The Neurobiology of Trauma: Ripple Effects through Individuals,

Generations, and Society Michelle Bosquet Enlow, PhD

Assistant in Psychology, Department of Psychiatry Boston Children’s Hospital

Assistant Professor, Department of Psychiatry Harvard Medical School

Terminology • Stress • Trauma

Exposure to actual or threatened (a) death, (b) serious injury or (c) sexual violation

Direct exposure

Witness event in person Learn event occurred to close family/friend Experience repeated or extreme exposure to aversive details of event

*Center on the Developing Child, Harvard University *DSM-5

Caveats! • Correlation ≠ Destiny • Resilience

– Individual, environmental – Positive growth – Inform interventions

• Focus on mothers – Fathers are also extremely

important!

Exposure Rates • By adulthood, 90% ≥ 1 trauma

• rates birth to 5 years

• Exposures “correlate” • Low-income, ethnic/racial

minority Severe Multiple Chronic Buffers

Exposure Effects Type x Timing Pre-exposure functioning Buffers Environmental response

Exposure Effects Stress Reactivity

Autonomic Nervous System

Hypothalamic -Pituitary-Adrenal Axis

Multiple Brain Regions (PFC, Amygdala)

Exposure Effects Cognitive Functioning

IQ Executive

Functioning

Academic Achievement

Job Options Socioeconomic Status

Exposure Effects Internal Representations

Trauma

Exposure Effects Mental and Physical Health • Leading cause of psychiatric illness

– PTSD, depression, anxiety, ADHD, substance abuse, disruptive behavior disorders, personality disorders

MISDIAGNOSIS! • Physical health

– Immune functioning – Lifetime disease risk

Race/Ethnicity & Exposure Effects Differential Effects of Exposure • Hypotheses

– Increased exposure to adversity – Ongoing discrimination stress – Reduced access to buffering resources – Different cultural style for coping – Differences in underlying physiology

• Mechanisms?

• More research needed!

Intergenerational Effects

Intergenerational Effects: Pregnancy • Vulnerability period

– heightened exposure – PTSD, depression, anxiety

• Lifetime cumulative effects • “Prenatal programming”

Intergenerational Effects: Pregnancy

Maternal History

ANS HPAA

Epigenetics

Immune Endocrine

Perinatal Complications

Intergenerational Effects: Developmental Context

Economic Environment

Neighborhood Schools

Stress Exposures

Nutrition/ Toxins

Compensatory Buffers

Social Support

Partners (Stability,

DV)

Child Friends

Community Connections

Caregiving

Attachment Relationship Maltreatment

Intergenerational Effects: Developmental Context

Maternal History

Child Prenatal Environment

Childhood Environment

Temperament Stress Reactivity

Cognition Physical Health Mental Health

Implications for Intervention

• Ongoing Research

– Methods for identifying at-risk

– Mechanisms Interventions

• Existing Research – Possible many points in system

Implications for Intervention

• Individual Level – Stress reduction – Improve mental health – Promote positive caregiving

• Support Systems – Schools – Social support – Religious/cultural institutions

Implications for Intervention

• Societal/Public Policy Level – Address barriers to treatment

• Insurance • Sufficient mental health, social support

resources • Logistics • Misdiagnosis

– Wrong treatment – “Bad” kid – Criminal justice system

Implications for Intervention

• Societal/Public Policy Level – Recognition

• Trauma has broad effects • Trauma contribution to “individual problems”

– Academic achievement, low SES, child maltreatment, DV, addiction, violent behavior

• Trauma as public health problem – Reduction

• Urgent need to reduce trauma exposures

Thank you