Commentary on Scheidell et al. (2018): En‐counting adversities; the ‘building blocks’ of psychopathology

Abstract

Commentary on Scheidell et al. (2018): En-counting adversities; the 'building blocks' of psychopathology Exposure to traumatic stressors, especially early in life, are the 'building blocks' for psychopathology and substance misuse, with consequences extending beyond the individual, to the family, society and the next generation.The greater the cumulative exposure to traumatic stressors, the greater the damage to health and psychological functioning. Although the amount of harm inflicted within any particular 'trauma' varies from person to person, it is possible to measure this statistically. Numerous studies have shown that the degree of harm caused by individual 'wounds', i.e. the trauma, depends upon several factors. These include the type, proximity and frequency of traumata and previous experiences as well as the genetics, epigenetics, resilience, gender, age or cognitive capacity of the individual who encounters trauma [1][2][3][4][5].Given this variation, it is surprising that merely counting traumatic exposures can predict detrimental consequences for psychological functioning. This was, however, shown in the seminal Adverse Childhood Experiences (ACE) studies, and now Scheidell and colleagues demonstrate that it also occurs for substance use and abuse [6]. Although an event's exact 'dose' of trauma (how much of the active substance, i.e. the 'traumatic stressors') is unknown, and its frequency (how often it occurs within a given time-span) is typically variable, there is undoubtedly a simple occurrence-dependent association between trauma and its consequences: the earlier in life, and the more often, the worse the impact. Like building blocks, each traumatic stressor adds to symptom severity and chronicity [7,8] not only for post-traumatic stress disorder (PTSD), but also for other areas of social and occupational functioning such as depressive symptoms, somatic problems and immunological changes [9][10][11][12]. The particularly 'toxic' stressors are those which involve serious threats to physical integrity (damage to the central nervous system, body and organs), threats to social integrity (social exclusion, loss of status) and threats to genetic fitness (rape, danger to the gene pool, long-standing cooperation and aggressive dominance behaviours).Traumatic stressors have particularly strong effects on the minds and bodies of children and adolescents, as the pathways of inflammation and stress hormones influence development of the child's brain directly [4,5]. Cumulative trauma during childhood predicts internalized and externalized destructive behaviours among young people and exacerbates later mental illness. The consequences are dramatic, and extend far beyond specific traumatic disturbances such as PTSD or disturbances of the affective spectrum. The behavioural consequences can include aggression and the perpetration of violence [13,14]. Scheidell and colleagues have demonstrated that traumatic stressors also cause destruction via substance misuse, associated with violence, reactive and appetitive ...

Five Applications of Narrative Exposure Therapy for Children and Adolescents Presenting With Post-Traumatic Stress Disorders

“…As was typical of the wider treatment cohort in the RCT, PTSD and depressive symptoms were reduced to the extent that she no longer met criteria for a diagnosis of either condition, appetitive aggression was reduced, but more importantly she had fewer episodes of actual violent behavior. In this particular case her alcohol use significantly reduced, in keeping with current theorizing about the role of trauma in substance misuse and the importance of trauma treatments for those who have substance misuse problems (43).…”

“…It might even be suited to being conducted in schools where young people might find it easier to access support, raising the possibility of prevention of later psychopathology. This is aligned with the "building block effect" theory where cumulative exposure to trauma leads to increased likelihood of PTSD, therefore the role of early processing to try and prevent further harm needs to be better studied (43,47). Exposure to potentially traumatic events might even help us understand a wider array of psychopathologies than PTSD and therefore exploration of poorly encoded memories using NET may be applicable in more contexts than just those where PTSD has fully developed.…”

Association of War-Related and Gender-Based Violence With Mental Health States of Yazidi Women

“…PTSD and depression are the most prevalent psychological disorders among forcibly displaced persons, 19,20 and both are affected by the load of potentially traumatic experiences. 21,22 Some studies have indicated that women are more likely to develop PTSD compared with men, 23,24 which may be related to gender-specific risk factors that come into play both before and after exposure to traumatic war events. 25,26 Here, we assume that gender-related stressful experiences contribute to mental health impairment among women, which may partly explain the gender difference in mental health disorders following violent conflicts.…”

NETfacts: a community intervention integrating trauma treatment at the individual and collective level

“…When an individual is exposed to severe trauma or perpetrates violence, strong affective responses are triggered that enhance implicit details of the terrifying scene that are stored in memory (Belleau et al, 2020 ; Elbert & Schauer, 2002 ; Wilker & Kolassa, 2013 ). Over time, the mnesic consequences of cumulative victimization and perpetration may alter cognitive and affective processes fundamental to meaningful engagement in the social environment (Köbach, Schaal, & Elbert, 2015 ; Schauer & Robjant, 2018 ; Wilker et al, 2015 ). The bi-cycles of violence model describes how violence increases the likelihood of future violent behaviours as a result of complex automatic defence reactions and associative neural networks that also determine the mental sequelae of these events (Elbert, Schauer, & Moran, 2018 ; Schauer & Elbert, 2010 ).…”