CHILDHOOD ABUSE AND NEGLECT: CAN IT HELP PSYCHIATRY TO HEED TRAUMA AND ITS EFFECTS ON MENTAL HEALTH?

Abstract

It is known that a large proportion of children and adults have been exposed to significant trauma at some stage in their lives and that childhood trauma is associated with mental and physical ill-health. There is an accumulating literature that shows a high proportion of the mentally ill report childhood abuse and neglect. Studies showing evidence of a strong association of childhood trauma histories and specific mental illnesses, high prevalence of childhood trauma in psychiatric out-patients and as a result, higher utilization of mental health services, are cited. The evidence of association of childhood trauma and the serious mental illnesses is compelling and the ACES’ study of the past three decades have emphasised its impact. The limitations of these studies are openly considered, but in spite of the immense volume of literature on the subject, there continues to be a widening gap between clinical and biological research with serious therapeutic implications. Most of the illnesses we deal with in psychiatry have neurodevelopmental origins, which underscore the importance of focussing on early life as an age to understand how non-heritable factors interact with the genome to confer vulnerability. It is suggested that if psychiatry recognizes early childhood trauma in patients’ histories, it may help modify the course and possibly the treatment outcome of mental illnesses, particularly mood disorders. This course of action would enable more rigorous research, encourage routine practice of taking into account ACE’s during assessment and consider trauma in the management of psychiatric illnesses across all service systems, irrespective of diagnosis.