Chapter 12 – Trauma- and Stressor-Related Disorders
There is a significant link between childhood trauma and immediate and long-term mental
health consequences.
• Traumatic events: exposure to actual or threatened harm or fear of death or injury are
considered common or extreme stressors.
• Stressful events: events that are less extreme than traumatic events and stem from single
events or multiple or ongoing stressful situations or events.
• Child maltreatment: the abuse and neglect of children by parents or by others
responsible for their welfare. Child maltreatment is a generic term used to refer to the 4
primary acts of physical abuse, neglect, sexual abuse, and emotional abuse of persons
less than 18 years of age.
History and family context
Family relations are the earliest and most enduring social relationships that significantly affect a
child’s competence, resilience, and sense of well-being.
For healthy development, children need a caregiving environment that balances their need for
control and direction (demandingness) with their need for stimulation and sensitivity
(responsiveness).
Expectable environment: external conditions or surroundings that are considered to be
fundamental and necessary for healthy development. The expectable environment for infants
includes protective and nurturing adults and opportunities for socialization; for older children it
includes a supportive family, contact with peers, and ample opportunities to explore and master
the environment.
Childcare has a hypothetical range from healthy to abusive and neglectful.
• Positive end: appropriate and healthy forms of child-rearing actions that promote child
development.
• Middle: poor/dysfunctional actions represent greater degrees of irresponsible and
harmful childcare.
• Negative end: parents who violate their child’s basic needs and dependency status in a
physically, sexually, or emotionally intrusive or abusive manner.
History and Family Context – Section Summary
- Traumatic events involve exposure to actual or threatened harm or fear of death or injury and
include a wide range of intentional acts and unintentional circumstances.
- Stressful events are typically more common and less extreme than traumatic events but can still
play a significant role in adjustment and well-being.
- Child maltreatment is considered among the worst and most intrusive forms of trauma and
stress. It refers to 4 primary acts: physical abuse, neglect, sexual abuse, and psychological abuse.
- Childcare can be described along a hypothetical continuum ranging from healthy to abusive and
neglectful.
- Boundaries between appropriate and inappropriate behavior toward children are not always
clear or well established, but an awareness of what is right and what is wrong can go a long way
in preventing maltreatment.
Trauma, stress, and maltreatment: defining features
Trauma and stress
Children exposed to chronic or severe stressors have an elevated risk of PTSD.
• Younger children exposed to violence are fearful and often show regressive and somatic
signs of distress.
• Older boys tend to be more aggressive; girls tend to be more passive and withdrawn.
, Allostatic load: refers to the progressive ‘wear and tear’ on biological systems caused by chronic
stress.
• Some children may show signs of being hyperresponsive to stress: excessive threat
vigilance, mistrust, poor social relationships, impaired self-regulation, and unhealthy
lifestyle choices.
• Other children may become hyporesponsive to stressful events: underreacting to signs of
danger or threat, indicating that their stress system is overtaxed and may be shutting down.
Prime factor in how children respond to various forms of stress is the degree of parental support
and assistance they receive to help them cope and adapt.
Maltreatment
Polyvicimization: the experience of victimization across multiple domains of the child’s life.
These youths are particularly at risk for mental health concerns.
Physical neglect: failure to provide for a child’s basic physical needs, including refusal of or delay
in seeking health care, inadequate provision of food, abandonment, expulsion from home or
refusal to allow a runaway to return home, inadequate supervision, and inadequate provision of
clean clothes.
Educational neglect: failure to provide for a child’s basic educational needs, including allowing
chronic truancy, failing to enroll a child of mandatory school age in school, and failing to attend
to a special educational need.
Emotional neglect: failure to provide for a child’s basic emotional needs, including marked
inattention to the child’s needs for affection, refusal of or failure to provide needed psychological
care, spousal abuse in the child’s presence, and permission for drug or alcohol use by the child.
Physical abuse: the infliction or risk of physical injury as a result of punching, beating, kicking,
biting, burning, shaking, or otherwise intentionally harming a child.
Psychological abuse (also known as emotional abuse): abusive behavior that involves acts or
omissions by parents or caregivers that cause, or could cause, serious behavioral, cognitive,
emotional, or mental disorders.
Sexual abuse: abusive acts that are sexual in nature, including fondling a child’s genital,
intercourse, incest, rape, sodomy, exhibitionism, and commercial exploitation through
prostitution or the production of pornographic materials.
• Poverty is the greatest factor in the child prostitution explosion.
Characteristics of children who suffer maltreatment
• Children with disabilities are 3 times more likely to be the victims of any sort of physical
or sexual abuse.
• Girls account for 80% of the reported victims for sexual abuse.
• There are demographic differences for maltreatment. These differences suggest different
vulnerabilities for children based on gender, ethnicity, disability, and social disadvantage.
Family context
Relational disorders: disorders that occur in the context of relationships, such as child abuse and
neglect. Relational disorders signify the connection between children’s behavior patterns and
the availability of a suitable child-rearing environment.
• A greater degree of stress experienced by the abusive parent in the social environment
will increase the probability that violence will surface as an attempt to gain control or
cope with irritating, stressful events.
There is a significant link between childhood trauma and immediate and long-term mental
health consequences.
• Traumatic events: exposure to actual or threatened harm or fear of death or injury are
considered common or extreme stressors.
• Stressful events: events that are less extreme than traumatic events and stem from single
events or multiple or ongoing stressful situations or events.
• Child maltreatment: the abuse and neglect of children by parents or by others
responsible for their welfare. Child maltreatment is a generic term used to refer to the 4
primary acts of physical abuse, neglect, sexual abuse, and emotional abuse of persons
less than 18 years of age.
History and family context
Family relations are the earliest and most enduring social relationships that significantly affect a
child’s competence, resilience, and sense of well-being.
For healthy development, children need a caregiving environment that balances their need for
control and direction (demandingness) with their need for stimulation and sensitivity
(responsiveness).
Expectable environment: external conditions or surroundings that are considered to be
fundamental and necessary for healthy development. The expectable environment for infants
includes protective and nurturing adults and opportunities for socialization; for older children it
includes a supportive family, contact with peers, and ample opportunities to explore and master
the environment.
Childcare has a hypothetical range from healthy to abusive and neglectful.
• Positive end: appropriate and healthy forms of child-rearing actions that promote child
development.
• Middle: poor/dysfunctional actions represent greater degrees of irresponsible and
harmful childcare.
• Negative end: parents who violate their child’s basic needs and dependency status in a
physically, sexually, or emotionally intrusive or abusive manner.
History and Family Context – Section Summary
- Traumatic events involve exposure to actual or threatened harm or fear of death or injury and
include a wide range of intentional acts and unintentional circumstances.
- Stressful events are typically more common and less extreme than traumatic events but can still
play a significant role in adjustment and well-being.
- Child maltreatment is considered among the worst and most intrusive forms of trauma and
stress. It refers to 4 primary acts: physical abuse, neglect, sexual abuse, and psychological abuse.
- Childcare can be described along a hypothetical continuum ranging from healthy to abusive and
neglectful.
- Boundaries between appropriate and inappropriate behavior toward children are not always
clear or well established, but an awareness of what is right and what is wrong can go a long way
in preventing maltreatment.
Trauma, stress, and maltreatment: defining features
Trauma and stress
Children exposed to chronic or severe stressors have an elevated risk of PTSD.
• Younger children exposed to violence are fearful and often show regressive and somatic
signs of distress.
• Older boys tend to be more aggressive; girls tend to be more passive and withdrawn.
, Allostatic load: refers to the progressive ‘wear and tear’ on biological systems caused by chronic
stress.
• Some children may show signs of being hyperresponsive to stress: excessive threat
vigilance, mistrust, poor social relationships, impaired self-regulation, and unhealthy
lifestyle choices.
• Other children may become hyporesponsive to stressful events: underreacting to signs of
danger or threat, indicating that their stress system is overtaxed and may be shutting down.
Prime factor in how children respond to various forms of stress is the degree of parental support
and assistance they receive to help them cope and adapt.
Maltreatment
Polyvicimization: the experience of victimization across multiple domains of the child’s life.
These youths are particularly at risk for mental health concerns.
Physical neglect: failure to provide for a child’s basic physical needs, including refusal of or delay
in seeking health care, inadequate provision of food, abandonment, expulsion from home or
refusal to allow a runaway to return home, inadequate supervision, and inadequate provision of
clean clothes.
Educational neglect: failure to provide for a child’s basic educational needs, including allowing
chronic truancy, failing to enroll a child of mandatory school age in school, and failing to attend
to a special educational need.
Emotional neglect: failure to provide for a child’s basic emotional needs, including marked
inattention to the child’s needs for affection, refusal of or failure to provide needed psychological
care, spousal abuse in the child’s presence, and permission for drug or alcohol use by the child.
Physical abuse: the infliction or risk of physical injury as a result of punching, beating, kicking,
biting, burning, shaking, or otherwise intentionally harming a child.
Psychological abuse (also known as emotional abuse): abusive behavior that involves acts or
omissions by parents or caregivers that cause, or could cause, serious behavioral, cognitive,
emotional, or mental disorders.
Sexual abuse: abusive acts that are sexual in nature, including fondling a child’s genital,
intercourse, incest, rape, sodomy, exhibitionism, and commercial exploitation through
prostitution or the production of pornographic materials.
• Poverty is the greatest factor in the child prostitution explosion.
Characteristics of children who suffer maltreatment
• Children with disabilities are 3 times more likely to be the victims of any sort of physical
or sexual abuse.
• Girls account for 80% of the reported victims for sexual abuse.
• There are demographic differences for maltreatment. These differences suggest different
vulnerabilities for children based on gender, ethnicity, disability, and social disadvantage.
Family context
Relational disorders: disorders that occur in the context of relationships, such as child abuse and
neglect. Relational disorders signify the connection between children’s behavior patterns and
the availability of a suitable child-rearing environment.
• A greater degree of stress experienced by the abusive parent in the social environment
will increase the probability that violence will surface as an attempt to gain control or
cope with irritating, stressful events.
