Psychopathology Linked to Trauma

Disclaimer: Please note that hundreds of studies have linked trauma exposure to a range of psychological disorders. The following are merely some of the studies that have found an association between trauma exposure and a given disorder.

The given disorders listed on this page are as follows: posttraumatic stress disorder, developmental trauma disorder, severe dissociative disorders, depression, anxiety disorders, bipolar disorder, ADD/ADHD, obsessive compulsive disorder, substance use disorders, personality disorders, multiple (comorbid) psychiatric disorders, psychotic symptoms, and anger, anxious arousal, and shame symptoms.

Posttraumatic Stress Disorder [13] [14] [27] [28] [29] [30] [31] [75] [76] [77] [78] [79] [80]

  • Posttraumatic stress disorder (PTSD) is one of the most common outcomes resulting from trauma: 7% of the people in the Unites States will experience PTSD at some point in their lives [29].
  • Trauma that first occurs at an early age and is “of an interpersonal nature” has significant effects on psychological functioning, including the development of PTSD symptomatology [14].
    • The younger the age of onset of trauma and the more complex the trauma is, the more likely an individual will suffer from PTSD [14].
      • However, it has also been shown that significantly severe PTSD symptoms can result from a single traumatic incident [80].
  • Trauma that occurs during adulthood is also associated with the development of PTSD, which in turn has also been shown to lead to poor health functioning as a result [78].
  • Additionally, rates of PTSD are exceptionally high in countries that have experienced war, such as 28% in Cambodia and 37% in Algeria [30].
  • Literature notes that most individuals with PTSD gradually recover from it; however, more than 1/3 of individuals who develop PTSD experience symptoms for a prolonged period of time  [31].
    • In a study of 144 young men and 72 young women with maltreatment histories, many experienced substance use complications as a result of enduring PTSD symptoms [77].
  • Studies also note that early and chronic abuse and neglect affects the process of brain development, resulting in unhealthy biochemical, functional, and structural changes in the brain, in turn affecting later quality of life and onset of PTSD symptomatology [75].
    • In a study of maltreated youth without PTSD (n = 38), maltreated youth with PTSD (n = 60), and control youth (n = 104), those youth with PTSD performed significantly worse than their counterparts on tasks that assessed higher order cognitive abilities [79].
  • Regarding gender, women are more likely to develop PTSD than men, and they are more likely to develop chronic PTSD than men (22% of women versus 6% of men) [27] [28].
  • Sexual assault and physical assault tend to be associated with the highest risk of developing PTSD [28].
    • In cases where children have been both sexually and physically abused, PTSD is highly comorbid with most affective disorders as well [13].
    • Individuals who have experienced frequent traumatization and/or are highly distressed by these experiences are most at risk for developing PTSD [28].
  • Emotional abuse is also associated with a risk of developing posttraumatic symptoms, as well as an inability to properly regulate emotions in later life [76].
  • Additional risk factors that moderate trauma can be found here.

Developmental Trauma Disorder [49] [50] [51] [52] [53] [54] [55]

  • Although many traumatized children and adolescents meet criteria for PTSD, it is not the most common psychiatric disorder found among traumatized youth.
    • One study found the most common diagnoses in order of frequency were separation anxiety disorder, oppositional defiant disorder, phobic disorders, PTSD, and ADHD [49].
    • Other studies have found that traumatized children have a wide range of problems including difficulties with aggression and impulse control, attention, dissociation, forming secure attachments, and interpersonal functioning [50] [51].
    • The existing diagnosis of PTSD also does not account for disturbance related to affect, attachment, or somatic difficulties; thus, it does not account for witnessing domestic violence, loss of attachment figures, or chronic bullying [53].
    • In children and adolescents, the usefulness of a PTSD diagnosis is limited because the condition is based on symptoms in adults [55]. As such, some experts recommend that traumatized children should be assessed for Developmental Trauma Disorder in addition to other psychopathology.
  • Developmental Trauma Disorder aims to diagnose younger children who have experienced multiple, chronic, or prolonged exposure to developmentally adverse interpersonal trauma [53].
    • Research suggests that the proposed symptom criteria for Developmental Trauma Disorder can differentiate children with histories of exposure to developmental trauma from other trauma-exposed children [52].
    • The absence of an appropriate diagnosis for these children may act as a barrier to treatment; therefore, it is important to consider Developmental Trauma Disorder as a diagnosis in practice [53].
  • Developmental trauma is such an important concept because the damage it causes can interfere with a child’s development of secure attachment relationships, cognitive abilities, affect regulation, behavior regulation, self-concept, and biological and physical maturation, as well as increase the likelihood of dissociation [54].
    • The likelihood of non-suicidal self-injury and suicidal behavior is also increased in those who have experienced developmental trauma [55].
  • For more information on Developmental Trauma Disorder and its link with child maltreatment, please see here.

Severe Dissociative Disorders [16] [17] [32] [33] [34]

  • Most cases of chronic, severe dissociative disorders are thought to be the result of severe trauma and difficult early childhood experiences [32].
  • Dissociative disorders are relatively common among psychiatric samples in North America and Western and Eastern Europe, ranging from 1% to 20.7% of inpatients and 12% to 29% of outpatients [33]. Higher prevalence rates are found in samples with higher trauma exposure.
  • After exposure to a serious traumatic incident, approximately three quarters of individuals will experience dissociative states in the following hours, days, or weeks [34].
  • Dissociative disorders are associated with high levels of impairment in areas such as overall global functioning and number of suicide attempts [33].
  • Patients with dissociation disorders are at risk for poor response to current treatments and higher relapse rates when their dissociative psychopathology is not addressed [33].
  • For most people, dissociative experiences will subside on their own within a few weeks after the traumatic incident subsides [34].

Depression [15] [35] [36] [37] [38]

  • Survivors from a multitude of post-conflict settings have commonly reported high levels of depression and suicidal ideation [35].
  • Exposure to trauma has been shown to increase the risk for major depressive disorder [36].
  • An unpredictable and uncontrollable traumatic event may lead individuals to feel fear, loss of control, and helplessness and hopelessness that often precede depression [37].
  • Examples specific traumatic events that have been shown to result in depression include childhood physical and sexual abuse, natural and human-made disasters, and exposure to combat and ongoing terrorism [37].
  • Overall, studies have found that there is an increased risk of depressive disorders and suicide attempts among individuals with a greater number of traumatic childhood experiences [38].

Anxiety Disorders [89] [90] [91] [92] [93] [94] [95] [96] [97] [98] [99] [100]

  • Anxiety disorders, characterized by frequent worrying, nervousness and somatic complaints, have been found in traumatized populations across the lifespan [94] [95] [97].
    • A meta-analysis found that individuals with early emotional trauma were 1.9 to 3.6 times more likely to develop anxiety disorders compared with a healthy control group [98].
  • 11.1% to 31.6% of traumatized individuals suffer from generalized anxiety disorder (GAD) [89] [90].
  • Trauma exposure may precipitate separation anxiety disorder (SAD).
    • Community-based studies have indicated that both natural and human-made disasters may precipitate SAD among older children and young adolescents [92] [93].
    • Interpersonal traumas that threaten the self and close others may also precipitate SAD symptoms [91].
  • Experiencing trauma has been shown to lead to diminished hope, subsequently placing victims at risk of psychological maladjustment, particularly anxiety disorders and suicidal reactions [96].
    • Individuals with low optimism after a traumatic event may especially be at risk for anxiety disorders [99].
  • There is a link between childhood trauma and the presence of social anxiety disorders across the lifespan [100].

Bipolar Disorder [1] [2] [3] [39] [40] [41]

  • Trauma has been associated with clinical characteristics of bipolar disorder (BD), including earlier onset of the illness, a rapid cycling course, more psychotic features, higher number of lifetime mood episodes, and suicidal ideation and attempts [39].
  • The presence of trauma also has predicted BD-individuals’ frequency of hospital admissions, quality of life, and inter-episode depressive symptoms [41].
  • Childhood physical abuse has been shown to be a strong predictor of unfavorable characteristics of bipolar disorder [39].
  • Likewise, individuals with bipolar disorder tend to report more negative life events and traumatic incidents as compared to individuals without bipolar disorder [1].
  • Individuals with bipolar disorder that have experienced a severe degree of trauma and developed symptoms are at higher risk to be exposed to physical violence, parental disregard, alcohol dependence of parents, and/or sexual assault by a family member or acquaintance [40].

ADD/ADHD [4] [5] [42] [43]

  • Environmental trauma occurring in early life poses a significant risk to children’s ability to focus and pay attention [42].
  • Complex trauma in childhood is strongly correlated with behavior that is common among children who have deficits in mentalization [42].
  • Children with ADHD are more likely to have experienced chronic adverse situations during childhood, such as high levels of poverty, and disruptions in attachment relationships, including parental divorce [5] [42].
  • Indeed, children with ADHD symptoms have 3% higher odds of experiencing physical abuse in comparison to their peers without ADHD [5].
  • Individuals with ADHD that have been exposed to trauma or experienced parent-child conflict are more likely to exhibit suicidal behavior [43].
  • Overall, exposure to trauma has been shown to result in, and exacerbate, the risk of induced ADHD and ADD [5].

Obsessive Compulsive Disorder [12] [46] [47] [48]

  • For some individuals, the development and maintenance of obsessive and compulsive symptoms may be a response to overwhelming experiences, particularly in childhood [12].
  • Specifically, childhood trauma has been implicated in the development of obsessive compulsive disorder (OCD) [46].
  • Emotional neglect in particular was noted to be higher in individuals diagnosed with OCD than in individuals without a diagnosis [48].
  • Individuals with OCD also frequently report dissociative symptoms, and researchers believe that this may be related to childhood traumatic experiences as well [12].
  • Clinical studies have reported that traumatic experiences are more prevalent among individuals with OCD compared to those who do not meet criteria for a disorder [46].
  • A number of case studies outline patients who developed OCD after combat exposure, sexual assault, personal violence, and serious road traffic accidents [47].
  • Additionally, childhood emotional abuse and neglect has been shown to be associated with an increase in obsessive-compulsive symptoms [48].

Substance Use Disorders [81] [82] [83] [84] [85] [86] [87] [88]

  • Among survivors of trauma, there are significantly higher rates of substance abuse [81].
    • Trauma severity has been shown to be positively associated with substance abuse, and rates of PTSD in particular tend to be higher among substance abusers [81].
    • A greater number of reported childhood traumatic events are also associated with an increased severity of later substance use [82].
  • The association between childhood trauma and the risk of developing substance use disorders appears to be higher in women [82].
    • In a culmination of studies among women with substance abuse, the following rates of trauma were found:
      • 10% to 82% of women reported childhood physical abuse
      • 23% to 82% reported childhood sexual abuse
      • 18% to 80% reported being raped
      • 30% to 75% reported intimate partner violence [85]
    • Approximately 60% to 75% of women enrolled in substance abuse treatment report a history of partner violence in their lifetime, as opposed to 25% of women in the general population [82].
  • Individuals with a history of trauma have higher distress and need more psychiatric treatment compared to those without a history of trauma [82].
    • This may be due to trauma survivors using substances as a way to “self-medicate” to reduce trauma-related distress [86] or avoid posttraumatic symptoms [87].
  • Strong links exist between substance use disorders, mental health symptoms, and a history of trauma:
    • 60% of women and 30% of men with a substance use disorder and a comorbid severe mental illness reported a history of physical trauma [83].
    • 47% of women and 17% of men with a substance use disorder and comorbid severe mental disorder reported a history of sexual trauma [84].
    • Substance abusers were 2.52 times more likely to have depression, and 70% of one sample experienced more than ten types of trauma, including childhood physical abuse, spousal abuse, witnessing domestic violence, and being stalked [88].

Personality Disorders [6] [67] [68] [69] [70] [71] [72] [73] [74]

  • Overall, patients reporting abuse or trauma in childhood generally present with more personality disorder symptoms as opposed to individuals who did not experience traumatic childhood events [67].
  • Different forms of childhood maltreatment, including sexual, physical, and emotional abuse, and emotional and physical neglect, have differential effects on personality disorder pathology [6].
    • Patients diagnosed with personality disorders report a high number of childhood trauma experiences [69].
  • Sexual abuse is associated with symptoms of paranoid, schizoid, borderline, and avoidant personality disorders [6].
    • Regarding borderline personality disorder (BPD) specifically, studies have identified that between 30% and 91% of BPD patients reported a history of childhood trauma including sexual, physical and emotional abuse, and neglect, compared with 17– 45% in control groups [69].
    • Emotional abuse has been associated with avoidant personality disorder and may contribute to chronic depression [71].
  • Physical abuse [6] and witnessing domestic violence [68] may contribute to the development of antisocial personality disorder.
    • Furthermore, exposure to violence has been linked with higher rates of antisocial personality disorder symptoms and subsequent posttraumatic stress [72].
  • Emotional abuse specifically has been linked with paranoid, schizotypal, borderline, and cluster C personality disorders (i.e., avoidant, dependent, and obsessive-compulsive personality disorder) [6].
    • Environments that foster feelings of victimization, alienation, and lack of control are linked with the development of paranoid personality symptoms [70].
    • In a study of 711 individuals, greater childhood trauma were related to elevated paranoid personality symptoms, as well as feelings of social inequality and low socioeconomic status [70].
    • In a study of 1,510 adults, both childhood maltreatment and the experience of an injury or life-threatening event were significantly associated with schizotypal symptoms [74].
  • Histrionic and borderline personality disorders also have strong associations with abuse and neglect [6].
    • In a study of 135 inpatients with dissociative identity disorder who experienced childhood physical and sexual abuse, over one third of participants endorsed traits from all three personality cluster areas [73]. This included:
      • Cluster A’s odd or eccentric behavior: paranoid, schizoid, and schizotypal personality disorder
      • Cluster B’s dramatic and erratic emotional responses: antisocial, borderline, histrionic, and narcissistic personality disorder
      • Cluster C’s anxious and fearful behavior: avoidant, dependent, and obsessive-compulsive personality disorder

Multiple (Comorbid) Psychiatric Disorders [7] [8] [9] [10]

  • Exposure to trauma has been shown to leave individuals at an increased risk for many psychiatric disorders, including mood disorders, anxiety disorders, alcohol use disorders, drug use disorders, disruptive behavior disorders, antisocial behavior, and psychosis [7].
  • Research has shown that trauma leaves individuals at risk for developing not only specific psychiatric disorders, but also for developing multiple psychopathologies [7].
  • Increased adversity is associated with more complex psychopathology: In a study of the National Cormorbidity Survery-Replication sample, individuals with more childhood adversities were more likely to be diagnosed with separate diagnoses, have diagnoses in different disorder categories, and exhibit coexisting internalizing and externalizing disorders [10].
  • Adversity involving maladaptive family functioning has been shown to have a stronger association with an onset of multiple psychiatric disorders than other types of adversity [9].
  • In particular, parental mental illness, substance abuse disorders, criminality, family violence, physical abuse, sexual abuse, and neglect are especially strong correlates of multiple disorder onset [8].
  • Research suggests that trauma is associated with 44.6% of all childhood-onset disorders and 25.9%-32% of later-onset disorders [8].

Psychotic Symptoms [11] [44] [45]

  • A review of 20 studies of exclusively psychotic samples reported that 50% of participants had been traumatized as children [11].
  • Research has shown that there is a strong link between psychosis and childhood emotional, physical, and sexual abuse, and childhood neglect [11].
  • Previous traumatic incidents appear to be related to the severity of the psychotic symptoms and have a negative impact on the outcome and course of psychotic disorders [44].
  • Individuals who experienced sexual assault as children are 3.3 times more likely to experience visual hallucinations and 3.5 times more likely to experience auditory hallucinations [11].
  • Likewise, individuals who have experienced a high degree of sexual abuse are 2 to 4 times more likely to develop psychosis than those who have experienced a lower degree of sexual abuse or did not experience sexual abuse at all [44].
  • Overall, in a meta-analysis of over 80,000 subjects, researchers found that individuals who experienced childhood trauma were 2.8 times more likely to develop psychosis [45].

Anger, Anxious Arousal, and Shame Symptoms  [15] [56] [57] [58] [59] [60] [61] [62] [63] [64] [65] [66]

  • Traumatic experiences are significantly associated with poor adult psychological functioning and emotion regulation [15] [60] [61] [62].
    • In particular, it has been shown that posttraumatic stress leads to a diminished affect regulation capacity [60].
    • Reduced affect regulation capacities may determine whether trauma exposure results in clinically significant dissociation as well [61]. However, it is hypothesized that emotional distress motivates dissociation and other psychopathology [62].
  • Experiencing trauma in childhood, especially emotional abuse and neglect, is linked with higher levels of anxious arousal and anger in emerging adulthood [15] [63] [64].
    • In a study of 88 individuals with schizophrenia or schizoaffective disorder, it was found that participants who had a history of trauma reported a heightened tendency to express anger both inwardly and outwardly [63].
    • In another study of 200 male substance-dependent inpatients, it was found that those who had a history of childhood trauma had a tendency to focus anger toward themselves and had a higher rate of self-mutilation [64].
  • Children who have experienced maltreatment are also prone to anger, more total behavior problems, difficulties with adjustment, and increased feelings of shame [56]. The effects of maltreatment at not only the social level, but also the behavioral, cognitive, and neurobiological levels, are implicated in more externalizing problems [65].
    • In a sample of nonmaltreated (n = 136) and maltreated children (n = 223), children who were maltreated during infancy, and children with a chronic history of maltreatment, exhibited “significantly poorer inhibitory control and working-memory performance than did children without a history of maltreatment” [66].
  • Increased anger and arousal is not limited to direct victims of abuse: children who have witnessed abuse are also prone to high levels of anger as compared to their peers who have not witnessed abuse [57].
  • Common triggers for anger and rage in traumatized adults may include perceiving a threat to oneself or a loved one [58], emotional abuse [58], and marital discord and suicidality [59], among others.

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*Please note that hundreds of studies have linked trauma exposure to a range of psychological disorders. The following are merely some of the studies that have found an association between trauma exposure and a given disorder.