Trauma and Stress Related Disorders

Traumatic events vs stressful events

Traumatic events involve exposure to actual/threatened harm; stressful events are more common and less extreme.

DSM-5 trauma/stressor disorders category

Includes ASD, adjustment disorder, PTSD, reactive attachment disorder, and disinhibited social engagement disorder.

Bidirectionality model

Children’s characteristics can increase their risk of being maltreated.

Transactional model

Maltreatment effects can make children more vulnerable to further abuse or rejection.

Child maltreatment definition

Four acts: physical abuse, neglect, sexual abuse, psychological abuse.

Sexual abuse prevalence

1 in 4 girls and 1 in 20 boys experience sexual abuse by an adult or peer.

Physical punishment prevalence

1 in 10 children receive physical punishment; 1/3 develop PTSD.

Parental abuse dilemma

Victims want violence to stop but also want to remain connected to family.

Expectable environment

An environment with protective, nurturing adults and cultural socialization opportunities.

Impact of exposure to partner violence

Younger children show fear, regression, bed-wetting, and somatic issues.

Allostatic load

Biological “wear and tear” from chronic stress.

Child maltreatment (legal definition)

Any recent act or failure to act by a caregiver resulting in harm, abuse, exploitation, or risk of serious harm.

Most common form of maltreatment

Neglect (75%); followed by physical abuse (17%) and sexual abuse (8.3%).

Polyvictimization

Experiencing victimization across multiple areas of life.

Ontario maltreatment investigations

3.1 per 100 children; 77% maltreatment, 23% risk of maltreatment.

Ontario substantiated cases

13% physical abuse, 3% sexual abuse, 26% neglect, 11% emotional, 48% exposure to partner violence.

Physical neglect

Failure to provide healthcare, supervision, shelter, or abandonment.

Educational neglect

Chronic truancy, failure to enroll in school, or ignoring special education needs.

Emotional neglect

Inattention to emotional needs, exposure to spousal abuse, or allowing substance use.

Effects of neglect

Physical health issues, poor growth, passivity or undisciplined behavior, poor impulse control in preschool years.

Effects of physical abuse

Increased disruptive and aggressive behaviour.

Psychological abuse

Repeated parental acts/omissions causing or risking serious emotional or cognitive harm.

Sexual abuse underreporting

Many cases are never disclosed; 1/3 of children show no visible symptoms.

Sexual abuse recovery timeline

2/3 recover within 12–18 months; PTSD and delayed symptoms common.

Victim demographics

Younger children more likely victims of neglect/physical abuse; sexual abuse more common in older children.

Sex of sexual abuse victims

About 80% are girls; boys more often abused by non-family members.

Relational disorders in abuse

Physical abuse and neglect often occur during stressful parental role transitions.

Maltreatment risk factors

Poverty, social isolation, acceptance of corporal punishment, and inequality.

Typical sexual abuse perpetrators

90% are fathers or father figures; 90% of neglect cases by mothers.

Single-parent risk

Single mothers under 30 at highest risk for perpetration.

Information processing disturbances

Maltreating parents misinterpret typical child behaviours as threatening or defiant.

Sexual abuser characteristics

More likely to have relational deficits and a history of childhood abuse; ~50% aware of pedophilic interests before age 17.

Child adaptation to physical abuse

Children may misbehave to elicit predictable reactions, providing a sense of control.

Family violence connection

About half of abusive parents are also violent toward partners.

Child response factors

Nature of exposure, child’s prior mental health, and quality of recovery environment influence outcomes.

Reactive Attachment Disorder core feature

Little or no seeking of comfort; failure to respond to caregiver comfort attempts.

RAD onset and criteria

Evident before age 5, child at least 9 months old; caused by extreme insufficient care.

DSED core feature

Overly familiar, culturally inappropriate behaviour with strangers.

DSED behaviours

Preschoolers wander away; school-aged children show intrusive friendliness toward strangers.

RAD vs DSED development

RAD improves with stable care; DSED tends to persist and involve superficial relationships.

DSED associations

Linked to ADHD and disruptive behaviour disorders.

RAD associations

Linked to internalizing problems such as depression.

Causes of RAD/DSED

Inadequate caregiving and insufficient attachment experiences early in life.

PTSD child needs

Consistency, stability, and supportive caregiving after trauma.

Purpose of Deblinger et al. (2011)

To compare TF-CBT with vs. without the trauma narrative and across 8 vs. 16 sessions for sexually abused children.

TF-CBT treatment conditions

8 No TN; 8 Yes TN; 16 No TN; 16 Yes TN.

Overall TF-CBT effectiveness

All four conditions improved all 14 child and parent outcomes.

Most efficient for fear/anxiety

8-session TF-CBT with Trauma Narrative.

Best for parenting/externalizing

16-session TF-CBT without Trauma Narrative.

Is TN required?

No; improvement occurs with or without it, but TN helps reduce fear and anxiety.

Session length findings

Both 8 and 16 sessions effective; 16 sessions yielded extra gains after week 8.

PRACTICE acronym

Psychoeducation/Parenting, Relaxation, Affective modulation, Cognitive coping, Trauma Narrative, In vivo exposure, Conjoint sessions, Safety skills.

Study inclusion criteria

Cases with verified contact sexual abuse + at least 5 PTSD symptoms across required clusters.

Main study conclusion

TF-CBT is highly effective across conditions; TN adds efficiency for anxiety reduction, longer treatment aids parenting/behaviour outcomes.