The National Institute of Mental Health (USA) defines childhood trauma as; “The experience of an event by a child that is emotionally painful or distressful, which often results in lasting mental and physical effects.” However with the right support it is possible to recover even from extreme early trauma.

1. Childhood and Trauma
Aqsa shahid

2. What is complex trauma?
• Trauma is very common. People can be traumatized in different ways and
situations e.g. natural disasters, accidents, being betrayed in relationships,
and/or being abused or victimized.
• Single incident’ : Single incident trauma can occur with a fire, flood, sexual or
physical assault in adulthood, or from fighting in a war.

3. • Most people who have trauma-related problems have experienced multiple
traumas. When their trauma is not resolved i.e. they have not ‘recovered’, it is
known as complex trauma.

4. • Complex trauma’ is usually interpersonal (occurs between people), and involves
‘being or feeling’ trapped. It is often planned, extreme, ongoing and/or
repeated. Complex trauma generally leads to more severe, persistent and
extreme impacts than single incident trauma. It impacts tend to be
cumulative. They include difficulties with shame, trust, self-esteem, identity,
relationships, regulating emotions, and physical and mental health. People
affected by complex trauma also often use a range of coping strategies to
cope with their trauma and these can include alcohol and drug use, self-
harm, over or under-eating

5. • When complex trauma occurs as a result of child abuse or other adverse
childhood experiences it is particularly damaging. Any form of violence
within the community – domestic and family violence, civil unrest, war
trauma or genocide, cultural dislocation, sexual exploitation and transferring
and/or re-traumatization of victims later in life can also cause complex
trauma.

6. What is childhood trauma?
• The National Institute of Mental Health (USA) defines childhood trauma as;
“The experience of an event by a child that is emotionally painful or
distressful, which often results in lasting mental and physical effects.”
However with the right support it is possible to recover even from extreme
early trauma.

7. Types of childhood trauma
The Adverse Childhood Experiences Study (Felliti and Anda, 1998) classifies
childhood trauma categories:
• Abuse of child: emotional, physical, sexual abuse
• Trauma in child's household environment: substance abuse, parental separation
and/or divorce, mentally ill or suicidal household member, violence to mother,
imprisoned household member
• Neglect of child: abandonment, child's basic physical and/or emotional needs
unmet

8. Childhood trauma prevalence
• National community-based surveys consistently identify the high prevalence of
traumatic experiences. One study showed that nearly half of all children in the
United States are exposed to at least one traumatic social or family experience
(Bethell, Newacheck, Hawes & Halfon, 2014).
• The Adverse Childhood Experiences (ACE) study investigated the association
between childhood trauma and adult health in over 17,000 predominantly white,
middle class Americans (Felliti et al., 1998). It showed that adverse childhood
experiences are vastly more common than recognized or acknowledged and that
they have a powerful effect on adult health a half-century later (Felliti, 2002).

9. What is child abuse?
• Child abuse and neglect (child maltreatment) refer/s to any non-accidental
behaviour by parents, caregivers, other adults or older adolescents that is
outside the norms of conduct and entails a substantial risk of causing
physical or emotional harm to a child or young person.

10. Types of child abuse
• Emotional abuse: The failure of caregivers and adults to nurture a child and
provide them with the love and security that they require, and where a child's
environment and relationships with caregivers are unstable, coercive or unable to
support the child's healthy development.
• Neglect and negligent treatment: Where a child is deprived of essential needs,
such as love, nutrition, clothing, warmth, shelter, security, protection, medical and
dental care, education and supervision.
• Physical abuse: The infliction of bodily injury upon a child which is not
accidental.

11. • Family violence: Where one partner uses violence, and the threat of violence, to
control their partners, children and other family members.
• Sexual abuse: The involvement of a child in any sexual activity with an adult, or
with another child who is in a relationship of responsibility, trust and power over
that child. Sexual abuse includes, but is not limited to, the manipulation or coercion
of a child into sexual activity, child prostitution and child pornography.
• Organized abuse: This form is very complex. It can involve multiple children and
multiple forms of abuse in abusive family groups and criminal networks. The
following terms: 'organized abuse', 'sadistic abuse' and 'ritual abuse' have previously
been used.

12. Child abuse prevalence
• Child abuse remains prevalent. The question is: how prevalent? Secrecy, silence and
social stigma mean that abuse often goes unreported. We know how many cases of
abuse are reported and how many cases are substantiated each year. However, it is
impossible to access true figures of the number of children being abused every day.
Many are fearful of disclosing. Often, when they do disclose they are not believed.
• In response to growing awareness around child abuse, mandatory reporting laws
have been introduced in every State. (Higgins, Bromfield, & Richardson, 2007)
These laws have mandated that certain professionals working with children are
legally obliged to report any child they suspect is being harmed or is at risk of being
harmed. Although these laws differ between States, they are in place Australia-wide.

13. • Rates of substantiated child abuse and neglect have remained relatively stable
since 2012-13, at around 8.0 per 1,000 children. 151,980 children, a rate of
28.6 per 1,000 children, received child protection services (investigation, care
and protection order and/or were in out-of-home care); three-quarters (73%)
of these children had previously been the subject of an investigation, care
and protection order and/or were in out-of-home care.

14. Myths about child abuse
Myth: Child abuse is rare
• Fact: All types of child abuse and neglect occur at significant levels in the Australian
community (CFCA Resource Sheet, 2013). Child abuse and neglect often go
undetected due to the private nature of the crime, difficulties children experience in
disclosing and being believed and a lack of evidence to substantiate the crime
(CFCA, 2015).
Myth: It is only abuse if it is violent
• Fact: Child abuse does not necessarily involve violence or anger. Abuse often
involves adults exploiting their power over children, and using children as objects
rather than respecting their rights as young people.

15. Myth: People lie about child abuse for attention and sympathy
• Fact: Research, including police and court statistics, shows that it is very rare for a
person of any age to state they were abused when they were not. However, “false
negative reports” of abuse are common e.g. many adults state that they were not
abused as children when they were.
Myth: Children usually tell someone about their abuse
• Fact: Most children do not tell anyone. They are often silenced through threats or
fear of not being believed. Some children do not have the words to speak about
what is happening to them.

16. Myth: Children ‘get over’ bad experiences in childhood
• Fact: Adults are often deeply affected by childhood trauma and abuse. You cannot
just “get over” it. Survivors need the right care and support to overcome the
impacts of abuse, recover and live full and healthy lives.
Myth: People who sexually abuse children are mentally ill
• Fact: Most people who sexually abuse children are not mentally ill. They are often
married or have sexual relationships with adults as well. In anonymous surveys, a
significant minority of men in the community indicate a sexual interest in children.

17. Myth: People who sexually abuse children have been sexually abused
themselves
• Fact: The majority of sexually abused children are female, and yet the
majority of sexual abusers are male. Some studies have found that sexually
abusive men are more likely to report a history of sexual abuse than other
men. However, the majority of men who sexually abuse children do not
report being sexually abused in childhood.

18. Myth: Children are very suggestible and they can easy "make up" stories of
abuse
• Fact: Children are no more suggestible than adults, and can clearly
distinguish between reality and fantasy. Research has shown that children
resist making false reports during leading and suggestive interviewing
techniques.

19. Impact of child abuse
Child abuse survivors demonstrate Poor mental health: are almost two and a
half times as likely to have poor mental health outcomes,
• Unhappiness: are four times more likely to be unhappy even in much later
life
• Poor physical health: are more likely to have poor physical health.

20. Childhood physical and sexual abuse Medical diseases: increases the risk of having
three or more medical diseases, including cardiovascular events in women
• Relationships: causes a higher prevalence of broken relationships, lower rates of
marriage in late life,
• Isolation/social disconnection: cause lower levels of social support and an
increased risk of living alone
• Behavioural health effects: is associated with suicidal behaviour, increased
likelihood of smoking, substance abuse, and physical inactivity.

21. • The impact of child abuse does not end when the abuse stops and the long-
term effects can interfere with day-to-day functioning. However, it is possible
to live a full and constructive life, and even thrive – to enjoy a feeling of
wholeness, satisfaction in your life and work as well as genuine love and trust
in your relationships. Understanding the relationship between your prior
abuse and current behaviour is the first step towards ‘recovery’.

22. Over two decades of research have demonstrated potential negative impact of child abuse and
neglect on mental health including:
• depression
• anxiety disorders
• poor self-esteem
• aggressive behaviour
• suicide attempts
• eating disorders
• use of illicit drugs

23. • alcohol abuse
• post-traumatic stress
• dissociation
• sexual difficulties
• self-harming behaviours
• personality disorders.

24. • Victims of child abuse and neglect are more likely to commit crimes as
juveniles and adults

25. Life problems and abuse
• Child abuse is rarely an isolated event. It often occurs in the context of other
factors which may harm a child's development, such as poverty, or parents
with mental health or alcohol and drug problems. As children grow up
within abusive environments, they develop adaptive ways of thinking and
behaving to survive their childhood. In adulthood, however, the defenses and
coping mechanisms that helped protect the child from the full impact of
their abuse are often less constructive.

26. Briere & Scott (2006) identified six key areas in which child abuse affects
psychological function in adult life:
• Negative pre-verbal assumptions and relational schemata: Children
who are abused internalize profoundly negative messages about themselves,
their place in the world and other people. These negative messages often
persist into adulthood, and powerfully influence how survivors interact with
others and how they feel about themselves. As a result, survivors often lack
the skills to mediate close relationships. They may be too defensive,
aggressive, scared or shy to fully connect with the people around them.

27. • Conditioned emotional responses to abuse-related stimuli: When adult
survivors encounter situations, words, or experiences that remind them of
their childhood abuse, they may become emotionally overwhelmed. Everyday
situations may trigger intense feelings of guilt, shame, grief or anger that
take a long time to fade away. These "emotional storms" can make the day-
to-day life of a survivor very unpredictable and frightening.

28. Implicit/sensory memories of abuse: Child abuse often involves experiences of
fear, betrayal and powerlessness - experiences that a child cannot understand or
explain. Such experiences become "implicit" memories (sometimes called "body
memories") which means that, when the memory returns, it does so with the physical
sensations and emotional force of the original experience. These experiences,
sometimes called "flashbacks", can be terrifying.
Narrative/autobiographical memories of maltreatment: For many adults, abuse is
a part of their life history. Making sense of this abuse poses a number of challenges.
Why did it happen? What does it say about my family? What does the abuse say about
me? These are common questions for many survivors.

29. Suppressed or "deep" cognitive structures involving abuse-related
material: Physical or sexual violence are overwhelming experiences for
children. They do not understand abuse, nor do they have the resources to
protect themselves. Trapped in a dangerous situation, children often respond to
abuse with a "last ditch" psychological defense: they suppress their
knowledge of the abuse. As they grow, their knowledge of their abuse may
remain "split off" from awareness, but it deeply shapes the survivor's thinking
patterns and ways of relating to others.

30. Inadequately developed affect regulation skills: Deprived of natural
patterns of learning and development, survivors frequently find themselves
overwhelmed by everyday situations and relationships. They often develop
"avoidant" coping styles in order to lessen the pain of their past abuse and
escape the discomfort of the present. This avoidance can take any number of
forms, including withdrawing from social situations, avoiding/sabotaging
personal relationships, self-medication through alcohol or drugs, or self-
harming in order to dissociate and/or express pain.