Childhood Physical Abuse Casts a Very Long Shadow: Physical and Mental Illness Among Older Adults

A burgeoning literature indicates adverse childhood experiences (ACEs) are associated with chronic illness. Most research, to date, has not focused on health outcomes among older adults. The objectives of the current study were to identify the prevalence and adjusted odds of two mental health and six physical health conditions among survivors of childhood physical abuse (CPA) who were aged 60 and older (n=409) in comparison to their peers who had not been physically abused (n=4,659). Data were drawn from a representative sample of older British Columbians in the Canadian Community Health Survey. Logistic regression analyses took into account sex, race, age, immigration status, marital status, education, income, smoking, obesity, binge drinking and number of other ACEs. For 3 health outcomes, CPA survivors had adjusted odds ratio more than twice that of their peers (Anxiety OR=2.22; 95% CI=1.46, 3.38; Depression OR=2.17; 95% CI=1.57, 3.01; COPD OR=2.03; 95% CI=1.40, 2.94). For CPA survivors, the adjusted odds ratios were more than 50% higher for cancer (OR=1.71; 95% CI=1.31, 2.24), migraine (OR=1.67; 95% CI=1.15, 2.45) and debilitating chronic pain (OR=1.58; 95% CI=1.22, 2.03), and 33% higher for arthritis (OR=1.33; 95% CI=1.05, 1.69). CPA was not significantly associated with either heart disease or diabetes (p>.05). The association between CPA and two mental health and four physical health outcomes remained significant, even after controlling for sociodemographic characteristics, health behaviors and other ACEs. Further research is needed to investigate potential pathways through which childhood physical abuse is linked to a wide range of chronic later-life health problems.

Stigma as a barrier to addressing childhood trauma in conversation with trauma survivors: A study in the general population

Victims of childhood trauma report shame and anticipation of stigma, leading to non-disclosure and avoidance of help. Stigma is potentially aggravating the mental health consequences of childhood trauma. So far there is no comprehensive study examining stigma toward adult survivors of various forms of childhood trauma, and it is unclear whether stigma interferes with reaching out to affected individuals. In a vignette study based on a representative sample of the German general population (N = 1320; 47.7% male) we randomly allocated participants to brief case vignettes pertaining to past childhood sexual/physical abuse or accidents, and adult physical abuse. Stigma was elicited by applying the Social Distance Scale, assessing respondents’ attitudes/stereotypes toward the persons in the vignette and their reluctance to address the specific trauma in conversation. While one aim was to establish the prevalence of stigma toward persons with CT, we hypothesized that attitudes differ according to type of trauma. Of the respondents, 45% indicated they were unlikely to reach out to a victim of childhood sexual abuse, 38% to a victim of childhood physical abuse, 31% to someone reporting a childhood accident and 25% to someone reporting adult physical abuse. Contrary to our expectations, childhood sexual abuse did not consistently elicit more stigma than childhood physical abuse in Krukall-Wallis tests. Equally, childhood interpersonal trauma did not consistently elicit more stigma than childhood accidental trauma. Structural equation modeling revealed social distance as mediator of the relationship between negative stereotypes and reluctance to address childhood trauma in conversation. Our analyses further revealed an ambiguous role of negative stereotypes in addressing childhood trauma in conversation with trauma victims, which has yet to be examined. There is evidence for stigma associated with having survived childhood trauma, which is interfering with offering help.

Childhood physical abuse and subsequent violent victimization among people who use illegal drugs in Vancouver, Canada

Background Violent victimization is common among people who use illegal drugs (PWUD) and is a source of significant health-related harm. However, little attention has been paid to how antecedent childhood trauma among PWUD may contribute to the risk of victimization in adulthood. Objective This study sought to examine the relationship between childhood physical abuse and victimization by physical assault among adult PWUD. Participants and setting Data were derived from three prospective cohorts of PWUD in Vancouver, Canada between 2005 and 2018. Methods Childhood physical abuse was assessed using the Childhood Trauma Questionnaire. Generalized linear mixed modeling was used to estimate the relationship between childhood physical abuse and subsequent violent victimization, after adjustment for potential confounders. Results Among 2960 PWUD, including 1018 (34.39%) female participants, 1030 (34.8%) participants reported a history of moderate to severe childhood physical abuse, and 949 (32.06%) participants reported recent violent victimization at baseline. In a multivariate analysis, childhood physical abuse (Adjusted Odds Ratio [AOR] = 1.34, 95% confidence interval [CI]: 1.23–1.46) remained independently associated with violent victimization after adjustment for potential confounders. Conclusions This study found a high prevalence of childhood physical abuse and that this was associated with a higher risk of subsequent violent victimization among PWUD in this setting. Greater support for PWUD with a history of childhood physical abuse is needed to decrease existing vulnerability to violence, including screening for and treatment of childhood trauma and related violence prevention.

The Mediation Effect of Hyperarousal Symptoms on the Relationship Between Childhood Physical Abuse and Suicidal Ideation of Patients With PTSD

Objective: This study examined the relationship of childhood physical abuse, posttraumatic stress disorder (PTSD), depression, and suicide in patients with PTSD through path analysis.Materials and Methods: A total of 114 patients with PTSD (36 men and 78 women) were recruited and completed psychological assessments including the Childhood Trauma Questionnaire, the scale for suicidal ideation, the clinician-administered PTSD scale for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the PTSD checklist, and the Hospital Anxiety and Depression Scale. Structural equation modeling was used to evaluate the results. We developed a model including childhood physical abuse experience as the causal variable, suicidal ideation as a result variable, and PTSD and depression as mediation variables. PTSD symptoms were divided into four clusters [intrusion, avoidance, negative cognition and mood, and altered arousal and reactivity (hyperarousal)] to determine predictive power for suicide.Results: PTSD symptoms fully mediated the relationship between childhood physical abuse and suicidal ideation. Furthermore, PTSD symptoms fully mediated the relationship between childhood physical abuse and depression. Among the PTSD symptoms, hyperarousal was the only symptom cluster that mediated the relationship between childhood physical abuse and suicidal ideation. The symptom clusters of negative cognition and mood as well as hyperarousal mediated the relationship between childhood physical abuse and depression.Conclusions: This study presents a link between childhood physical abuse and current symptoms in patients with PTSD, and highlights specific PTSD symptom clusters (i.e., hyperarousal, negative cognition and mood) that may increase the risk for psychopathology later in life.

Borderline personality pathology, health behavior, and inflammation: Potential behavioral and biological mechanisms underlying childhood physical abuse and age-related disease

The frequent comorbidity of psychiatric and physical health conditions may be partially attributable to early life stress-related changes in inflammatory signaling and behavior (e.g., borderline personality pathology, health behaviors) that reciprocally maintain and enhance their effects on overall health. Using data from older adults (N=1,630) who participated in the ongoing longitudinal St Louis Personality and Aging Network (SPAN) study, we examined associations between childhood physical abuse, borderline personality pathology, inflammation markers (i.e., interleukin-6 [IL-6], C-reactive protein [CRP]), health behaviors, and physical health. Morning fasting serum IL-6 and CRP were assayed from a subset of participants (n=791). Borderline pathology factor scores were computed using interviews as well as self- and informant-reports across the course of the study. Physical health, health behaviors, and additional covariates (e.g., medication use) were also assessed. IL-6 was associated with higher BPD symptomatology, greater exposure to childhood physical abuse, worse physical health, and lower preventative health behaviors (all p values < 10-11). Similar findings for CRP emerged, though the association with childhood physical abuse was not robust to covariate inclusion. An integrated model suggests an indirect pathway between exposure to childhood physical abuse, greater BPD symptomology, reduced preventative health behaviors, elevated IL-6, and worse health outcomes (-0.07, p < .001).These findings suggest that physical abuse during childhood may be predictive of later poor physical health through behavioral (i.e., borderline pathology, reduced preventative health behaviors), and biological (i.e., inflammatory) pathways.

Revictimization and the Specificity Hypothesis- Do Different Subtypes of Interpersonal Violence Predict Each Other?

Background: Revictimization refers to the finding that victims of child abuse have an increased risk of experiencing violence as adolescents and adults. To date, revictimization has been well documented for sexual violence. Recent findings show that the same phenomenon occurs for physical and emotional types of violence and indicate specificity in the relationship. In particular, childhood sexual abuse predicts sexual violence in adulthood and childhood physical abuse predicts future physical victimization. Although emotional violence is among the most harmful types of maltreatment, emotional revictimization has not yet been systematically documented. The aim of this study was to investigate how the three different types of childhood abuse (sexual, physical, and emotional) were related to the three different types of adult victimization (sexual, physical, and emotional).Methods: In an online survey of 135 adult women with high levels of victimization, sexual, physical and emotional experiences of violence were assessed separately for childhood and adulthood.Results: Linear regressions indicated specific relationships between childhood sexual and physical abuse and sexual violence in adulthood (standardized beta coefficients .33*** and .21*), while childhood physical abuse predicts physical violence in adulthood (standardized beta coefficient .44***). Emotional violence experiences in adulthood were predicted by childhood sexual and emotional abuse (standardized beta coefficients .20*** and .08*).Conclusions: The findings partly support the specificity hypothesis of revictimization and have significant implications for practice, particularly for the development of more effective approaches to preventing repeated violence.

Disentangling sex differences in the shared genetic architecture of posttraumatic stress disorder, traumatic experiences, and social support with body size and composition

There is a well-known association of posttraumatic stress disorder (PTSD) and traumatic experiences with body size and composition, including consistent differences between sexes. However, the biology underlying these associations is unclear. To understand this complex relationship, we investigated large-scale datasets from the Psychiatric Genomic Consortium (12 823 cases and 35 648 controls), the UK Biobank (up to 360 000 individuals), and the GIANT (Genetic Investigation of Anthropometric Traits) Consortium (up to 339 224 individuals). We used genome-wide association statistics to estimate sex-specific genetic correlations (rg) among PTSD, traumatic experiences, social support, and multiple anthropometric traits. After multiple testing corrections (false discovery rate, FDR q<0.05), we observed 58 significant rg relationships in females (e.g., childhood physical abuse and body mass index, BMI rg=0.245, p=3.88×10−10) and 21 significant rg relationships in males (e.g., been involved in combat or exposed to warzone and leg fat percentage; rg=0.405, p=4.42×10−10). We performed causal inference analyses of these genetic overlaps using Mendelian randomization and latent causal variable approaches. Multiple female-specific putative causal relationships were observed linking body composition/size with PTSD (e.g., leg fat percentage➔PTSD; beta=0.319, p=3.13×10−9), traumatic experiences (e.g., childhood physical abuse➔waist circumference; beta=0.055, p=5.07×10−4), and childhood neglect (e.g., “someone to take you to doctor when needed as a child”➔BMI; beta=-0.594, p=1.09×10−5). In males, we observed putative causal effects linking anthropometric-trait genetic liabilities to traumatic experiences (e.g., BMI➔childhood physical abuse; beta=0.028, p=8.19×10−3). In conclusion, our findings provide insights regarding sex-specific causal networks linking anthropometric traits to PTSD, traumatic experiences, and social support.