Skip to content

Posts tagged ‘Child Maltreatment’

May 24

Finding Resiliency in Vulnerability: Shifting Perspectives on Genes and Environment

Clients frequently ask me if their mental and emotional struggles are a result of their genes or their environment.  My answer is always the same – “yes”.  Of course, my simplistic response refers to the interaction between genes and environment that characterizes nearly all mental health conditions, but it clearly belies the centuries of debate on this fundamental and contentious topic.  In recent decades, the Cartesian dualism that has traditionally dominated the nature-nurture debate has given way to scientific theories that describe complex, bi-directional relations between genes and environment.  These theories of human development have also furthered our understanding of “neural plasticity” – the exciting notion that our brains are more malleable and open to change than we once thought.

First, a brief historical regression may be helpful.  In the early part of the twentieth century, psychoanalysis was the dominant perspective in psychology and its guardians were particularly keen on environmental influences.  In fact, parents of the baby-boomer generation were likely told that schizophrenia was entirely caused by cold, unresponsive mothering (i.e., so-called “schizophrenigenic mothers”).  Behaviorism, which rose to prominence in the early-to-middle part of the century, saw human development as a process of learning based on stimulus-response interactions between an organism and its environment. By the nineteen-sixties, the “cognitive-revolution”, with its emphasis on internal mental states and the promise of neuroscience advances, largely eclipsed these theories, but still had relatively little to say about the role of genetics.

In the second half of the twentieth century, geneticists began conducting large twin and adoption studies and found that a number of psychiatric conditions showed evidence of genetic heritability.  For example, studies showed that schizophrenia occurs in 1% of the general population, but this increases to 6% if a parent is affected and 48% if an identical twin is affected.  Findings such as these clearly showed that genetics play a role in many forms of mental illness.  However, by the end of the twentieth century, the pendulum had swung too far in the direction of genetic influence, with some researchers claiming that single genes could be wholly responsible for complex phenomena like depression, violence and even suicide (e.g., one research group claimed to have found “the suicide gene”). Read more

May 8

Attachment, Emotion Regulation, and Resiliency

Often, during the first week of treatment at The Meadows, people will skeptically inquire, “Do experiences in childhood really continue to affect my life as an adult?”  While social scientists and mental health clinicians have been exploring this question for decades, other fields of science and medicine have been slow to recognize the effects of childhood adversity on adult health and wellbeing.  However, this trend may be changing, in part due to a very influential study by a group of researchers at the Centers for Disease Control and Prevention that are examining the long-term effects of adverse childhood experiences (ACE) on various health outcomes in over 17,000 members of a managed healthcare organization in California.

In general, the results of the ACE study1 show that adverse childhood experiences (e.g., abuse, neglect, abandonment) are relatively common and are associated with higher rates of early initiation of tobacco use and sexual activity, adolescent pregnancy, multiple sexual partners and STD’s, intimate partner violence, alcoholism, illicit drug use, depression, and suicide attempts.  Of course, this resonates completely with our clinical experience and treatment model at The Meadows.  However, these investigators also found that adverse childhood experiences are related to elevated rates of liver disease, autoimmune disease, chronic obstructive pulmonary disease, ischemic heart disease, and lower levels of health-related quality of life.

These compelling data suggest that childhood maltreatment is associated with a variety of mental, emotional, social, and physical health problems in adulthood.  In fact, results such as these have led some people to elevate childhood maltreatment to the level of a “public health threat”.  Yet, as indicated by the conceptual model used in the ACE study (see Figure 1), there are considerable gaps in our scientific understanding of the mechanisms and mediating pathways connecting adverse childhood experiences to the host of deleterious outcomes mentioned above.

Attachment theory has proven to be a useful framework for understanding how early relational experiences influence developmental pathways and adult functioning (see earlier article on attachment).  Over fifty years ago, John Bowlby (the “father” of attachment theory) studied adverse childhood experiences in delinquent and homeless children and found that a warm, continuous, and secure attachment relationship between caregiver and child was of critical importance, not only because this biologically-driven bond enhances survival and reproductive fitness, but also because it establishes the foundation for successful social-emotional development and resiliency throughout the lifespan.

Read more

Jan 27

3 Comments

Attachment Theory and the Developmental Consequences of Relational Trauma

As Humans, we are intensely social creatures.  Close relationships with other people are often the source of our greatest joy in life, but they can also be associated with tremendous pain and suffering.  Early relationships with caregivers, siblings, and extended family are not merely a static backdrop to a mechanistic unfolding of human development – these relational experiences have profound effects on biological and psychological processes, for better or for worse.  We now know that children come into the world with sophisticated neurobiological systems that are keenly attuned to the social environment and in turn these systems are shaped by the social milieu.  This means that the narrative of the early social experience is written into the biology of the developing child, or in other words, nurture actually becomes nature.

Unfortunately, overt forms of childhood abuse and neglect are all too common and can result in serious long-term physical and psychological consequences.  In fact, large research studies have shown that adverse childhood experiences can lead to serious health risks, including many forms of chronic illness and even shortened length of life.  However, it is increasingly recognized that covert forms of relational trauma and emotional abuse can also lead to deleterious outcomes, particularly in the area of social-emotional development.

While the term “relational trauma” often connotes overt forms of maltreatment such as physical and sexual abuse, it can also be used to describe covert forms of maltreatment such as abandonment, enmeshment, parent-child role reversal, verbal abuse, love-withdrawal, and many other forms of emotional abuse.  Relational trauma can be difficult for children, caregivers and outside observers to recognize, which means it can persist throughout much of childhood and even into adulthood.  For this reason, relational trauma can have insidious effects on development through persistent, maladaptive interaction patterns.  These social interaction patterns occur while the brain is developing and can therefore shape the way that individuals think and feel about themselves, others, and the world around them.

Attachment theory is a very useful framework for understanding how differences in the quality of close interpersonal relationships, particularly parent-child bonds and adult romantic bonds, influence health and well-being throughout the lifespan.  In the mid-nineteen hundreds, John Bowlby proposed that an attachment behavioral system evolved in humans (and other animals) because it improved the chances of offspring survival and successful reproduction by fostering proximity to caregivers, protection and safety, and sense of security for the developing child.  Bowlby argued that a secure attachment relationship between a parent and child doesn’t lead to dependency, which was the contention of his psychoanalytic colleagues at the time, but instead creates a secure base for the child.  In fact, he postulated that attachment security, and specifically a secure base, actually facilitates exploration and learning in childhood and ultimately leads to greater autonomy and social competence later in life. Read more