The Impact of Early Life Trauma on Health and Disease: the Hidden Epidemic

Blog Post by Eric Vermetten, MD, PhD, e.vermetten@umcutrecht.nl Associate Professor Psychiatry at the University Medical Center Utrecht, The Netherlands

Traumatic events of the earliest years of infancy and childhood are not lost but, like a child’s footprints in wet cement, are often preserved life-long. Time does not heal the wounds that occur in those earliest years; time conceals them. They are not lost; they are embodied .” (Felitti 2010, this volume)

The quote above is the cornerstone of our book. As clinicians and researchers, we felt an obligation to the field of psychotrauma:  a concise review of the impact of early life trauma on health and disease was imperative. Especially sinceThe Impact of Early Life Trauma on Health and Disease there is now ample evidence from the preclinical and clinical fields that early life trauma has both dramatic as well as long-lasting effects on general health. We have underpinned the whole array: epidemiology, veracity, genetics, neurobiology, sociology as well as the therapeutic spectrum that is involved in different forms of psychopathology related to early life trauma. To date, a comprehensive review was lacking. This book fills an obvious gap in the clinical and academic literature. It provides cutting edge reviews by top researchers and clinicians that synthesize and summarize the newest findings and perspectives.

Yanghee Lee, PhD, Chairperson of the UN Committee on the Rights of the Child, Sungkyunkwan University, Korea

I found this book to be an invaluable collection of chapters from a variety of global experts in the field of early life trauma, with a helpful synthesizing commentary following each section.  It is a “must read” not only for clinicians and researchers in mental health, but for all who care for and work to protect the rights of the child.  

Christine A. Courtois, PhD, Author, Healing the incest wound: Adult survivors in therapy, revised edition Co-editor, Treating Complex Trauma: An evidence-based guide, Washington DC, US

This important book makes a huge contribution to the existing literature on early life trauma and its sequelae. Based on a growing line of scientific evidence that now includes information from the neurosciences, the authors compellingly discuss the various lifelong trajectories of early trauma.

Their discussion begins with an emphasis on the bio-physiological impact of early trauma as the foundation upon which other reactions build across a number of major life domains. The editors and authors are to be congratulated for their contributions to this text which fills a major gap in the trauma and developmental literature. It is a major resource for researchers and clinicians alike.

Carole Jenny, MD, MBA, FAAP, Professor of Pediatrics, Warren Alpert Medical School of Brown University Providence, Rhode Island, USA

This is a unique and important evidence-based review of the impact of early life trauma on the physical and mental health of children and adults.  It is a timely book that gathers together some of the most prominent scientists, researchers and theorists writing in the field of psychological trauma today.  By amassing epidemiological, biological, psychological, and clinical data on the effects of childhood trauma, this book adds significant weight to the recognition that trauma in childhood has profoundly deleterious mental and physical effects across the lifespan.  It is indeed the hidden epidemic and accounts for a great deal of suffering as well as our health care dollars.  This book is an essential read for all health professionals and their students interested in the health and wellbeing of children and adults. 

E. Ronald de Kloet, PhD, Academy Professor in Neuropharmacology, Leiden University Medical Center, Leiden, The Netherlands

This timely book highlights why individuals fail to develop resilience to the lifelong consequences of early neglect, abuse and trauma. To address this fundamental question in the neurobiology of mental health the reader is guided progressively through several sections from the impact and neurobiological underpinning of early trauma effects to assessment and treatment options of trauma-related disorders. A synopsis commenting on future directions concludes each section and collectively provide a sense of urgency.  I therefore highly recommend this book to clinical and preclinical scientists committed to the emerging field of translational developmental neurobiology, ultimately with the goal to enhance clinical attention and appropriate public health measures. 

Chris R. Brewin, PhD, University College London, London, UK

This book should be required reading for therapists, psychopathology researchers, and anyone with an interest in the childhood roots of medical and psychiatric disease. The editors have commissioned brief reviews that provide a masterly synthesis of recent insights and discoveries concerning the unfolding impact of early trauma on biological systems, attachment, emotion, and dysfunctional behaviour, as well as an update on the most recent treatment models. This will be an important sourcebook for years to come.

Highlights from Section1

The need for special safeguards for children was recognised in the Geneva declaration of the rights of the child of 1924, which were further enunciated in the Universal Declaration of Human Rights after the Second World War (UN, 1995).  Already in the 19th Century, as the rates of infant mortality dropped, allowing more highly valued attachments without fear of loss, the rights of the child progressively became an underpinning characteristic of society.   The enlightenment’s ideals were embodied in the belief in free education for all children. 

One of the greatest challenges in ensuring the protection of children is to acknowledge the brutality, neglect, and exploitation that children can be subject to, even in the modern world.  The idealised life of middle class society is in contrast to the dark and silent social underbelly of childhood abuse, whether it be physical or sexual.

Ironically, one of the great challenges of improving the protection of children has been the conflict of interest of many of the most esteemed social institutions.  For example, the Christian churches, independent of denomination, as part of their socially benevolent philosophies have set up schools and orphanages.   The value of the child and the child’s future, implicitly are the values that have underpinned their establishment.  Yet it is within these institutions that some of the most endemic forms of abuse have existed and these have emerged in their true reality in the spate of litigation in the last two decades.  This reality highlights the complexity of describing, highlighting, and implementing systems that better protect children.  For this to occur, societies must confront the dark undercurrents of perversity and exploitation that do not quickly dissipate from civilised societies.  

Highlights from Sections II

We now have accumulating evidence for the mechanism by which early life attachment difficulties alters the developmental trajectory of stress and affect regulation across the life span, and predisposes toward significant mental health problems following later traumatic live events.  This is particularly important in light of an overwhelming body of research examining the biological basis of psychological trauma that has emerged over the last decade. Studies have moved from solely examining the effects of physical or sexual abuse, to the stressors resulting from dysfunctional attachment relationships between child and caregivers.

Highlights from Section III

There is a saying in popular psychology that “what doesn’t kill us makes us stronger.“  Well, what almost kills us may make us weaker, or at the least, the strength required to survive the aftermath of trauma may exact a high cost in cognitive function, affect management, identity development, and relationship growth (Spiegel 2010 this volume). 

Successful treatment of the psychological effects of early life trauma requires attention not only to what happened to the survivor, but also to what did not happen.  Early life trauma involves prolonged, recurring abuse that is generally coupled with neglect.  The survivor must try to contend with the impact of the abuse, while lacking the developmental learning that comes from having had a secure attachment figure.

The chapters in this section describe five approaches to treating the complex traumatic disorders that result from childhood abuse and neglect.  At first glance all approaches are specialized, using unique language to describe their theoretical frameworks and therapeutic techniques.  Nevertheless, despite the specificity of each treatment model, the chapters share a number of common themes that are interpersonal and affect-focused in nature.  How does the therapist help create a sense of safety, when it is paradoxically both a prerequisite and an anticipated outcome of successful treatment?  What is the affective core of trauma-related pathology and how should this be addressed in treatment?   How can therapist and patient together create a relational framework within which traumatic memories can be addressed?

Lastly, the most dedicated professional can be left unsupported and attacked through the legal process due to a complex collusion of interests when they attempt to stand up and protect children.  Hence, this is not a field where professionals can function without examining their values, allegiances, and potential for denial.  This domain is likely to continue the area for psychology and psychiatry that will challenge, extend, and divide those in research and clinical practice alike.

The Impact of Early Life Trauma on Health and Disease: the Hidden Epidemic is edited by Ruth Lanius, Eric Vermetten and Clare Pain and published by Cambridge University Press, 2010

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2 Responses to The Impact of Early Life Trauma on Health and Disease: the Hidden Epidemic

  1. Pingback: Lessons: Reporting on trauma faced by children of deported parents | Reporting on Health

  2. Carol Hudak says:

    Thank you for this most important book. I ordered it today.

    I am not a clinician, I am a woman, who at age 60, had repressed memories surface of childhood sexual abuse by my adopted father. I lost a career in classical music (voice), when at 28 he died. I could not understand why suddenly my passion for singing suddenly became ambivalent. I became fearful of performing, cancelled performances on a moment’s notice where once I was an agressive and gutsy performer, deeply passionate about music. I developed anorexia and severe bulimia. My personality changed from confident to apologetic. I was sure that I caused the sinking of the titanic. (!!)

    With a narcisisstic adopted mother, I spent my adult years caring for her. I became labeled, ‘manic-depressive’ and spent 10 years on lithium and other heavy drugs, which I never needed.(due to this, I developed hyper-parathyroidism.)

    I am in therapy (somatic) now and making tremendous progress!!! Yes, Dr. Felitti, childhood wounds are not lost, they are embodied. Profoundly true.

    I grieve the life I lost. I am writing my story in hopes I can help someone else.

    Today I am forging a new life.

    I cannot wait to begin reading this timely book.

    Thank you all from the depth of my heart for doing the work you do.

    Sincerely,

    Carol Hudak
    USA

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