"If the role of dysfunctional parenting in psychological disorders was ever fully recognized, the DSM would shrink to the size of a thin pamphlet"
This statement by traumatologist John Briere is quoted in Pete Walker's FAQ on Complex PTSD, a proponent of the unified Trauma model of mental disorders. Dr. Gabor Mate has become popular in recent years, who similarly claims that (e.g.) "Attention Deficit Disorder is a reversible impairment and a developmental delay, with origins in infancy. It is rooted in multigenerational family stress and in disturbed social conditions in a stressed society." Another famous champion of this theory was Alice Miller. Quote: "Experience has taught us that we have only one enduring weapon in our struggle against mental illness: the emotional discovery and emotional acceptance of the truth in the individual and unique history of our childhood." A more recent bestseller around this topic is Philippa Perry's "The Book You Wish Your Parents Had Read" (Guardian review).
The various personality disorders from ICD-10 were replaced by a single personality disorder diagnosis in ICD-11, and they finally added Complex PTSD. The director of the largest psychiatric clinic in Germany is in favor of removing the category of "mental personality disorders" altogether (German article).
Studies seem to confirm strong links between "adverse childhood experiences" and various forms of mental illnesses. To pick just one of the many I found: "Compared to children with no Adverse Childhood Experiences, the odds of an ADHD diagnosis were 1.39, 1.92, and 2.72 times higher among children with one, two and three or more ACEs. The ACE most strongly associated with the odds of ADHD was having lived with someone with mental illness closely followed by parent/guardian incarceration." (https://doi.org/10.1016/j.chiabu.2020.104884)
I'm interested in hearing your takes, and potentially this thread can serve as a collection of quotes and links around this theory.
About Gabor Maté. I suggest even just cursing through the Criticism section on his wiki page. This piece, although mainly focused on his claims about addiction, is also revealing. The guy has a very strong tendency to overreduce psychological problems to childhood trauma.
Another point. Neither Gabor Maté nor Pete Walker has proposed their hypothesis on a scientific basis. It's much easier to propose an idea to the general public, rather than actually proposing it scientifically, which would open it up to much harsher criteria of scrutiny.
Alice Miller was born in 1923, and her ideas seem to pertain to an era of psychiatry which was scientifically much less rigorous.
Lastly, John Briere seems to be a legitimate researcher, but a single quote by him that is just a hyperbole to make a point in a specific context doesn't really say much.
I don't see much reason to think this idea has much scientific merit. And as a person with ADHD, I find it offensive that a pop psychotherapist would try to explain away my condition with an overreductionist tale. As a scientist (from a different field), I find it entertaining but harmful any time a pop scientist or science-adjacent person pops up and tries to reduce an entire, extremely complicated, and layered literature to a single explanation.
In my experience, many people have a monocausality bias, tending to think there is a single explanation to a phenomenon, when in reality there's almost always many reasons. I also think there's a tendency in people to attribute things to "meaningful" reasons. For example, "trauma you suffered at the hands of your parents, who were also traumatized as kids, thus continuing a cycle of trauma" sounds more meaningful than "weird and complex stuff in brain we still don't know much about." It constructs a more alluring narrative, urging you to "break the cycle!"
Not to discredit social conditions, they obviously play an extremely prominent role in psychiatric conditions, but there are a myriad of factors in brain development and functioning. These factors are affected by all things like physical conditions and genetical makeup. For example, a quick cursory glance at the contemporary literature suggests that schizophrenia has around 80% heritability. A recent meta-analysis (quantitative examination of many research findings for a topic) of twin studies estimated 77-88% heritability for ADHD. I don't think reducing the social conditions to just familial trauma is a good idea either, even though it plays a very important role in many conditions.
As a result, I'm extremely skeptical of this claim. If any scientific findings come out in time, it's worth much more attention. But until then, I don't see much reason to give it credit. As a last remark, I also want to ask how many more conditions were added to ICD-11? How many were expanded into multiple conditions? There's always tinkering going on with things like this, and there's no particular reason to think, assuming it's true, because some personality disorders were grouped together under a single condition, it points to a general trend of "simplification" so to speak.
Edit: I feel like I might have come off a bit harsh, but this harshness is in no way aimed at OP or people who like the mentioned authors. It's aimed at the pop people I mentioned. I try to maintain a strong stance on ethics of science and its communication, so I'm easily upset by people who I think don't adhere to these ethics. Also, I think OP's question opened up an opportunity for communication, which is a good idea and a net contribution to this topic. I expressed my opinion about this topic as a result of this conversation. But I tend to think and write in terms of formal and confrontational arguments, so I wanted to make it clear that it's not an attack on people here.
The article you link and which is the basis of the first paragraph in the Criticism section mentions studies done by Felitti. The ones I scanned seem to confirm that there is a link between ACEs and drug abuse; summary on Wikipedia. To quote one, "Although the retrospective reporting of these experiences cannot establish a causal association with certainty, exposure to parental alcohol abuse is highly associated with experiencing adverse childhood experiences."
I tried to read and find the actual factual criticism in the article linked and quoted in the second paragraph of the Criticism section.
The third paragraph is about a Chinese study, with even the authors mentioning the different... educational style between Western and Eastern worlds. One could claim that the whole society there is a sequence of adverse childhood experiences? The quote on Wikipedia is incomplete in an interesting way, and the study seems to mostly say the complete opposite. "Notably, recent Chinese twin studies on other psychiatric symptoms (e.g., depression) suggest that genetic influences are smaller, whereas shared environmental influences are larger in Chinese children and adolescents than in Western populations [35-38]. Scarce twin studies have examined genetic etiology of ADHD in Chinese children and adolescents, and all were cross-sectional. [...] Therefore, current evidence of genetic and environmental influences on ADHD in Chinese children and adolescents remains inconclusive, whereas genetic and environmental contributions to the stability and change of ADHD in the Chinese population are unknown. [...] Therefore, the substantial shared environmental influences as compared to Western populations suggest that socialization experiences of Chinese children and adolescents both inside and outside their homes are particularly important during this developmental transition period. Given that previous studies have also found profound shared environmental influences in Chinese samples on other psychiatric symptoms [35–38], this particular finding has implications for the development of child and adolescent psychopathology in Asian societies. As opposed to the individualistic culture in most Western societies, Asian collectivistic cultures emphasize more family, parentchild, and interpersonal relationships, and parents have different parenting behaviors (e.g., corporal punishment is more commonly adopted) [49, 50]. Therefore, shared environmental influences might be more pronounced during this developmental transition period that is also accompanied by drastic environmental changes.". I would suspect the respective twins were subject to similar parenting behaviors.
The fourth and final paragraph of the Criticism section is about how he uses "unorthodox" practices to "diagnose" people. OK.
I just checked an online version: Pete Walkers book on Complex PTSD contains 8 pages of biography. I did not go deeper on this claim on either two, but it would be interesting to validate.
I think there's a misunderstanding here. I never rejected that there's a link between familial childhood trauma and various mental conditions. There obviously is. The mistake here is attributing everything to familial childhood trauma. It's just, after all, one of the contributing factors. Also, adverse childhood experience doesn't just mean dysfunctional parenting either, as also mentioned in the wiki page you shared.
If I explain myself with another example, let's talk about height. You have a relatively set height you can reach based on your genetic makeup. But your nourishment as a child affects to a great deal whether you reach this potential. Furthermore, exposure to some toxic substances or certain illnesses affect whether you will reach this height too. So, based on the information I've given, we know that your height at adult age depends on: (1) genetics (2) nourishment during growth period (childhood and adolescence) (3) exposure to adverse effects during growth period. I don't claim that this is an exhaustive list of the scientific literature of height growth, but it will do as an example for my point.
Now, we can see that there are at least three broad categories that affect height development. In other words, there is a link between all the things I've listed and height. But if I claim that only one of these things decides your height, it would be overreductive. Because we know that there are other factors that affect your height.
What the claim you shared does is exactly this. It takes a legitimate factor that's important for development of mental conditions, and it overreduces these conditions to that factor.
Bibliography doesn't mean their hypothesis was proposed on a scientific basis. It just means that they've cited some stuff, not necessarily even reflecting the content of their references correctly. What I meant was that they didn't present their argument in a peer reviewed, scientific journal. I didn't find any scientific articles published (on a peer reviewed, scientific journal) by either author.
I'll throw this out there:
How much is it actually hereditary, and not just children of bad parents, badly parenting their own children? And how would we be possibly control for studying that in a remotely ethical way?
I know some of my worst parenting moments are when I run out of ideas and fall back to what was done to me.
Edit, caught your bit in there:
Yup, the problem being that adoption has its own giant clusterfuck of trauma-inducing problems interfering, and hard to do at scale.
A very simple way one can determine effects of genetics vs parenting is looking at rates of concurrence in identical twins vs. fraternal twins. The former is 100% genetically the same while the latter are 50% however both will be raised in similar environments.
I am not an expert. The studies I've looked at so far in terms of heratibility are questionable to at least the same degree to this theory that you say is "largely BS". Can you point me to studies that properly address the difficulty in separating biological herability from early childhood experiences and picking up emotional dysfunction from caretakers? From my limited understanding, I imagine such studies can only be done with a very limited set of children, those who did not grow up at all with their biological parents? And how does one account for that experience in such research? Sorry for asking what seem like basic questions, but I did try to find answers to them, and the studies I found did not answer them.
Seems like just another variant of the refrigerator mom theory. If ADHD (or autism or whatever) is rooted in infancy and multigenerational family stress, what you're basically saying is it's the parents' fault. Or maybe the grandparents. I really can't see any other way of interpreting that statement. And that's a view that psychiatry abandoned at least a generation or two ago, and for good reason.
If instead what you're saying is it's not specifically Little Timmy's family's fault, it's really society as a whole that is sick, well... Then you're begging the question. You haven't explained why Timmy got ADHD and Sarah next door, who lives in the same society, didn't. If it's supposed to be an explanatory model of the development of developmental disorders or mental illness, it has to explain why some people are neurotypical and mentally healthy and some are not. So we're back to basically blaming the parents, or the teachers, or other adults whose job it ostensibly is to create a safe and healthy childhood for the child.
I think it's possible to acknowledge that environmental factors can affect the development and recovery process of mental health issues, without going so far as to say that everything is the fault of a shitty childhood. It's very difficult to separate cause and effect. Children who are not neurotypical or "mentally healthy" are also much more likely to have shitty childhood experiences, because they have disabilities and they live in a society which is not made to fully accomodate them.
I am observing that you introduce concepts such as "fault" and "blame". I am more interested in the pathways to healing mental illnesses or conditions such as ADHD instead of medicating them and having to live with them; and the reduction of overall violence in societies and their origins. The trauma model and various modern forms of psychotherapy like CBT/ACT seem to point in that direction. You do agree with the research that neurodiversity and what you call "shitty childhood experiences" correlate. This means that is worthwhile, even if one will not necessarily "heal" from the condition, to look into what works for PTSD to at least heal from those shitty experiences, even if one does not agree with it as the origin of the conditions?
But greater understanding of the underlying causes of some cases does not "reduce the DSM to a pamphlet." Is there a potential that childhood stress exacerbates some disorders? Absolutely. But reducing childhood trauma, which in fairness trauma has been the default of all of human existence, is not going to make ADHD, Schizophrenia, and BPD magically curable. Even if we assume that childhood trauma is somehow the cause of these things than what is the mechanism that makes people in stressful situations not develop dysfunctions?
Carrying your childhood trauma is obviously not going to help grow but either getting over that or, if you're lucky, not having them at all isn't going to prevent you from failing the dice roll somewhere in life and your brain just doing things different.
I didn't introduce those concepts. They're implicit, arguably even explicit, in the quotes you posted. If you tell someone "you traumatized your child so much with your poor parenting that they got a mental disorder that caused them a great deal of pain", there is no reasonable way to interpret that as not laying blame. Which, ironically, can serve to traumatize next-of-kin and make them less likely to seek help for their children.
You don't get to say "I'm not blaming you, I'm only putting down the sole cause of your child's suffering as you." This kind of moral wishy-washiness pisses me off to no end. Of fucking course when you say that someone is the cause of something that is universally considered bad, you're blaming them. Trying to weasel out of it is cowardly and unfair. And the complete disregard for what those claims do to the people who are on the receiving end is unbefitting of someone who claims to be very much concerned with trauma.
I apologize if this comes across as harsh. I'm not addressing you specifically, but rather this whole train of thought. I think you maybe haven't really thought through how it comes across.
There's ample evidence of genetic factors in mental health. There are also many environmental factors that are potentially out of the parents' control. I personally have wonderful parents who happened to raise a child that developed mental health issues. It's insulting and unfair to lay the blame solely or even primarily on poor parenting. I don't know how to bring that point across strongly enough without being rude.
I don't deny that poor parenting can be the cause of mental issues, but to posit it as an overarching explanation of all mental illness or developmental disorders is both scientifically unsound and morally wrong.
Thank you. I do not dispute most of what you contribute to this discussion. Or, to say it differently, I agree with much of what you write. Thank you for being mindful about it, but you did not come across as harsh. For me, however, assigning blame is something different than assigning (or taking) responsibility and accountability for one's actions. How much certain actions contribute or worsen certain conditions of life, and what comes first, "neurodivergence" or these actions, and how much and many generations have an influence, whether they are mostly "poor" re-actions or "poor" actions, is up for debate, both here and in the mental health profession.
There seems to be a consensus that there are correletions between what parents experienced, how that affects relationships to others including their children especially if it stays "unprocessed", that certain behavior influences 'internal chemistry' and/or the other way round, and that hereditary traits can similarly be influenced and changed over time by environmental factors and actions. The directionality is unclear, and it is difficult to practically research this to "prove" anything. There is research around violence and into the dynamics of how victims seem to "re-enact" unprocessed and often repressed experiences later in their lives, as repeated victim or as victim turned perpetrator, just from looking at factual behavior. (see e.g. literature around offender profiling and criminal research). How such data is to be interpreted is then part of the discussion, and all it can lead to the observation of identifable patterns and various theories. It is difficult to claim that one theory is "wrong" and the other is "right", as long as both fit the underlying data. What seems to be a consensus too is that "poor" parenting definitely does not create beneficial circumstances for anyone. As society, we should look at any and all factors that we can influence and control, and we should not shy away to assign accountability, and to investigate which behavior likely leads to beneficial properties in children (self-esteem, self-worth, confidence, kindness/cooperation, ability to form healthy relationships etc). To reject any such influence is at least equally unconstructive than to assign all the responsibility, but I understand how parents, who volunteered for that role, who made the decision to raise children, have to carry the biggest weight. Even if the bad conditions were bad actions by others, parents/caretakers have the original responsibility to protect their children from such harm. Yes, obviously there are practical limits, and we are all "just humans": all the quoted authors take this into account in their work.
I think I was successful in finding a very provocative quote to stir up the conversation. We both seem to agree that black-and-white thinking and attempts to find "sole causes" is unlikely going to lead to what is true and useful. I understand how this topic caused you to "vent" about certain people, but neither Alice Miller, Philippa Perry, Gabor Mate, nor Pete Walker, do that. They do go into the depths of how other people and society around children contribute to children's upbringing, so it's a bit unfair to put them into that camp. The quote from Mate directly shows that he doesn't, and you can easily find quotes by the others where they talk about what they consider problematic behavior of other adults in childcare roles, school, other parents, etc.
To reiterate, I do agree with your final paragraph!
Blame and responsibility are two very different concepts. If i’m working on a tree, and am forced to work with an old rope, which snaps and causes injury to a pedestrian, am I to blame? The falling limb is certainly responsible, and I certainly tied the rope and began cutting. But having been limited in my materials, I am not really to blame, especially if I am unaware that I am being forced to use compromised tools.
This is why the most successful interventions treat the whole family.
I'll put it this way:
I noticed that I was clinically depressed for years. Met all the symptoms, many teen years of suicidal thoughts, had meds and everything to help cope.
But once I cut my parents out of my life in my 30's, my mood has never been better.
There is immense overlap in effectiveness for almost all mental health meds for different mental health disorders. This tells me that there is some degree of unifying cause.
I'd say it's much a yin and yang thing: Phsychiatry and Therapy go hand-n-hand, one without the other will not be nearly as effective.
And at the end of the day, if it sheds walls for psychiatrists to use medications for different disorders for different things, it doesn't much matter what the diagnosis code on paper is. The more tools in the toolbox, the better.
In recent years I have begun to think that the pathologization of a handful of mental illnesses has caused some degree of damage to the people suffering from them. When I was young I was diagnosed with Aspberger’s syndrome very briefly (further inspection dispelled that theory, and then for years with major depression. Then in my late teens I was separated from my father and within a few months I was basically cured from it.
While I don’t even remotely think that my experience is universal, I have wondered how much mental illness is a result of environment. A while back a Philosophy Tube video equated CBT - the most common form of talk therapy - as a practical application of stoicism, and one of the potential dangers of it is that it can cause people to try to accept things that should not be accepted. So I wonder if we are using this tool as a hammer looking for nails when we really need a screwdriver - in this case meaning something like social workers.
This is not to say that I don’t think people should be going to therapy - even if there is a bit of damage being done they are much better than having nothing.
Going kind of off-topic here but I stopped following her after this video. She got a few things wrong or misrepresented them (I don't remember specifically anymore sorry) so people were correcting her in the comments and it made me realize that a person with a philosophy degree should not be making videos about subjects that they have zero qualifications to actually talk about, especially to such a wide audience.
To put it another way: Who hasn't seen people, or themselves, develop mental health problems as a result of trauma?
You can see it in your pets, if you happen to know one that's experienced some level of trauma. It's just how brains and nervous systems work, since long before we had modern forebrains.
That said I agree with many that trying to wrap things up in a neat "one cause" package, especially where biology and psychology are concerned, is silly.
I think evironmental factors deserve more attention than they've been getting in the last 10 years or ao, but it's not surprising that there's more money in research that could result in marketable products
I'm suspicious of totalizing psychological theories that try to corral every symptom or syndrome within a single framework. We've seen these frameworks come and go - Freudianism, behaviorism, dopamine/serotonin, etc. Someone else posted about schizotypy theories earlier, and I'm just going to shrug and say, "give me an evidence-based mechanism and some studies that show this theory aids treatment".
From a sample size of one, I can say with great certainty that there are both experiential and physiological factors in my depression. SSRIs, CBT, and EMDR helped, but the lights didn't really come back on this time around until I got on antirheumatic drugs. There's at least some evidence for autoimmunity and mental illness, including the hereditary nature. There's even evidence that SSRIs may have as much effect from reducing neuroinflammation as from direct modification of serotonin receptor affinities. [Edit: It turns out that the one SSRI that worked for me, after painful trial and error, is also a particularly potent immune modifier.]
Again, I don't believe there's any single theory that accounts for a majority of mental illness, let alone the breadth the Complex PTSD author proposes.
I mean, there are definitely things that don't map cleanly to trauma, namely various psychosis-related ones.
PTSD as an official disorder, or a bare minimum as a modifier on another disorder, makes a hell of a lot of sense.
"ADHD is curable and caused by trauma in childhood" is as scientifically backed as "vaccines cause autism" -- aka, it has no valid scientific basis, is actually quite opposed to all current scientific evidence, and actively harms people with the condition and their access to care that actually helps them. I suppose it probably harms people who don't have ADHD less than the "vaccines cause autism" myth harms allistic children, to be fair but that's about as much credit as I can give such quackery.
EDIT TO ADD:
This is does not occur anywhere in the German article you link. The closest thing is that Heinz advocates for getting rid of the label Persönlichkeitsstörung, which translates to "personality disorder" -- a tiny subset of mental disorders and the principle subject of the German article, as it's discussing the ICD-11 change in personality disorder diagnosis. The next sentence in the article lists the areas where he believes categorization of mental disorders makes sense. Claiming he was advocating for removing the category of "mental disorders" based on this article is a gross misrepresentation.
Your statement and theirs are overbroad.
This becomes especially true when considering ADHD is generally defined as exhibiting a certain number, frequency, and intensity of some group of symptoms, often parent reported.
Parents have an incentive to dispel any notion that they share any responsibility for what is happening; providershave an incentive to at least seem to accept this view. Providers’ incentive come both from the noble, where parents won’t agree to needed treatment if they think they are exposed to risk pf blame, and ignoble, where providers stream of clients is parent decision makers.
For some science: https://www.academicpedsjnl.net/pb/assets/raw/Health%20Advance/journals/acap/ACAP_900_approved.pdf
The journal article you link is already titled with a much weaker claim than theirs -- that ADHD and adverse childhood experiences are associated. They don't claim ADHD is caused by trauma and principally discuss the effects ACEs can have on the symptoms of ADHD and the potential for care providers to misattribute behaviors that are due to or influenced by their underlying trauma to solely ADHD. They also discuss the potential for ADHD's heritability to influence the likelihood that a child with ADHD would experience ACEs (e.g., a parent with untreated ADHD may be more likely to be poor or suffer from addiction).
These are all good findings and interesting to discuss! But they aren't remotely close to the kinds of claims being made by the doctors OP brought up, which I maintain are quackery and which definitely contradict the consensus among experts on ADHD.
That they are associated/linked is a fact. That one is a causation for the other can only ever be a theory, or even weaker, a therapeutic model/assumption to inform treatment. How would you prove, and how would you disprove such a theory? What is it that you can measure? Anything I can come up with (without thinking too hard about it) would be to play highly unethical games with large amounts of people... I agree that it would be "quackery" in academic contexts to claim causation and not only association, which is why it is unlikely that we will find such a claim there. Outside of academia, and this is my personal "belief", I want to allow people to come up with all kinds of theories and hold all kinds of beliefs. It is interesting to question each other's beliefs and theories, find logical flaws, disagree, but it is a different level to "disprove" a theory, or, even harder, a model.
On the same level, I can potentially "measure" brain chemistry, physical differences (e.g. relative sizes of brain structure), and then look for signs of inheritance, but at least on a logical level that is addressed by the "trauma model": according to that model, a traumatic experience changes brain chemistry, changes brain structures, influences genetics, and is "transmitted" to children. Inheritance is bigger than DNA, since there is typically a nine month period of exchanges of fluids going on between mother and child, plus all the attempts to measure prenatal environmental impact on children.
Prenatal: "A growing body of research shows that prenatal stress can have significant effects on pregnancy, maternal health and human development across the lifespan. These effects may occur directly through the influence of prenatal stress-related physiological changes on the developing fetus, or indirectly through the effects of prenatal stress on maternal health and pregnancy outcome which, in turn, affect infant health and development. Animal and human studies suggest that activation of the maternal stress response and resulting changes in endocrine and inflammatory activity play a role in the aetiology of these effects." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5052760/
Postnatal: "Both babies and their parents may experience a stay in the newborn intensive care unit (NICU) as a traumatic or a ‘toxic stress,’ which can lead to dysregulation of the hypothalamic–pituitary–adrenal axis and ultimately to poorly controlled cortisol secretion. Toxic stresses in childhood or adverse childhood experiences (ACEs) are strongly linked to poor health outcomes across the lifespan and trauma-informed care is an approach to caregiving based on the recognition of this relationship." https://www.nature.com/articles/jp2017124 (further interesting studies cited in that article)
I'm not suggesting these opinions be banned. I'm saying that their ideas are unscientific garbage and should not be taken seriously when it comes to the diagnosis or treatment of ADHD. And since their beliefs are quackery on a topic that I'm rather well-read on, I can't take their beliefs seriously for other mental and developmental disorders that I've read less about.
It appears to me that this "trauma model" you describe is more or less unfalsifiable as you present it. The way you would typically falsify a belief that trauma causes some sort of disorder is statistical -- how many people develop said disorder after trauma vs without any trauma, how much evidence is there for other causes especially in the absence of trauma, etc. But your claims here indicate that you believe it's impossible to ever falsify the existence of trauma, because even if someone has had absolutely zero ACEs, you could attribute their mental or developmental disorder to prenatal trauma or to trauma "influencing genetics". At that point, "trauma" is as useful an explanation as "ghosts" or "divine intervention" -- you're using it with the same amount of scientific rigor. I would prefer the models used for the treatment of my disorder to have more behind them than that.
And for what it's worth, I think trauma is hugely important to study in relation to almost every mental and developmental disorder. Even when the disorder is clearly caused by something other than trauma, it inevitably influences and is influenced by one's experiences of trauma throughout one's life. But claims like those made by people like Gabor Maté imo debase the study of this relationship by associating it with such obvious quackery.
2022 meta study: "Following literature searches, we finally identified 64 published journal articles, including 70 independent studies involving nearly 4 million participants. It was found that individuals who experienced any form of ACEs had a 1.68-fold increased vulnerability of ADHD, compared to those without a history of ACEs. [...] Our findings support the hypothesis that ACEs are associated with ADHD to a certain extent, especially for individuals who ever experienced multiple ACEs and females." https://doi.org/10.1016/j.acap.2016.08.013
"Childhood trauma is linked to ADHD, and vice versa. They share similar symptoms that are often confused and misdiagnosed. Each also amplifies symptom severity in the other. These are just a few reasons why clinicians must increase their understanding of trauma and adopt an informed approach when assessing and treating children for ADHD." https://www.additudemag.com/adhd-and-trauma-overview-signs-symptoms/
"Opinion piece" by ADHD Foundation UK: "[...] I know that this all sounds very grim and I must stress that these risks will not apply to all children and young people with ADHD. However, it is important to consider that there is a link between ACEs and ADHD supported by the research evidence in that young people with ADHD have a higher prevalence of ACEs overall. Understanding this must surely encourage us to not only ensure that ADHD is supported within every family, through early identification and diagnosis and access for all to appropriate psychoeducative interventions and for improved supports for adults with ADHD but also to consider the broader context in which the child or adult is living and how difficulties and challenges with ADHD can be exacerbated as a result." https://www.adhdfoundation.org.uk/wp-content/uploads/2022/06/Is-there-a-link-between-ADHD-and-ACEs.pdf
You are correct. I mixed up "personality disorder" and "mental disorder". Which to me are fuzzy categories and rough translations, and may or may not map to the same meaning depending on context of use; but they do have a distinct and (somewhat; as far as psychology allows?) well-defined meaning in the context of ICD-11!
"Mental, behavioural and neurodevelopmental disorders are syndromes characterised by clinically significant disturbance in an individual's cognition, emotional regulation, or behaviour that reflects a dysfunction in the psychological, biological, or developmental processes that underlie mental and behavioural functioning. These disturbances are usually associated with distress or impairment in personal, family, social, educational, occupational, or other important areas of functioning. "
Personality disorders are a subtype of mental disorders in ICD:
"Personality refers to an individual’s characteristic way of behaving, experiencing life, and of perceiving and interpreting themselves, other people, events, and situations. Personality Disorder is a marked disturbance in personality functioning, which is nearly always associated with considerable personal and social disruption. The central manifestations of Personality Disorder are impairments in functioning of aspects of the self (e.g., identity, self-worth, capacity for self-direction) and/or problems in interpersonal functioning (e.g., developing and maintaining close and mutually satisfying relationships, understanding others’ perspectives, managing conflict in relationships). Impairments in self-functioning and/or interpersonal functioning are manifested in maladaptive (e.g., inflexible or poorly regulated) patterns of cognition, emotional experience, emotional expression, and behaviour."
https://icd.who.int/browse11/
So I'd like to come back and discuss this more when I have more time to read, but I'm an adult with ADHD (and depression) that didn't get dx until I was in college. I don't have any major childhood trauma. My dad was an engineer and I suspect neurodivergent himself, at least one of my siblings has ADHD and anxiety but not all have a ND dx. My dad didn't have any major childhood trauma. I was spanked which impacted my relationship with my dad but not abused. Did well in school because I was clever and quick and allowed to read when I was bored. I have plenty of adulthood trauma but it's mostly caregiver/secondary and comes after the fact.
If you can erase neurodivergency by lumping it all into trauma, I cannot explain my brain function. I'm a single person and anecdote doesn't equal data but this contrasts so hard with my lived experience it's hard to ignore it.
I do think trauma absolutely exacerbates or triggers existing potential conditions. If hypothetically 5 percent of the population has X gene that causes Y dx but it only activates Z percent of the time unless trauma is present which makes it 5Z percent of the time, you're going to see an increase in presentation of Y dx among people with trauma. You also then have the people whose trauma is stemmed from Y dx presenting and not getting treatment/support/accommodations for it making it hard to tell if Y came from that trauma or was there the whole time, especially if Y impacts memories like my ADHD does.
But I'll come back and read more.
I'm sorry but spanking is definitely abuse. Maybe it isn't major childhood trauma but it most certainly can result in trauma.
Look, I'm aware of this but I'm telling you I don't believe I was abused. I don't feel abused. I am carrying no weight from it. I wouldn't spank my own kids but I don't have any so it doesn't matter. My relationship with my father was distant more because I was queer and polyamorous and hadn't figured that out til adulthood so I distanced myself from everyone.
I was also not emotionally abused or neglected. Unless we really want to re-label all these experiences as abuse, and then yeah I guess everyone has trauma so all the ND people have ptsd.
Well, you might, at least in the mental framework of the discussion: ADHD?
Case in point? :)
No I actually find it incredibly offensive.
Edit: I'm actually quite upset about this but I will elaborate.
Defining someone else's experiences as abuse who is in front of you and telling you otherwise is what I find offensive. It's not the sort of thing you do in therapy without a rapport built and even then. I was spanked maybe 4 times in my life. It wasn't a good choice, it was the best my parents had at the time, but I do not believe that I, personally, was abused nor carrying any trauma from it. I would not define abuse for anyone else outside of a therapeutic or otherwise working relationship.
And if everything, truly everything is abuse and major trauma, then everyone should be neurodivergent. And everyone isn't. Unless we change the meaning of ND as well.
Anyway, I'm offended and angry so I'm going to stop here but this is one of those times an emoji indicating your tone made things worse.
Really apologize for my comment earlier, I never intended any offense and it's definitely true that you are the only one who can tell whether or not you were abused. I was also spanked by my father just one time, but that's the least of my worries about him (check my post history if you care) so I understand what you're saying and again, sorry.
I am genuinely not offended by your comment. I understand why you made it and I'm not going to argue that spanking isn't abusive or harmful to kids. I just truly have zero trauma impact from it and was upset by the other commenter disregarding my words, not you.
Thank you for your thoughtfulness.
I guess you are refering to me as "the other commenter". Can you point me to where I disregarded your words?
A specific action can be considered abusive. We may or may not have different opinions on what each of us considers abuse, both on an individual, and on on a societal level. None of it is meant to be "offensive", but purely the observation and judgment of an action, which has a clear direction, in this case from a parent towards a child; and assigning accountability for that action. Whether you share the definition based on your own experiences or not is up to you. I do not consider that to be offensive, it was certainly not meant that way by me. I also don't read smoontjes comment as an attack against you on a personal level.
"The World Health Organization (WHO) defines child maltreatment as “all forms of physical and emotional ill-treatment, sexual abuse, neglect, and exploitation that results in actual or potential harm to the child’s health, development or dignity.” There are four main types of abuse: neglect, physical abuse, psychological abuse, and sexual abuse. Abuse is defined as an act of commission and neglect is defined as an act of omission in the care leading to potential or actual harm." https://www.ncbi.nlm.nih.gov/books/NBK459146/
In the language used by the authors refered to in the top post, they would likely judge your reaction as a sign of unresolved/unhealed trauma. A "trigger" (reminder) like that may make a victim feel attacked in the present where it is actually a memory of getting attacked in the past.
Yeah they might define that as unhealed trauma but it's actually that I find the comments you made, with the implied tone of the emoji, to be offensive and demonstrative of the idea that you can reduce everything to trauma. Because now not only are you stating I've been abused, you're indirectly telling me that my response is unhealed trauma. You're hiding behind the authors of the article but you're saying it to me. So any unfavorable response I make is now about my trauma. Which you will explain to me.
If you were licensed this would be, in my opinion, a serious ethics violation. I'm going to assume you're not. I have a counseling degree and 14 years of post-graduate experience in the non-clinical side of mental health, despite clinical training. I'm speaking from training and experience, including experience with victims and perpetrators of abuse.
I'm angry, not because I have unhealed trauma from my childhood, but because I found your emoji contradiction of my very serious comment to be dismissive and demeaning, as is attempting to play therapist by internet forum. I'm angry at behavior that could be so much more harmful to someone else. And I'm angrier that my honesty about my anger being used to attempt to dismiss my response as irrational by implication.
This topic is about the theory, and I tried to relate your comments to what proponents of this theory might say about it. If you carefully read again what I wrote, you may find that I did not actually take a position on it myself. I am merely trying to understand and summarize the different perspectives. I could consider your claim that I am "hiding behind the authors" as offensive, but I do not take that perspective in general. You are sharing your perspective, and I appreciate it. I appreciate also how you are staying in dialog. It helps me to understand, and to improve my wording in the future, in the hopes of reducing misunderstandings.
Your interpretation of my emoji is: your interpretation. To me, it is neither a "winking emoji", nor a contradiction. You could ask what I meant to express by it, but you take it as offense and do not even allow that I explain myself, or take into account that I may not be a native speaker and that I may have different cultural imprinting in how I express myself. I did not mean anything I wrote as an offense.
I also do not consider your emotions, or anyone's emotions, as ground to dismiss them or consider them irrational. That's again your reading of what I was trying to say. You are angry, and you feel offended. That's what you say, and that's what I take as fact.
You wrote you have ADHD, and that you experienced what would be considered adverse childhood experiences, which to me does not disprove the theory. That was what I was trying to say. I do not understand how you decide that you do not "carry any weight" from those childhood experiences, and how you know that it has nothing to do with your ADHD. There may or may not be a connection, and your statements didn't help me to further my understanding.
I am not licensed in the mental health area, but I know a few things about what is expected from a licensed therapist and what would be considered an ethics violation in the framework of my country, and I disagree that what I wrote would be seen as such by some external reviewer. Especially not as a "serious" one. I can relate to your anger, and understand where such a comment is coming from. You are hurt, directly, by your interpretation of what I wrote, dismissing my intentions. Societal norms would allow me to ask for forgiveness for the misunderstanding. I do not want to make people feel hurt from what I write. I will try and improve my language and be more precise in the future. I "hide behind citations", because I do often feel I cannot adequately express myself well enough in foreign languages without being misunderstood, especially around emotional topics such as this one.
The fact that this is what you got from Fae's comment is a bit strange to me. Someone literally telling you that they do not carry trauma from their undoubtedly bad experience, and you telling them (paraphrased): "you sure? :)" is dismissive. You're not actually addressing anything, but rather just presenting the same argument as before but in a manner that doesn't feel respectful.
This is my main issue with studies like this and the insistence to fit everything into a neat little box, which would be commendable if the people they were trying to treat weren't literally telling them "hey, this isn't why I feel this way." When someone tells you that an experience isn't traumatic for them you generally take it at face value ESPECIALLY if you're not a professional.
I'm sorry, but trying to force people into your theories is not cool. It's okay to present an idea, but you should recognize when you're pushing said ideas a bit too far and too aggressively.
Without regard to any user’s experience or truth, denial and projection are powerful and subtle things. They work across individuals, groups, whole societies.
So while it’s inappropriate and fruitless to argue directly against someone’s truth, it’s entirely reasonable to be skeptical, and probably helpful to be curious, when the truth communicated runs counter to our own. This is especially so when there is some credible evidence to bolster our own truth.
That is perfectly fine, and I agree with you wholeheartedly, I however feel that when someone's truth runs counter to an entire history of research without any scientific explanation of said truth, it is irresponsible to then tout it as "the solution". It can be presented and argued for, but not brought forth as an answer.
Like I wrote in my most recent comment my issue is with how stubborn both Mate and OP are that their truth is the absolute correct one, and not just a piece of the puzzle.
I do actually understand this - counseling degree, been through therapy, etc. - but being skeptical and speaking in the aggregate is very different. Things that I might process as trauma don't necessarily flag as traumatic for someone else and vice versa.
Talking to suicidal people is a major part of my job, this leads to a lot of people processing a lot of trauma in my direction. That could cause secondary trauma if it causes that emotional durress. (Most mental health disorders are have a diagnostic criteria of causing the symptoms causing distress in one or more facets of one's life. ) But the impact of that on myself is very different than the impact of those conversations on the people I train on suicidal intervention, because they're usually new to it and have less experience and may have personal reasons that it's more impactful.
So while I was speaking about my personal experience. I'm coming from a professional background. And while I do have plenty of other traumatic experiences - mostly caregiver trauma - and I suppose it's possible that I'm shoving feelings from my childhood in a metaphorical jack in the box and just spinning the handle randomly. I really don't think so.
Let me ask this again: How can anyone know that they do not carry trauma from their experience? I am asking this question honestly, and I tried to play "devil's advocate" or "take the position of the people mentioned in the top post, as far as I understand it". I am not trying to put anyone into any box. Yes, I am "dismissing" that as simply not logically sound. From where I stand, nobody, not me, not you, not them, can rule out anything like that.
Yes, of course I am attempting to present the same argument again, in different words, because I did not see anything that addresses my question. I could equally claim they and you are "dismissive" of my question, but I am not claiming such things because I know you and Fae are trying to understand me, the same way I am trying to understand you.
A few ways.
The first is if they felt that way before their trauma - if someone struggles with ADHD in school and was abused as a result, then it's safe to say that ADHD came before the abuse.
The second is if there is a clear pathway in a person's mind that they can connect to previous trauma. I know that I can trace a lot of mine to my current issues, but they came as a result of my neurodivergence and inability to fit in, ruling them out.
The third is if they sit down and unpack their trauma, overcoming it. This won't "cure" anyone's ADHD, and it might not even make it specifically better, but it'll remove a weight from the rest of their life that might help them manage it better.
I could think of more but I think you get the point. Saying that childhood abuse exacerbates and worsens mental illness/neurodivergency is completely fine. Refusing to entertain the idea that these could exist without abuse or trauma is absurd and lacks scientific ground (I mean, really, HOW would this even happen?! How would a condition that is ~80% genetic also be 90% a result of trauma?)
(edit: the opening of this paragraph was needlessly rude. oops.) Most of the issues surrounding him, and my main issue with him and with your post (sorry for repeating myself) is the insistence that abuse and trauma are the only causes of these issues, against mountains and mountains of evidence to the contrary. Saying it's a partial reason, sure! I actually agree that it could make it worse, but you're generalizing an incredibly complicated issue and in the process, I feel, shoving people into a box.
Please quote where I, and you put that in bold for a reason, insist that abuse and trauma are the only cause of these issues. I am re-reading my writing, and I do not see how one can read that into it even if you wanted to put it in there.
The linked authors go as far as claiming that emotional and psychological abuse, and especially emotional neglect, not getting your emotions validated, are the cause of "major" childhood trauma.
I won't pretend I know enough about the area to comment on it but my unqualified opinion is that it seems strange that they would remove a ton of diagnoses that may or may not help people find the correct treatment.
I see a lot of people (who are probably equally unqualified) on BPD forums talking about something kind of related to this in that they believe that CPTSD and BPD are so similar in nature that one or the other should be entirely removed. Or they at least argue that since trauma is so significant to a person developing BPD, it doesn't make sense that they have that diagnosis but not the CPTSD diagnosis.
I don't fully understand why you would remove diagnoses. Is it not ultimately most helpful to have as specific a diagnosis as possible, so that you can fine-tune treatment as exactly as possible? And is it not also further stigmatizing mentally ill people that mental disorders as a whole shouldn't exist at all? I am not a lesser human for having a mental illness - not that I think this director is saying I am - however for me, it's very helpful to know exactly what is wrong with me.
The term "personality disorder" being introduced as the catch-all (with additional specifiers of course) also seems a little strange unless it's just a sort of headline for the category. Those two words only mean that compared to most others, you are dysfunctional in one way or another. I like the cluster grouping in the DSM a lot more than I like the new ICD system, however I will say that I found it kind of validating to know that instead of my diagnosis being simply "BPD", it is now "severe personality disorder, borderline pattern". Ultimately though, a diagnosis is just a reference to find the best tool for treatment: ICD-11:
First my anecdote: to the extent I have identified and worked with the many ways in which my parents treated me badly, to that same extent my life has gotten a lot better. To wit, I recently was accepted into a fairly prestigious divinity school. This acceptance is remarkable, because it is the first significant academic milestone I achieved based on my ability to form relationships. Heretofore, it has alway been my exceptional ability to score well on standardized tests.
I don't know about ADHD or any specifid disorder, but I do know there is a growing body of research around the links between trauma, emotions, and brain. A lot of third- and fourth-wave treatment modalities, things like EMDR, EM therapies, psychedelics, are based on this research. Somatic psychology in particular is really getting to the feelings side of it. Anecdote, again, healing from me begins with feeling the pain--often outrage--that I could not allow myself to feel as an abused child. There's real brain research that I have reviewed (and alas cannot seem to lay my hands on now) about the emotional processing differences in brains were kids were raised in supportive environment, and those that were raised in all different kinds of abusive families.
The hybperbole in TFA is probaby uncalled for. As others have noted, there are certainly non-environmental genetic factors. The mindblowingly complex and fascinating field of epigenetics also plays a big role.
Note well, I do not blame my parents. They were doing the best they knew how, and were themselves operating as a result of traumatic upbringings. They were responsible for my own dysfunction, but are not at fault. I am not at fault for my own dysfunction behaviors. As stated elsewhere in the thread, fault is really a pointless concept. Understanding cause, however, can be very helpful to healing.
I know there is a fair bit around psychedelics and the dmn. And I also see a lot around unique ways psychedelics promote neipuroplasticity, especially functional neuroplasticity. Both are useful in trauama therapies, the first helps individuals re-contextualize the events. The latter helps individuals unlearn trigger responses and reactions.
Harvard "Mastery of Stress" 35 year study:
"Ninety-one percent of participants who did not perceive themselves to have had a warm relationship with their mothers (assessed during college) had diagnosed diseases in midlife (including coronary artery disease, hypertension, duodenal ulcer, and alcoholism), as compared to 45% of participants who perceived themselves to have had a warm relationship with their mothers. A similar association between perceived warmth and closeness and future illness was obtained for fathers." (https://pubmed.ncbi.nlm.nih.gov/9058175/)
"Subjects who had illnesses such as coronary artery disease, hypertension, duodenal ulcer, and alcoholism in midlife had used significantly fewer positive words to describe their parents (eg, loving, friendly, warm, open, understanding, sympathetic, just) while in college. This effect was independent of the subject's age, family history of illness, smoking behavior, marital history, and the death or divorce of the subject's parents. Furthermore, 95% of subjects who used few positive words and also rated their parents low in parental caring had diseases diagnosed in midlife, whereas only 29% of subjects who used many positive words and also rated their parents high in parental caring had diseases diagnosed in midlife." (https://pubmed.ncbi.nlm.nih.gov/9058175/)
Public Neurodiversity Support Center: "We need to talk about the ways in which neurodivergent kids are systemically traumatized. [...] If you’re neurodivergent, do you experience these symptoms? Do you think that’s because of your neurodivergence specifically, or do you think maybe it’s because you’ve got some acquired CPTSD going on? Because the good news is that CPTSD can be addressed."
(The link in this comment doesn't work, fyi)
Thanks for posting this! This topic is deeply within my wheelhouse, to the point that answering at a top level is too overwhelming...
But as a traumatized autistic whose special interest has been abnormal psych for literally 20 years, my take is that everyone is so close and then just misses the mark. The binary is not traumatized vs not, it's neurodivergent vs neurotypical. The rates of ACEs and trauma in NDs is so high because we were raised by traumatized NDs, who themselves were raised by traumatized NDs, and on and on..... The world wasn't built for us, because we are not a monolith; but NTs are and thus the common ground is with them. So when we don't fit, and are punished for it, it comes from everywhere, all sides at all times and that's traumatizing. Our parents tried to save us from the trauma they felt by pushing us into "normal boxes" and that caused trauma too. We don't bounce back well, especially in childhood when the only examples we have to learn from are traumatized NDs who may just barely be keeping their own heads above water (or not). We can learn, and we can heal, but until the psych community acknowledges that the root cause is neurodivergence (and the therapies must be catered to that) we're just going to keep having undiagnosed, traumatized NDs raising kids with personality disorders, treatment resistant depression, and all the rest.
(Sorry if this is all over the place; see above re: excited by the topic but very overwhelmed in trying to distill my beliefs into a single comment)
This observation is really insightful, and a succinct summary of something I've been thinking about a lot lately: sometimes, the "cycle of trauma" isn't something that only needs to be broken once within a family; sometimes it may need to be broken again and again within a lineage because it may be self-generating.
If a lineage is genetically predisposed to behaviour that is "incompatible" with society as defined by neurotypical people, members of that lineage may need to teach each successive generation how to handle their tricky DNA and love themselves despite it.
This in no way downplaying the heroic efforts of those labouring to break the cycle of abuse! Those who succeed are doing the noblest form of work and have my undying admiration. I only recommend that you chronicle your journey for the sake of your descendants lest they one day find themselves having to break the cycle anew.
One other thought: I would be cautious about referring to neurotypicals as a monolith. I understand you're referring to them as monolithic in the same sense that Tolstoy once referred to happy vs unhappy families ("Happy families are all alike; every unhappy family is unhappy in its own way") but I think lumping large groups of people together is almost always dangerous.
I think this is important because a neurotypical German, a neurotypical American, and a neurotypical Iraqi are all neurotypical within the context of their culture - things one person might say or process or perceive aren't exactly the same due to the amount of cultural pressures on 'normal' being different in each culture.
So to say "neurotypicals interact with reality the same" is failing to notice the same thing Tolstoy did, everyone has a different definition of happiness.
You're totally right about my monolith comment, I was using it as shorthand as you described, and it's not true, on the whole. But man... Being autistic, raised and surrounded by autistics, it's genuinely startling encountering someone who is so clearly on a different wavelength and realizing/being reminded of how weird I am! That this person just moves through a world that suits them, and responds to them the way they intend.... Wild.
And I appreciate that you understood what I was trying to say. It felt very disjointed coming out, so I'm glad it was somewhat coherent!
This entire thread seems like a mess, but you managed to put the key points into one comment, even if you found it challenging. Thank you. I think you hit the nail on the head.
In a world made for neurotypical people, trauma of some kind is almost inevitable for neurodivergent people, without a great deal of care.
Thank you so much. It's so tiring. For a lot of us, our childhood is spent blaming ourselves for not being normal enough, and our adult lives are spent desperately trying to tell the neurotypical world that we don't want to be "fixed", just understood.
I appreciate you and your excitement/interest! Just saying.