Which came first? Biological disorder or childhood trauma as causes of adult mental illness
May 6, 2012
-- does childhood abuse contribute to the development of mental disorder, or neurophysiological disorder, and then later does that neurophysiological disorder lead on to mental illness? Or does pre-existing biological vulnerabilities interact with childhood abuse to lead to later adult mental disorders such as major depression (MDD) and borderline personality disorder (BPD). This is a crucially important question in terms of how patients, sufferers of "abuse induced" mental illness, are regarded by care providers. It could affect whether or not abuse-related disorder is regarded as an "adjustment disorder", or as other types of disorder, such as BPD or MDD. Considerable research in the past, examining factors related to "hardiness", have suggested that pre-existing vulnerabilities are what's fundamentally the cause of such mental illnesses. Recent research by Carvalho and colleagues, from Blefeld Hospital, Germany, has compared healthy control participants to BPD and MDD patients and found that such patients exhibited both enhanced cortisol concentrations before and after the administration of 0.5mg dexamethasone. Higher cortisol levels were positively correlated with a history of childhood trauma, current dissociative symptoms and severity of borderline and depressive symptoms. Statistical prediction (regression analyses) revealed that some aspects of early trauma were associated with cortisol release before and after dexamethasone, whereas psychopathology did not contribute to the regression model. Thus, these researchers argue, the well known disturbances in neurophysiological (HPA) function associated with MDD, BPD, and also likely PTSD, appear to be related to childhood trauma rather than to psychopathology in adulthood. Exposure to childhood trauma thus may contribute to long-lasting alterations in HPA activity and might enhance the risk for the development of later mental disorder. (Pubmed 2012) -- the causal chain would then be: childhod trauma -> neurophysiological dysfunction -> adult mental disorders -- rather than neurophysiological dysfunction + childhood trauma -> adult mental disorders -- which would seem to highlight the essential need to prioritise treatment the effects of childhood trauma rather than to treat neurophysiological dysfunction (through drugs) alone, which is particularly problematic, given the often limited range of treatments available -- see my previous post, regarding the importance of need for, and provision of, choices of treatment and this study