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The recent past has been characterized with unprecedented interest in the study of childhood trauma and its relationship with adult mental illness. Maltreatment during childhood including sexual abuse, neglect, tragic accidents to parents and family members, violence in the family, mental illness of parents, criminality and substance abuse by parents have been associated with adult psychological challenges. According to a research conducted by Morgan & Fisher (2007) young adults with a past experience of childhood maltreatment were much more likely to suffer psychiatric illness as compared to those without such a past. In a study of 2,144 young adults aged 16 years and above (Morgan & Fisher, 2007) found out that 221 individuals whose past records of childhood maltreatment had been documented by the child protection agency were significantly susceptible to adult mental illness. In this investigation, the research question seeks to determine the extent of documentation of adult mental illness with direct connection and link with childhood trauma. To obtain a conclusive answer, multivariate scholarly journals addressing diverse adult mental illness need to be analyzed. In this literature review, different adult mental illnesses addressed by scholars as having a direct relationship with childhood trauma are analyzed.
Childhood Trauma and PTSD
Post Traumatic Stress Disorder (PTSD) opened a serious focus and attention on trauma related illness within the community of mental health. Nevertheless, the attention was basically channeled to areas associated with non-psychotic disorders. Many researchers who studied PTSD steered clear of its relationship with childhood psychosis due to reasons such as fear of blame from families, strong observance of biological paradigms, fear that clinicians and researchers were also susceptible to vivid traumatization as well as possibility of diagnosis of psychosis into PTSD. In real sense, not all people experiencing maltreatment in childhood suffer or demonstrate symptoms of PTSD in their adulthood. Children who embrace functional and appropriate coping techniques are less likely to experience PTSD in their adulthood. However, those who engage in negative coping styles are likely to demonstrate logical extensions of the childhood trauma in form of PTSD during adulthood (Briere & Elliot, 1994). According to Briere and Elliot (1994), adult survivors of physical, sexual and emotional childhood abuse demonstrate signs of PTSD. Clinicians working with Vietnam veterans also diagnosed them with Post-traumatic stress disorder.
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In an effort to discern the presence of PTSD in these Vietnam veterans, clinicians sought to investigate any form of maltreatment during childhood. Conclusive results on the presence of PTSD and relationship with childhood trauma were determined by verification of three symptoms: repeated vivid experience of the traumatic event in form of intrusive thoughts as well as nightmares, shunning off or numbing current events and continued arousal such as disturbance of sleep, jumpiness as well as poor level of concentration. Briere and Elliot (1994) note that about 80% of survivors of sexual abuse depict some form of PTSD. These survivors are said to experience flashbacks, being hyper-vigilance as well as experiencing intrusive thoughts. The research showed that these veterans were particularly triggered by various stimuli such as repeated form of abuse by an adult, sharing past abusive encounters and witnessing abusive actions on others. Sometimes, the responses were initiated by sensory mechanisms related with the abuse in form of tastes, sounds as well as scents. Similarly, a qualitative study, by Rhoades and Hutchinson (1994), shows that child birth can quickly trigger memories of childhood sexual abuse.
Bob Murray, his wife and a colleague therapist give an account of their firsthand experience with PTSD patients. In their practice, they have encountered people suffering PTSD some of whom were Vietnam veterans. The three therapists were particularly interested in the relationships that existed between the childhood traumas of these patients with their adult mental illnesses. The therapists argued that from their series of observations and close inquiry from the patients there exist a strong link between childhood maltreatment and adult experience of PTSD. Nevertheless, their observations were not conclusive. For instance, they do not show that all cases of PTSD are linked with childhood trauma as they are quick to add that not all depression cases were caused by maltreatment in childhood. Murray et al, (2004) elucidate that the vast majority of PTSD patients are usually misdiagnosed. They cite an example where patients with severe hyperarousal and depression symptoms which end up being wrongly diagnosed as a condition of obsession in depressive order. Similarly, it is not uncommon for symptoms of hyperarousal to be diagnosed as anxiety and insomnia. From the foregoing, it is evident that PTSD is not a deeply researched area. For instance, it is not clear how the condition develops and what particular symptoms are associated with childhood trauma only.
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Bi-Polar Disorders and childhood Trauma
From past research, it is evident that early traumas in ones childhood have a serious role in adult mental illness. A review by Hammersley et al (2003) involving 20 different studies between 1922 and 1989 with the aim of investigating bipolar disorder and prevalence of hallucinations showed a weighted mean average of about 18%. Apart from this long range study, there is no further investigation done on the relationship between childhood trauma and adult patients with bipolar disorder. Paul Hammersley et al (2003) conducted a research on a sample of patients to investigate the relationship between childhood trauma and bipolar disorder. In the study, 255 people satisfying DSM-IV criteria on bipolar disorder were randomly recruited based on behavioral therapy for bipolar disorder. The recruitment was controlled for all the participants. From the group, 126 participants were to undergo a therapy from 5 different qualified therapists. Four of the therapists were asked to fill a questionnaire with record of patients with signs of spontaneous trauma. To ensure that nothing was left to chance, trained research assistants carried initial assignment of diagnosing the participants. Similarly, the participants were supposed to be 16 years and above and 4 different geographical areas of UK.
After the investigation, it was found out that 45 people out of the total studied had suffered hallucinations. It was also evident that 30 of them had gone through hallucinations of auditory nature, 11 confessed having heard people comment on their actions, 25 suffered hallucinations of visual nature and 9 experiencing hallucinations of other types such as somatic, tactile and olfactory. From the questionnaire of trauma history, participants were classified depending on the evidence of divulging trauma types. Even though 15 participants gave information about sexual abuse during childhood, consistent results were not realized during the onset of the study for the mean age studied (22.2) with the group without trauma experience. The absence of reasonable deviation prompted Hammersley et al (2003) to use the chi-squared statistic to analyze the link between childhood trauma and hallucinations.
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By application of the Chi-squared statistics method, contingency tables were drawn. The tables demonstrated the association between diverse report of hallucinations with childhood maltreatment; especially sexual abuse. From the results it was evident that significant relationship existed between cases of childhood trauma with and auditory hallucination (X²=7.61, P<0.01, d.f. =1), reports of past abuse and hallucinations (2=6.83, P<0.005, d.f.=1), hallucination of auditory nature (2=14.66, P<0.001, d.f.=1) and hearing of commenting voices (X2=14.28, P<0.002, d.f. =1). In the study, there was no significant relationship between delusions, tactile and visual hallucinations with trauma. Nevertheless, childhood sexual abuse revealed a high level of association with hallucinations even with the exclusion of the affected patients from the study.
The answer as to whether any direct link between childhood trauma and bi-polar disorder exist is not completely exhaustive. In spite of the research carried out by Hyun et al (2000) and showing some association between childhood sexual abuses with bipolar disorder, it is not possible for verification of results due to the prevailing absence of control data. Most of the participants studied by Hammersley et al (2003) did not have a history of childhood maltreatment yet they showed consistent results of bipolar disorder. It is therefore evident that there is a ranging confusion and lack of conclusive agreement on the direct impact of childhood trauma and bipolar disorder. Either, the available literature fails to rightfully and clearly demonstrate borderline disorder in personality as well as the psychotic symptoms of mood-incongruence.
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Schizophrenia and Childhood trauma
Renewed focus has been witnessed in the need to understand the link between childhood traumas with psychosis in adulthood. Several studies on inpatients and outpatients suffering from psychiatric illnesses suggest a high possibility of childhood trauma. Nevertheless, the studies available are minute and contain very little information on the etiological importance of maltreatment in childhood and psychosis in adulthood. Spence et al, (2006) carried out a study aimed at assessing the relationship between childhood and adult exposure to trauma. In the study, a group diagnosed with Schizophrenia and one with no such history was compared. The aim of the study was to assess psychiatric symptomatology and psychosocial functioning and the relationship with the schizophrenia group exposed to trauma. A consultant psychiatrist's caseload was used to generate the two lists randomly. In the study, individuals excluded in the psychosis group had a traumatic head injury history, disability in learning, PTSD diagnosis as well as below 18 years old. On the other hand, individuals with a past record of psychotic encounter were excluded from the non-psychotic group. At the onset of the study, the psychosis group had 40 participants while the non-psychosis group had 30 participants. To obtain data, structured interview was applied. This ensured that optimal understanding by the participants was attained and that accurate assessment of incidents of trauma was obtained.
From the study, Spence et al (2006) observed that the level of exposure to trauma for the two groups was high throughout the lifespan. Surprisingly, about 75% of the group with Schizophrenia had a past record of childhood trauma. On the contrary, only 23% of the non-psychotic group had such experience. Similarly, 77.5% of the group with schizophrenia had reported at least one trauma during adulthood. On the other hand, 73% of the non-psychotic group reported an occurrence of trauma as adults. In terms of lifetime encounter of trauma, 90% of schizophrenia group and 80% of the non-psychotic group suffered trauma as adults. When independent t-tests were carried out to correct possibilities of effects of multiplicity applying Bonferroni adjustment on levels of significance, clearer results were obtained. The group with schizophrenia was significantly susceptible to childhood trauma. Similarly, bivariate correlations exploring childhood and adulthood exposure to trauma were applied. Further results obtained from social functioning scale as well as psychiatric symptomatology for the group with schizophrenia revealed that exposure to childhood trauma had a negative correlation with the subscale of intercommunication. This means that intercommunication functioning was depleted by childhood trauma.
From the results it is evident that adults with schizophrenia had a strong background of childhood trauma. For instance, it was very likely that physical abuse during childhood played a major role in causing schizophrenia during adulthood. The results were consistent to a study conducted by Read et al (2004) which showed that psychosis was mainly as a reaction by individuals who experienced traumatic moments in their childhood. In spite of the results obtained, the literature reviewed has several failures. For example, when measuring trauma, it is unclear on what form of abuse is involved. Similarly, most of the studies are small as they only cover a limited population. Finally, the studies on schizophrenia have not separated the presence of dissociative disorders prevalent in groups studied.
Although scholarly literatures have shown some extent of links between childhood trauma and adult mental illness, there is much more to be done. The literature available leaves several methodological and conceptual issues unattended. For instance, a 'gap' in the available literature can be seen where adult clinicians with AXIS I diagnosis are not accessed for schizophrenia and Bi-polar disorder. Similarly, the literature available grossly fails to suggest some of the ways histories on abuse can be properly taken to provide more reliable information. Several adult mental illnesses like PTSD and Bi-polar disorder are often misdiagnosed due to absence of concrete models of assessment. It can also be seen that most of the literature use reports offered by participants spontaneously giving a room for biasness. Thus proper studies are needed on how valid trauma histories can be obtained. Finally, most of the literature in this area fails to address the issue of causal mechanisms on mental illness.
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