DEVELOPMENTAL TRAUMA AND ITS EFFECTS
The largest study of the scope of adverse childhood experiences (ACEs) surveyed over 17,000 adult patients of the Kaiser Permanente Health System and found that 64 percent of them reported at least one type of childhood maltreatment or household dysfunction, and nearly 13 percent reported four or more (CDC, 2013). Although these numbers dem- onstrate the high prevalence of ACEs, the rates of early trauma among poor, disadvantaged, clinical, and criminal populations are even higher (Christensen et al., 2005; Eckenrode, Smith, McCarthy, & Dineen, 2014; Larkin, Felitti, & Anda, 2014; Levenson, Willis, & Prescott, 2016;Wallace, Conner, & Dass-Brailsford, 2011). As ACEs accumulate, the risk increases for countless medical, mental health, and behavioral problems later in life, including chemical depen- dency, smoking, depression, suicidality, fetal mor- tality, obesity, heart and liver diseases, intimate partner violence, sexually transmitted diseases, and unintended pregnancies (Felitti et al., 1998). The combined effects of early adversity on health and psychosocial well-being are profound and bring with them grave implications for public health and social justice (Anda, Butchart, Felitti, & Brown, 2010; Larkin et al., 2014).
The pathways from early adversity to psychosocial problems are complex, but early toxic environments stimulate hyperarousal and overproduction of neu- rochemicals that activate automated fight-flight- freeze responses and inhibit the natural development and connection of neurons (Anda et al., 2006; van der Kolk, 2006). These changes in the brain over time can destabilize emotional regulation, social attachment, impulse control, and cognitive proces- sing (Anda et al., 2010; Anda et al., 2006; Whitfield, 1998). This is especially true when children are exposed to chronic and persistent adverse condi- tions, enabling maladaptive responses to become extremely well rehearsed. Developmental psy- chopathologists propose that emotional and social adaptations to environmental conditions arise from a reciprocal intersection of thoughts and emotions; we “establish a coherence of functioning as a thinking, feeling human being” through the meaning we affix to our experiences (Rutter & Sroufe, 2000, p. 265). When previously traumatized clients encounter current stress, they may feel intense and intolera- ble emotions, and cope with them through nega- tive behaviors (Brown et al., 2012). Social workers taking psychosocial histories should consider the
damaging effects of child maltreatment and chaotic family environments and their contribution to the exacerbation of presenting problems.
Attachment theory illustrates the linkage between early adversity and adult psychosocial troubles. Attachment theorists argue that children must experi- ence nurturing, consistent, and responsive interactions with primary caretakers to perceive the world as a safe place (Bowlby, 1988). Children who are exposed to maltreatment and family dysfunction suffer inconsis- tent parenting patterns that impair the development of secure attachments to caretakers, and chaotic households often lack good role models for healthy interpersonal functioning across the life span (Carlson & Sroufe, 1995; Cicchetti & Banny, 2014). Early abusive and neglectful relationships are characterized by betrayal and invalidation, which can then manifest in disorganized attachment patterns, distorted cog- nitive schema, boundary violations, and emotional dysregulation (Young, Klosko, & Weishaar, 2003). Early attachment disruptions have been correlated with deleterious long-term impacts including com- promised relational skills, self-regulation difficulties, and mental disorders ( Jovev & Jackson, 2004; Loper, Mahmoodzadegan, &Warren, 2008).