You don't need to experience direct, deliberate abuse in order to experience trauma. There are lawyers who experience second-hand trauma while working on tough cases and health care workers who burn out after being overloaded with cases. Recent events in the news, such as the COVID-19 epidemic and former President Donald Trump's inflammatory rhetoric, can also traumatize people even if they are not direct targets of mistreatment.
If nothing else, scientists and doctors have learned that the roots of trauma are extremely complicated.
Now a new study from the journal Depression & Anxiety has shed light on an unexpected potential origin of trauma — unpredictable childhoods.
Using an updated version of a questionnaire that assesses whether adults had unpredictable childhoods, researchers analyzed 156 individuals who had been exposed to trauma in order to determine whether there was any correlation between their mental health symptoms and their childhood experiences. The results were striking: Individuals who had experienced unpredictable childhoods were at a statistically greater risk of anxiety, anhedonia, higher depression and even suicidal ideation. This was true regardless of the traumas they experienced as adults — or even whether they were traumatized as children.
"Often unpredictable, unreliable and inconsistent parenting has to do with the parent's difficulty with emotion regulation, distress tolerance and attunement to their child."
"Unpredictability in the context of the Questionnaire of Unpredictability in Childhood (QUIC) instrument is focused on non-traumatic events, but instead on how predictable caregiving and the care environment was for the individual," explained Victoria Risbrough, the lead researcher for the study. She said that the questionnaire focused on seemingly mundane matters such as after school routines; bedtime routines; the number of times a family moved from its household; and other environmental factors that lead to unpredictability, even if they are not considered intrinsically traumatizing.
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These kinds of questions were designed to "capture a different element of environmental effects on childhood rather than frank trauma or deprivation, to understand how development might be affected by whether parental actions and care environment are consistent," Risbrough wrote to Salon. "We know from foundational work in sensory systems that brain circuit development is dependent upon consistency of sensory signals, and we think a similar concept may be in play for consistency in environmental and caregiver signals, in particular for brain circuits associated with reward and emotion."
Risbrough also emphasized that correlation does not automatically demonstrate causation; therefore, the study does not prove that unpredictable childhoods leave people more prone to trauma, but merely provides evidence suggesting this is possibly the case.
"Under a NIMH-funded Conte Center headed by Dr. Tallie Z. Baram, we are conducting studies across multiple fronts to identify and explore potential causal mechanism for the effect of unpredictable care on the brain and risk for mental health disorders," Risbrough told Salon, adding that the studies include animals as well as humans and that their field is focused on "trying to identify the mechanisms of how unpredictability affects development."
Gail Saltz MD — a Clinical Associate Professor of Psychiatry at The New York Presbyterian Hospital and host of the "How Can I Help?" podcast from iHeartRadio — told Salon by email that because the study mostly looks at veterans, its conclusions cannot necessarily be applied to the general population. In addition, because the researchers performed a retrospective study (that is, asking patients to recall their past experiences) instead of a prospective study (that is, assessing patients' conditions at the present and then tracing their health over time), Saltz argued that "this greatly reduces the value of these findings."
At the same time, Saltz did not dismiss the notion that childhood unpredictability is linked to adult trauma.
"It is meant to capture a different element of environmental effects on childhood rather than frank trauma or deprivation, to understand how development might be affected by whether parental actions and care environment are consistent."
"There has been other research looking at early life trauma and early life difficulties that may underlie later life psychopathology, and findings that early life unpredictability which is a known stressor (even if it is not a trauma) can increase adult outcomes of psychopathology is not surprising and consistent with other research findings," Saltz explained. When children feel they lack control over their environment, it creates high levels of stress which shape how their brains develop.
"Maintaining high levels of stress does impact the developing brain via neurochemicals and changes in neurocircuitry," Saltz told Salon. "In this sense the outcome of this study is believable."
Dr. Jessica January Behr, a licensed psychologist who practices in New York City, told Salon by email that the study's conclusions are believable based on her own experiences with patients.
"These study conclusions are directly in line with what psychologists know in the field of attachment research," Behr explained. "A disorganized attachment style has been linked to increased psychiatric symptoms and diagnoses later in life. Particularly, we see disorganized attachment related to disorders of psychopathy. Disorganized attachment results form unpredictable parenting where the child is unable to predict or rely on their parents behavior. This leads to difficulty later in life with trust, closeness, separation and forming bonds. As we know, social development is highly implicated in many psychiatric disorders."
Olivia James, a London-based therapist who specializes in trauma and treats high-functioning professionals who struggle with anxiety, observed to Salon by email that "clients with unstable and unpredictable childhoods can experience lasting effects on self-esteem, confidence and anxiety levels. This can impact life and career choices." As a result, she finds the study's conclusions to be believable.
"Unpredictability is especially difficult because it's hard to settle into a coping strategy," James explained. "The only option is hypervigilance, distrust and feeling permanently unsettled."
Perhaps one of the most important takeaways from the study is that parents can traumatize their children without intending to. In order to create a mentally healthy environment for a child, parents should recall that their good intentions are not the only thing that matters. Even parents operating with the best intentions can still traumatize their children. As Behr pointed out, most parents do not intentionally inflict distress on their children.
"Often unpredictable, unreliable and inconsistent parenting has to do with the parent's difficulty with emotion regulation, distress tolerance and attunement to their child," Behr explained. "My best advice for parents is to reflect, be honest and work on their ability to regulate their emotions, tolerate stress and keep their child and their experience in mind." Children absorb their parents' emotions and distress, even when they are so young that they can't verbalize it.
Yet there are ways to avert this: parents who struggle with their emotions can seek certain types of therapy. Behr mentioned as one example DBT, or Dialectical Behavior Therapy, that for some parents helps them better regulate their emotional responses. "General mindfulness can also be useful," Behr added. "Mindfulness practices can also help to increase attunement to both yourself and others in your environment — including your children."
Risbrough pointed out that building consistent and safe household routines can offset the risk of trauma due to unpredictability.
"Unpredictability is one element of many potential factors that affect development," Risbrough told Salon. She noted that trauma and deprivation are both very unhealthy for children, and there is evidence that healthy brain development depends on a level of consistency in one's environment. When that consistency is lacking, children are more likely to grow into adults with issues like depression and anhedonia. "Establishing household routines and consistency in care may help build resilience," Risbrough added.