Childhood trauma such as neglectful parenting causes physical scarring to the brain and increases the risk of severe depression, a new study has found.
For the first time, scientists have linked changes in the structure of the brain both to traumatic early-years experiences and poor mental health in later life.
Published in the Lancet, the study found a “significant” link between adults who had experienced maltreatment as children with a smaller insular cortex, part of the brain believed to help regulate emotion.
It focused particularly on a phenomenon known as “limbic scarring”, which previous research has hinted is linked to stress.
It involved 110 patients admitted to hospital with major depressive disorder who were then monitored for relapses over the following two years.
They were subjected to a detailed childhood trauma questionnaire, which retrospectively assessed historical incidents of physical abuse, physical neglect, emotional abuse, emotional neglect and sexual abuse.
The patients were then given MRI brain scans, which looked for changes to brain structure.
Dr Nils Opel from the University of Münster, Germany, who led the research, said: “Given the impact of the insular cortex on brain functions such as emotional awareness, it’s possible that the changes we saw make patients less responsive to conventional treatments.
“Future psychiatric research should therefore explore how our findings could be translated into special attention, care and treatment that could improve patient outcomes.”
The findings suggest that the reduction in the area of the insular cortex due to limbic scarring could make a future relapse more likely, and that childhood maltreatment is one of the strongest risk factors for major depression.
All participants in the current study, aged 18 to 60 years, had been admitted to hospital following a diagnosis of major depression and were receiving inpatient treatment.
A study of over a hundred people’s brains suggests that abuse during childhood is linked to changes in brain structure that may make depression more severe in later life.
Nils Opel at the University of Münster, Germany, and his colleagues scanned the brains of 110 adults hospitalised for major depressive disorder and asked them about the severity of their depression and whether they had experienced neglect or emotional, sexual or physical abuse during childhood.
Statistical analysis revealed that those who experienced childhood abuse were more likely to have a smaller insular cortex – a brain region involved in emotional awareness.
Over the following two years, 75 of the adults experienced another bout of depression. The team found that those who had both a history of childhood abuse and a smaller insular cortex were more likely to have a relapse.
“This is pointing to a mechanism: that childhood trauma leads to brain structure alterations, and these lead to recurrence of depression and worse outcomes,” says Opel.
The findings suggest that people with depression who experienced abuse as children could need specialised treatment, he says.
Brain changes can be reversible, says Opel, and the team is planning to test which types of therapies might work best for this group.
Journal reference: Lancet Psychiatry, DOI: 10.1016/S2215-0366(19)30044-6
1. He apologized. He said he was sorry. He promised he was never going to make the same mistake again. Even though it’s not the first time he screwed up, he seemed genuinely upset about hurting you this time. His apology seemed authentic this time. You love him, so you want to see the best in him. You want to believe him. You want to give him a second chance.
2. You have a long, complicated history. You’ve invested hours, months, years into this relationship. You fought to get this far, so you don’t want to give up on him now. You don’t want all of your hard work to be for nothing. Besides, you are a ride or die. You won’t walk away when there is something, anything, you can do to try to make the relationship work. You are willing to sacrifice for him. You are willing to put your happiness and mental health aside because you stubbornly want this relationship to work out, even if you’re the only one putting in effort.
3. You don’t want to admit he’s changed. You don’t like the way he’s been treating you lately — but it doesn’t matter. You still see him as the good guy you first met. You know he has a soft heart. You know he has a kind soul. You aren’t sure why he’s been treating you so terribly lately, but you are holding onto the hope he will change back into the guy you first fell in love with a long time ago. You know he’s in there somewhere.
4. You blame alcohol for his actions. He’s not himself when he’s drinking or smoking or shooting up. He’s fine when he’s sober. He’s nice when he’s sober. You love him when he’s sober. You don’t want to blame him for things he doesn’t even remember doing. You don’t want to leave him when he never actually meant to hurt you.
5. You think the single life would be too hard to adjust to. You don’t want to find a new place to live. You don’t want to split your belongings. You don’t want to change your entire lifestyle. You’re used to him, used to the arguments, used to the pain. You can handle it for a little longer.
6. You blame yourself for his actions. When he gets angry with you, you see his point. You know how frustrating you can be. You can’t blame him for screaming at you, cursing at you, hitting you. You consider yourself unlovable, so you are happy he sticks around at all. You are happy you’ve found someone who can deal with you. That’s what you keep telling yourself.
7. You are lying to yourself. You are making excuses. You are covering for him. You are telling yourself what you want to hear.
But you need to leave. It doesn’t matter if he apologized. It doesn’t matter if you have a history. It doesn’t matter if he used to treat you well. It doesn’t matter if he’s different when he drinks. It doesn’t matter if you get under his skin. It doesn’t matter if it will be difficult to live without him. You need to leave.
A recent series of tragic deaths has underscored how traumatic events can claim lives years after the fact. Three people affected by mass shootings—the father of a girl killed in the Sandy Hook Elementary School shooting in December 2012 and two students who survived the Marjory Stoneman Douglas High School shooting in February 2018—have died of apparent suicides.
In the wake of these incomprehensible losses, it’s clearer than ever that trauma can lead to years-long suffering. If somebody you love has survived a traumatic event, be it public (like a natural disaster or terrorist attack) or private (such as a sexual assault), you may not be sure how best to be there for them on this journey. While survivors can have very different responses to trauma, interpersonal support is one of the core pieces of recovery, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).
Here, several trauma counselors and one trauma survivor explain how to help a friend or family member who has been through something horrible. Exactly what they need from you will depend on your relationship and evolve throughout their recovery, but the suggestions below are a good place to start.
1. Validate their trauma.
“Acknowledge that what has happened to them is terrible,” Daniel A. Nelson, M.D., advisory board member of the USC National Center for School Crisis and Bereavement (NCSCB) and medical director of the Child Psychiatry Unit at Cincinnati Children’s Hospital Medical Center, tells SELF.
You can do this by saying something like, “This is a truly horrible thing that has happened. I can see you’re in an incredible amount of pain.”
It might feel like you’re saying something obvious, but this affirmation can be reassuring. “It’s about articulating that you see they are in pain and that you are OK with holding that pain,” Katherine Marshall Woods, Psy.D., a Washington, D.C.-based psychotherapist in private practice and adjunct professor of clinical psychology at George Washington University, tells SELF.
This was helpful for Manya C., 53, who was sitting in the bleachers across the street from where the first of two bombs exploded at the Boston Marathon in 2013. She appreciated when people confirmed that it really was a devastating event. “Just letting me know that they [understood] that … was validating,” Manya, who advocates for and speaks about those who are psychologically impacted by trauma, tells SELF.
You might feel a natural urge to fill the silence when you want to help but don’t know what to say, says Dr. Nelson, who has counseled survivors of traumatic events including the Oklahoma City bombing of 1995, the September 11 terror attacks, and the Marjory Stoneman Douglas High School shooting. This typically comes out of wanting to “fix” the situation, Dr. Nelson says.
But you can’t “fix” someone’s trauma, especially not by talking non-stop. It’s better to be present as they work through their feelings. “It’s really hard to mess up if you’re just intent on listening,” Dr. Nelson says.
Manya remembers breaking down sobbing, seemingly out of nowhere, while at dinner with a friend a few weeks after the bombing. Her friend remained calm and stayed with her until she was done crying before asking Manya where her tears were coming from. “She didn’t tell me, ‘Don’t cry,’ or offer me advice. She just listened and was present,” Manya recalls.
3. Admit that you don’t understand.
Survivors are often reluctant to open up because they’re afraid a loved one will not have the emotional capacity to understand, says Marshall Woods, who has counseled active military personnel and their families in the Middle East and natural disaster survivors through the American Red Cross. Unless you’ve been through a very similar trauma, you don’t get it. And that’s fine. What matters most is that you’ll be there anyway.
Say something like, “I cannot begin to imagine what you’re going through right now, but I am here for you whenever you are having a hard time.” This kind of statement acknowledges the reality—that you don’t understand—while reinforcing your willingness to be there. “It’s a piece of security that can really help them feel safe,” Marshall Woods says.
Manya remembers how helpful it was when a friend expressed this. “Hearing her honestly say, ‘I don’t know what to do to help you, but I’m here’ was huge for me,” Manya says. “I didn’t know what I needed either. But I knew she was there to listen, and that started a really great conversation.”
4. Accept if they don’t want to talk.
It’s not unusual for survivors to prefer not to talk about their feelings, even with some of the people closest to them. Discussing trauma with someone who doesn’t understand can be draining. “There are things I don’t have to say to a survivor, for example, because they get it—things I would have to explain to a friend,” Manya explains.
While it’s OK (and encouraged) to ask if your loved one feels like speaking, respect that they may not want to, Dr. Nelson says. Part of being a good support system is being there for them regardless of how much they will or won’t share.
If your loved one is still navigating how much they’re comfortable sharing, Marshall Woods recommends figuring out a verbal or non-verbal cue they can give you to back off when they need space, no questions asked.
5. Keep checking in.
Survivors often get a lot of support immediately after the traumatic event, but attention from the media, the public, and loved ones tends to dwindle soon after. “It feels like other people have gone on living their lives normally as if the trauma has not even happened, when it’s still very much alive for them,” Marshall Woods explains.
Let the person you love know that you’re still continuing to think of them by checking in accordingly. “Knowing that someone has their eyes on them can be a real source of support and security,” Marshall Woods says. She also suggests offering to sit in silence with the person if they don’t feel like talking but don’t want to be alone.
Manya’s family members called her every day for longer than she expected after the attack. The conversations weren’t long, but the constant reminder of their presence and concern was comforting. “It meant a lot to me just to get those calls,” she says.
6. Offer to help limit news coverage.
If your loved one has been through a highly publicized trauma, such as a mass shooting, the early deluge of media coverage may continually retraumatize them. If you think they’re having this problem, you can ask if they want help limiting their media exposure. You can do this by changing their news alerts and muting certain hashtags or words on Twitter, for instance. This helps some people feel safer throughout the recovery process, Marshall Woods says.
But it’s possible your friend may want to stay up with the news coverage because it helps them feel less alone. “They [may be] grateful that people are taking notice of the pain they’re experiencing and that people are grieving with them,” Marshall Woods explains. So, even if your friend is visibly upset by news stories about what happened, keep in mind that this may be a part of their healing process.
7. Avoid clichés.
Looking for a silver lining can be great in many situations. The aftermath of a trauma usually isn’t one of them. “When someone is feeling this pain, you need to meet them there,” Marshall Woods says. “You want them to feel better now, but that is not the reality of where they are.”
Urging your friend to be optimistic or not “dwell” on the tragedy communicates that you’re not accepting how they’re feeling. What you mean as an expression of hope (“Things will get better!”) can come off as a dismissal of their suffering and make them feel misunderstood. “Usually when the individual hears something like that, they think ‘You’re trying to fix me, and you don’t know the first thing about what’s wrong,’” Dr. Nelson explains.
8. Help them find mental health support.
If you’re concerned for your loved one’s well-being—like if they are struggling to eat, get out of bed, go to work, or otherwise function months after the event—you can offer to help connect them with some professional resources like a therapist or support group, Dr. Nelson says. (Even if they are currently receiving mental health treatment, if it doesn’t seem effective, you may be able to help them find a better option.)
This is also a good idea if you begin to feel overwhelmed with the level of support they need from you. “Sometimes it’s really hard to hear these stories,” Dr. Nelson says, “and it’s important to have the proper tools to metabolize it.” Friends and family of survivors can even experience secondary trauma, according to SAMHSA. It’s OK to be mindful of your limits and communicate those needs in a compassionate way.
In that situation, Dr. Nelson suggests saying something like, “What you’re telling me sounds like it really deserves the appropriate level of support, and it may be more than I know what to do with. I would love to know you’re with somebody who really knows what they’re doing. Can we hit pause and work on finding you that help?”
9. Be patient.
The aftermath of trauma is complex, evolving, and inscrutable at times—not just to outsiders, but also to the people who are in it. “Trauma generally is an experience of something that is so chaotic that our brains really struggle to … make meaning out of what has happened,” Marshall Woods explains.
Be prepared for emotions to be intense and fluctuating, Dr. Nelson says. Also keep in mind that your loved one may struggle to understand why they are feeling the way they are, or to even know what it is they’re feeling. This was Manya’s experience in the first few months after the bombing, before she was diagnosed with post-traumatic stress disorder. “At the time, ‘I was thinking I should be better, I shouldn’t feel like this,’” she says.
You can’t speed up the recovery process for your loved one, but you can remain a steady, patient, and adaptable source of love throughout. “It can be a rollercoaster,” says Manya. “But people should understand it’s normal to feel this way and that they can heal.”
Healing from a toxic relationship takes time. It takes effort. You have to make the conscious decision to change, to better yourself, to put your past in the past.
In order to heal from a toxic relationship, you have to accept your ex is in your past. You have to delete their number from your phone. You have to avoid the urge to reach out to them when you are drunk, when you are lonely, when you are scared you’ve made a mistake by leaving them. You have to remind yourself they are out of your world for a reason. You have to remind yourself you are better off without them weighing you down.
In order to heal from a toxic relationship, you have to forgive yourself. Forgive yourself for accepting such poor treatment. Forgive yourself for staying for such a long time. Forgive yourself for growing distant from family and friends who were only trying to help you. Forgive yourself for ignoring the red flags, ignoring your gut.
In order to heal from a toxic relationship, you have to grow comfortable with the idea of being alone. You have to accept the single life is better than life with an abusive ex. You have to get used to being on your own. You cannot rebound with the first person who treats you better than your ex treated you. You cannot jump into a new relationship without working on ridding yourself of the baggage your last relationship brought you. You cannot assume a brand new relationship is the only thing that will make you feel better. You cannot let yourself believe happiness and relationship status are linked.
In order to heal from a toxic relationship, you have to raise your standards. You have to rediscover your self-worth. You have to practice self-care. You have to treat your mental health as a priority. You have to realize you are someone worthy of love and respect. You have to promise yourself you are not going to take crap from anyone anymore. You have to recognize what you deserve. You have to fight for what you deserve.
In order to heal from a toxic relationship, you have to remain patient. You have to remember results are not going to be seen overnight. It’s going to take a while to trust again. It’s going to take a while to love again. Your struggles are valid and so are your emotions. No matter how long your healing takes, you cannot give up on yourself. You cannot swear off of relationships. You cannot hide yourself away. You cannot assume you are unlovable and will never be happy again.
Even if it’s hard to believe right now, you are going to heal from this heartbreak. You are going to reach a place where you feel confident and strong again. You are going to mean it when you say you are okay. You just have to have faith in yourself. You are more resilient than you think
Toxic relationships come with the emotional damage you don’t even realize while you’re in them. Sometimes a victim of a toxic relationship will continue the cycle of pining after other toxic people as if winning over their love and affection will heal the emotional damage others might have caused in their past. So when this […]
If I could talk to my 16-year-old self, what would I say to her? I’d tell her that she eventually escapes that toxic relationship, but it sadly takes her years to leave. I’d tell her this to give her hope and motivate her to say something sooner. I’d tell her to speak up, to find […]
This question came up in conversation when I was speaking with someone who has experienced severe panic attacks to the point of calling them “debilitating”, requiring inpatient care. As they were sharing about the ordeal, they told me that when they contemplate the time spent seeking treatment and the aftermath, it ramped up both the anxiety and PTSD symptoms. Even as a career therapist with decades of experience treating people with stand-alone anxiety, with no overt PTSD symptoms, I had not considered that remembering the anxiety was re-traumatizing. I have heard clients share that anticipating panic attacks was in and of itself anxiety provoking. For this person and so many others, it is hard to determine the line between the two.
As is the case for many who struggle with this condition, they experienced body memory, flashbacks and tremors, as if the events of the past were recurring. Reminding themselves, “I am here and now, not there and then,” alleviated some of the more intense indicators.
This person is also intent on taking on challenges and resilience is one of their superpowers. Overcoming life changing physical conditions were part of the symbolic exercise equipment that helped them to become stronger and more flexible. They were aware that life events happen, unbidden at times and all they can do is ride the waves, sometimes treading water, until things settle back into place. Having solid support from family, friends and professionals keeps them afloat.
Although it might be hard to acknowledge an upside to anxiety or trauma, this person and others I have encountered in both personal and professional realms have been grateful for accompanying lessons. Keep in mind, that no one is sugar-coating it, nor are they denying the pain. They are making a conscious decision to face what comes their way. Paradoxically, the one certainty of life is uncertainty. A catch-22, since anxiety thrives on unpredictability.
The field of Positive Psychology, which offers a strengths-focused perspective to recovery from traumatic experiences, was pioneered by psychologist Martin Seligman, who directs the Positive Psychology Center at the University of Pennsylvania. One concept in this approach is post-traumatic growth, which reflects counterintuitive responses to horrific circumstances. Research from Lawrence G. Calhoun and Richard G. Tedeschi of the University of North Carolina Charlotte found that survivors of trauma often experienced profound healing, a stronger spiritual faith and philosophical grounding. One powerful reframing is referring to the outcome as Post Traumatic Growth.
The 21-item Post-Traumatic Growth Inventory examines responses to painful event in five areas:
- Relating to others
- New possibilities
- Personal strength
- Spiritual change
- Appreciation for life
When survivors view themselves in that light and additionally as thrivers who give back or pay it forward, rather than as victims who have no choice but to feel as they do, healing is possible. One such thriver is Michele Rosenthal, a keynote speaker, award-winning blogger, award-nominated author, workshop/seminar leader and certified professional coach. Michele is also a trauma survivor who struggled with posttraumatic stress disorder (PTSD) for over twenty-five years. She calls herself Chief Hope Officer (CHO) of Your Life After Trauma, LLC.
Her trauma came in the form of a condition called, ToxicEpidermal Necrolysis Syndrome (TENS), which she describes as “a freak allergy to a medication that turned me into a full-body burn victim almost overnight.” This horror was followed by a series of physiological and psychological conditions that would flatten even the strongest of people. It took years of determination to recover that led her to be symptom free and now she guides others to overcome their own trauma-trials.
What helped her see her way clear to the other side of suffering is what she refers to as a “healing rampage.”
Rosenthal says, “It is an approach to recovery that is, 1) committed — we keep going no matter what; 2) consistent — we work at it every day; 3) creative — we look for new options and healing opportunities; and, 4) complex — we do the deep work rather than skim the surface as we seek relief.
These are important resiliency building skills regardless of diagnosis or symptomology, whether it falls under the umbrella of anxiety or PTSD.
- Learn relaxation and breathing techniques to center yourself in the here and now.
- Do grounding exercises such as walking barefoot on the grass or sand or tapping the bottoms of your feet.
- If possible, avoid people, places or things that may overtly trigger reaction. Some PTSD survivors may steer clear of fireworks or large numbers of people if loud noises or crowds are related to the initial events.
- Contemplate an exit strategy if you get inadvertently triggered.
- Breathe in relaxing aromas, such as lavender, chamomile, vanilla or bergamot.
- Listen to music that is soul soothing.
- Seek support from family and friends who may understand your situation and if not, offer a listening presence.
- Engage in therapy with a licensed professional.
- If medications are indicated, work with a Psychiatrist or CRNP (Certified Registered Nurse Practitioner) who can prescribe.
- Attend a self-help group.
- Utilize the therapeutic modality of EMDR (Eye Movement Desensitization and Reprocessing).
- Exercise, whether it is in a gym, or a dance floor or basketball court assists in moving the energy. I think of emotion as ‘e-motion’ or ‘energy in motion’.
- Spend time in nature which is restorative.
- Dig in the dirt, and plant seeds for new beginnings.
- Avoid self-medicating with drugs, alcohol, gambling, work, shopping or food.
- Indulge in healthy hobbies, such as reading, crafts, music, playing board games, putting together puzzles or models.
- Volunteer your time in your community.
- If you have a spiritual practice, use it as an additional therapeutic modality.
- Determine your passion and live it as fully as you can.
- Spend time with children and learn how to be silly from them.
- Lighten up by experiencing Laughter Yoga.
- Enjoy a pampering therapeutic massage.
A long-term study of 1,420 people finds that childhood trauma is more commonplace than is often assumed, and that its effects upon the transition to adulthood and adult functioning are not only confined to post-traumatic stresssymptoms and depression, but are more broadly based.
These conclusions were reported on November 9, 2018, by a team led by 2009 BBRF Young Investigator William E. Copeland, Ph.D., of the Vermont Center for Children, Youth and Families at the University of Vermont. He and his colleagues are part of the Great Smoky Mountain Study, a study of children in 11 mainly rural counties in North Carolina.
Beginning in 1993 and continuing through 2015, the study annually observed 1,420 children, selected randomly from a group of 12,000 local children, through age 16, and again when they reached ages 19, 21, 25 and 30. Results are based on analysis of over 11,000 individual interviews. The sample was designed to over-represent frequently overlooked rural and Native American communities.
One striking perspective emerging from the study is that “it is a myth to believe that childhood trauma is a rare experience that only affects few,” the researchers say. Rather, their population sample suggests, “It is a normative experience — it affects the majority of children at some point.” A surprising 60 percent of those in the study were exposed to at least one trauma by age 16. Over 30 percent were exposed to multiple traumatic events.
“Trauma” for the purpose of the study included violent events (e.g., the violent death of a loved one, physical abuse or harm, war or terrorism, captivity); sexual trauma; witnessing a trauma that caused or could have caused death or severe injury; learning about a traumatic event involving a loved one; and other traumas, such as diagnosis with a serious illness, serious injury, or fire.
“Our study suggested that childhood trauma casts a long and wide-ranging shadow,” the researchers say, associated with elevated risk for many adult psychiatric disorders affecting many “important domains of functioning,” with impacts in the form of diminished health, financial and academic success, and social life.
The impact of trauma across the lifespan has been noted in many past studies. The newly reported study, appearing on the website of the Journal of the American Medical Association (JAMA), differed, because it followed children from year to year. Prior studies relied upon memory-based reports of childhood events made by participants during their adulthood, which tend to be less accurate. The new study also statistically compensated for the presence of other childhood factors that often co-occur with childhood trauma, such as poverty and family instability or dysfunction.
The researchers say their results are consistent with an “accumulation” model of trauma that assigns increased lifetime risk of psychosocial impact with each additional traumatic exposure during childhood. While they do not shed light on the question of which children are more likely to experience trauma, the team hopes the results will inform public policy, via “interventions or policies that broadly target this largely preventable cluster of childhood experiences.”
The research team included: E. Jane Costello, Ph.D., 2009 Ruane Prizewinner and 2007 BBRF Distinguished Investigator; and Edwin J.C.G. van den Oord, Ph.D., 2002 BBRF Independent Investigator.