Psycho- and neurobiological consequences of abuse (6463PS026Y)
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Hoorcolleges: Psychological &
Neurobiological Consequences of Child
Abuse
Week 1: Introduction
Maltreatment (abuse & neglect): Any act of commission or omission by a parent or other
caregiver that results in harm, potential for harm, or threat of harm to a child. Harm does not
need to be intended. Commission is actively doing something harmful, while omission is the
failure to meet a child’s needs.
We have different types of maltreatment:
Emotional neglect: Failure to meet a child's emotional needs and failure to protect a child
from violence in the home or neighbourhood.
Physical Neglect: Failure to meet a child's basic physical, medical/dental, or educational
needs; failure to provide adequate nutrition, hygiene, or shelter.
Emotional abuse: Intentional behaviour that conveys to a child that he/she is worthless,
flawed, unloved, unwanted, endangered, or valued only in meeting another's needs.
Physical abuse: Intentional use of physical force or implements against a child that results in,
or has the potential to result in, physical injury.
Sexual abuse: any completed or attempted sexual act, sexual contact, or non-contact sexual
interaction with a child by a caregiver.
In the DSM-5, psychological consequences are classified under Trauma- and Stress-Related
Disorders, but other comorbid disorders include other categories of the DSM. In general, the
most common symptoms of abuse an neglect are
- Internalizing/externalizing disorders
- Personality disorders (BPD, anti-social)
- Psychotic symptoms
- Self-injury (including suicide)
The severity of the symptoms is usually related to an early onset with severe and chronic
maltreatment. These symptoms are also harder to treat. Those symptoms are usually not
related to one single disorder but rather have comorbidity with several diagnostic criteria.
Besides psychopathology, psycho-social problems are very common too, like interpersonal
problems, self-image problems and re-victimizations.
There might be inter-generational transmission of maltreatment. This happens in about 30 %
of the cases, as the consequences of being abused can be a risk factor for further abusive
behavior. Still, some people do not become perpetrators although they experienced abuse
themselves. This is related to resilience, which will be discussed later.
,Week 2: Psychological consequences and methods
There are different ways to assess the presence of maltreatment in childhood. There are
different types of reports, so who reports the findings. This matters, because it gives different
answers and different outcomes in research. It can be done via self-reports, if victims are old
enough and have the capacity to answer themselves. You also have informant-based reports
which is done from an outside perspective, that observes the situation and assesses the victim
as well as the perpetrator. It is however important to note that the perpetrator is not willing to
share the information or that the child is not aware of the abnormal state of their household. It
can also be done in a multi-informant way, in which several generations are assessed.
Another way of reporting is retrospective or prospective assessment. This will be discussed
in a sec. Another way of reporting is doing this subjectively or by observing.
About 30 % of victims will perpetrate their own childhood maltreatment to their own
children. However, the outcomes of these tests depend on which person you ask. Like said
here above, maybe the child is not aware of the abnormal state of their household, or because
someone experienced neglect in their past they feel like they are easily coming short to their
own children. So, it depends who you ask (child/parent) what the outcome is.
A way of assessing information is through retrospective or prospective methods.
Retrospective research method (terugblikken)
Advantage:
- This is practical in the case of long-term consequences.
Disadvantages:
- Based on memory retrieval which can often have errors. This can even be influenced
by mood. This problem with memory is called recall bias.
- The consequences and the abuse are assessed at the same moment, and therefore the
causality regarding cause and effect is unclear. So if you e.g. are speaking to a man
with anger problems, you wouldn’t now if those where already there from before the
maltreatment or whether they developed after the maltreatment.
Prospective research method (verwachting): you follow children in which maltreatment has
happened/is happening to look how they are developing.
Advantages:
- Temporal order abuse & consequences: you have a bit of a better view if certain
symptoms develop over time and how someone as a person develops.
- This is an objective identification of abuse because:
o No recall bias
o No selective inclusion based on the outcome: in retrospective research for
example you only see people that developed a disorder, with this method this is
not the case.
Disadvantages:
- It selectively includes the cases in which kids are abused: which often isn’t known
generally so you might be missing certain kids.
- Can be unethical if there is not intervention taken place when maltreatment is
observed.
- It could take long (many years), which means high costs.
- High drop-out rates.
A combination of these 2 methods is best.
, Like we said before, it is often difficult to have an objective measuring of parenting. Because
what is seen as good? A way of doing this is by studying parent-children interactions by
observations in the lab. You can give them a game or other assignments, but it can also
incorporate the child sharing their feelings with the parents.
This was for example done in the study of Buisman et al (2019) in which they placed parents
and their children in the lab to do conflict interaction task, in which the behavior of the
parents was observed and graded. In the meanwhile, they measured their autonomic nervous
system by means of PEP reactivity and RSA reactivity.
The study showed that if the parents was abused, it showed less warmth and more negativity
towards the child. If the parent was neglected in the past, this wasn’t the case. However, they
were hyper-aroused. This means that their sympathetic nervous system (gets the body’s
fight-or-flight response activated) was more active, while their parasympathetic nervous
system (controls homeostasis and the body’s rest-and-digest response) was less active.
The study suggests that behavioral and physiological systems of parents respond differently to
experiences of childhood abuse versus neglect. Specifically, parents who experienced higher
levels of childhood abuse responded more strongly at a behavioral level during conflict with
their offspring, while those with experiences of childhood neglect showed a more strong
response at an autonomic level. Both response patterns—behavioral in the case of abuse and
autonomic in the case of neglect—may indicate maladaptive emotion regulation. This can
contribute to the transmission of dysfunctional caregiving behaviors.
Explaining causality
Like mentioned before, it is sometimes unclear what causes what. So, for example it could be
that neglect leads to depression, but it could also be someone reports more neglect because
they have depression. This concept is known as bi-directionality. Underlying confounders
like genetic traits, personality and mood are also possible. So if a child was neglected during
childhood and develops depression later in life: is this because of the neglect or did she have
certain genetic traits or the type of personality to develop this regardless of the maltreatment?
Luckily, we can have research methods that help us determine this causality. We have
observational studies, in which it is more likely to find causality by means of confounding
variables. These are studies like epidemiological research, longitudinal research and cross-
sectional research. We also have experimental research methods, which are methods like
analogue ‘acute stress’ studies & animal research. Analogue acute stress studies are studies
in which we temporarily induce psychological or psychosocial stress, with which we try to
mimic the stress response of a child. Examples of acute stress studies are the Trier Social
Stress Test, which temporarily induces psychosocial stress and the Cold Pressor Test, which
induces, besides psychological stress, a somatic stressor. The outcomes of these stressors are
usually assessed by looking at changes in mood, behavior, cognition, choices and coping.
Those form the basis for indications of changes after chronic stress. It is important to mention
that a reaction to an acute stressor is good, because your body is adaptive. However, if you are
always chronic stressed and this becomes your coping style, this can become maladaptive.
Also a lot of research has been done on animals. This is transitional research, because you
kind of translate the findings of the animal to the human being. You can stress animals by
taking them away from their mothers or giving the mother limiting nesting availabilities. The
Morris water maze test can be used to test cognition. The effects of early life stress on HPA-
axis, the amygdala, hippocampus, as well as cognition and emotions can be relatively
directedly transferred to humans.
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