By Dr. Matthew Kerr

1. An Unwanted Legacy:
Long-term effects of chronic
childhood trauma
Matthew Kerr, Ph.D. C.Psych.
June 13, 2013

2. Where we are headed…
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What is trauma?
How common is childhood trauma?
Why is chronic childhood trauma so damaging?
What is the lasting impact of these experiences?
What do I do about it?

3. What is trauma?
• ISTSS
– “Traumatic events are shocking and emotionally
overwhelming situations that may involve actual or
threaten death, serious injury, or threat to physical
integrity.” – ISTSS
• PTSD Criterion A (DSM-5)
– “Exposure to actual or threatened death, serious injury, or
sexual violence in one of the following ways:”
• Direct experience, witnessing, learning about, repeated or
extreme exposure to aversive details

4. What is trauma?
• Post Traumatic Stress Disorder (PTSD)
Symptoms
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Intrusion (re-experiencing)
Avoidance
Hyperarousal
Negative alterations in thoughts and mood
• At times, the definition of trauma has been
too focused on identifying specific events

5. What is trauma?
• Some adverse childhood experiences do not coincide
with diagnostic definitions of trauma
Psychological Trauma:
“…the unique individual experience, associated with an
event or enduring conditions, in which the individual’s
ability to integrate affective experience is overwhelmed
or the individual experiences a threat to life or bodily
integrity…”
(Pearlman & Saakvitne, 1995)

6. What is trauma?
Chronic Developmental Trauma
– Repeated adverse, traumatic
experiences/psychological trauma during the very
early childhood to pre/early adolescence
– Accompanied by significant disruptions to healthy
parenting, the provision of security, and
caretaking experienced by the child
• aka Complex Trauma

7. How common is it?
• National (U.S.) Comorbidity Study –
Replication (2010)
• Surveyed 3019 women and 2673 men
• Inquired about numerous adverse life
experiences prior to age 13
• Rape – 5.9%
• Sexual assault/molestation – 9.8%
• Any sexual violence – 13.1%
• Any assaultive violence – 25.5%
• The NCS-R did not consider many nonCriterion A trauma, including those
that would contribute to a complex
traumatization

8. How common is it?
• Canadian Incidence Study of Reported Child Abuse
and Neglect (CIS):
– In 2003, an estimated 235,315 child maltreatment
investigations were conducted in Canada
– About 3.8% of Canadian children age 15 and under
• Approximately 1.9% of Canadian children experienced
substantiated abuse
– Many cases are never reported.
• 5.1% of those with history of childhood physical abuse
• 8.7% with a history of childhood sexual abuse (MacMillan, Jamieson, &
Walsh, 2003)

9. How common is it?
• The impact of chronic developmental
traumatization poses a significant public
health risk
“Dealing with the effects of trauma is a healthcare priority; it is as serious as any major
medical illness” (US Surgeon General, 1999)

10. Why is chronic childhood trauma so
damaging?

11. Why is chronic childhood trauma so
damaging?
• Often this trauma involves:
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Contextual factors
A betrayal of trust
Inadequate parenting
Disrupted neurophysiological and social development
• 50 to 75%+ of children experiencing complex and chronic
trauma will develop PTSD (and other difficulties) in
adulthood
• Compared to 18-25% of those traumatized as adults
• As the number of adverse childhood experiences
increases, so does the risk for various psychological and
medical disorders

13. Why is chronic childhood trauma so
damaging?
• Neurophysiological development
– Learning brain:
• engaged in exploration, searches for balance between novelty and
familiarity
• Involved in more complex adaptations to the environment
– Anterior cingulate cortex, insula, prefrontal cortex, hippocampus
– Survival brain:
• anticipate, prevent, or protect against real or imagined dangers,
motivated to identify threats and conserve internal resources to
be able to respond to them
• Depends on rapid automatic processes involving basic brain
structures
– Brainstem, midbrain, parts of the limbic system (amygdala)

14. Why is chronic childhood trauma so
damaging?
• Neurophysiological development
– Stress response system
• Reduces immune system activity
• Interferes with more complex brain function
– Learning, seeking rewards, managing distress, making conscious
judgements, planning
– Particularly sensitive periods are around age 2
(language development) and late preadolescence/early adolescence

15. Why is chronic childhood trauma so
damaging?

16. Why is chronic childhood trauma so
damaging?
• Relational development
– Attachment Theory (John Bowlby)
• In times of stress/distress, humans are wired to seek a safe haven
for safety and protection
• In times of reduced stress, humans use attachment figures as a
secure base for play and exploration
• Developing a stable pattern of relating to caregivers depends on
them having stable/predictable behaviour
– Results in a secure or insecure attachment, both are relatively stable
with stable patterns of soliciting or responding to support
• Inconsistent parenting, or parents who are the source of
pain/trauma yields a disorganized attachment style

17. What is the lasting impact of these
experiences?
• Disrupted psychobiological/Interpersonal functioning
in the following domains:
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Affect and impulse regulation
Biological self-regulation
Attention or consciousness
Perception of perpetrators (and/or dangerous others)
Self-perception
Capacity for relationships (Trust)

18. What is the lasting impact of these
experiences?
• Self-blame, felt sense of being
bad/defective/evil/deserved what happened
• Fear of strong emotion (especially anger)
• Fear that one is like their abuser
• See world as a dangerous place

19. What is the lasting impact of these
experiences?
• Mental Health correlates to complex trauma
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Depression
Anxiety
Psychosis
Substance use/abuse
Eating disorders
Personality disorders (e.g. BPD)
Dissociative symptoms/disorders & Somatoform disorders
Suicidality and risk-taking behaviour

20. What is the lasting impact of these
experiences?
• Physical Health correlates of complex trauma
– Coronary artery disease
– Liver disease
– Chronic obstructive pulmonary disease
– Autoimmune disease
– Chronic pain
– Overutilization of emergency medicine /
underutilization of routine healthcare

21. What do I do about it?
• Get more education about trauma and its impact
• See web resource list
• Know that the trauma is/was not your fault
• Trauma-related symptoms are treatable
• See community resource list
• Tell your (mental) health care provider
• Advocate for yourself

22. What do I do about it?
• Trauma-based psychotherapy
– 3 stages:
• Stabilization
• Processing of Traumatic Memories
• (Re-) Integration
– Often movement back-and-forth between first two stages
– Gradual exposure to sharing for traumatic material

23. Community resources (free or low fee)
Centre for Treatment of Sexual Abuse and Childhood Trauma
www.centrefortreatment.com
Family Services of Ottawa http://familyservicesottawa.org
Sexual Assault Support Centre of Ottawa www.sascottawa.org
Ottawa Rape Crisis Centre www.orcc.net
Catholic Family Services of Ottawa www.cfsottawa.ca
Jewish Family Services of Ottawa
www.jfsottawa.com/TheCounsellingGroup/site

24. Web resources
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http://www.sidran.org/sub.cfm?sectionID=4
http://www.trauma-pages.com/trauma.php
http://www.istss.org/ForthePublic.htm
http://www.nimh.nih.gov/health/publications/posttraumatic-stress-disorder-ptsd/nimh_ptsd_booklet.pdf
• http://www.cmha.ca/mental_health/post-traumatic-stressdisorder/#.UaOOE9Ksg6Y
• http://www.nami.org/factsheets/ptsd_factsheet.pdf
• http://www.isst-d.org/default.asp?contentID=13

25. Discussion and Questions?