Effect of Childhood Psychological Trauma on Mood and Neurotic Disorders: A Systematic Review

Abstract

Childhood trauma has been always associated with an increase in the prevalence of mental illnesses. Here, in this paper, we try to investigate and analyse different research papers to understand the relationship between childhood trauma and neurotic and mood disorders. We analysed more than 55 papers from the various sample populations which comprised various age groups. The results showed that childhood sexual and physical abuse is more prevalent in patients with depressive and anxiety disorders. Also, bipolar and neurotic excoriation patients had a history of childhood trauma. This concluded that childhood trauma can increase the risk of developing mood or neurotic disorders.

Introduction

I. INTRODUCTION

Childhood plays an important part in forming an individual’s personality and character. It also plays an important role in a person’s belief system, cognition, etc. Unfortunately, many children around the world do not have a good childhood or parents and have to go through some unfortunate incidents or environments which can have a significant impact on their adulthood, personality, cognition, etc. According to the data given by WHO (World Health Organization, 2020), globally, it is estimated that around one billion children from the age of 2-17 years have experienced physical, sexual, or emotional violence or neglect in the past year. The National Institute of Mental Health (USA) defines childhood trauma as, “The experience of an event by a child that is emotionally painful or distressful, which often results in lasting mental and physical effects.” The following things are considered as traumatic experiences by The National Child Traumatic Stress Network:

1. Physical, sexual, or psychological abuse and neglect (including trafficking).
2. Natural and technological disasters or terrorism.
3. Family or community violence.
4. Sudden or violent loss of a loved one.
5. Substance use disorder (personal or familial).
6. Refugee and war experience (including torture).
7. Serious accidents or life-threatening illness.

According to Hopkins Medicine, mood disorder is characterized as, “A mood disorder is a mental health class that health professionals use to broadly describe all types of depression and bipolar disorders.” It includes disorders like depression, bipolar disorder, and substance-induced mood disorder. According to (American Psychological Association, n.d.) depression as, “Depression is more than just sadness. People with depression may experience a lack of interest and pleasure in daily activities, significant weight loss or gain, insomnia or excessive sleeping, lack of energy, inability to concentrate, feelings of worthlessness or excessive guilt, and recurrent thoughts of death or suicide.”  According to (American Psychological Association, n.d.) Bipolar disorder is defined as, “Bipolar disorder is a serious mental illness in which common emotions become intensely and often unpredictably magnified. Individuals with bipolar disorder can quickly swing from extremes of happiness, energy, and clarity to sadness, fatigue, and confusion. These shifts can be so devastating that individuals may choose suicide. All people with bipolar disorder have manic episodes - abnormally elevated or irritable moods that last at least a week and impair functioning. But not all become depressed.

Mayo Clinic Mania defines mania as a more severe type of manic episode that causes more noticeable problems at work, school, and social activities, as well as relationship difficulties. Mania may also trigger a break from reality (psychosis) and require hospitalization. Some of the symptoms of manic episodes are as follows:

a. Abnormally upbeat, jumpy or wired.

b. Increased activity, energy, or agitation.

c. An exaggerated sense of well-being and self-confidence (euphoria).

d. Decreased need for sleep.

e. Unusual talkativeness.

f. Racing thoughts.

g. Distractibility.

h. Poor decision-making, for example, going on buying spree, taking sexual risks, or making foolish investments.

According to the American Psychological Association suicide as “Suicide is defined as the act of killing oneself. Suicide is the 10th leading cause of death in the United States, according to the Centres for Disease Control and Prevention. Frequently suicide occurs in the context of a major depressive episode, but it may also occur as a result of substance use or other disorder. It sometimes occurs in the absence of any psychiatric disorder, especially in untenable situations, such as extreme or prolonged bereavement or declining health.” According to (American Psychological Association, n.d.) neurosis means,  “any one of a variety of mental disorders characterized by significant anxiety or other distressing emotional symptoms, such as persistent and irrational fears, obsessive thoughts, compulsive acts, dissociative states, and somatic and depressive reactions. The symptoms do not involve gross personality disorganization, total lack of insight, or loss of contact with reality.”  According to the American Psychological Association, n.d.), anxiety disorders are defined as, “Anxiety is characterized by feelings of tension, worried thoughts, and physical changes. Anxiety disorders such as panic disorder and obsessive-compulsive disorder (OCD) cause recurring intrusive thoughts or concerns and physical symptoms such as sweating, trembling, dizziness or a rapid heartbeat.”  In this paper, we will focus mostly on panic disorders. Also according to a study published by (Mock & Arai, 2010), individuals with a history of childhood trauma are at greater risk for developing chronic health conditions and more chronic conditions in adulthood. Analysing the seriousness of the topic and how it can leave an impact on an individual as they grow up, in the upcoming review paper we are going to understand and write a review on how Childhood Trauma can have an impact on a person in developing a psychological disorder specifically mood disorders and anxiety disorders by analysing papers on the similar topic.

II. REVIEW OF LITERATURE

A. Mood Disorders

It was found that people with childhood family problems are at increased risk of developing persistent mood disorders. (Angst et al., 2011) We have also observed that negative childhood experiences are one of the most critical elements in determining how underlying genetics are related to environmental factors in the development of mood disorders. (JaworskaAndryszewska & Rybakowski, 2019) In adults with mood disorders, there is an association between cumulative exposure to negative experiences in childhood and different functional outcomes. In particular, cumulative exposure to childhood traumatic experiences was associated with a younger age at first hospitalization and the number of recent suicide attempts; Re-victimization of adults and diagnosis of PTSD; harmful behaviour such as having multiple sexual partners and sharing drug needles; Diagnosis of substance use disorder; self-reported health problems and utilization of medical services; and homelessness. (Lu et al., 2008) Early traumatic experiences were reported more frequently in youth with mood disorders than in the general population, confirming previous research. In this way, traumatic childhood experiences seemed to play a role in the development of the disease. (Konradt CE, et al., 2013) Women who have suffered physical or sexual abuse have a higher rate of mental illness than women in general. (Chartier et al., 2007) A higher prevalence of migraines has been linked to a history of childhood sexual abuse in women with menstruation-related mood disorders (MRMD). (Bunevicius Et Al., 2013)

1. Bipolar Disorder: Bipolar patients are associated with traumatic childhood experiences, and sexual abuse is more common in bipolar I disorder, while emotional neglect is more common in bipolar II disorder. (D. Janiri et al., 2015) There is a strong association between patients with bipolar disorder and emotional abuse followed by emotional neglect. (M. Aas et al., 2014). The same results can be found in a study by (Etain et al., 2008; Goodman et al., 2003), in which they also found the strongest association with emotional abuse in bipolar patients. There was a significant prevalence of childhood traumatic events and mood disorders, and an association between childhood sexual abuse and bipolar disorder. (Jansen et al., 2016) Maternal neglect in bipolar offspring is also related to the development of an affective disorder. (Doucette et al., 2016). There is a link between the development of mood disorders and offspring who have been subjected to emotional abuse. (Manja A. Koenders et al., 2020) In patients with mental disorders (depression, bipolar disorder, and schizophrenia), childhood trauma is more severe and more common than in healthy people. (Xie et al., 2017)  A study by Post et al., (2014) found that experiences of verbal abuse in childhood are related to the early onset of bipolar disorder, combined with a poor prognosis and deterioration of the course of illness. However, there is no research showing an association between child abuse and intimate partner violence in Indian women with mood disorders. (P.V. Reddy, et al., 2020).
2. Mania and Bipolar Disorder: It was found that bipolar disorder patients with a history of child abuse have an increased risk of developing severe manic, depressive, and psychotic symptoms, the early age of onset of bipolar disorder, the risk of rapid cycling, the number of manic and depressive episodes, and the risk of a suicide attempt. (AgnewBlais and Danese, 2016) A study by Sala, R., Goldstein, BI, Wang, S., and Blanco, C. (2014) showed a high rate of child abuse in patients with bipolar disorder. They found that manic patients were the only ones exposed to repeated incidents of community violence, physical and sexual abuse as children. (Zavaschi et al., 2006) However, there was no evidence of a relationship between childhood trauma or lifelong trauma and symptoms of mania over time. Despite the lack of a link between childhood trauma and mania, childhood trauma has been found to be a common environmental component in the development of the bipolar disorder. (Ventimiglia et al., 2019) Patients who experienced physical neglect in childhood had a higher prevalence of severe mood episodes. (Cakir et al., 2015) It is also shown that verbal abuse in childhood is linked to an increase in the frequency and severity of mania. (Post et al., 2014)
3. Depression: Some types of childhood trauma have a long-term association with depression. Childhood emotional abuse and neglect, and childhood physical abuse and neglect, were found to have the strongest weekly associations with depressive symptoms. (Ventimiglia et al., 2019) While child sexual abuse has received significant attention as a crucial life experience, its relationship to depression is not as strong as other types of abuse. (Cong et al., 2012; Cutajar et al., 2010; Musliner and Singer, 2014) There is an association between childhood trauma and depressive disorders, alcohol abuse, and eating disorders. 4,444 (Park et al., 2015) patients with a history of childhood trauma had severe and chronic depression and a higher suicide rate. Kim et al. (2013) It was also found that victims of sexual violence are three times more likely to suffer from depression than the general population. (Mondin TC et al., 2016) A study by Hovens et al. (2010) showed that a history of childhood trauma, particularly emotional physical, and sexual abuse in childhood, is associated with an increased risk of developing depressive disorders, even the loss of parents in childhood is only associated with a greater risk of being depressed Associated disorders when the relationship with the surviving family member is poor. (Luecken L. J., 2000)  A study by Hovens et al. (2012) shows that a history of reported childhood trauma is associated with the worst course of depressive disorders.  A study by Opel N. et al., (2019) shows that childhood abuse is associated with unfavourable outcomes in major depression. This has been demonstrated by Nelson et al. (2016), who demonstrated that childhood abuse increases the risk of depressive disorders, treatment failures, and the chronic course of the disease. Many studies have shown the relationship between childhood trauma and depression in terms of a cause-and-effect perspective. Some studies have shown what can act as a mediator between factors. In a study by Vieira et al. (2020) resilience can act as a mediator between childhood trauma and depressive symptoms. Also a study by Kim S. Ji. et al., (2017) it was shown that rumination in non-clinical participants can act as a mediator between childhood trauma and depression, and this effect was more common in female participants. The hippocampus, a part of the human brain primarily involved in long-term memory storage, shrinks in people with depression (Sapolsky, 2001). A study by Vythilingam, Heim, Newport, et al., (2002) showed that adult women who suffered from major depression and had a history of severe sexual and/or physical abuse in childhood had lower left hippocampal volume than women with depression without a history of child abuse. A study by Gladstone, Parker, and Mitchell et al., (2004) found that there were no distinguishable characteristics based on the severity of depression between depressed women with a history of childhood sexual abuse and those without a history of childhood sexual abuse, people with a history of childhood sexual abuse depression developed early stage of life.

B. Anxiety

Child physical and sexual abuse is associated with the risk of developing anxiety disorders. (Hovens et al., 2010) A history of childhood trauma can lead to poor outcomes for initial anxiety disorder. (Hovens et al., 2012) A study by Kim S. Ji. et al., (2017) demonstrated that rumination in non-clinical participants can act as a mediator between childhood trauma and anxiety. In another study by Safron et al. (2002) patients with panic disorder had significantly higher rates of past childhood physical or sexual abuse than patients with social phobia. In another study by Lähdepuro et al. in 2019, The effects of several different forms of Early Life Stress on anxiety and found that emotional and physical childhood traumas and low childhood Socioeconomic Status were associated with higher anxiety symptoms in late adulthood. These stressors and parental divorce were also associated with a higher risk of clinically significant anxiety symptoms. In addition, the accumulation of different Early Life Stress types was associated with higher anxiety symptoms and the risk of clinically significant anxiety. Anxiety and pain were associated with a higher prevalence of emotional abuse and emotional and physical neglect in the community population and with a higher prevalence of emotional and physical abuse and emotional and physical neglect in the clinical population. (Kascakova et al. 2020) Patients reporting greater childhood traumatic experiences had a tendency to use more overall maladaptive cognitive emotion regulation strategies, which mediated the relationship between early-life traumatic experience and current depression/anxiety symptoms. This suggests that using maladaptive cognitive emotion regulation strategies is an important possible mechanism underlying the negative effect of childhood trauma on depression/anxiety symptom severity in adulthood. (Jung Huh et al. 2017)

1. Panic Disorder: In a study by De Venter et al., 2017 they found a link between childhood trauma, particularly emotional neglect, and psychological abuse in the development of a social phobia. In the study by De Venter et al. (2017), there is no significant association between the persistence of panic disorder.  It was found that women with a history of childhood sexual abuse were more likely to be diagnosed with lifetime panic disorder than women without a history of childhood sexual abuse. (Gladstone, Parker y Mitchell, et al., 2004). Childhood trauma seems to be a common factor in Psychiatric outpatients however these events don’t appear to be a unique risk factor for psychiatric disorders like Panic Disorder. (Friedman et al. 2000) The study by R. D. Goodwin et al. (2005) confirms the results of previous research that has suggested that exposure to childhood physical abuse, childhood sexual abuse, or inter-parental violence is associated with increased risks of panic attacks and panic disorder but we also found that traumatic life events may have a triggering function, but are not a necessary condition to explain the development of the panic disorder. (Bandelow et al. 2002) The influence of childhood trauma as a specific environmental factor on the development of adult psychopathology is far from being elucidated. (Lochner et al. 2010)

C. Neuroticism

Significant positive correlations were found between neuroticism scores and CTQ subscale scores for emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect; significant correlations were also found between neuroticism scores and CTQ subscale scores for emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect. Childhood trauma can also be a factor in neuroticism, which can predispose to mental health problems. (Roy., 2002) Patients who experienced child sexual abuse scored significantly higher on the NEO Neuroticism Scale (Test) than those who did not. (Lysaker et al. 2001) Childhood trauma can influence the development of psychiatric problems in adults in a number of ways. Family dysfunction, cognitive attribution style, and low self-esteem have been identified as psychosocial factors that may influence the association. Traumatized people are more likely to have disadvantaged lives due to their trauma, with more frequent teenage pregnancies, divorces, and worse financial situations. (Weiss et al. 1999). Neurotic excoriation is more common in women and middle-aged people, and childhood traumatic events play an important role in the self-infliction seen in patients with neurotic excoriation from scratching and pulling.  (Yalç?n et al., 2015).

III. AIM

The relationship between childhood traumatic events and their role in the development of the onset of the course of neurotic and mood disorders in patients with mental illness has not been widely reported. The main aim of this systematic review is to gain an understanding and explore how the traumatic events that a child goes through in childhood can influence the prevalence, onset, course, and difficulty in developing a neurotic and mood disorder and how they are connected.

IV. OBJECTIVE

To analyse and investigate different research papers to understand the relationship between childhood trauma and neurotic and mood disorders.

V. METHODOLOGY

The following review will be mostly focused on the literature which was published after the year 2008 although some papers which are important for our review may go till 2000 as well based on the significance of it. The research papers which will include will be found through Google Scholar, Scinapse, The Lancet Psychiatry, and Academia. The target age group of this study would be 16-30 years. The articles will be selected based on their aim, the purpose of the study, age range, and their results. The search will be started by searching with relevant keywords such as Childhood psychological trauma, neurotic disorders, PTSD, anxiety disorders, panic disorders, childhood trauma, and mood disorders.

VI. ETHICAL CONSIDERATION

All the reporting research papers are registered studies in which the consent and approval of the participant were taken. All the necessary citations are given for the respective studies.

VII. RESULTS AND FINDINGS ETHICAL CONSIDERATION

VIII. DISCUSSION

The primary purpose of this review was to examine the effect of childhood trauma on the course of mood and neurotic disorders later in life. In the results, it was seen that women with childhood sexual abuse have an early onset depressive disorders. These women require tailored interventions to tackle depression. It was observed that a wide range of mental illness like PTSD (Post-traumatic Stress Disorder) is associated with childhood sexual abuse victims and also with poor psychosocial functioning in adults. In addition to that, a strong association was revealed between childhood sexual abuse victims and presence of mood disorders and which also affects memory and executive functioning. It was also seen that the odds of developing depression reduces in childhood sexual abuse victims if received emotional support from adulthood from friends and families. Findings also suggest, childhood trauma is more severe and prevalent in patients with mental disorders. It was also seen that childhood trauma instead of life events lead to depressive disorders and it also increases the comorbidity with anxiety. Results reported that there was greater prevalence of panic disorders in victims of childhood physical abuse. Physical abuse and violence also had associations with development of psychopathology in adults.  A strong association between mood disorders and violence was found. Results also revealed that childhood trauma is a possible factor for development of anxiety in both clinical and general populations. It can be further stated that accumulation of early life stress increases the prevalence of anxiety symptoms in adulthood. Childhood trauma is also associated with chronicity of anxiety symptoms and occurrence of social phobia. Many studies have shown that childhood sexual abuse increases the prevalence of depression and anxiety co-morbidity. It was further noticed that anxiety disorders have higher prevalence to be comorbid if there is even a chance of depression. Childhood trauma increased the persistence of comorbidity in adults with anxiety and depressive disorder while other tragic events that happened in childhood didn't seem to have as much impact. It’s course outcome depended on the unfavourable number of clinical characteristics observed, the more characteristics the poorer the course. It was also observed that cognitive emotional dysregulation is an important factor affecting anxiety or depression symptoms in patients with childhood trauma. Results have also shown that childhood maltreatment predicts unfavourable outcomes for patients suffering from bipolar disorder. It's seen that many types of childhood trauma and maltreatment lead to the development of bipolar disorder especially sexual, verbal and neglect from mother. People with bipolar disorders also reported attachment anxiety and the predictors of this were insecure attachment, frequency of childhood trauma and young age of the patient. To tackle the prevalence of developing depressive or mood disorders, many studies found that building resilience could help to lower the risk or at least improve the course of the illness, emotional support from friends and families reduced the odds  developing mental illness in childhood sexual abuse victims. Overall, many of the papers had reported that childhood sexual abuse and physical abuse increased the risk of developing many disorders running from depressive to anxiety. The findings here, will help to understand how Childhood trauma can cause issues related to a person's mental health as it is a common factor in the history of patients suffering from depressive and anxiety disorders. It could also be applied to parenting styles which could reduce the risk of developing mental illnesses during adulthood in the general population.

IX. LIMITATIONS

The limitation of this study is that the population it covers is mostly from the western countries and there are only a handful of studies that are done in the eastern countries with no study done in the Middle East, and Indian region. This is because there isn't much funding available for these types of research in these regions and the general population in the eastern countries isn’t much aware of such topics. The second limitation is that most of the research present in this study measures the behavioural and emotional aspects of the effects and only a little research focuses on the brain and biological aspects of childhood trauma. This is because the equipment that is required to do such studies as the MRI is very expensive and only a few universities and research institutes have them. Future research can focus more on the neurobiological aspects of this topic.

X. IMPLICATIONS

The finding of this paper offers a novel perspective on the relationship between physical and sexual abuse and how it can have a serious impact on the course of mood disorders such as depression and bipolar disorder and anxiety disorders. Depression and anxiety have been the primary interest of many researchers for decades and our paper pushes this interest further. Our findings point towards a new approach to dealing with children while they are still young and more care and support should be given to children who are still young.

XI. ACKNOWLEDGEMENT

The successful accomplishment of this systematic review paper required extensive research from our side along with a great amount of guidance from my mentors who gave us great support and assistance throughout the completion of this paper. We would like to express my special thanks of gratitude to Ms. Dimple Panchal for providing us the necessary supervision to duly complete our work and we are extremely thankful for her guidance and effort. We would also like to thank our classmates, parents, and friends for being so supportive and encouraging which further helped us during this entire program. Thank you.

Conclusion

In this present review, we investigated childhood trauma and how it affects the course of anxiety and mood disorders. We found that some types of traumas have a long-term association with mood disorders, especially anxiety and depressive disorders. It was seen that victims of childhood sexual abuse are three times more likely to develop depression than the general population (Kim et al., 2013). Also, childhood sexual and physical abuse victims are more likely to develop anxiety disorders. It was also seen that women and middle-aged people with a history of childhood traumatic events are more likely to develop neurotic excoriation. In addition to that, victims of childhood maltreatment have unfavourable clinical features and course of illness with bipolar disorder. There was also some research that showed that childhood abuse and traumas can alter structural changes in the brain. Also, patients with panic disorder reported childhood physical abuse and were also more likely to have comorbid depression. Taking all this together, this paper offers a novel perspective on how childhood trauma and abuse can change the course of mood and anxiety disorders, especially depression, anxiety, and bipolar disorder. Future research may extend this work to study the effects of childhood trauma and abuse on psychotic disorders and substance abuse in the young population.

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