Adverse Childhood Experiences and Psychiatric Disorders

 

In my last post, I mentioned that the American Psychiatric Association rejected the diagnosis of Developmental Trauma Disorder in 2011, and refused to acknowledge that “…childhood adverse experiences lead to substantial developmental disruptions” and added that this idea is “more clinical intuition than research-based fact.”

In fact, there have been numerous studies showing a correlation between ACEs and a wide variety of clinical conditions. Below are brief descriptions of the results of four studies, recently published, addressing this contention. One is a review and meta-analysis, which is a research process used to systematically synthesize or merge the findings of, in this case, 39 (!) single, independent studies, using statistical methods to calculate an overall or 'absolute' effect.

Of course, the studies do only show correlations, which means that they do not “prove” that ACE’s actually cause psychiatric disorders or even symptoms. But the correlations are as good as any in the psychiatric research literature, which is pretty much minimal in findings that prove actual causation for almost every psychiatric disorder.

 

Adverse Childhood Experiences Among Adults With Eating Disorders: Comparison To A Nationally Representative Sample And Identification Of Trauma

The primary objectives of the current study were: (1) to examine and compare ACEs between two samples: treatment-seeking adults, and a nationally representative sample of adults, (2) to characterize ACEs items and total scores across demographic and diagnostic information in adults seeking treatment for an ED, (3) to statistically classify ACEs profiles using latent class analysis, and (4) to examine associations between ACEs profiles and diagnosis.  Results: Patients with EDs had significantly higher ACEs scores than the nationally representative sample. Within patients with EDs, four latent classes of ACEs item endorsement were identified. Patients with other specified feeding or eating disorder (OSFED) and binge eating disorder (BED) were more likely to fall into the "Household ACEs" and "Abuse ACEs" groups, respectively, compared to anorexia nervosa-restricting subtype (AN-R). Conclusion: Patients with EDs reported more ACEs than the nationally representative sample, across all ED diagnoses.

“Adverse childhood experiences among adults with eating disorders: comparison to a nationally representative sample and identification of trauma profiles.” Rienecke, Johnson et.al. Journal of Eating Disorders , volume 10, Article number: 72 (2022). 

 

Considerable Mental Health Burden Associated With Childhood Trauma

Trauma is associated with increased odds of anxiety disorders and any psychiatric disorder at age 6 years. There is a considerable mental health burden in association with childhood trauma. 

 “The association between childhood trauma and psychiatric disorders in low-income and middle-income Countries." Alckmin-Carvalho et. al., The Lancet Psychiatry, Oct. 31, 2022.

Association of Neural Connectome With Early Experiences of Abuse in Adults

In this cohort study of 768 participants, individuals with abuse experienced during childhood (but not adolescence) demonstrated an altered connectome [connections between brain neurons] of greater functional connectivity [changes in usual and not pathological connections in various brain areas] associated with somatomotor and dorsal-ventral attention brain networks, irrespective of current diagnosis or symptom state. These findings suggest that a history of child abuse is associated with altered functioning of systems responsible for perceptual processing and attention, and these findings were found in the presence of many different psychiatric conditions.

"Association of Neural Connectome With Early Experiences of Abuse in Adults." Korgaonkar et. al., JAMA Network Open. 2023;6.

 

A  Systematic Review and Meta-Analysis of the Relationship Between Childhood Adversity and Adult Psychiatric Disorder.

A review and analysis of 39 different studies suggests that childhood and adolescence is an important time for risk for later mental illness, and an important period in which to focus intervention strategies for those known to have been exposed to adversity, particularly multiple adversities. There was some evidence of a dose-response relationship with those exposed to multiple forms of maltreatment having more two and a half times odds of developing a mental disorder. 

“A revised and extended systematic review and meta-analysis of the relationship between childhood adversity and adult psychiatric disorder  [Review]." McKay et. al., Journal of Psychiatric Research, 156 (2022).

 

 

Book Review: The Body Keeps the Score by Bissel Van Der Kolk

As I stated in my Review of Nadine Harris’s The Deepest Well, every mental health professional should know that adverse (traumatic) childhood experiences (ACE’s) - especially with parents who are abusive, neglectful, are perpetrators or victims of domestic violence, have multiple partners, or have substance abuse issues - are a major risk factor for children developing many different psychiatric disorders, as well as being a risk factor for a variety of physical illnesses. Yet therapists and psychiatrists often ignore this issue in favor of theories about some sort of genetically-caused, pre-existing brain disorder.

 

In this fascinating book, the author also makes the case for the importance of ACE’s, especially in the case of pediatric psychiatric conditions, by examining the physiological effects of trauma on brain development. There is an extensive literature on this, although most of it neglects the fact that a continued relationship with an abusive or formerly abusive parent is usually continuing in some form throughout much of these patients’ adult life. 

In any event, the author points out that organized psychiatry in 2011 refused to acknowledge that “…childhood adverse experiences lead to substantial developmental disruptions” and added that the idea that it is is “more clinical intuition than research-based fact.” They then added, “There is no known evidence of developmental disruptions that were preceded in time in a causal fashion by any type of trauma syndrome.” (From the American Psychiatric Association rejection of a Developmental Trauma Disorder diagnosis, as quoted in the book).

 

That last part is misleading if not an outright lie. We don’t have high caliber causal evidence on the causes of just about any diagnosis in the DSM. Van Der Kolk has a list of references from an extensive literature on the enduring negative effects of early maltreatment. ACE’s are a major contributor to a variety of psychiatric symptoms that are part and parcel of the genesis of many different psychiatric disorders. Especially the childhood ones like ADHD, conduct disorder, and oppositional defiant disorder, as well as many of the mood and anxiety disorders.

 

This blindness by the psychiatric community has led to what is called “malignant polypharmacy”  – the tendency of some psychiatrists and psychiatric nurse practitioners to confuse symptoms that appear in different forms within a variety of different psychiatric diagnosis as instead being co-morbid (co-occurring) conditions. When I was in practice, I would find new patients who were on several different psych medications – sometimes including both uppers and downers simultaneously – because new drugs were added whenever the practitioner noticed additional, seemingly untreated symptoms. 

Clinicians had misinterpreted these symptoms as being due to their being indicative of other psychiatric disorders that were not being addressed by the existing drug regimen. As the author points out, what was really not being addressed is the underlying issue – the history of abuse.

 

As mentioned, and as with the Deepest Well, this book unfortunately ignores the question of whether brain changes caused by ACE’s are at least partially reversible - were it not for continuing reinforcement of the trauma throughout the lives of the subjects of this literature. This question lurks in many of the book’s case examples and within the literature that the author quotes. 

For example, he talks about a case where a woman continued to blame herself for her father molesting her despite her rational mind knowing full well that this was nonsense. He describes traumatized firefighters who were “desperately trying to protect the system.” As part of a suggestion for criteria for a proposed diagnosis of developmental trauma disorder, he included,  “Intense preoccupation with the safety of the caretaker or other loved ones.” He even describes himself as mistakenly thinking that his own parents no longer had a major influence on him!

 

In the numerous, highly interesting case examples, Van Der Kolk omits mention of whether or not the patient still maintained contact with abusive parents. The closest he comes is a statement on page 210 about a perpetrator "hopefully" not still being around to hurt a traumatized individual.

 

Nonetheless, this well-written and almost entertaining book is a good introduction to the consequences of ACE’s on psychological and brain development, as well as introducing some possible therapeutic ways to treat traumatized patients. Van der Kolk is a master story teller.