Investigators said childhood trauma is the experience of a highly distressing event or situation during one’s youth, which is beyond a minor’s capacity for coping or control.
Although the majority of children who experience trauma do not exhibit signs of psychosis later, a sizable share (by some estimates as much as 35 percent) of children go on to experience psychotic episodes.
Trauma encompasses many possible events, from enduring sexual or physical violence to facing the death of a parent. While such events would be painful for anyone, some children who experience trauma become particularly susceptible to psychosis.
For this subgroup of kids, they may become more prone to unusual thoughts, beliefs, and experiences that might make it hard to distinguish things as either real or imagined.
Currently, before most people experience full-blown psychotic disorders such as schizophrenia, they are often diagnosed as being at clinical high risk (CHR) for psychosis.
A small but growing number of studies on the CHR population have begun to focus on identifying possible factors that predict the conversion to psychotic disorders, such as the role of childhood trauma.
These can occur in later childhood or young adulthood. At worst, these events require psychiatric hospitalization, which can become yet another form of trauma.
As such, early identification of the warning signs of psychosis is critical. Current evidence suggests some particular forms of trauma do increase the risk, including bullying, sexual abuse and emotional neglect.
Nevertheless, while various models have been proposed to explain why certain children who experienced trauma become susceptible to psychosis, physicians still do not have a clear understanding of this process.
To address these concerns, Dr. Danessa Mayo of the University of California, Davis, and colleagues performed a comprehensive literature review on the trauma-psychosis risk cycle. They then created a model, published in Frontiers in Psychiatry, that provides a comprehensive approach to detecting and mitigating effects of childhood trauma.
According to the model, early childhood trauma interacts with a child’s genetic vulnerability and propels them towards greater likelihood of altered developmental growth.
Factors such as poor emotional control, limited coping skills, poor social functioning and increased stress sensitivity increase a child’s risk of experiencing psychotic-like symptoms (e.g., unusual thoughts, suspiciousness, perceptual disturbances). The experience of having psychotic-like symptoms and a trauma history creates increased vulnerability for future trauma, creating a vicious circle.
New programs that provide early detection of those at risk of psychosis serve the vital function of preventing and reducing the severity of psychosis.
In their review, Mayo and colleagues found a benefit to such CHR screenings for trauma history. By closely analyzing the findings in a large sample of CHR screenings, physicians can effectively deduce early childhood predictors of conversion to psychosis.
Researchers explain that this work is ongoing, and a more consistent and specific definition of what is considered “trauma” should be determined.
Moreover, investigators said it will also be necessary to pay particular attention to the experience of members of different ethnic groups and races, as well as gender. It is possible that these variables impact the types of childhood traumas that later cause psychosis.
The researchers also recommend that physicians on the front lines of dealing with CHR youth get targeted training for assessing and treating individuals with both trauma and psychosis.
In addition, physicians should develop and adhere to standard protocols for assessing a history of childhood trauma. Finally, physicians should document any connections they uncover between childhood trauma and other health concerns, they said.
Appropriate early intervention can make a difference.
As Mayo noted, “We can promote resilience and mitigate the vulnerability of CHR individuals to developing a psychotic disorder and improve their chances of recovery.”