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The body keeps the score: Childhood adversity andsomatic symptoms in adulthood

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  1. Tez No: 913601
  2. Yazar: BESTE AYDOĞAN
  3. Danışmanlar: DR. MARİJE AAN HET ROT, PROF. DR. ISABELLA NİESTEN
  4. Tez Türü: Yüksek Lisans
  5. Konular: Belirtilmemiş.
  6. Anahtar Kelimeler: Belirtilmemiş.
  7. Yıl: 2021
  8. Dil: İngilizce
  9. Üniversite: University of Groningen (Rijksuniversiteit Groningen)
  10. Enstitü: Yurtdışı Enstitü
  11. Ana Bilim Dalı: Belirtilmemiş.
  12. Bilim Dalı: Belirtilmemiş.
  13. Sayfa Sayısı: 47

Özet

Current study is an extension of HowNutsAreTheDutch national crowdsourcing study. In this study, childhood adversity was found to be positively associated to occurrence of somatic symptoms in adulthood. Current study found that sexual abuse was associated to general symptoms, cardiopulmonary symptoms and musculoskeletal symptoms, whereas emotional abuse was associated to gastrointestinal problems and general symptoms. Physical abuse, physical neglect and emotional neglect was not associated to experiencing somatic symptoms. Childhood adversity was measured with self-report retrospective questionnaire (CTQ-SF) and somatic symptoms were measured with both Patient Health Questionnaire (PHQ-15) and ecological momentary assessments of somatic discomfort rate over 1 month course. The current study used two different non-clinical sample in total for the EMA and PHQ-15. Possible implications for clinicians and policymakers as well as future directions were discussed. Childhood adversity and trauma refers to a broad range of negative experiences that can potentially harm the children physically and mentally and bring detrimental consequences over the long and short term (Butchart et al., 2006). Childhood adversity is a globally present issue that can have tremendous impact in the long-term throughout the life (UNICEF, 2019). Prevalence of childhood trauma in the world was demonstrated by Benjet et al. (2005) in 29 types of traumatic events. According to the findings in a sample containing 24 countries with large number of participants, 7.9 % percent of the children experience being beaten up by their caregiver. According to World Mental Health (WMH) surveys, 1.6% of the participants experienced sexual abuse, 4.4% experienced neglect and 8% experienced physical abuse (Kessler et al., 2010). In the Netherlands, one study estimated that 2.6%- 3.7% of the children experience maltreatment. From 2005 to 2017, there was an overall increase in the prevalence of childhood adversity. These adversities include sexual, physical and emotional abuse as well as emotional and 3 physical neglect. Emotional neglect steps forward with the frequency over 1000 people. Prevalence estimates are as follows respectively for sexual, physical, emotional abuse and the last two values for emotional and physical neglect: 0.08%, 0.29%, 0.38%, 0.97% and 1.87%. Study shows that sexual abuse has the lowest rate, which was in accord with the findings of Kessler et al. (2010). Whereas physical neglect has the highest rate with 1.87%. 46% of the reported families includes child maltreatment in the context of domestic violence. (van Berkel et al., 2020). These findings may suggest that it is a challenge to obtain the accurate number and measure childhood adversity precisely. Family Survey of Dutch population conducted in 2018 indicates that around 19% of the people experienced physical maltreatment between the frequency of sometimes and often. Around 17% report emotional maltreatment. In this study, it was also found that some of the abuses cooccur. Prevalence of cases reporting having more than 1 ACE is 25.8% (Bussemakers, et al., 2019). ACE is used to express all kinds of abuse occurred under the age of 18. Some of the major ones are defined as physical, sexual, emotional abuse, as well as psychological and physical neglect (UNICEF, 2019). ACE score provides remarkable information about how severe a childhood trauma was by questioning which and whether it was more than 1 type of childhood trauma occurred before age of 18 years. ACE measures the cumulative exposure to adverse childhood experiences and each condition was counted as 1. A national study conducted in U.S shows that over 40% of the people experienced 1-3 ACEs, 12.7% experienced 4-6 ACEs and 2.6% experienced more than 7 ACEs (Gilbert et al., 2015). ACE includes abuse, neglect and household dysfunction. The current study will be focusing on the first two categories. Abuse and neglect contains sexual, physical, emotional abuse and physical and emotional neglect. Childhood trauma may lead to significant problems in many areas of physical health throughout the life. According to UNICEF (2019), higher number of ACEs are associated to 4 neurological symptoms as well as to respiratory, gastrointestinal and cardiovascular problems. According to Gilbert et al. (2010), experiencing at least one ACE increases the odds of asthma than 0 ACE, and the odds gradually increase as the ACE score increases. Moreover, coronary heart disease is more likely to occur when the ACE score is higher than 7 compared to ACE score of 0. Interestingly, disability (health problem requiring certain equipment) has been the most predicted outcome among other diseases and especially having more than 3 ACE creates large differences in terms of the number of physical conditions comparing to 0 ACE (Gilbert et al., 2010). There is an increasing evidence that experience of maltreatment in childhood is an important determinant of developing chronic diseases in adulthood (Sonu et al., 2019). Psychosomatic symptoms are characterized by pain, chronic illnesses and unexplained somatic symptoms that are caused by psychological disturbances and more specifically stress (Arai et al., 2011). Mock and Arai (2011), found that there was a significant relationship between childhood trauma and adult mental health; as well as between adult mental health and experiencing adult chronic illnesses. Thus, the study suggest that childhood abuse can lead to poor mental health; and poor mental health may predict poor adult physical health. Childhood trauma is linked with broad range of illnesses such as cardiovascular and autoimmune diseases (Harvard Health, 2021). An interview conducted with 60 women with somatization disorder demonstrated that 31 of them had been molested in their childhood. (Morrison, 1989). Maltreatment in childhood was also linked to endocrinological defeats such obesity and type II diabetes (Danese & Tan, 2014). A study conducted in New Zealand showed that childhood physical abuse was significantly associated with more chronic pain and fatigue. (Romans et al., 2002). Another study found that for women, physical or sexual abuse was associated to feeling tired, experiencing trouble in sleeping, chest pain, constipation, nightmares, stomach pain, shortness of breath and stomach pain (McCauley et al., 1997). Goodwin and Stein (2004) found that childhood physical abuse increases 5 the risk of lung diseases, peptic ulcer and arthritic disorders. According to Goodwin et al. (2003), frequent physical abuse was associated to increased likelihood of stomach problems, migraine and ulcer. Another study found that frequent physical and psychological violence was associated to chronic conditions such as asthma, thyroid, diabetes, etc. (Greenfield & Marks, 2009). Further, childhood trauma was associated with increased risk of being hospitalized for autoimmune diseases (Dube et al., 2009). Overall, physical abuse can predict several poor physical health outcomes. According to a meta-analytic review, sexual abuse was associated to higher musculoskeletal pain, obesity and gastrointestinal problems (Irish et al., 2010). Lampe et al. (2000) showed that sexual victimization before age of 15 is associated with later chronic pelvis pain. Childhood sexual abuse was significantly associated to increased risk of cardiac diseases; and childhood neglect was linked with increased risk of autoimmune diseases and diabetes. Romans et al. (2002) found that childhood sexual abuse was linked to chronic fatigue, headache/migraine, asthma, diabetes and cardiovascular diseases. Similarly, Talbot et al. (2009) found that sexual abuse in childhood predicts cumulative medical illness burden, worse physical function and higher bodily pain in patients over 50 years of age. Cumulative medical illness burden consists of cardiac, vascular, respiratory, gastrointestinal, etc. Afifi et al. (2016), showed that childhood sexual abuse was associated to back problems, high blood pressure, cancer, chronic fatigue in adulthood. Overall, sexual abuse may be increasing the risk of several medical conditions that can decrease the quality of life. Kascakova et al. (2020), showed that emotional abuse, emotional neglect and physical neglect was associated with long-term pain in both clinical and non-clinical population. Further, emotional abuse was associated to increased odds of reporting asthma symptoms (Strathearn, 2020). Research suggests that childhood neglect may lead to untreated medical conditions and untreated obesity. Moreover, childhood abuse and neglect was associated to infections and 6 cardiorespiratory diseases (Leeb et al., 2011). Widom et al. (2012) found that childhood neglect was linked to increased risk of poorer lung functioning, diabetes and poorer vision and oral health. Research also suggest that emotional abuse may increase the risk of irritable bowel syndrome (IRB) (Sansone & Sansone, 2015). There are pathways that are connecting childhood trauma to experiencing psychosomatic problems in adulthood. Kendall-Tackett (2002), posited four pathways of how childhood adversity can lead to poorer physical health outcomes, including (1) behavioral reasons such as substance abuse, smoking, and eating disorders; (2) social factors such as poor relationships and homelessness; (3) cognitive pathways like unhealthy thinking styles, attitude toward others and (4) emotional reasons such as internalized problems, depression and PTSD. These are considered to be health harming behaviors and actions to contribute to a low well-being. As an example for the first pathway, survivors of childhood abuse are more likely to have more than 50 intercourse partners. This the case especially for adults who have experienced sexual abuse and neglect in childhood (UNICEF, 2019). Sexual behavior is associated to engaging in risky sexual activities which can result in having STDs and increase the chance of eight-fold of struggling with HIV. As an example to the second pathway, sexual abuse was also found to be leading to less seek of social support which in turn increasing the negative health outcomes (Ericsson et al., 2009). (Ferguson et al., 1997; UNICEF, 2019). Likewise, children who experiences poor quality rearing are more likely to engage in health harming behavior (1). An example explained by Brown et al. (2010) for harmful habits is that ACE and lung cancer can be partially explained by regular smoking (1). Further, experiencing family traumas was associated with being a current smoker. As an example to pathway 3 and 4, experiencing trouble in sleeping can also be a bridge between trauma and physical illnesses. Lack of sleep can lead to depression, chronic illnesses 7 (National Sleep Foundation, 2000). Further, Poon and Knight (2011) showed that emotional abuse and physical abuse; as well as parental neglect predicts sleep disturbances in adulthood via emotional distress and current relationship status with family and friends, which correspond to pathway 4 and 2 respectively. This was consistent with the findings of Mock and Arai (2011), who suggested that mental health is a significant predictor of physical health caused by childhood trauma. A study conducted in Netherlands showed that there was a direct relationship between childhood trauma and adult chronic physical disorders. In addition, there was an indirect association between childhood trauma and physical disorders via lifetime mood, anxiety and substance use disorders (Noteboom et al., 2021). Waldinger et al. (2006) found that insecure attachment mediates the relationship between childhood trauma and adult somatization. This mediating factor was more explicit comparing to other mediators mentioned below since experiencing violence or and abuse from a parent disrupts the relationship fundamentally. Further, they found that for women, fearful attachment fully mediates the link between two concepts. Another subcategory of mediators explaining the relationship was described as biological stress systems. Kuzminskaite et al. (2020), found that there is a significant relationship between childhood trauma and high levels of cortisol, cumulative HPA axis markers (HPA dysregulation) and inflammation. The activation of stress system is considered to be normal and healthy across acute stress. However, when the stress system is over-stimulated for prolonged periods, cortisol starts to damage the tissues and creates a whole-body effect (Biodesign Wellness, 2019). Childhood abuse is also found be significantly predicting the adult inflammation, which in turn increases the risk for chronic diseases such as diabetes, metabolic syndrome, cancer, etc. (Baumeister et al., 2015; Zhong & Shi, 2019). Likewise, persistent low level of inflammation may also be predicting age-related diseases. (Hostinar et al., 2017). Childhood abuse can also impair immune functioning and influence having autoimmune diseases as an outcome (Ericsson et al., 2009). 8 HowNutsAreTheDutch (HoeGeklsNL) is a national crowdsourcing study that has been conducted on a large Dutch population. The main study was interested in investigating mental strengths and symptoms in multiple domains such as childhood trauma, psychotic symptoms, wellbeing, somatic symptoms, etc., as well as their interaction. Moreover, there was a diary study which is collecting information for 90 days about every domain with one question for each and it was a longitudinal addition to the rest of the cross-sectional study (van der Krieke et al., 2015). HND is the first study for looking at the effect of childhood abuse on psychosomatic symptoms via measuring it with daily recordings of subjective somatic experiences, which was named as ecological momentary assessments. Research show that using ecological momentary assessments (EMA) has several benefits among currently used methods. EMA provides an accurate information about the symptoms, since, in theory, the measurement time is close to the time of experience. EMA enables to gather information over a certain period per individuals and provide more detailed measurements of what is being investigated. EMA reduces the dependence on retrospective memory and decrease the inaccurate measurement of the mood, affect, symptoms, etc. (Moskowitz & Young, 2006). EMA points out to the fact that mood, symptoms or behaviors can fluctuate and narrowing down these differences to one answer may not reflect the true experience, which traditional methods often fail to cover (Li et al., 2009). My current study has 3 main research interests. I have investigated whether; 1. There is a relationship between experiencing childhood trauma and occurrence of psychosomatic symptoms in adulthood. 2. There is a relationship between childhood trauma and diary recordings (EMA) of somatic symptoms over 30 days. 3. There is a meaningful relationship between particular types of childhood adversity and particular clusters of psychosomatic symptoms.

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