Early childhood trauma exposure and neurocognitive and emotional processes: Associations in young children in a partial hospital program

Early childhood trauma has been linked to neurocognitive and emotional processing deficits in older children, yet much less is known about these associations in young children. Early childhood is an important developmental period in which to examine relations between trauma and executive functioning/emotion reactivity, given that these capacities are rapidly developing and are potential transdiagnostic factors implicated in the development of psychopathology. This cross-sectional study examined associations between cumulative trauma, interpersonal trauma, and components of executive functioning, episodic memory, and emotion reactivity, conceptualized using the RDoC framework and assessed with observational and performance-based measures, in a sample of 90 children (ages 4-7) admitted to a partial hospital program. Children who had experienced two or more categories of trauma had lower scores in episodic memory, global cognition, and inhibitory control as measured in a relational (but not computerized) task, when compared to children with less or no trauma. Interpersonal trauma was similarly associated with global cognition and relational inhibitory control. Family contextual factors did not moderate associations. Findings support examining inhibitory control in both relationally significant and decontextualized paradigms in early childhood, and underscore the importance of investigating multiple neurocognitive and emotional processes simultaneously to identify potential targets for early intervention.

Making meaning of one's own life story in words and images: A narrative case report of personal recovery from personality disorder through the interventions "An Empowering Story" and art therapy

Understanding and processing life experiences are essential in the treatment of personality disorders to promote personal recovery and psychological wellbeing. In this qualitative case report, drafted in co-creation between the client, clinical psychologist, and art therapist, individual treatment consisted of two psychotherapeutic interventions, "An Empowering Story" and life-story-focused art therapy, in 12 parallel sessions for 24 weeks. Hilda, 68 years of age, had been diagnosed with an unspecified personality disorder and various traits of borderline personality disorder. She experienced emotional exhaustion following long-term mental health problems rooted in a traumatic early childhood. This affected her ability to manage her emotions and social relations, resulting in the sense that her life had no meaning. Hilda was invited to reconstruct her life experiences, divided into the past, turning point, and present/future, in a written and a painted life story. This allowed for the integration of traumatic as well as positive memories, enhanced self-compassion, and meaning making. She developed self-reflection and integration of internal conflicts leading to a better emotional balance and self-understanding. Art therapy emphasizes bottom-up regulatory processes, while narrative psychology supports top-down regulatory processes. The combined approach effectively integrated bottom-up, experiential, sensory experiences with top-down, cognitive emotion-regulation processes. The results suggest that psychotherapeutic interventions involving a multi-pronged, complementary, and thus more holistic approach can support personal recovery in personality disorders.

An Overview of the Psychodynamics of Addiction

The author provides an overview of the psychodynamics of addiction, diverging from outdated conceptualizations such as orality and regression, and emphasizing the clinical relevance of the self-medication hypothesis. Rado and Bion paved the way for Khantzian's self-medication hypothesis by describing the drug user's need to escape unpleasure and seek self- containment. The author reviews research corroborating the relevance of the self-medication hypothesis and other relevant constructs such as self-deceptive attempts at adaptation, inability to prioritize self-care or delay gratification, excessive hedonism and novelty seeking, and impulsivity. Adverse childhood experiences, abuse and neglect are known to cause epigenetic changes altering gene expression, which may endure throughout life and be transmitted intergenerationally. Effective psychotherapeutic interventions have the potential to reverse DNA methylation and other epigenetic changes triggered by trauma and co-morbid psychopathology. Lastly, this editorial also introduces the psychodynamically informed clinical recommendations of Baurer and Gottdiener, further described in separate articles in this issue of Psychodynamic Psychiatry.

The Trauma Symptom Checklist for Young Children: A Psychometric Review

The Trauma Symptom Checklist for Young Children (TSCYC) is a 90-item caregiver-report measure of childhood traumatic stress and abuse-related experiences in children, ages three to twelve years old.

PURPOSE

The objective of this review is to examine the current empirical evidence (n = 22) regarding the psychometric properties of the TSCYC.

METHOD

A variety of study designs were reviewed for psychometric evidence supporting the reliability and validity of the TSCYC.

RESULTS

The psychometric evidence for the TSCYC indicates it is a reliable scale. However, evidence of validity is moderate and focuses on older children.

DISCUSSION

Clinicians may utilize the TSCYC to support a PTSD diagnosis in children. Further psychometric exploration would strengthen the body of evidence for younger children (ages 3-5) who have had traumatic experiences.

Problem Analysis in Community Violence Assessment: Revealing Early Childhood Trauma as a Driver of Youth and Gang Violence

Problem analysis conducted by a university-based research partner can provide communities with data-driven options to address the local drivers of serious youth and gang violence. Situated in Worcester, Massachusetts, this article describes how subsequent to early childhood trauma being identified as a potential driver of adolescent and young adult violence; problem analysis using local data confirmed that being the victim or witness of a traumatic incident before the age of 12 years was significantly correlated with involvement in violence in adolescence or young adulthood. Although there is a robust literature on the relationship between early childhood trauma and later delinquency, local decision makers did not consider this knowledge actionable until the research partner used the city's own police records to demonstrate the extent of the problem in the city. Rigorous problem analysis, conducted collaboratively between practitioners and an academic research partner, helped to compel local change and ensured that strategies addressed the right risk factors and directed service to the appropriate target population.

The Economy of the Totalitarian Mind: the Case of the Immigrant Child. Am J Psychoanal 2017;76:376-388. [PMID: 28077848 DOI: 10.1057/s11231-016-9054-5]

Immigration in early childhood can be considered as a traumatic situation. It often goes unrecognized since children adapt to most conditions and conform to their environment with astonishing agility. Inspired by the sensitive work of Sándor Ferenczi, and Donald Winnicott, regarding the psychic economy of maturational processes, the author explores the concept of totalitarian functioning and its obstruction of the growing psyche. Before birth we are all totalitarian, one with the mother; this symbiotic, invincible state of survival mode is prolonged as the immature newborn child ignores the requirements of reality and enjoys omnipotent pleasure through hallucination. The loss of place in immigration often becomes the loss of identity-the question of "where am I?" becomes confused with "who am I?". Clinical practice exposes this fragility in adults torn from their home environment at an early age, forced into precocious maturity, never to grow up in reality. Through clinical examples, the author illustrates how totalitarian mental functioning of "all or nothing, right or wrong, black or white" is exposed in the transference and can be worked through within the psychoanalytical space.

Survivors of early childhood trauma: evaluating a two-dimensional diagnostic model of the impact of trauma and neglect

BACKGROUND

A two-dimensional diagnostic model for (complex) trauma-related and personality disorders has been proposed to assess the severity and prognosis of the impact of early childhood trauma and emotional neglect. An important question that awaits empirical examination is whether a distinction between trauma-related disorders and personality disorders reflects reality when focusing on survivors of early childhood trauma. And, is a continuum of trauma diagnoses a correct assumption and, if yes, what does it look like?

OBJECTIVE

We describe the design of a cross-sectional cohort study evaluating this two-dimensional model of the impact of trauma and neglect. To provide the rationale of our study objectives, we review the existing literature on the impact of early childhood trauma and neglect on trauma-related disorders and personality disorders. Aims of the study are to: (1) quantify the two-dimensional model and test the relation with trauma and neglect; and (2) compare the two study groups.

METHOD

A total of 200 consecutive patients referred to two specific treatment programs (100 from a personality disorder program and 100 from a trauma-related disorder program) in the north of Holland will be included. Data are collected at the start of treatment. The assessments include all DSM-5 trauma-related and personality disorders, and general psychiatric symptoms, trauma history, and perceived emotional neglect.

DISCUSSION

The results will provide an evaluation of the model and an improvement of the understanding of the relationship between trauma-related disorders and personality disorders and early childhood trauma and emotional neglect. This may improve both diagnostic as well as indication procedures. We will discuss possible strengths and limitations of the design.