Childhood Abuse and Neglect Hurt Your Brain Forever
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Consistently loving encounters with caretakers engrave a physical substrate of memory patterns into a child's brain. Good parenting will result in automatic expectations that one's needs will be met and fears and distress will be soothed. The quality of your childhood parenting predicts your later life ability to adapt and adjust. Steadfast nurturing and protection renders healthy brain circuits that engender feelings of safety and happy attachment, releasing energy for exploration and learning.

It is the right brain that lays down memory patterns of our first experienced emotional reactions to survival issues of safety, nurturance, and trust. The right brain begins developing before the left brain in the first years of life. With good parenting we will be taught self protection, self soothing, self awareness, relationship appreciation, and appraisal of others. Most of the early formed habits of emotional reactivity, relationship and self awareness patterns are laid down in the right brain of the young child outside of consciousness. The stress reactive circuitry is centered in the right brain. An unfortunate childhood experience of chronic early life stress and or neglect may set the stage for dominance of the right brain stress reactive circuitry.

However, with predictable love, nurturance and protection, the infant's brain gradually develops in complexity and association, moving slowly toward left brain dominance. It is the left brain that is now thought to be our social approach, “happier” side of the brain and primary access to complex discernment and judgment. Moderate stress that is negotiated with the help of a loving parent may actually help to prepare a youngster to effectively manage life's challenges. On the other hand, excessive stress overwhelms the child and if continuous, it may begin to dysregulate many brain systems that interface with the primary stress reactive circuitry in the right brain.

Structural Brain Changes From Abuse and Neglect

Unfortunately there are countless children who have experienced long-term disturbances in protective caregiving and who have been the target of violence or witness to it. Some children have been exposed to multiple forms of abuse. Childhood exposure to one kind of abuse increases the risk of exposure to other kinds. For example, it has been found that parental verbal abuse is a toxic form of maltreatment, and like physical and sexual abuse, leads to neuropsychiatric damage, including structural brain changes.

Early adverse experience may create deeply etched stress circuitry pathways where neuronal signals are easily and habitually traversed, invoking reflexive reactions of rapid and intense emotions of stress. These children may grow up to repetitively demonstrate poor judgment, and become quickly aggressive, fearful, and vigilant. When stress is high, complex thinking is shut down, and reactivity takes its place. Physical neurobiological changes happening to this stress reactive child may lead to trouble getting over upset feelings. Moreover, chronic stress may curtail the development of self awareness of one's own feelings and body states. This may result in a growing child with diminished capacity to trust or to discuss inner feelings or the feelings of others. It is hard to manage feeling states well if you do not have the skills to recognize or understand them in the context of past or present experience, and learn to speak about them thoughtfully and constructively. A youngster needs these skills in order to respond with measured behavior. If the adults around you express their feelings reactively, without much thought, and do not speak to one another respectfully and collaboratively, it is hard not to follow their prototype.

Deficits in brain development resulting from childhood abuse and/or neglect may last a lifetime. Abuse and neglect have a cumulative, harmful effect on the brain. Frequent right brain stress circuitry activation may result in reflexive and often aggressive reactions that are coded in the right brain stress response memory outside of conscious awareness and, without the benefit of self-scrutiny and self-correction. The malformed brain structure changes that occur with childhood adversity appear to depend upon the particular timing and length of abuse and/or neglect. A child's age at exposure may impact which brain circuitry is damaged and the resulting psychiatric sequelae. Earlier mistreatment seems to render more pervasive brain structure changes that promote long-term personality problems. During periods of rapid development, certain areas of the brain become acutely vulnerable to damage from external threat and stress.

Neuroimaging shows that the brain structures that are most negatively impacted by childhood adversity are the temporal lobes including the hippocampus (which encompasses crucial parts of memory coding), the hypothalamus (which helps to regulate homeostasis and the stress reactive centers), the amygdala ( a primary part of the brain's alarm center, which may persistently fire under prolonged adversity), the cerebellum (a center for memory and connection to other systems including movement), and the prefrontal cortex (which subserves complex thinking and has the ability to inhibit stress reactivity systems). The prefrontal cortex particularly modulates emotional responsivity by suppressing the amygdala alarm system. This structure and related complex thinking systems are turned off under circumstances of severe stress. These so-called executive areas are used to help calm us down and move us away from reactivity to thoughtfulness.

The prefrontal cortex develops slowly as the child grows. In an abused child it may mature early leading to behaviors like the “parental child” who learns to take thoughtful control (often in an uncontrolled environment) and to sooth and take care of others, including at times the parents. This precocious development seems to arrest the complete growth of the prefrontal cortex which otherwise should continue developing until the late twenties. It is this area that is nurtured and developed in cognitive behavioral trauma therapy-- a research-supported treatment for psychological angst associated with childhood abuse and neglect.

The corpus callosum, a primary connective tissue joining left and right brain functions, is also developmentally diminished by early life stress. This diminishment is partly detrimental because signals across the corpus callosum are sent from the right-brain stress circuitry to the left-brain complex thought centers for assessment and possible inhibition. Thus, one who has grown up with childhood abuse or neglect may be rewired by the experience to be less reflective, leading to more frequent risk-taking and poor choice-making because he/she is living in the right-brain stress reactive circuitry with fewer signals crossing over to the left-brain complex assessment and inhibitory centers.

It has also been found that brain areas related to accurately interpreting facial expression may be malformed in adults with adverse childhood histories. Research on children and adolescents with a history of abuse has delineated that they have a tendency to interpret pictures of ambiguous faces as hostile and threatening. It is difficult for these children to grow up with the open communication and trust necessary for close, happy attachments as they may be predisposed to misinterpreting slight signals from others as rejection or threat.

The emotional and thinking systems in the brain circuitries interact with one another and function optimally when integrated and calibrated. The lack of fully integrated, balanced brain circuits is part of the underlying etiology of hyper-reactive and intensified emotional and behavioral impulsivity. On the other hand, too little emotion (too much prefrontal cortex control over stress reactivity (which is thought to be the neuroscience underlying dissociation) may leave one feeling dull, over-controlled, and out of touch with a sense of self in the present. Respectful self-awareness and mindfulness of others may also be restrained with too little emotional reactivity. Emotions (and their stress neurochemistry and intense cell firing patterns) tag memories as important or not. Thus habitual use of dissociation may result in awareness gaps in the important autobiographical narrative of the events of one's life that are placed in memory and become an integrated part of one's self-awareness. Researchers have found resiliency in a subgroup of individuals who grow up using dissociative defenses. This subgroup seems to have been able to insulate the memory of abusive or neglectful experiences, freeing up energy for development and learning. They have used the dissociative defense of selective inattention to survive a difficult childhood.

Long Term Neurochemical Changes Related to Childhood Abuse and Neglect

Research on young animals subjected to unpredictable stress (an animal equivalent of unpredictable family abuse or threat) suggests that the neurochemical systems, which are part of the brain neurocircuitry, are negatively impacted by early life stress. The basic arousal system and its neurochemistry, the hypothalamic-pituitary-adrenal (HPA)axis, becomes primed in childhood circumstances of chronic tribulations or neglect for hyper-reactivity and intensified response to even the slightest stress. The opposite effect could also occur. Under chronic threat or parental indifference, the HPA axis may protectively shut down in resting states of depression and dissociation, becoming under-reactive until a stressor causes a volatile activation.

Persistent childhood adversity is associated with elevations of brain stress chemistry, in particular cortisol which is neurotoxic at long-term exposure The increased stress reactivity results in an anxious, angry, or depressive focus (which is maintained by stress neurochemistry) that fragments sleep and memory consolidation, and decreases certain chemicals that are neurogenic, that is good for the brain.

Childhood neglect and/or abuse also impinges on the serotonin system, one function of which is neuromodulation which helps to equilibrate underlying emotional neurochemistry. This brain chemical system is depleted with chronic childhood stress, leading to behaviors of aggression, helplessness, and depression. Many years of research demonstrate that serotonin blood levels are low in people who committed suicide. Some people are more genetically vulnerable than others to decreasing levels in the serotonin system as a result of childhood stress.

The dopamine system, a key component of reward (addiction) and cognition and movement, is also abysmally impacted by long-lasting early life distress. We are aware that certain dopamine receptor variations in the brain are determined by our genes, meaning that some people are more genetically vulnerable to dopamine dysregulation with childhood maltreatment.

The endocrine system is another circuitry defectively influenced by early life stress. Recent research indicates that children who have been sexually abused often experience a dramatic increase in sexual hormones during adolescence. Sexual hormonal changes can distract any adolescent, but to have abnormal elevations may lead to sexual impulsivity, pregnancy, and poor focus for the important learning and achievement that set the stage for successful college education and career credentialing. Childhood sexual abuse victims typically experience a lifetime of confusion and regulation difficulties related to sexual issues.

Emotional Legacies of Childhood Brain Changes

Unconscious memory traces attributable to abuse and poor care in early life often engender habitual distrust of self and others. Relationship schemas intertwining nurturance with abuse set the stage for later victimization. Such children may quickly exhibit cognitive distortions of their own self perceptions and of others that may have been subsumed as a result of poor treatment and malicious projection from abusive caretakers.

The ability to speak constructively about the feelings of oneself and others is rarely a characteristic of these kinds of families. Addictive behaviors may develop as a kind of maladaptive self-soothing. In addition, early childhood adversity is a precursor to disease states of many kinds, including--in addition to addiction--impulsive sexual behavior, ischemic heart disease, pulmonary disease, liver disease, and sleep disorder. Thus the adverse alterations in brain development that are caused by neglect and chronic abuse in childhood set the stage for poor health habits and addictive behaviors which may themselves sadly increase brain insult.

What Can We Do?

We have learned the importance of exercise and healthy relaxation, such as yoga and meditation for survivors of childhood abuse. Neuroimaging shows us that we may change the state of the brain by changing the state of our bodies. For a person with a history of childhood adversity, these kinds of habits become an essential part of healing. Staying centered and calm with an internal sense of competence and safety is important when the body and brain have been entrained during childhood for reactivity and dysregulation. Abused and/or neglected children focus on danger. Once in a context of safety, they must learn to refocus and actively regulate their own feeling states.

Some therapists use desensitization techniques to help people decrease the strength of the memories of past adversity. Many psychiatric medications are used. The only medication that has been studied to show any prophylactic impact on traumatic memory is a beta blocker. However,because it must be taken within a few hours following trauma to disrupt memory consolidation and protect (somewhat) against post-traumatic stress symptoms, it can do little to dislodge recollections of ongoing abuse or neglect experienced by a child.

By helping to bring a history of abuse and neglect to language, psychotherapy may clarify reactive feeling states, place trauma memories into historical context, and facilitate the acquisition of skills needed to regulate one's own emotion states. The reappraisal of past life events can sometimes bring an increased sense of self-esteem gained in the ability to see how childhood adversity was survived and negotiated until the present. Reclaiming self-esteem is essential as every victim is inevitably humiliated. Abuse communicates to the victim a signal of his/her unimportance. Past cognitive distortions of self must be brought to a respectful present reality. Proclivities toward distrust or the misinterpretation of others caused by growing up with untrustworthy and abusive people who frequently present distorted and untruthful information, must also be re-calibrated to present experience. Sleep hygiene needs to be carefully programmed into the habitual routines as fearful, worried people do not sleep well, and most of our neurochemical emotional and cognitive restoration occurs in sleep.

A critical therapeutic strategy is preventative intervention. This method relies on teaching parents the importance of self-regulation skills that are modeled and actively taught to the child. Highly nurturing parents who exhibit good personal emotional regulation, who are protective in ways that support safety, love and guidance, increase their children's chance for peaceful survival, learning, and happy attachment. Teaching children to learn to “think about thinking” promotes the ability to change a negative focus, become aware of alternative perspectives, and gain more cognitive control over feeling states. Helping parents to promote habits of good judgement in their children is another facet of nurturing a compassionate respectful sense of one's self and others.

- Dr. Linda Klaitz, Medical Psychologist


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