Running head: PTSD AND CHILDHOOD PHYSICAL ABUSE

University of Southern California

School of Social Work

SOWK 503 – 2015

Post-Traumatic Stress Disorder & Childhood Physical Abuse: Analyzing the Biological,

Psychological & Social Impact

By:

Daniel R. Gaita, Kathryn Bullock & Katie M. Austin

December 12, 2015

Professor Siegal

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PTSD AND CHILDHOOD PHYSICAL ABUSE

Abstract

As societies continue to develop and humanity continues to evolve, the social work field has

proven itself instrumental in delving deeper into the root causes of social dysfunction, behavioral

challenges, cognitive development, and environmental factors that impact every individual,

locally as well as globally. Research studies and repeated data outcomes continually demonstrate

that young children who are exposed to physical abuse or witness interpersonal violence in the

home are at a higher risk for developing post-traumatic stress disorder (PTSD) (Lieberman,

Ippen & Van Horn, 2006; Cohen, & Mannarino, 1996), depression, heart disease, drug abuse, as

well as experiencing incarceration and premature death (Felitti et al., 1998). Herein, the authors

will investigate the impact that childhood physical abuse has on the development of PTSD and

its consequential impacts on biological, psychological, social, and environmental outcomes for

individuals and society.

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PTSD AND CHILDHOOD PHYSICAL ABUSE

Post-Traumatic Stress Disorder & Childhood Physical Abuse: Analyzing the Biological,

Psychological & Social Impact

I. Definitions

A. Post-Traumatic Stress Disorder (PTSD)

The Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM–5) (American

Psychiatric Association, 2013) is the most widely accepted nomenclature used by both clinicians

and researchers for the classification of mental disorders. For that reason, we will rely upon its

definition of PTSD for the purposes of this work. “Diagnostic criteria for PTSD include a history

of exposure to a traumatic event that meets specific stipulations and symptoms from each of four

symptom clusters: intrusion, avoidance, negative alterations in cognitions and mood, and

alterations in arousal and reactivity” (American Psychiatric Association, 2013).

B. PTSD Symptom Clusters

Intrusion symptoms. Intrusion symptoms are defined as the re-experiencing of symptoms via

recurrent and intrusive distressing recollections of the/an event(s) (American Psychiatric

Association, 2013). Re-experiencing includes memories of the traumatic event, recurrent dreams

related to it, flashbacks or other intense or prolonged psychological distress.

Avoidance symptoms & negative alterations in cognitions and mood. Avoidance symptoms

are displayed as a variety of symptoms such as “loss of interest,” “restricted range of affect,”

“detachment from loved ones,” “avoidance of thoughts and feelings related to the trauma,”

“sense of foreshortened future,” and “inability to recall an important aspect of the event”

(American Psychiatric Association, 2013). Avoidance refers to distressing memories, thoughts,

feelings or external reminders of the event. Negative cognitions and moods represent myriad

feelings, such as having a persistent and distorted sense of blame of self or others, estrangement

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from others or markedly diminished interest in activities, and in some cases an inability to

remember key aspects of the event.

Increased arousal symptoms. Symptoms such as “irritable behavior,” “reckless or destructive

behavior,” “hyper vigilance,” “exaggerated startle response,” “problems with concentration,” and

“sleep disturbances” often accompany marked alterations in arousal and reactivity associated

with trauma (American Psychiatric Association, 2013). Thus, “arousal” is marked by aggressive,

reckless or self-destructive behavior; sleep disturbances, hyper-vigilance or other related

problems.

C. Childhood Physical Abuse

For the purposes of this work, the authors will cover the effects of only one form of child

abuse, physical abuse. There are 2.9 million reports of child physical abuse every year in the

United States (Safe Horizon, n.d.). Whereby children are subjected to, or are victims of, trauma

associated with being: pushed, grabbed, shoved, slapped, or hit so hard that marks were left, or

physically injured. Often, this type of physical abuse is accompanied by psychological abuse in

which a child is frequently sworn at, insulted, put down, or made to fear for his or her physical

safety. Additionally, research has linked this type of physical abuse with associated experiences

wherein a child witnesses his or her mother also being abused, beaten, kicked, slapped, punched,

or threatened with a knife or gun (Felitti et al., 1998). It will be this area of child abuse that the

authors investigate with respect to the onset and impacts of post-traumatic stress disorder.

II. Biological Aspects

A. Physical

The stress produced from childhood physical abuse can potentially derail an individual’s

human development throughout his or her entire life if he or she does not have the necessary

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emotional and physical support (Gunnar, 2011). Physical abuse in childhood creates stress on the

body that can predispose these children to a “raised non-specific inflammatory profile” (Ferrara,

2014). In other words, these children have increased chances of developing diseases caused by a

decrease in their immune function (Ferrara, 2014). Studies indicate that 28% of children exposed

to physical abuse will exhibit a chronic health condition within three years of the abuse (Centers

for Disease Control and Prevention, 2013). This type of PTSD also has the potential to become

hard coded into the genome, resulting in “epigenetic memory of the events” (Ferrara, 2014). This

change in DNA has the potential to lead to health problems later in life (Ferrara, 2014). Some of

these health problems include infection, obesity, asthma, cardiovascular disease, hypertension,

hyperlipidemia, metabolic abnormalities, ischemic heart disease, cancer, chronic lung disease,

skeletal fractures, and liver disease (Anda et al., 2006; Brown, Anda, & Henning, 2009; Duncan,

Saunders, Kilpatrick, Hanson & Resnick, 1996; Lang, Laffaye, & Satz, 2006; Myers, 2002;

Felitti et al., 1998; Anda et al., 2006).

B. Neurobiological

Synaptogenesis, the formation of synapses in the nervous system, is affected by the

quality of care given in early childhood (Applegate, 2005). If a child were physically abused

during early childhood, then their neural circuits would receive a negative effect (Applegate,

2005). These early childhood experiences of physical abuse also impact the adult number of

synapses in the frontal lobe, which is the area controlling reason and comprehension (Nelson,

2011). Among the neural circuits negatively affected are the amygdala, which manages fear

responses, and the prefrontal cortex, which regulates mood as well as emotional and cognitive

responses (Anda et al., 2006).

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Furthermore, continual physical abuse produces abnormal changes in an individual’s

hypothalamic-pituitary adrenal (HPA) axis function, or changes in the body’s hormones (Ferrara,

P., 2014). Changes in the HPA axis lead to elevated corticosterone stress hormone levels, which

reduce the number of hippocampal neurons (Teicher, Anderson, & Polcari, 2012). There are

many psychiatric disorders associated with reduction in hippocampal neurons, such as PTSD,

depression, and schizophrenia (Teicher et al., 2012).

III. Psychological Aspects

Repeated studies continue to link childhood physical abuse to the development of PTSD

and other symptoms. Hence, researchers continue to witness the growing list of negative health

outcomes and high probability of engagement in harmful behaviors in this population due to the

development of PTSD (Godfrey, Lindamer, Mostoufi, & Afari, 2013). The high level of stress

experienced from childhood physical abuse can be reflected through numerous psychological

factors. Considerable amounts of literature repeatedly associate significantly increased

vulnerability to depression and anxiety disorders with those experiencing markedly increased

levels of childhood physical abuse (Penza, Heim, & Nemeroff, 2003).

In addition, individuals who have experienced childhood physical abuse are susceptible

to “trauma spectrum disorders,” which is the condition of having multiple psychiatric disorders

at once (Anda et al., 2006, p. 182). Some of these disorders include PTSD, substance abuse,

dissociative disorder, depression, schizophrenia, anxiety and borderline personality disorder

(Anda et al., 2006). Certainly, these individuals can also experience multiple disorders at

different times during their development process, and in different conditions (Cicchetti & Toth,

1995). For instance, an individual with PTSD as a result of physical child abuse may stop

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experiencing anxiety after he or she develops a substance abuse disorder. Consequently, that

individual might then develop depression as a result.

IV. Social Aspects

A common characteristic of individuals with PTSD who have experienced childhood

physical abuse is difficulty managing stress and controlling anger, impeding their ability to form

substantial, long-term, attachments or relationships throughout their lives (Anda et al., 2006). For

example, many individuals that experience PTSD are unable to obtain or maintain gainful

employment, which further relegates them to poverty and its cycle of repeated and continual

oppression through loss of dignity and self-respect. This inability to regulate anger for these

individuals is also linked to intimate partner violence (IPV) (Iverson, McLaughlin, Adair, &

Monson, 2014). Conversely, these individuals (particularly women) who have experienced

childhood physical abuse are also more susceptible to become victims in IPV in adulthood

(Iverson et. al, 2014).

Moreover, attainments of standardized levels of educational achievement are often

delayed due to repeated trauma and the impact it has on cognitive development. This has a

multiplier effect on society and holds the abused back from higher levels of education due to

symptoms suffered as a result of child abuse. With marked and diminished interest or

participation in previously enjoyed activities, many victims of abuse find themselves socially

isolated and develop a quick temper, which can lead to aggressive behavior with little or no

provocation (American Psychiatric Association, 2013).

Moreover, research continues to repeatedly demonstrate how those that suffer from

physical childhood abuse are also more likely to experience increased behavioral health risks;

such as promiscuous sexual activity with multiple partners, alcoholism, drug abuse, smoking,

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violence and criminal activity (Anda, 2006; Brown, 2009; Duncan, 1996; Lang, 2006; Myers,

2002; Felitti et al., 1998). As the data and evidence mount through repeated research and

longitudinal studies, it is becoming obvious that childhood physical abuse is not only a precursor

to problematic behavior as a child and developing adolescent, but also poses a probable threat to

adult behavior through manifestation of far greater and dangerous activity if the damage done is

not treated through effective evidence-based interventions.

V. Social Work Implications & Policy Advocacy

Social workers must adhere to the National Association of Social Workers’ (NASW)

code of ethics when assisting clients. This code emphasizes cultural competency, social

diversity, respect, impartiality, and providing justice to individuals who are socially and

politically dominated or exploited (NASW, n.d.). When a social worker assists a client who has

experienced physical childhood abuse, it is critical to determine if they are in immediate danger

of experiencing further abuse in their current environment, such as a child with abusive parents

or an adult victim of IPV.

If they were in eminent danger, then the social worker would need to take action to bring

that individual into a safe environment. Next, the social worker must assess, or refer the child to

specialists who can assess, the individual’s biological, psychological, and social development.

The social worker would then take into consideration the client’s physical and social

environments to aid in therapy progress.

Social workers promote policy advocacy for PTSD victims of physical child abuse

through preventative measures and rehabilitation. For instance, offering parenting classes to

prevent physical child abuse and providing rehabilitative treatment to prevent abusers from

further acts of abuse. These preventative and rehabilitative programs are often attained by social

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workers efforts through lobbying and collaborating with communities, politicians, and even

businesses. There are various types of organizations that social workers are able to launch these

programs and policies within, such as private non-profit, private for-profit, and public agencies.

VI. Theoretical/Developmental Perspectives

A. Psychodynamic Theory

Psychodynamic theory explores the concept that what an individual endures in his or her

childhood will influence his or her personality as an adult. Humans are born with the ambition to

develop self, and predisposition to the individual’s external environment can define the

individual’s future self (Borden, 2009, p. 93). When psychodynamic theory is applied to

childhood abuse, the theory explains that if a child experiences abuse, then his or her future is

predisposed to abuse. Additionally, the child him or herself may continue abuse onto other

children.

Psychodynamic theory aids in the understanding of childhood abuse, which can lead to

PTSD. Individuals that suffer from PTSD pertaining to childhood physical abuse might

experience problems regulating emotions and interpersonal relationships (Woller, Leichsenring,

Leweke, Kruse, 2012, pp. 70). Psychodynamic theory further explores the depth of trust and

relationship issues that develop later in life when a child experiences PTSD (Woller et. all, 2012,

pp. 70).

There are limitations to psychodynamic theory in regards to childhood abuse, more

specifically to PTSD. One limitation is that not all children who suffer from abuse will fail to

overcome the trauma; this is a weakness to applying psychodynamic theory to childhood abuse.

For example, if two children both experience abuse as a child they are both predisposed to abuse

in the future (Borden, 2009). However, one child may not experience abuse in the future if

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proper steps were taken to aide the child, this might include some form of therapy with a social

worker. The difficulty with this is that often times abuse is not discovered until a child is much

older. While childhood abuse is a lasting trauma, it can be overcome. Strength to applying

psychodynamic theory to individuals with PTSD from physical childhood abuse is that children

who experience abuse might have different personality traits than non-abused children as an

adult that can be understood through the application of this theory. These traits might include,

but are not limited to, aggression, anger, fear, and violence.

B. Attachment Theory

The stress that a child might experience after a traumatic event could limit the child’s

ability to attach to another individual. Attachment theory is the individual’s ability to develop a

strong bond to that of another individual (Bowbly, 1979, p.127), which is important when

children have experienced a traumatic event such as abuse. A physically abused child may

experience an array of emotions and personality changes after a traumatic event. However,

through attachment, the child will be able to seek out support for his or her needs. Children who

experience trauma such as childhood abuse are at risk for a heightened level of detachment,

depression, and anxiety disorders (Penza, 2003, p.15).

Children that suffer from childhood abuse that results in PTSD have issues in regards to

basic attachment relationships (Woller, et all. 2012, pp. 70). Attachment theory explains

children’s attachment styles and the age that these styles will be seen (Bowbly, 1979). If there is

an interruption of this such as childhood abuse then the individuals who attachment style will be

disrupted. Through the heightened level of detachment (Penza, 2003), an individual with PTSD

may not be able to develop and stay on track with normal attachment development.

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One of the greatest limitations to attachment theory the lack of specification on how the

attachment can still form if it is interrupted. More specifically being if a child experiences abuse

what can be done to keep the child on target for attachment development. Conversely, a

significant strength to attachment theory in regards to childhood abuse is the explanation of

attachment development.

C. Object Relations Theory

Object relations theory explores the experiences a child has in his or her infancy and

early childhood years and how this will impact his or her relations with other people (Flanagan,

2011). Applying this theory to childhood abuse demonstrates that a physically abused child will

seek out other relationships that provide that same experience. More specifically, if a mother

abuses a child, that child might then have problems in relationships with other women. However,

it is possible to change these interactions through changing the external factors that contributed

to the abuse in an individual’s childhood. The external factors might include things such as the

removal from the environment in which the abuse occurred.

It is important in applying object relations theory to keep in mind the concept that this

specific theory explores the psychological side as well as the physical side (Flanagan, 2011).

Therefore, just like our body digests food that we put in our mouths, our mind processes

experiences with others (Flanagan, 2011, pp. 121). If a child experiences child hood abuse that

experience is fed into the mind and stored there. It is remembered, which leads to PTSD.

One limitation to applying object relations theory to childhood abuse is that is focuses on

how early childhood experiences will affect the child in adulthood. While some might not view

this as a limitation, it is limiting. It focuses on early childhood experiences and not experiences

throughout childhood. Furthermore, it does not focus in great detail on how to change the child’s

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experience so that they do not affect the child in adulthood. It is possible to change behaviors and

PTSD side effects through counseling and other forms of therapy. If this is done, it would be

important to identify triggers with the individual and how to cope once a trigger is experienced.

However, strength of applying this theory to childhood physical abuse is the explanation that

childhood experiences do impact every individual throughout their lives. Therefore, looking into

childhood experiences can help evaluate an individual’s physical and emotional condition as an

adult.

VII. Conclusion

The culmination of research, studies, and data cited herein clearly demonstrate the strong

prevalence, likelihood, and probability of development of PTSD following childhood physical

abuse. As the DSM-5 details, PTSD is the result of exposure to actual or threatened serious

injury, violence, traumatic events, or even witnessing or learning about traumatic events

(American Psychiatric Association, 2013, pp. 272-273).

We have also learned that PTSD symptoms such as negative alterations in cognition,

irritable behavior, angry outburst, recklessness, self-destructive behavior, sleep disturbances,

impairment in social functions are commonly observed in children exposed to abusive and

traumatic environments. Additionally, there are the accompanying symptoms of fear, guilt,

sadness, shame, confusion, and avoidance of social functions, people, conversations, or even

interpersonal situations that arouse recollections of the trauma/abuse (American Psychiatric

Association, 2013, pp. 274-275)

Additionally, we have learned that PTSD is also associated with high levels of physical,

social, and economic disability and that these tend to result in higher levels of medical

utilization. Furthermore, the associated impaired functions exhibited by those suffering from

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PTSD transcend social, interpersonal, developmental, educational, physical health, and

occupational domains (American Psychiatric Association, 2013, pp. 278-279).

Equally as worrisome is the high probability (80%) that individuals with PTSD are more

likely to develop at least one other mental disorder, such as depression, bipolar, anxiety, or

substance abuse, with comorbid substance use disorder and conduct disorder more common

among males than females. There is also considerable comorbidity between PTSD and major

neurocognitive disorders with symptoms overlapping between these and other disorders

(American Psychiatric Association, 2013, pp. 280)

The research results are clear, repeated, and provide the information relied upon to link

childhood physical abuse to onset of PTSD and myriad disabling symptoms that accompany the

disorder. Further, we have detailed how these symptoms manifest in the neurological, biological,

psychological, and social realms of human development across the lifecycle.

While “treatment” is not the topic of this analysis, our efforts and information herein

would be remiss if we failed to highlight the efficacy of cognitive behavioral therapy (CBT)

techniques being used today to enable social workers to free victims of childhood physical abuse

from the long-term and lingering symptoms suffered as a result (Institute of Medicine, 2008;

Kuehn, 2008; Cahill, & Foa, 2007; Rausch, & Foa, 2005).

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