Ongoing Effects of Childhood Trauma

I am writing in reference to the article “Neurobiological Impact of Child Abuse to Be Discussed” in the March 15 issue. In the article, Charles Nemeroff, M.D., discusses why people who were abused as children become more vulnerable to a wide variety of psychiatric disorders. He correctly points out that this is due to brain changes resulting from trauma, to which some individuals may be more vulnerable than others because of genetic variation.

Later on in the article he mentions, almost in passing, that some of these problems are also exacerbated by current problems causing stress. This important idea gets almost no attention in studies. Most formerly abused adults are experiencing ongoing stress that stems from the fact that most maintain contact with their abusive attachment figures. Even the ones who are ostensibly cut off from parental figures may continue to get messages from them through siblings, as well as through other relatives and even third parties.

In clinical experience, the ongoing stressors occur because the abuse often remains fresh in everyone’s memory, and victims may be exposed to continuous denial, invalidation, blaming, or just everyone walking on eggshells fearing that the topic might come up. This sort of communication may not necessarily be overt but characterized by subtext.

Also, as with posttraumatic stress disorder, there are many reminders of the abuse in the outside environment. Even more important, there is strong clinical evidence that abuse victims have been trained to act in ways that elicit from intimates the very behavior that has traumatized them. This takes place through a process similar to the old psychoanalytic concept of projective identification.

These phenomena are very difficult to study “empirically” because we cannot read minds, subtext is difficult to measure let alone quantify, and we do not have a camera on our research subjects 24/7 to see how they are really interacting with others. Still, their current context must be taken into account by therapists. ■

DAVID M. ALLEN, M.D.

Germantown, Tenn.