The Center on Trauma and Children (CTAC) is dedicated to the enhancement of the health and well-being of children and their families through research, service and dissemination of information about child abuse and trauma.

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Research to Practice- Special Edition

 

This edition of Evidence in Action is an annual feature in which CTAC scientist-practitioners share clinical implications of a specific research study to illustrate how the findings can be used in trauma practice. For this issue, CTAC Faculty Associate Debra Katz, M.D. discusses a 2013 paper published in the American Journal of Psychiatry on childhood trauma and psychosis. The reference for this paper is as follows:

 

Psychosis and Trauma

A growing number of studies are examining childhood trauma as a risk factor for the development of psychosis (Varese et al., 2012; Read et al., 2001; Shevlin et al., 2007). Many questions remain, however, about whether experiences of physical or sexual abuse, neglect, bullying, and parental loss and separation are merely associated with psychotic symptoms or are causal.

 

A recent study published in the American Journal of Psychiatry (Kelleher et al., 2013) attempts to answer the following important questions:

(1)   Does childhood trauma increase the likelihood of psychotic symptoms or experiences?

(2)   Does the elimination of trauma exposure bring about a cessation/ reduction of psychotic experiences?

(3)   What is the direction of the relationship between childhood trauma and psychotic experiences? For example, most research has focused on childhood traumatic experiences increasing the risk for psychotic symptoms, but could the direction be reversed? Could psychotic experiences increase the risk for exposure to trauma?

The answers to these questions have profound clinical implications in assessing, monitoring and treating traumatized children.     For example, if psychotic symptoms are clearly linked with traumatic experiences in childhood and resolve after the traumatic exposure ends, clinicians might be able to more comfortably assess and follow these symptoms with a trauma-focused treatment approach. On the other hand, if psychotic symptoms are independent of traumatic exposure and persist or intensify despite cessation of traumatic exposure or treatment, the clinical management and prognosis would be different, and the child may need to be referred for specific evaluation and treatment of the psychotic symptoms.

 

The Study

As part of a collaborative, multinational European project, researchers in Ireland conducted a longitudinal, prospective study of 1,112 school-based adolescents, 13-16 years of age. Students completed self-report measures at baseline, and at 3 months and 12 months. Childhood trauma was defined as physical assault or bullying and psychotic experiences were identified by the presence of auditory hallucinations. The findings revealed a bidirectional relationship between childhood trauma and psychosis, meaning that trauma was shown to predict psychotic experiences over time and psychotic experiences were shown to predict trauma. Even after accounting for this bidirectional relationship with a number of statistical adjustments, trauma was strongly predictive of psychotic experiences. A dose-response relationship was observed between the severity of bullying and the risk for psychotic experiences. Importantly, the cessation of trauma experiences predicted the cessation of psychotic symptoms. The incidence of psychotic experiences decreased significantly in adolescents whose exposure to trauma ended over the course of the study.

 

The authors concluded that exposure to childhood trauma predicted new incidences of psychotic experiences. This study provides the first direct evidence that the termination of traumatic experiences leads to a reduced incidence of psychotic experiences.

 

Implications for Practice

Psychotic symptoms in adolescents or young adults may be particularly worrisome to clinicians since serious illnesses like schizophrenia or bipolar disorder often present in adolescence or young adulthood. Trauma is often not considered when a child or adolescent endorses psychotic symptoms, which often leads to referral for psychiatric evaluation to diagnose or treat these symptoms. This article demonstrates not just a strong association between trauma exposure and the development of psychotic symptoms but confirms trauma as a causal factor for psychotic experiences. This was demonstrated by the strong temporal relationship between exposure to childhood trauma and the onset of psychotic experiences, the dose-response relationship between the two and the fact that the cessation of childhood trauma led to a cessation of psychotic experiences.