Friday, August 30, 2019
Psychopathology And Traumas Essay
Abstract            This paper is a literature review of studies and discussions of the effect of various stressors to children, such as violence, sexual abuse, and trauma. There are also some articles that explain how the human brain processes and adapts to these various factors. The goal of all these articles is to understand and explain the relationships between different stressors in the way that a child’s brain develops. They presume that the brain is the organ responsible for causing different children from reacting differently to the various stressors in their childhood. There is also a discussion analyzing the relationship between the size of the hippocampus and exposure to stress. These articles provide valuable insight into a very important aspect of human life, specifically, coping with trauma.     The article of Friedrich, Fisher, Broughton, Houston and Shafran discussed sexual behavior in children, with the goal of understanding the relationship between sexual behavior and sexual abuse. The authors of this article believed that the existing literature had gathered limited knowledge on the topic of normative sexual behavior among children (Friedrich, Fisher, Broughton, Houston & Shafran, 1998).            In order to achieve an understanding of normative childhood sexual behavior, the authors conducted a study of children between the ages two and twelve, whose sexual behaviors were rated by primary female caregivers, such as their parents and day care providers. The children were screened on whether they were sexually abused. The authors likewise used a 38-item scale called the Child Sexual Behavior Inventory, Third Version, to assess the children’s sexual behavior, the diversity of which could cover a wide range (Friedrich, Fisher, Broughton, Houston & Shafran, 1998).            After the study, the authors found that the children exhibited a broad range of sexual behaviors, such as such as exhibitionistic behavior or excessive modesty. Sexual behaviors also had different frequencies, and these are influenced by the age groups of the children, as well as other factors, like maternal education, family stress and violence, and number of hours spent in day care (Friedrich, Fisher, Broughton, Houston & Shafran, 1998).            Specifically, the authors noted that â€Å"a review of the reported endorsement frequencies indicated that for each age and gender group, there are 1 to 5 items that at least 20% of the parents endorsed.†This led the authors to conclude that the behavior of the children could be considered development-related sexual behaviors, and not too far removed from the mean (Friedrich, Fisher, Broughton, Houston & Shafran, 1998, p. 3).            On the other hand, the article by Ford and Kidd on Early Childhood Trauma and Disorders of Extreme Stress as Predictors of Treatment Outcome with Chronic Posttraumatic Stress Disorder (PTSD) sought to determine whether early childhood trauma could be considered as a predictor of the outcome of treatment for people with chronic posttraumatic stress disorder. This goal is influenced by studies showing the prevalence of early childhood trauma in cases of people with recurring PTSD (Ford & Kidd).            A study with participants from patients in a PTSD live-in rehabilitation facility, who were exposed to trauma, was conducted. Most participants were classified as trauma-exposed since they came from war zone military duty. Others who did not show â€Å"pervasive avoidance and emotional numbing symptomatology†were considered people who had to trauma-related experience. Structured interviews were conducted to classify patients to determine their classification as a person with PTSD or Disorders of Extreme Stress Not Otherwise Specified (DESNOS). Participants were asked in interviews whether they were exposed to certain traumatic events, such as witnessing the death of a family member or experiencing sexual abuse. On the other hand, DESNOS was a good empirical basis for treatment planning of PTSD. DESNOS is considered a good instrument in assessing trauma and treatment planning for PSTD because it has been observed in previous studies that most war veterans with PTSD also had histories of DESNOS symptoms (Ford & Kidd).        On a different aspect of trauma and its effect on children, Gilbertson, Shenton, Ciszewski, Kasai, Lasko, Orr and Pitman (2002), investigated the validity of the hypothesis that Smaller Hippocampal Volume Predicts Pathologic Vulnerability to Psychological Trauma and conducted a study to determine the relationship between the volume of the hippocampus and the tendency of a person to develop PTSD. The researchers’ hypothesis focused on the hippocampus of animals that the hippocampus gets damaged by severe stress and that humans with stress-related psychiatric conditions have smaller hippocampal volume. Hence, the researchers investigated whether the smaller hippocampal volume comes before or after a severely stressful event. If smaller hippocampal volume comes before the event, then it would mean that it is a preexisting condition of the person and not influenced by trauma, violence or stress. On the other hand, if the smaller hippocampal volume comes after the event, then it means that it is a result of the trauma caused by the experience (Gilbertson, Shenton, Ciszewski, Kasai, Lasko, Orr, & Pitman, 2002).  Using a â€Å"case-control†design, Gilbertson, et al. conducted a study to analyze the the hippocampi volume of monozygotic twins. The twins have the same genetic makeup, which the researchers theorized any difference in the volumes of their hippocampi may be caused by external factors, such as stress. Thus, the study involved twins, where one is exposed to a traumatic event such as combat, and the other one is not exposed (Gilbertson et al, 2002). After comparison of images taken through magnetic resonance imaging (MRI), the researchers concluded that the volumes of the hippocampi of the twin subjects are preexisting vulnerability factors. This means that smaller hippocampal volumes are not caused by mere exposure to stress. There conclusion was based on the finding that there was no significant difference between the hippocampal volumes of twins who were and were not exposed to traumatic events (Gilbertson et al., 2002).             In the next article however, no case study was conducted, but Perry (1997) explained the workings of the human brain in relation to exposure to violence. In Incubated in Terror: Neurodevelopmental Factors in the ‘Cycle of Violence’ In: Children, Youth and Violence: The Search for Solutions introduced the concept of a person’s adaptability to experience through a brief discussion of the process of development that began centuries ago. Perry traced the development of the human brain through a process called sociocultural evolution. Perry pointed out the human existence had long been pervaded by violence, which began from interspecies violence to interspecies violence, from prehistoric times. Perry believed that up to the present, different forms of violence, such as physical abuse, victimize of children. Thus, Perry sought answers on matters relating to the effect of violence on parents and children, particularly in the c ontext of neurodevelopment (Perry, 1997).            Perry discussed how violence affects children. This effect depends on various factors, such as the pattern and type of violence and the presence of support systems or caretakers for the child. Furthermore, Perry considered the age of the child an important factor that affects the child, considering that the human brain develops in a linear fashion, and certain developments only occur when a child reaches a specific age. Perry also believed that humans are capable of adapting to violence or trauma (Perry, 1997).            Perry also discussed the organization and function of the human brain. The brain has a hierarchical organization that functions to promote a person’s survival. Perry described that the brain matures throughout the life of a person. In relation to this development, Perry explained that there are factors affecting the process that lead to a child’s predisposition to violence. For Perry, violence is rooted in neurobiology, and factors that affect activity in different parts of the brain would affect a person’s propensity toward violence. Specifically, Perry explains that changes in the activity in the brainstem, such as stress, would increase a person’s propensity for violence (Perry, 1997).            Furthermore, Perry discussed different pathways to violence to which children may be exposed. Perry suggested that it is most dangerous when all different negative experiences, such as lack of care in childhood and physical abuse, combine and affect a child. Another important part of Perry’s observations are his discussion on the implications of the theory to the formulation of public policy. He purports that ultimately, the solution to problems of violence lie within primary prevention, through the transformation of violence (Perry, 1997).   In another article written by Perry (2001b), in â€Å"The neurodevelopmental impact of violence in childhood, in Schetky D & Benedek, E. (Eds.) Textbook of child and adolescent forensic            psychiatry, he discussed how violence affects the development of a child’s brain. Perry noted that violence pervades American society despite its many technological advances. Thus, while violence is abhorred by many, there are a few solutions presented for its avoidance (Perry, 2001b).            Perry noted that violence is multidimensional and complex. It has different effects, both on adults and children. In particular, Perry pointed out that violence causes fear in children, which has negative consequences on the neurodevelopmental changes of a child, such as causing a child to become more susceptible to being violent (Perry, 2001b).            Perry further noted that violence could be seen in various situations, such as in the home, community, school, and media. It seems that violence is everywhere. Most especially in the United States, violence can be seen in the home, as shown by statistics (Perry, 2001b).            Perry then discussed how the brain works and develops in general. He stated that the brain grows more complex with age. Such development may cause some areas of the brain, such as the higher, sub-cortical and cortical areas, to become less impulsive. In turn, this may cause the brain to have lower excitatory activity. These tendencies may lead to increased tendencies of an individual to become aggressive and violent (Perry, 2001b).            Perry then noted the growing body of evidence supporting the position that the neurodevelopment processes of an individual’s developing brain is hindered or altered by exposure to violence. Thus, exposure to violence leads to the stimulation of responses from a child’s brain, causing alterations in the brain’s development and consequences as related to the brain’s function (Perry, 2001b).            A similar discussion on the effect of trauma on the development of the brain is provided by Perry, Pollard, Blakley, Baker and Vigilante (1996). In an article entitled â€Å"Childhood Trauma, the Neurobiology of Adaptation & Use-dependent Development of the Brain: How States become Traits,†the authors provided observations on childhood trauma and its effect on the essential functioning of affected children. The researchers theorized that a mature brain is born out of developmental experiences. Therefore, neurodevelopment is important, and this occurs in a very critical point in a human’s life, which is his childhood. However, neurodevelopment is disturbed by experiences that disrupt the brain’s processes of organizing information, such as traumatic experiences (Perry, Pollard, Blakley, Baker & Vigilante, 1996).            The researchers believed that given an understanding of the effect of traumatic experiences on a child’s neurodevelopment, that modifications in public policy and societal perspectives may occur. Therefore, more research should be undertaken to explore this field of study (Perry, Pollard, Blakley, Baker & Vigilante, 1996). Conclusion.            All the articles provide insight on the relationship of various factors with children’s mental development. In particular, the articles endeavored and succeeded in analyzing data on the relationship between children’s brain development and traumatic events. There were detailed accounts on the specific brain areas that were affected by exposure to stress, such as the hippocampus and the brainstem. The time of exposure to trauma was also investigated to determine whether the size of a person’s hippocampus is predetermined prior or consequent to the exposure to stress. However, some of the articles did not discuss specific studies conducted that established the conclusions, but only discussed theories based on other studies. Therefore, more studies should be conducted, or more research made, to provide basis for some of the given conclusions. References Friedrich, W. N., Fisher, J., Broughton, D., Houston, M. & Shafran, C. R. (1998).           Normative Sexual Behavior in Children: A Contemporary Sample. Pediatrics  101(4). Retrieved February 23, 2008, from   http://pediatrics.aappublications.org/cgi/content/full/101/4/e9. Ford, J. D. & Kidd, P. Early Childhood Trauma and Disorders of Extreme Stress as                 Predictors of Treatment Outcome with Chronic Posttraumatic Stress Disorder. Gilbertson, M. W., Shenton, M. E., Ciszewski, A., Kasai, K., Lasko, N. B., Orr, S. P.,    Pitman, R. K. (2002). Smaller Hippocampal Volume Predicts Pathologic   Vulnerability to Psychological Trauma. Nature Neuroscience 5(11), 1242-1247. Perry, B. D. (1997). Incubated in Terror: Neurodevelopmental Factors in the ‘Cycle of Violence’ In: Children, Youth and Violence: The Search for Solutions (J Osofsky,         Ed.). New York: Guilford Press, 124-148, Perry, B.D. (2001b). The neurodevelopmental impact of violence in childhood. In          Schetky D & Benedek, E. (Eds.) Textbook of child and adolescent forensic        psychiatry. Washington, D.C.: American Psychiatric Press, Inc. (221-238) Perry, B. D., Pollard, R. A., Blakley, T. L., Baker, W. L. & Vigilante, D. (1996). Childhood            Trauma, the Neurobiology of Adaptation & Use-dependent Development of the Brain: How States become Traits. Infant Mental Health Journal.  Â
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