Entropy Rules

Mental Pathology:

Psychology Of Adult At-Risk Behavior Challenges

    Experiences of child maltreatment have been linked to a variety of risk behaviors, suggesting that the stress of child maltreatment generates a cascade of risk factors through disrupted attachment, compromised emotion regulation, and subsequent engagement in risk behaviors (Norman et al., 2012). A meta-analysis of 124 studies of long term health consequences of child physical and emotional abuse and neglect found consistent associations between childhood physical abuse, emotional abuse, and neglect, and adverse health outcomes including the later development of mental disorders, drug use, risky sexual behaviors and sexually transmitted infections (Norman et al., 2012). Oshri, Sutton, Claywarner and Miller (2015) examined associations between various types of maltreatment and risk behaviors. They investigated whether attachment style and emotion dysregulation might mediate associations between maltreatment and risk behavior, including drug and alcohol use, unprotected sex, and antisocial behavior. Sexual and emotional abuse predicted anxious and avoidant adult attachment styles, emotion dysregulation, and variety of risk behaviors (e.g., experiences of childhood verbal abuse directly predicted alcohol use). Among emotion regulation capacities, impulsivity showed the strongest mediating effect between child maltreatment experiences and risk behaviors (Oshri et al., 2015).


    Norman et al. (2012) found that exposure to physical abuse, emotional abuse, and neglect, approximately doubled the likelihood of adverse mental health outcomes. Harsh, rejecting, and punitive parenting puts children at risk for externalizing behaviors both immediately and later during adolescence (Stormshak et al., 2000; Dodge & Pettit, 2003). A sample of high-risk adolescents indicated that factors associated with a history of child maltreatment accounted for more than 30% of the variance in adult psychopathology, even after accounting for temperament (Carlson, 1998). Flynn, Cicchetti, & Rogosch (2014) conducted a prospective longitudinal study of 407 maltreated youth throughout adolescence and found that child maltreatment predicted low self-worth, low relationship quality, and internalizing/externalizing symptoms across adolescence, supporting the view that child maltreatment creates multiple vulnerabilities that mutually influence each other as children develop through adolescence. Research has found that disorganized attachment correlated with dissociation, internalizing and externalizing disorders, and self-mutilation in young adults (Hesse & Main, 2006; MacDonald et al., 2008). One meta-analysis showed that disorganized attachment predicted problematic stress management, elevated risk of externalizing behaviors, and a tendency towards dissociation later in life (Van Ijzendoorn et al., 1999). Highlighting dissociation's role in posttraumatic stress symptomology, another study found that children with disorganized attachment style in infancy had a greater likelihood of developing PTSD following childhood trauma exposure at 8.5 years old (MacDonald et al., 2008).
    Much converging evidence suggests survivors of maltreatment are at increased risk of psychiatric, mood, and anxiety disorders, attention deficit hyperactivity disorder (ADHD), substance use disorders, eating disorders, schizophrenia, and depression, (Shonkoff et al., 2011; Palasznski & Nemeroff, 2009; Norman et al., 2012). Heim and colleagues (2008) suggested the link between childhood trauma and depression is related to certain psychobiological changes including neuroendocrine features that closely parallel depressive symptoms. This type of development leaves survivors of child maltreatment more vulnerable to developing depression in response to later life stress due to less functional neural connectivity in circuitry associated with emotional, neuroendocrine, and autonomic functions involved in coping (Heim et al., 2008).
    Childhood traumatic maltreatment has also been associated with the development of personality disorders (Johnson, Cohen, Brown, Smailes, & Bernstein, 1999), most of which involve chronic dysregulation of emotion, aggression, and problematic ways of relating interpersonally (e.g., Antisocial Personality Disorder, Borderline Personality Disorder (BPD)). For example, scores on the Adverse Childhood Events scale (ACE) has been shown to predict BPD symptoms and severity (Elices et al., 2015). Rather than representing categorically different pathological personalities, personality disorder diagnoses have been conceptualized by some researchers as extreme and maladaptive variant of normal temperamental dimensions (American Psychiatric Association, 2013; Samuel, Carroll, Rounsaville, & Ball, 2013; Trull, Widiger, Lynam, & Costa, 2005). Personality disorders can be understood as extreme versions of the typical personality traits of neuroticism, impulsiveness, and aggression/hostility that have been exacerbated by the psychoneurobiolgical impact of maltreatment (e.g., Schore, 2003a/2003b). Child maltreatment has also been linked with the development of ADHD (Becker-Blease & Freyd, 2008; Briscoe-Smith & Hinshaw, 2006; Ford et al., 2000; Glod & Teicher, 1996; Weinstein, Staffelbach, & Biaggio, 2000). In the absence of screening for contextual influences such as maltreatment, the impulsivity, hyperactivity, and difficulties in regulating attention characteristic of the neurobiobehavioral profile of child maltreatment survivors may easily be construed as ADHD.
    Increased risk of developing psychopathology puts adult survivors of child maltreatment at increased risk of creating disrupted attachment with their offspring (Cyr, Euser, Bakermans-Kranenburg, & Van Ijzendoorn, 2010; Van Ijzendoorn, Schuengel, & Bakermans-Kranenburg, 1999; Belle Doucet, 2003; Chung, McCollum, Elo, Lee, & Culhane, 2004; Young, Tolman, Witkowski, & Kaplan, 2004; Levendosky & Graham-Bermann, 2001; DiGiuseppe, Linscott, & Jilton, 1996). For example, stress and maternal depression have been indicated as important risk factors that predict differences in attachment (Phelps, Belsky, & Crnic, 1998). Having a parent with PTSD is a risk factor for maltreatment in and of itself (Mulsow, O'Neal, & Murray, 2001).

⇲ About The Author

Robin Hertz, MA is currently in the process of completing a PhD in Clinical Psychology at the University of Oregon.