Delayed responses to stress and transgenerational transmission of trauma: Possible psychiatric outcomes of childhood abuse

The following is the third part of the article “Some specifics of global pandemic stress and natural disasters” published on March 24, 2020. The second part is published on March 27, 2020 under the heading “Immediate and acute global pandemic and natural disasters: How do you help yourself? ”

After experiencing stress experiences, disorders directly related to the effects of stressors will have the highest incidence and are a direct consequence of the traumatic experience experienced. These are disorders that are well defined in the International Classification of Diseases, Tenth Revision, ICD-X. These are acute stress response F43.0, adjustment disorder F43.2, post-traumatic stress disorder F43.1, post-stress responses / post-traumatic stress disorder, civilian type F43.8, and severe stress response, unspecified F43.9. In the International Classification of Diseases, the tenth revision also defined permanent personality changes after catastrophic events F62.0, permanent changes in personality after psychiatric illness F62.1, other permanent changes in personality F62.8 and permanent changes in personality, unspecified F62.9.

However, it should be emphasized that other disorders that have been associated with exposure to traumatic experience and stress have long been known within the field of mental health. Post-traumatic stress disorder itself can be delayed. In most traumatized PTSD, it occurs soon after the trauma is experienced, but it can occur several months, even years after the traumatic experience. Late or delayed PTSD occurs after six months of experiencing psychotrauma. It is important to distinguish between delayed PTSD or recurrence of cured symptoms.


Stress, trauma, covert stressors and transgenerational trauma benefits

Stress is defined as a psychophysical reaction to various causes of stress. Causes of stress are called stressors. Stressors can be psychic, physical, biological or social in nature, and often stressors are inherently combined, such as psychosocial stressors.

A traumatic event is classically described as a sudden and unexpected event that directly endangers the life and physical integrity of the exposed individual, involves a threat to life and physical integrity, implies a clear possibility of death of the traumatized person, or witnesses severe suffering and death of another. Such an event necessarily leads to a feeling of helplessness. Such an event is not, and cannot be, part of everyday life experience, including catastrophic experiences such as the experience of being in concentration camps, torture experiences, the experience of catastrophic earthquakes and floods with human victims, rape and other serious forms of abuse accompanied by severe impairment of a person’s psychophysical integrity. The traumatic experience is in some way an interruption of normal functioning as well as an interruption of the usual state of alertness. Remembering trauma does not resemble the usual memory of adults. It can be said that these memories are “frozen” and can occur in the form of images and sensations.

Consideration of delayed responses to stress and trauma would not be complete without thorough consideration and those covert stressors, which often pass “under the radar” and are more difficult to access for clinical detection. As a result, clinicians are less likely to encounter their acute consequences, which are often less pronounced and do not always meet the strict diagnostic criteria for acute stress reactions, and the late consequences of such traumas often take forms that are no longer classified as stress reactions by current diagnostic manuals. The consequences of such stressors, depending on the age of the person in which the traumatic event took place and / or lasted, may take a different clinical form and will later be diagnosed with various psychological disorders ranging from simple emotional difficulties to more severe disorders such as obsessive compulsive disorders and psychotic disorders and personality disorders.

It is also possible that the person with mental disabilities was never a direct victim of the traumatic experience, but the trauma was exposed by significant ancestors, eg parents or grandparents. Fine and often hidden psychological mechanisms allow transgenerational transmission of trauma from significant ancestors to a child, or offspring in the first or second generation, which can then manifest various forms of psychological disorders, suffering and psychiatric disorders, without a stressful or traumatic event in their life path. Transgenerational transmission of trauma is an important component of delayed traumatic reactions, although trauma transmission is involved. It is important to emphasize that in transgenerational transmission trauma ancestors (parents, grandparents) are not “guilty” of the disorder, since these are unconscious processes.


Delayed forms of stress reactions

In this article, I will endeavor to present the forms of late or delayed forms of stress reactions.

First of all, back to the many hidden stressors that a child, but also an adult, may be exposed to. The characteristic of such stressors is their long duration and repetitive / repetitive exposure to the stressor. The child is often and for a long time exposed to stressful experiences. Such stressful experiences are repeated and although the stressors may not necessarily be strong here, they act cumulatively, ie the effect becomes stronger the longer the exposure and the longer they are. But stressors can be more powerful depending on the situation.

In some situations, weaker stressors and milder reactions, such as peer problems, that are not peer abuse may be possible. In bullying as a form of peer abuse, even if it does not impair the victim’s physical integrity, the power of the stressor to cause emotional problems is greater and at the same time has a stronger effect in the event of recurrence and duration of such situations. It is similar to the effect of psychosocial stressors in negative life events or in other stressful situations, for example, during the divorce of a parent.

Particularly strong stressful situations as situations of neglect and abuse, both of physical abuse and of subtle, psychological abuse and neglect. Here, stressors can be so intense that they cause acute stress responses that will meet the diagnostic criteria of an acute stress response, but cumulative stressors and subsequent psychological and psychiatric disorders may occur when they may experience any form of psychological distress or psychiatric disorder childhood, adolescence. The onset of psychiatric disorder later in early adulthood and later in life or during important transitional periods of life, such as menopause or childbirth for women, is possible, while men have frequent triggers to promote the development of psychiatric disorder, life failure or unfulfilled expectations. Women are also not protected against the latter triggers. The accumulated psychic energy must be expressed somewhere, and depending on coping mechanisms and other characteristics of the psyche, as well as later life circumstances that may be more favorable and more difficult for someone, the onset of conscious psychic suffering in the form of a psychiatric disorder may be delayed until late adulthood or even to adulthood and even adulthood.

Unfortunately, children can also be traumatized in such a way that, even in our time, they are still involved in military fighting. It is widely known and reported in the media that in the Middle East, in the ISIL terrorist formation, children participated in fighting, carrying weapons of combat, and were otherwise used in war. In these circumstances, a particularly unfavorable set of repeated and frequent exposures to very severe stressors and complex traumatic situations occurred. There are also experiences of sexual abuse. These experiences are repetitive and can last for years, and it is difficult for children to confide in this experience, some never trust such experiences. All experiences of abuse can lead to acute stress reactions and post-traumatic stress disorders and adjustment disorders, but also to delayed, stress-related reactions, and such traumatic experiences associated with abuse of any manifestation and modality can be transgenerationally transmitted to subsequent generations within the family.


Personality disorders associated with experiences of childhood abuse and neglect

Numerous psychiatric entities have in their causality an association with experiences of severe childhood abuse and neglect. There is a clear link between borderline personality disorder and the experience of abuse and neglect, especially sexual abuse. The same is true of other personality disorders. Neglected childhood experiences are often experienced by people with depression and those with suicidal intent. Addicted to the disease of addiction of any modality eg alcohol addiction, drug addiction, people suffering from pathological gambling can often experience neglect and abuse in childhood. Patients with severe psychiatric disorders such as psychotic disorders, bipolar disorders and obsessive compulsive disorders often receive careful and comprehensive examination of the experience of childhood neglect and, in some cases, of abuse.

However, for a person suffering from a psychiatric disorder to experience neglect and abuse in childhood alone is not enough, but other factors must coincide, a predisposition or a certain vulnerability to psychiatric disorders is required, which is often determined at the level of genetic and epigenetic activities. Important is the information on psychiatric heredity, that is, whether there were persons in the family suffering from true mental illness or whether there were any freaks in the family, persons committing suicide and the like. The exception is somewhat the borderline personality disorder, in which the mere experience of severe childhood abuse and abuse is often one of the main causative factors.

In the American cultural milieu, a dissociative identity disorder, commonly known as multiple personalities, is occurring more frequently among the psychiatric population there. It is rare in the European cultural circle, the author has met only two such patients during her twelve years of active work in the field of psychiatry, and has heard from her old psychiatry professors as a young student about how they met few such patients mainly among those who children surviving the concentration camp. As far as it is known, multiple personalities are caused by severe and prolonged and recurrent experiences of abuse and endangerment in early childhood, and the onset of this disorder is mainly during late adolescence or early adulthood.


Transgenerational transmission of trauma

Transgenerational trauma is defined as relational trauma (König, Reimann, 2018). Severe trauma (eg stay in a concentration camp, etc.) has been experienced by older family members, often parents or grandparents, and children / offspring themselves feel hurt and suffer from traumatic experiences experienced by their ancestors but not consciously knowledge of the traumatic event itself experienced by their ancestors. The process of transgenerational transmission of trauma from one generation to another is not easily visible or visible. However, the results of transgenerational transmission of trauma are clearly visible and visible, and the fact that it has long been proposed to call such disorders secondary traumatic stress disorder (Rowland) Klein, Dunlop, 1998) and to enter as a separate disorder in the diagnostic manuals, but for the time being they have not yet been included in the International Classification of Diseases, tenth revision.

Various theories have so far tried to explain how the traumatic experience is transmitted between generations.

Psychodynamic theory assumes that an ancestor who survived severe trauma subtly leaves behind an unfinished trauma-related psychological task. An extremely traumatized adult transmitted his or her image of himself or her to their offspring. Parents who are themselves highly traumatized can continue to function in a modality of normality and everyday life only if they unknowingly transfer the burden of their traumatic experience and life tragedy to offspring, who thus unwittingly receive the task of psychologically responding to the transmitted trauma. Transgenerational transmission of trauma is believed to be possible based on the lack of communication between close family members about a family tragedy, the trauma experienced, and the emotional withdrawal of one who survived severe trauma. The process of transgenerational transmission remains unconscious, and the ancestral affliction remains a family secret.

Even so, she always feels the family’s secret, though she is not consciously aware of it. A difficult to explain feeling of sadness and pain comes with the unconscious feeling that they, the children of the survivors, must live in the past of their ancestors in order to understand what their ancestors had to go through and what they were going through. The second generation internalizes emotional states of fear and discomfort that their ancestors could neither raise nor face. Denial and silence are often present in such families, family members feel that in this way they have to protect each other from the painful traumatic experience and awareness of it. As the second generation of offspring is also silent, further transmission of trauma transmission to the next generation in the family is possible.


From a social point of view, a narrative, or a conversation about trauma, is important. To the next generations, either the silence about the traumatic experience or the narrative, ie the story of the traumatic experience, its psychological, symbolic and emotional elements is transmitted, which can significantly contribute to the formation of the identity of larger groups of people.


Treatment options for delayed traumatic and stress reactions

As the area of ​​trauma is often delicate and associated with a strong sense of shame, it is recommended that you seek the help of a mental health professional. Assistance may be sought from a psychiatrist or pediatric and adolescent psychiatrist, clinical psychologist, and trained psychotherapist. Choice therapy is psychotherapy. In delayed and late forms of stress reactions in a person who has experienced traumatic experience and there is awareness and memory, the therapies that are considered for treatment are cognitively behavioral, supportive, integrative or psychodynamic modalities of therapy.

In the case of comorbid psychiatric disorders such as severe depression, pronounced post-traumatic reactions, severe anxiety or other disorders that may render the person incapable of psychotherapy treatment, the psychiatrist will evaluate the need for medical treatment, which may be followed by psychotherapy treatment. In the presence of transgenerational transmission of trauma, preference is given to psychodynamic and supportive modalities of therapy.


By: Dijana Staver, MD, Specialist Psychiatrist

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