Trauma model of mental disorders

Last updated

The trauma model of mental disorders, or trauma model of psychopathology, emphasises the effects of physical, sexual and psychological trauma as key causal factors in the development of psychiatric disorders, including depression and anxiety [1] as well as psychosis, [2] whether the trauma is experienced in childhood or adulthood. It conceptualises people as having understandable reactions to traumatic events rather than suffering from mental illness.

Contents

Trauma models emphasise that traumatic experiences are more common and more significant in terms of aetiology than has often been thought in people diagnosed with mental disorders. Such models have their roots in some psychoanalytic approaches, notably Sigmund Freud's early ideas on childhood sexual abuse and hysteria, [3] Pierre Janet's work on dissociation, and John Bowlby's attachment theory. There is significant research supporting the linkage between early experiences of chronic maltreatment and severe neglect and later psychological problems. [4]

In the 1960s trauma models became associated with humanist and anti-psychiatry approaches, particularly in regard to understanding schizophrenia and the role of the family. [5] Personality disorders have also been a focus, particularly borderline personality disorder, with the role of dissociation and 'freezing responses' (more extreme reactions than fight-flight when someone is terrified and traumatised) thought to have a significant role in the aetiology of psychological disturbance. [6] Extreme versions of trauma models have implicated the fetal environment and the trauma of being born, but these are not well-supported in the academic literature and have been associated with recovered memory controversies.[ citation needed ]

People are traumatised by a wide range of people, not just family members. For example, male victims of sexual abuse report being abused in institutional settings (boarding schools, care homes, sports clubs). [7]

Trauma models thus highlight stressful and traumatic factors in early attachment relations and in the development of mature interpersonal relationships. They are often presented as a counterpoint to psychiatric orthodoxy and inform criticisms of mental health research and practice in that it has become too focused on genetics, neurochemistry and medication. [8]

History

From the 1940s to the 1970s, prominent mental health professionals associated with neo-Freudian and psychodynamic psychology proposed trauma models as a means of understanding schizophrenia, including Harry Stack Sullivan, Frieda Fromm-Reichmann, Theodore Lidz, Gregory Bateson, Silvano Arieti and R.D. Laing. Based on their clinical work, they theorized that schizophrenia appears to be induced by children's experiences in profoundly disturbed families and reflects victims' attempts to cope with such families and live in societies that are inherently damaging to people's psychological well-being. In the 1950s, Sullivan's theory that schizophrenia is related to interpersonal relationships was widely accepted in the United States. Arieti's book, Interpretation of Schizophrenia , won the American National Book Award in the field of science in 1975. The book advanced a psychological model for understanding all the regressive types[ definition needed ] of the disorder. [9]

Some of the psychogenic models proposed by the non-biologic psychologists, such as that of the "schizophrenogenic mother", came under sustained criticism from feminists who saw them as 'mother-blaming' and from a psychiatric profession that increasingly moved towards biological determinism. [10] From the 1960s, pharmacological treatments became the increasing focus of psychiatry, and by the 1980s, the theory that family dynamics could be implicated in the aetiology of schizophrenia became viewed as unacceptable by many mental health professionals in America and Europe. [11] Before his death in 2001, Theodore Lidz, one of the main proponents of the "schizophrenogenic" parents theory, expressed regret that current research in biological psychiatry was "barking up the wrong tree". [12] Like Lidz, Laing maintained until his death that the cause of both schizoid personality disorder and schizophrenia was influenced by family relationships. [13] Some more recent research has provided support for this. For instance, child abuse has been shown to have a causal role in depression, PTSD, eating disorders, substance abuse and dissociative disorders, [14] and research reveals that the more severe the abuse the higher the probability that psychiatric symptoms will develop in adult life. [15]

Judith Herman's book Trauma and Recovery has heavily influenced therapeutic approaches. Recovery entails three phases that are best worked through sequentially: first, "establishing safety"; second, a process of remembrance and mourning for what was lost; and third, "reconnecting with community and, more broadly, society".

Critiques

Critics of the model, such as August Piper, argue that the logic that childhood trauma causes insanity has a serious flaw: If the claim was true, the abuse of millions of children over the years should have caused higher prevalence rates of mental disorders than the literature reveals. [16] However, this critique disregards the possibility of underdiagnosis and the fact that not every instance of abuse causes lasting trauma. Other critics, particularly proponents of behavior family therapy, have seen trauma models as parent blaming and have emphasized the fact that families are usually the main, and often only, source of support for people diagnosed with severe mental illness. Lucy Johnstone has pointed out that some critics advocate family interventions for adult psychiatric patients whilst at the same time maintaining that childhood experiences are not causal as regards mental illness – as if family members can only have a helpful or damaging impact on their adult children. [17]

In response to Piper's assertion, it has been noted that Arieti stated in Interpretation of Schizophrenia that trauma is more significant when committed by people to whom young human beings are emotionally bonded, and abuse is often interwoven with other forms of neglect and confusing behaviours from caregivers:

First of all we have to repeat here what we already mentioned..., that conditions of obvious external danger, as in the case of wars, disasters, or other adversities that affect the collectivity, do not produce the type of anxiety that hurts the inner self and do not themselves favor schizophrenia. Even extreme poverty, physical illness, or personal tragedies do not necessarily lead to schizophrenia unless they have psychological ramifications that hurt the sense of self. Even homes broken by death, divorce or desertion may be less destructive than homes where both parents are alive, live together, and always undermine the child's conception of himself. [18]

Recent approaches

A 2005 meta-analysis of schizophrenia revealed that the prevalence of physical and sexual abuse in the histories of people diagnosed with psychotic disorders is very high and has been understudied. This literature review revealed prevalence rates of childhood sexual abuse in studies of people diagnosed with schizophrenia ranging from 45% to 65%. [2] An analysis of the American National Comorbidity Study revealed that people who have endured three kinds of abuse (e.g., sexual, physical, bullying) are at an 18-fold higher risk of psychosis, whereas those experiencing five types are 193 times more likely to become psychotic. [19] A 2012 review article supported the hypothesis that current or recent trauma may affect an individual's assessment of the more distant past, changing the experience of the past and resulting in dissociative states. [20] Several reviews of risk factors for common mental disorders have emphasised trauma. [21] [22] Such research has rejuvenated interest in this field, both from clinicians, researchers and service user organisations such as the Hearing Voices Movement.

Psychiatrist Colin Ross calls his model the "trauma model of mental disorders" and emphasises that, unlike biological models, this addresses the literature on comorbidity of trauma with mental disorders. Ross describes the theoretical basis of his trauma model: "The problem faced by many patients is that they did not grow up in a reasonably healthy, normal family. They grew up in an inconsistent, abusive and traumatic family. The very people to whom the child had to attach for survival were also abuse perpetrators and hurt him or her badly.... The basic conflict, the deepest pain, and the deepest source of symptoms, is the fact that mom and dad's behavior hurts, did not fit together, and did not make sense." [23]

In terms of psychoses, most researchers and clinicians believe that genetics remains a causative risk factor, but "genes alone do not cause the illness". [24] [25] Modern views of genetics see genes more like dimmer switches, with environmental factors switching the genes on; the more severe the environmental stress, the more effect genes have. [8]

In the field of criminology, Lonnie Athens developed a theory of how a process of brutalization by parents or peers that usually occurs in childhood results in violent crimes in adulthood. Richard Rhodes's Why They Kill describes Athens's observations about domestic and societal violence in the criminals' backgrounds. Both Athens and Rhodes reject the genetic inheritance theories. [26]

Criminologists Jonathan Pincus and Dorothy Otnow Lewis believe that although it is the interaction of childhood abuse and neurological disturbances that explains murder, virtually all of the 150 murderers they studied over a 25-year period had suffered severe abuse as children. Pincus believes that the only feasible remedy for crime would be the prevention of child abuse. [27]

See also

Related Research Articles

Dissociative identity disorder (DID), previously known as multiple personality disorder (MPD), is one of multiple dissociative disorders in the DSM-5, ICD-11, and Merck Manual. It has a history of extreme controversy.

<span class="mw-page-title-main">Causes of mental disorders</span> Etiology of psychopathology

A mental disorder is an impairment of the mind disrupting normal thinking, feeling, mood, behavior, or social interactions, and accompanied by significant distress or dysfunction. The causes of mental disorders are very complex and vary depending on the particular disorder and the individual. Although the causes of most mental disorders are not fully understood, researchers have identified a variety of biological, psychological, and environmental factors that can contribute to the development or progression of mental disorders. Most mental disorders result in a combination of several different factors rather than just a single factor.

Psychology is an academic and applied discipline involving the scientific study of human mental functions and behavior. Occasionally, in addition or opposition to employing the scientific method, it also relies on symbolic interpretation and critical analysis, although these traditions have tended to be less pronounced than in other social sciences, such as sociology. Psychologists study phenomena such as perception, cognition, emotion, personality, behavior, and interpersonal relationships. Some, especially depth psychologists, also study the unconscious mind.

Richard Bentall is a Professor of Clinical Psychology at the University of Sheffield in the UK.

Dissociation is a concept that has been developed over time and which concerns a wide array of experiences, ranging from a mild emotional detachment from the immediate surroundings, to a more severe disconnection from physical and emotional experiences. The major characteristic of all dissociative phenomena involves a detachment from reality, rather than a false perception of reality as in psychosis.

Schizotypal personality disorder, also known as schizotypal disorder, is a cluster A personality disorder. The Diagnostic and Statistical Manual of Mental Disorders (DSM) describes the disorder specifically as a personality disorder characterized by thought disorder, paranoia, a characteristic form of social anxiety, derealization, transient psychosis, and unconventional beliefs.

Psychological trauma is an emotional response caused by severe distressing events, such as bodily injury, sexual violence, or other threats to the life of the subject or their loved ones; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not always produce trauma per se. Examples of distressing events include violence, rape, or a terrorist attack.

The Hearing Voices Movement (HVM) is the name used by organizations and individuals advocating the "hearing voices approach", an alternative way of understanding the experience of those people who "hear voices". In the medical professional literature, ‘voices’ are most often referred to as auditory verbal hallucinations. The movement uses the term ‘hearing voices’, which it feels is a more accurate and 'user-friendly' term.

Depersonalization-derealization disorder is a mental disorder in which the person has persistent or recurrent feelings of depersonalization and/or derealization. Depersonalization is described as feeling disconnected or detached from one's self. Individuals may report feeling as if they are an outside observer of their own thoughts or body, and often report feeling a loss of control over their thoughts or actions. Derealization is described as detachment from one's surroundings. Individuals experiencing derealization may report perceiving the world around them as foggy, dreamlike, surreal, and/or visually distorted.

Dissociative disorders (DDs) are a range of conditions characterized by significant disruptions or fragmentation "in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior." Dissociative disorders involve involuntary dissociation as an unconscious defense mechanism, wherein the individual with a dissociative disorder experiences separation in these areas as a means to protect against traumatic stress. Some dissociative disorders are caused by major psychological trauma, though the onset of depersonalization-derealization disorder may be preceded by less severe stress, by the influence of psychoactive substances, or occur without any discernible trigger.

<span class="mw-page-title-main">Emotional detachment</span> Inability and/or disinterest in emotionally connecting to others

In psychology, emotional detachment, also known as emotional blunting, is a condition or state in which a person lacks emotional connectivity to others, whether due to an unwanted circumstance or as a positive means to cope with anxiety. Such a coping strategy, also known as emotion-focused coping, is used when avoiding certain situations that might trigger anxiety. It refers to the evasion of emotional connections. Emotional detachment may be a temporary reaction to a stressful situation, or a chronic condition such as depersonalization-derealization disorder. It may also be caused by certain antidepressants. Emotional blunting, also known as reduced affect display, is one of the negative symptoms of schizophrenia.

<span class="mw-page-title-main">Complex post-traumatic stress disorder</span> Psychological disorder

Complex post-traumatic stress disorder is a stress-related mental and behavioral disorder generally occurring in response to complex traumas.

Theodore Lidz was an American psychiatrist best known for his articles and books on the causes of schizophrenia and on psychotherapy with patients with schizophrenia. An advocate of research into environmental causes of mental illness, Lidz was a notable critic of what he saw as a disproportionate focus on biological psychiatry. Lidz was a Sterling Professor of Psychiatry at Yale University. In his lifetime, he did a great amount of research on interpersonal causes of schizophrenia.

Childhood trauma is often described as serious adverse childhood experiences. Children may go through a range of experiences that classify as psychological trauma; these might include neglect, abandonment, sexual abuse, emotional abuse, and physical abuse. They may also witness abuse of a sibling or parent, or have a mentally ill parent. These events can have profound psychological, physiological, and sociological impacts leading to lasting negative effects on health and well-being. These events may include antisocial behaviors, attention deficit hyperactivity disorder (ADHD), and sleep disturbances. Additionally, children whose mothers have experienced traumatic or stressful events during pregnancy have an increased risk of mental health disorders and other neurodevelopmental disorders.

Schizophrenia is a neurodevelopmental disorder with no precise or single cause. Schizophrenia is thought to arise from multiple mechanisms and complex gene–environment interactions with vulnerability factors. Risk factors of schizophrenia have been identified and include genetic factors, environmental factors such as experiences in life and exposures in a person's environment, and also the function of a person's brain as it develops. The interactions of these risk factors are intricate, as numerous and diverse medical insults from conception to adulthood can be involved. Many theories have been proposed including the combination of genetic and environmental factors may lead to deficits in the neural circuits that affect sensory input and cognitive functions.

Derealization is an alteration in the perception of the external world, causing those with the condition to perceive it as unreal, distant, distorted or in other words falsified. Other symptoms include feeling as if one's environment is lacking in spontaneity, emotional coloring, and depth. Described as "Experiences of unreality or detachment with respect to surroundings in the DSM-5, it is a dissociative symptom that may appear in moments of severe stress.

Colin A. Ross is a Canadian psychiatrist and former president of the International Society for the Study of Trauma and Dissociation from 1993 to 1994. There is controversy about his methods and claims, which include recovering memories through hypnosis of Satanic ritual abuse.

Betrayal trauma is defined as a trauma perpetrated by someone with whom the victim is close to and reliant upon for support and survival. The concept was originally introduced by Jennifer Freyd in 1994. Betrayal trauma theory (BTT) addresses situations when people or institutions on which a person relies for protection, resources, and survival violate the trust or well-being of that person. BTT emphasizes the importance of betrayal as a core antecedent of dissociation, implicitly aimed at preserving the relationship with the caregiver. BTT suggests that an individual, being dependent on another for support, will have a higher need to dissociate traumatic experiences from conscious awareness in order to preserve the relationship.

The traumagenic neurodevelopmental (TN) model of psychosis synthesizes current knowledge of biological and psychological processes to describe the relationship between childhood trauma, and psychosis. Proposed in 2001, the TN model suggests increased stress sensitivity observed among individuals experiencing psychotic symptoms may be attributed to trauma-induced neurodevelopmental changes during key developmental periods. Proposed as a partial explanation for the association between childhood adversity and psychosis, the TN model suggests observed increases in stress reactivity among individuals diagnosed with psychotic disorders may be attributed to trauma-induced neurological changes during sensitive developmental periods. As a result, the TN model underscores the importance of routine comprehensive assessments of childhood trauma histories when evaluating individuals presenting with psychotic symptoms for mental health services.

In the context of the nature-nurture debate, interactionism is the view that all human behavioral traits develop from the interaction of both "nature" and "nurture", that is, from both genetic and environmental factors. This view further holds that genetic and environmental influences on organismal development are so closely interdependent that they are inseparable from one another. Historically, it has often been confused with the statistical concept of gene-environment interaction. Historically, interactionism has presented a limited view of the manner in which behavioral traits develop, and has simply demonstrated that "nature" and "nurture" are both necessary. Among the first biologists to propose an interactionist theory of development was Daniel Lehrman. Since then, numerous interactionist perspectives have been proposed, and the contradictions between many of these perspectives has led to much controversy in evolutionary psychology and behavioral genetics. Proponents of various forms of interactionist perspectives include Philip Kitcher, who refers to his view as "causal democracy", and Susan Oyama, who describes her perspective as "constructive interactionism". Critics of interactionism include major figures in behavioral genetics such as Arthur Jensen, Robert Plomin, and philosopher Neven Sesardic.

References

  1. ↑ Jeronimus, B.F.; Ormel, J.; Aleman, A.; Penninx, B.W.J.H.; Riese, H. (2013). "Negative and positive life events are associated with small but lasting change in neuroticism". Psychological Medicine. 43 (11): 2403–15. doi:10.1017/s0033291713000159. PMID   23410535. S2CID   43717734.
  2. 1 2 Read J, van Os J, Morrison AP, Ross CA (November 2005). "Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications". Acta Psychiatr Scand . 112 (5): 330–50. doi: 10.1111/j.1600-0447.2005.00634.x . PMID   16223421. S2CID   5324960.
  3. ↑ Candace Orcutt, Trauma in Personality Disorder: A Clinician's Handbook (AuthorHouse, 2012).
  4. ↑ Main, M. & Hesse, E. (1990). "Parents' unresolved traumatic experiences are related to infant disorganized attachment status: Is frightened and/or frightening parental behavior the linking mechanism?" In Greenberg, M., Cicchetti, D., and Cummings, M. (Eds.), Attachment In The Preschool Years: Theory, Research, and Intervention. Chicago: University of Chicago Press.
  5. ↑ Laing, R.D. (1960). The Divided Self. London: Tavistock.
  6. ↑ Dillon, J., Lucy Johnstone, L. and Longden, E. (2012). "Trauma, Dissociation, Attachment and Neuroscience: A new paradigm for understanding severe mental distress" (PDF). Journal of Critical Psychology, Counselling and Psychotherapy. 12.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  7. ↑ Holmes, G. Offen, L. and Waller, G. (1997). "See no evil, hear no evil, speak no evil: why do relatively few male victims of childhood sexual abuse receive help for abuse related issues in adulthood?". Clinical Psychology Review. 17 (1): 69–88. doi:10.1016/S0272-7358(96)00047-5. PMID   9125368.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  8. 1 2 Bentall, Richard (2003). Madness Explained: Psychosis and Human Nature. Penguin.
  9. ↑ associazionesilvanoarieti.org Archived 2007-03-11 at the Wayback Machine  – page on Arieti (mostly in Italian)
  10. ↑ Newnes, C (1999). Histories of Psychiatry, In C. Newnes, G. Holmes & C. Dunn, This is Madness: A critical look at psychiatry and the future of mental health services. Ross-on-Wye: PCCS.
  11. ↑ Hahlweg, K; et al. (2000). "Familienbetreuung als verhaltenstherapeutischer Ansatz zur Rückfallprophylaxe bei schizophrenen Patienten", in M. Krausz, D. Naber (eds.) Integrative Schizophrenietherapie. Freiburg: Karger.
  12. ↑ "Yale Bulletin and Calendar". Archived from the original on 2015-02-27. Retrieved 2015-02-27. – article on Theodore Lidz
  13. ↑ Laing, Adrian (1997). R.D. Laing: A Biography. Harper Collins.
  14. ↑ Kendler, K; et al. (2000). "Childhood sexual abuse and adult psychiatric and substance use disorders in women". Archives of General Psychiatry. 57 (10): 953–959. doi:10.1001/archpsyc.57.10.953. PMID   11015813.
  15. ↑ Mullen, P. E.; et al. (1993). "Childhood sexual abuse and mental health in adult life". British Journal of Psychiatry . 163 (6): 721–32. doi:10.1192/bjp.163.6.721. PMID   8306113. S2CID   4694330.
  16. ↑ Piper, August (1998). "Multiple Personality Disorder: Witchcraft Survives in the Twentieth century". Skeptical Inquirer . May/June.
  17. ↑ Johnstone, L. (2000). Users and Abusers of Psychiatry. Routledge.
  18. ↑ Arieti, Silvano (1994). Interpretation of Schizophrenia. Aronson. p. 197.
  19. ↑ Shevlin, M, Dorahy, M & Adamson, G. (2007). "Trauma and psychosis: An analysis of the National Comorbidity Survey". American Journal of Psychiatry. 164 (1): 166–169. CiteSeerX   10.1.1.557.8867 . doi:10.1176/ajp.2007.164.1.166. PMID   17202562.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  20. ↑ Stern DB (January 2012). "Witnessing across time: accessing the present from the past and the past from the present". The Psychoanalytic Quarterly . 81 (1): 53–81. doi:10.1002/j.2167-4086.2012.tb00485.x. PMID   22423434. S2CID   5728941.
  21. ↑ Ormel J.; Jeronimus, B.F.; Kotov, M.; Riese, H.; Bos, E.H.; Hankin, B. (2013). "Neuroticism and common mental disorders: Meaning and utility of a complex relationship". Clinical Psychology Review. 33 (5): 686–697. doi:10.1016/j.cpr.2013.04.003. PMC   4382368 . PMID   23702592.
  22. ↑ Malouff, J.M., Thorsteinsson, E.B., & Schutte N.S. (2005). "The relationship between the five factor model of personality and symptoms of clinical disorders". Journal of Psychopathology and Behavioral Assessment. 27 (2): 101–114. doi:10.1007/s10862-005-5384-y. S2CID   145806896.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  23. ↑ "The Colin A. Ross Institute for Psychological Trauma - Research, Education, and Clinical Treatment of Trauma Based Disorders". www.rossinst.com.
  24. ↑ "Media report of sexual abuse as cause of schizophrenia". 2006-06-14. Retrieved 2009-04-15.
  25. ↑ "Maudsley debate on sexual abuse as a cause of schizophrenia" . Retrieved 2009-04-15.
  26. ↑ Rhodes, Richard (2000). Why They Kill: The Discoveries of a Maverick Criminologist . Vintage. ISBN   978-0-375-40249-4.
  27. ↑ Pincus, Jonathan (2002). Base Instincts: What Makes Killers Kill . W.W. Norton & Company. ISBN   978-0-393-05022-6.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.