Trauma model of mental disorders

Theory in psychopathology

The trauma model of mental disorders, or trauma model of psychopathology, emphasises the effects of physical, sexual and psychological trauma as key causal factors in the development of psychiatric disorders, including depression and anxiety as well as psychosis, Pierre Janet's work on dissociation, and John Bowlby's attachment theory. There is significant research supporting the linkage between early experiences of chronic maltreatment and severe neglect and later psychological problems. In the 1960s trauma models became associated with humanist and anti psychiatry approaches, particularly in regard to understanding schizophrenia and the role of the family. Personality disorders have also been a focus, particularly borderline personality disorder, with the role of dissociation and 'freezing responses' (more extreme reactions than fight flight when someone is terrified and traumatised) thought to have a significant role in the aetiology of psychological disturbance. Extreme versions of trauma models have implicated the fetal environment and the trauma of being born, but these are not well supported in the academic literature and have been associated with recovered memory controversies. People are traumatised by a wide range of people, not just family members. For example, male victims of sexual abuse report being abused in institutional settings (boarding schools, care homes, sports clubs). Trauma models thus highlight stressful and traumatic factors in early attachment relations and in the development of mature interpersonal relationships. They are often presented as a counterpoint to psychiatric orthodoxy and inform criticisms of mental health research and practice in that it has become too focused on genetics, neurochemistry and medication. Some of the psychogenic models proposed by these early researchers, such as the "schizophrenogenic mother", came under sustained criticism, from feminists who saw them as 'mother blaming' and from a psychiatric profession that increasingly moved towards biological determinism. From the 1960s pharmacological treatments became the increasing focus of psychiatry, and by the 1980s the theory that the family dynamics could be implicated in the aetiology of schizophrenia became viewed as unacceptable by many mental health professionals in America and Europe. Before his death in 2001, at 90, Theodore Lidz, one of the main proponents of the "schizophrenogenic" parents theory, expressed regret that current research in biological psychiatry was "barking up the wrong tree". Like Lidz, Laing maintained until his death that the cause of both schizoid personality disorder and schizophrenia was influenced by family relationships. Some more recent research has provided support for this; for instance, child abuse has been shown to have a causal role in depression, PTSD, eating disorders, substance abuse and dissociative disorders, and research reveals that the more severe the abuse the higher the probability that psychiatric symptoms will develop in adult life. Judith Herman's book Trauma and Recovery has heavily influenced therapeutic approaches. Recovery entails three phases which are best worked through sequentially: First 'establishing safety'; secondly 'a process of remembrance and mourning for what was lost'; thirdly 'reconnecting with community and more broadly, society'.

A 2005 meta analysis of schizophrenia revealed that the prevalence of physical and sexual abuse in the histories of people diagnosed with psychotic disorders is very high and has been understudied. This literature review revealed prevalence rates of childhood sexual abuse in studies of people diagnosed with schizophrenia ranging from 45% to 65%. An analysis of the American National Comorbidity Study revealed that people who have endured three kinds of abuse (e. g., sexual, physical, bullying) are at an 18 fold higher risk of psychosis, whereas those experiencing five types are 193 times more likely to become psychotic. A 2012 review article supported the hypothesis that current or recent trauma may affect an individual's assessment of the more distant past, changing the experience of the past and resulting in dissociative states. Several reviews of risk factors for common mental disorders have emphasised trauma. Such research has rejuvenated interest in this field, both from clinicians, researchers and service user organisations such as the Hearing Voices Movement. Psychiatrist Colin Ross calls his model the "trauma model of mental disorders" and emphasises that, unlike biological models, this addresses the literature on comorbidity of trauma with mental disorders. Ross describes the theoretical basis of his trauma model: "The problem faced by many patients is that they did not grow up in a reasonably healthy, normal family. They grew up in an inconsistent, abusive and traumatic family. The very people to whom the child had to attach for survival were also abuse perpetrators and hurt him or her badly The basic conflict, the deepest pain, and the deepest source of symptoms, is the fact that mom and dad's behavior hurts, did not fit together, and did not make sense." In terms of psychoses, most researchers and clinicians believe that genetics remains a causative risk factor but "genes alone do not cause the illness". Modern views of genetics see genes more like dimmer switches, with environmental factors switching the genes on; the more severe the environmental stress, the more effect genes have. In the field of criminology, Lonnie Athens developed a theory of how a process of brutalization by parents or peers that usually occurs in childhood results in violent crimes in adulthood. Richard Rhodes's Why They Kill describes Athens's observations about domestic and societal violence in the criminals' backgrounds. Both Athens and Rhodes reject the genetic inheritance theories. Criminologists Jonathan Pincus and Dorothy Otnow Lewis believe that although it is the interaction of childhood abuse and neurological disturbances that explains murder, virtually all of the 150 murderers they studied over a 25 year period had suffered severe abuse as children. Pincus believes that the only feasible remedy for crime would be the prevention of child abuse.