronger links for (……….)
1) Increased
2) Specific psychotic experiences (paranoia)
Greater exposure to discrimination may be associated with (……………) in a dose-response fashion.
A greater risk for psychosis
What are the important predictors of physical health and psychological well-being globally?
Poverty and social deprivation
What is social inequality?
Unequal opportunities and rewards for different social positions or statuses within a group or society
Unequal opportunities and rewards for different social positions or statuses within a group or society
This is known as…?
Social inequality
What is emerging as a more robust predictor of health and well-being?
Social inequality
What is the unequal distribution of wealth and social resources in a given population correlated with?
The incidence of many mental health issues
Is the prevalence of mental illness higher is countries with more unequal wealth distributions or countries with less unequal wealth distributions?
Countries with more unequal wealth distributions (countries with a larger economic gap)
What can buffer or counteract the impact of life adversities (i.e. resilience / protective factors)?
Positive life experiences and relationships across the lifespan
How can positive life experiences and relationships across the lifespan help an individual overcome or cope with ACEs?
They can buffer or counteract the impact of life adversities (i.e. resilience / protective factors)
Access to (……………..) can help survivors even after they have developed mental health problems as a result of life experiences and circumstances
Corrective experiences
ACE = Physical abuse
What is the counter-ACE in this situation?
Liking school
ACE = Verbal abuse
What is the counter-ACE in this situation?
Teachers who care
ACE = Sexual abuse
What is the counter-ACE in this situation?
Opportunities to have fun
ACE = Physical neglect
What is the counter-ACE in this situation?
A predictable home routine
ACE = Emotional neglect
What is the counter-ACE in this situation?
A predictable home routine
ACE = An alcoholic parent
What is the counter-ACE in this situation?
Feeling comfortable with yourself
ACE = A family member in jail
What is the counter-ACE in this situation?
Feeling comfortable with yourself
ACE = The disappearance of a parent through divorce, death or abandonment
What is the counter-ACE in this situation?
Having a caregiver whom you feel safe with
ACE = A family member diagnosed with mental health illness
What is the counter-ACE in this situation?
Beliefs that provide comfort
ACE = A mother who’s a victim of domestic violence
What is the counter-ACE in this situation?
Having good friends and neighbours
The fundamental shift in providing support using a trauma-informed approach is to move from thinking ‘What is wrong with you?’ to considering ….?
‘What happened to you?’
Exposures to adverse life circumstances, such as ACEs, discrimination and social inequality, are associated with ….?
Greater risk of developing mental health difficulties
Cumulative exposure to these adverse life circumstances is associated with …?
Greater risk for mental health difficulties
It is important to take ACEs, discrimination and social inequality into account when working with people in distress because…?
They can affect the bio-psycho-social functioning of individuals
