Specifically, depression is associated with a neurochemical imbalance of neurotransmitters Bair et al. Analgesic effects are produced by serotonin and norepinephrine through descending pain pathways, and these effects may be disrupted by decreased levels of these neurotransmitters Andrews and Pinder, ; Blackburn- Munro and Blackburn-Munro, The pain modulation system influences affect and attention to peripheral stimuli and plays a role in suppressing minor signals coming from the body Blackburn-Munro and Blackburn-Munro, ; Stahl, These signals may be less suppressed when serotonin and norepinephrine are depleted Bair et al.
Thus, the association between pain and depression may be due, in part, to the neurochemical impact depression plays in the pain response Blackburn- Munro and Blackburn-Munro, Emotionally negative mood states may also reduce tolerance to aversive stimuli Meagher et al. The motivational priming model proposes that negative emotional states enhance pain perception while pleasant. Thus, negative affective states of depressed individuals may magnify their experience of pain. In our research using the NCS data, we found that participants who experienced childhood abuse reported more pain in relation to their health problems compared to those participants without abuse histories.
We had also hypothesized that because childhood abuse is associated with higher rates of depression and depression is associated with more reported pain, depression would mediate the relationship between childhood abuse and adult pain reports. Indeed, we did find higher rates of pain reports, as well as higher rates of depression, among abuse survivors.
Whereas we found initially that depression mediated the relationship between childhood abuse and pain reports, after controlling for differences between the abused and non-abused participants on specific health problems which were greater among the abused participants , depression was not found to mediate the relationship. Thus, we concluded that the higher rate of depression found among adults who experienced childhood abuse was not the primary factor for their increased pain reports.
Rather, childhood abuse and depression contributed independently to pain reports Sachs-Ericsson et al. Thus, both depression and pain, common sequelae of childhood abuse, need to be appropriately addressed within the context of medical and psychological treatments.
This chapter has highlighted the connection between abuse history and poor adult health functioning. Considering the costs, both personal and societal, that are associated with this relationship, continued research on etiological mechanisms and the development of abuse-preventive measures is vital.
Of more immediate and practical importance is a number of treatment. The first step necessary in attenuating the psychological and physical health consequences of trauma is to identify those individuals presenting for medical care or mental health treatment who have experienced childhood abuse Schnurr and Green, This emphasizes the need for practitioners to identify individuals with past abuse history and to screen for health problems as well as for psychiatric disorders.
For a typical medical setting, the most cost-effective method to identify psychiatric symptoms would be to employ a variety of initial screening methods, in combination with referrals to appropriate agencies Green and Kimmerling, Schoenbaum and colleagues Schoenbaum et al. We also would hope that both medical and mental health practitioners who work with adult survivors of childhood abuse will assess their clients for chronic pain and make referrals as necessary.
Screening for pain can initially be completed with the use of a one- or two-item pain measure. Researchers have used these single-item self-report measures of pain, and research supports the validity of such measures. It will also be advisable for mental health professionals to identify those individuals within their care who may be at risk for serious health problems.
Furthermore, mental health practitioners may wish to refer their patients to a non- psychiatric physician to aid in the detection of any potential medical problems DeVellis and DeVellis, Clinicians should inform and educate their patients on the association between physical health, pain, and psychological distress.
Raising awareness in this way will lead to greater focus on the physical manifestation of mental illness, which can in turn aid in the individual obtaining appropriate treatment for both physical and mental health functioning. Consistent with the principles of self-determination theory Sheldon et al.
This approach encourages the patient to be more in control of deciding a treatment course. Further, by educating individuals on their illness and available treatment options, abuse survivors will feel more respected and are more likely to have greater treatment adherence. In addition to the more general implications discussed above, there are several specific treatment guidelines and recommendations.
These include the monitoring of health risk behaviors, the reduction of current life stress, and efforts to strengthen social support. Research has established a number of health behaviors and lifestyle factors e. Kendall- Tackett, , and these health-risk behaviors often represent the most proximal causes of disease or death. Researchers have furthermore shown that adverse childhood experiences contribute to the development of these harmful health behaviors and lifestyle factors e.
With regard to treatment, it will be important for primary care physicians to screen and monitor these behaviors, given their connection to many medical problems. Importantly, these coping skills can be replaced during therapy with healthier strategies from both a mental and physical health standpoint.
A second specific treatment recommendation is the reduction of current life stress. As outlined in this chapter, a growing body of literature indicates that current life stress can exacerbate the relationship between trauma and poor health e.
Moreover, stress is an important factor in the onset and relapse of most psychiatric disorders Rende and Plomin, Education on this relationship can empower patients, and a component of treatment can be aimed at methods for reducing psychosocial stressors. A third specific recommendation is the strengthening of social support networks. Biggs and colleagues Biggs et al. Similarly, Kimerling and Calhoun found that supportive responses to disclosures of assault may act as a buffer against increased health problems.
Further, social support has been shown to be an important buffer against psychiatric disorders, and in particular depression Petty et al. Thus, one aspect of psychological interventions may be to incorporate a component that enhances a supportive environment for individuals with an abuse history.
There are several psychotherapy protocols that focus on increasing interpersonal skills and reducing reactivity to stress. For example, dialectical behavior therapy has a focus in building interpersonal relationships, increasing stress tolerance, and developing self- soothing behaviors Comtois and Linehan, Exposure-based therapies proven to be efficacious for several anxiety disorders appear to be helpful for individuals with an abuse history who have health-related problems Leserman, However, as Leserman notes, we need more research examining psychological treatments that might be efficacious in treating the physical health problems associated with sexual abuse history.
In treating individuals with chronic pain, our research suggests that childhood abuse and depression contribute independently to pain experiences. For those individuals who have experienced childhood abuse and have comorbid pain and depression, addressing one problem without the other would likely be insufficient in adequately meeting their treatment needs. Many of the same recommendations described above for increasing social skills, increasing social support networks and decreasing stress are also applicable to the treatments of comorbid pain and depression among individuals with a history of abuse.
In addition, both depression and chronic pain can be treated with antidepressants, which will help alleviate both their pain and depression. Further, these health- and pain-related problems can be treated with exercise, physical and occupational therapy, stress management, and activity pacing. All of these approaches have been found to be helpful in reducing chronic pain Kendall-Tackett et al.
The above recommendations, when taken altogether, may seem daunting given our current health care system.
An integrated care model can more effectively accomplish the preceding treatment recommendations. Although more research needs to be conducted on the integration of physical and mental health treatment, initial studies indicate that the simultaneous treatment of psychological disorders can substantially reduce health care utilization, dramatically increase treatment adherence, and lead to better recovery e.
Until better abuse-preventative measures are. In so doing, they will be able to provide abuse survivors with the most effective and holistic treatment of the psychological and physical sequalae of trauma exposure. Our research, based on a large representative epidemiological sample, has extended past research by demonstrating a relationship between childhood sexual and physical abuse and increased rates of overall health problems, and the subsequent occurrence of several specific health problems.
Moreover, we found that among participants with abuse histories, health problems were associated with increased report of pain. Further, our work has shown that current life stressors moderate the relationship between abuse and health problems such that, in the presence of stress, health problems are greater among those with abuse histories. Whereas several researchers have speculated that increased rates of health problems and higher pain reports among individuals with abuse histories may be related to an increase in psychiatric comorbidity, our work and the work of others has shown that psychiatric disorders have a relatively minor influence on the relationship of abuse, health problems, and pain reports.
From our data it appears that health problems, chronic pain, and psychiatric disorders are all sequelae of past abuse. That conclusion should change the way we approach treatment of patients. Each of these problems needs to be addressed in treatment.
The continuing influence of childhood abuse on adult health functioning, as well as the impact of current stress, underscores the significant public health concern surrounding childhood abuse.
Various mechanisms most likely underlie the association between childhood abuse and poor health, some of which we have reviewed in the current chapter. Future research identifying and elaborating upon these underlying mechanisms will play an important role in extending our understanding of the negative sequalae of childhood abuse.
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Download PDF. Harry and the Storm — A story for children who have experienced trauma This colourful storybook describes the types of feelings and difficulties that a child may experience after a traumatic event. The story tells of Harry, a nine year old boy who experienced a terrifying storm, and how he is later helped by seeing a counsellor. The booklet includes some strategies for kids to use to help them feel better and more in control when they get upset. It includes: What is a traumatic event?
If we grow up in an emotionally supportive environment our posture will be secure, our movements fluid, and our speech expressive.
We will also be at ease with our bodies, and enjoy an open connection between body and psyche. If we grow up in the wake of emotional trauma, it is a different story. Our bodies take on the postures, movements, and ways of speaking that seem to offer us protection: we may puff ourselves up or make ourselves small, overeat or starve, yell or stutter.
Once established, these bodily defences limit our experience of ourselves and the world. Additionally, they often create painful physical symptoms. Equally damaging is the disembodiment that accompanies childhood trauma.
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