Childhood Abuse and Psychological Effects in Adulthood

Ellie Osterberger

Loras College
 I chose to center my literature review around the topic of childhood abuse and the

psychological effects in can have leading into adulthood, as well as later in life. This topic is

important because it explains how the trauma that someone experiences in the younger years of

their life can affect them later, starting in teenage years and leading into adulthood.

Psychological effects can be long term and sometimes don’t appear until years after the

individual was exposed to the trauma. When people think of abuse, they tend to think physical

abuse right away, when that isn’t always the cause of psychological problems. Physical abuse is

not the only form of abuse that can have lasting effects on an individual. Abuse can also be

experienced as verbal and emotional abuse, as well as neglect. Abuse can make it extremely

difficult for a person to form relationships, and can lead to high rates of anxiety, depression, and

post-traumatic stress disorder (PTSD). In this literature review, I will explore these concepts in

further detail.

Childhood abuse can also be referred to as victimization, as stated in numerous studies

that I looked at. One study in particular stated that victimized was a form of aggravated assault

by a parent or other caregiver. It could also be referred to as attempted or successful sexual

assault (Hanson, et al, 2001). Childhood abuse is any form of emotional, physical, or sexual

abuse that is experienced before the legal age of 18. Typically, children are more likely to

experience physical or sexual abuse. These two tend to be the most common and are strong

predictors of psychological problems in adulthood like depression, PTSD, and alcohol

dependence (Douglas, et al, 2010).

One study that I looked at examined the relationship between childhood emotional abuse

and depressive symptoms. The study took into consideration the genetics of a person as well as

the trauma that they were exposed to. They examined stress-related genes in 222 girls and boys,
aging between 10-12 years old. These participants lived in the Washington D.C., metropolitan

area. These participants completed the Revised Child Anxiety and Depression Scale and the

Emotional Abuse subscale of the Childhood Trauma Questionnaire, alongside their parents. The

study found that there is a detrimental effect for both boys and girls who experience emotional

abuse, but both are affected in different ways. It was found that in boys, emotional abuse had a

larger impact on depressive symptoms, and in girls, the stress-related genes were heightened as

an effect to emotional abuse, and the genes are what contributed to depressive symptoms

(Banducci, et al, 2014).

There has been a lot of research conducted on the results of childhood abuse and the

effects that it has on women in their adult years of life. A study conducted with a diverse sample

of California women shows that women who experience childhood physical abuse have an

elevated risk for a lifetime diagnosis of major depression and anxiety disorder (Schneider,

Baumrind, Kimerling, R., 2007). Not only does abuse in general lead to elevated risk of adult

mental health problems but experiencing more than one type of abuse also leads to a higher risk

of mental health issues.

In the same study conducted with a culturally diverse group of women from California,

results showed that those who experienced both child sexual and physical abuse are at a higher

risk to develop PTSD in adulthood, rather than those who experienced no form of abuse

(Schneider, Baumrind, Kimerling, 2007). PTSD was assessed first by using a question, then by

using the Primary Care PTSD Screen (PC-PTSD). The screening looked at and measured four

domains: re-experiencing, numbing, avoidance, and hyperarousal. Participants met criteria for a

possible diagnosis of PTSD if they showed 3 of those 4 symptoms. Results of this study showed

that those who experienced more two types of childhood abuse were associated with a 10-fold
increase for PTSD and exposure to all three types had almost a 23-fold increased risk for PTSD

(Schneider, Baumrind, Kimerling, 2007). Another study conducted with a random sample group

of women located in the United States showed that women who experienced a combination of

aggravated assault and rape experienced higher rates for lifetime PTSD. Results from this study

showed that women who experienced both injury and life threat were twice as likely as those

experiencing neither to develop a life PTSD. They were also five times as likely to meet the

diagnostic criteria for PTSD (Hanson, et al, 2001). Physical and sexual abuse in childhood were

both high predictors of PTSD in adulthood. Childhood rape was a significant factor in lifetime

PTSD. The same goes for physical injury (Hanson, et al, 2001).

Neglect is also a form of childhood abuse that can have a profound impact on the

development on a child. In a longitudinal study conducted over the course of 30 years, results

showed that those who experienced child abuse and neglect have higher risk of experiencing

mental health disorders, substance use and abuse, and poor physical health (Herrenkohl, et al,

2013). This study also measured the adverse childhood events (ACE) that a person experienced.

When an individual’s ACE score is calculated and they fall above a certain score, their chances

of developing a disorder rises. This study took place in two counties in Pennsylvania at child

welfare agencies. A total of 457 children were part of the research study. Depression was

measured by the 21-item Beck Depression Inventory (BDI). On this scale, people rate their

feelings on a scale and all their ratings are added up to total their score. Anxiety in individuals

who also experienced neglect was measured in the same study. Anxiety was measured using the

Generalized Anxiety Disorder Scale (GAD-7). Participants were asked once again to rate how

they had been feeling over the course of the past two weeks. The scores were totaled again and

depending on what range the individual fell in, determined their diagnosis. Results showed that
those who were in the sample, child welfare group scored twice as high on the scales than those

in the control group (Herrenkohl, et al, 2013). In another study conducted, those who had

reported childhood abuse and neglect reported depression in adulthood more than twice the rate

of others in the sample (Herrenkohl, et al, 2012). The study measured neglect by combining

observer’s ratings of mothers’ negative emotional or physical interactions with a child. The

ratings are measured based on observations made during parent-child interaction. Results showed

that neglect had a negative correlation with self-esteem, autonomy, purpose in life, and overall

life satisfaction. This means that the more neglect a person experiences, the lower a person’s

self-esteem, autonomy, sense of purpose, and life satisfaction are. When an individual doesn’t

feel good about oneself, this can lead to psychological issues (Herrenkohl, et al, 2012).

After reviewing previous research and writing this literature review, I would say that my

biggest takeaway from this is realizing the lasting effects that childhood abuse can have on an

individual. Abuse is something that sicks with someone throughout their entire life and it can

lead people in all sorts of directions; depression, anxiety, substance abuse, and PTSD are only a

few of them. Not only are there so many disorders that childhood abuse can lead to, but there are

so many that go hand in hand with each other. Typically, a person may be suffering from more

than one disorders. One could be severe and the other could be mild, or vice versa. Another

important takeaway is that the effects of abuse don’t always occur right away. Someone could

experience abuse in their younger years of childhood and not show symptoms of a psychological

disorder for ten years. There is no timeline. I think that more research needs to be done in boys

and men. I had an easier time finding studies that had been done with girls and women and I

think that’s because there are more women who are victims of physical abuse. But the one study

that I read stated that men were likely to show more depressive symptoms when they
experienced emotional abuse. Outside of that study, I couldn’t find a whole lot on the male

population. I also think that more research could be conducted based on other factors that

weren’t really touched on in the research. I think there are outlying factors like socioeconomic

status, race, and ethnicity that could play a large role in childhood abuse and psychological

effects. This topic is important to keep doing research on, because sadly, I don’t think that it is

something that is going to go away. But the more we as a human population know, the more we

can help those who are victims. Due to the minimal research conducted with the male

population, I would like to conduct a research study examining the correlation between males’

ACEs and depression. I hypothesize that males who score higher on an Adverse Childhood

Experiences survey (ACEs) will also score higher on the Beck Depression Inventory, compared

to males that score lower on the ACEs survey.

Methods

Participants

Participants will consist of those who are actively seeking treatment for depression and

volunteer for this study. Those who participate in this study must be 45 years old or older. This is

due to the fact that we want to assess the effects of Adverse Childhood Experiences on

adulthood. There will be 100 participants, 50 females and 50 males, in order to examine if there

are differences in results based on gender. Participants will be asked to participate in both the

Behavioral Risk Factor Surveillance System survey and the Beck Depression Inventory. They

will also be told that they are allowed to back out at any time if they are uncomfortable with the

study. Participants will all be given a random number upon registering to ensure that the data

remains confidential. This is also a between-group study, so participants will complete both

surveys assessing their ACEs and score on the Beck Depression Scale.
Procedure

Participants will be recruited by their therapists and be informed of the study taking place

within their next appointment. They will engage in this study upon arrival to one of their therapy

sessions. In the session, they will be asked to complete two surveys, the Behavioral Risk Factor

Surveillance System survey and the Beck Depression Inventory.

Childhood trauma will be assessed using the Adverse Childhood Experiences Scale

(ACEs). ACEs refer to potentially traumatic events, including various forms of abuse, neglect,

and household dysfunction, occurring before the age of 18 years old (Bryant, Oo, & Damian,

2020). These stressful events can lead to harmful, long-term health outcomes such as anxiety,

depression, Post Traumatic Stress Disorder, heart disease, diabetes, lung cancer, and

psychopathology (Ford, 2014). The ACEs will be measured by using the criteria created by U.S.

Centers for Disease Control and Prevention (CDC) and the Southern California region of the

HMO, Kaiser Permanente. The questions on this survey were selected from 3 different sources:

The Conflicts Tactics Scale, the National Health Interview Survey, and a previous study

examining sexual abuse among adult women (Ford, 2014). Participants will take the Behavioral

Risk Factor Surveillance System (BRFSS) survey that encompasses survey questions addressing

ACE scores.

The BRFSS consists of 11 items adapted from the CDC/Kaiser questionnaire. The items

on the scale cover nine different types of childhood exposures such as emotional abuse, physical

abuse, sexual abuse, household-member mental illness, household-member substance abuse,

witnessing domestic violence, parental separation/divorce, and incarcerated family members

(Ford, D.C., 2014). Participants are asked a question such as, before age 18, how often did a

parent or adult in your home ever hit, beat, kick, of physically hurt you in any way? Responses to
all questions were categorized into two items never or one or more times (Ford, 2014). To

answer another question such as, did you live with anyone who was depressed, mentally ill, or

suicidal? Responses were given in a yes/no format. To compute an ACE score for each

participant, an overall ACE score is calculated based on the responses of each subcategory of the

survey.

The Beck Depression Inventory (BDI) was used to measure depression. BDI is a 21-item,

self-report rating inventory that measures the characteristic attitudes and symptoms of depression

(Dozois, Dobson, & Ahnberg, 1998). Participants are asked to rate themselves on a scale of 0-3

on how frequent they experience a symptom of depression. The survey lists the 21 items and

presents it with a response. For example, the BDI presents sadness, and the response is I am sad

all the time. Participants rate themselves on how often they experience the symptom. 0 being, I

do not experience the symptom, and 3 being that the symptom is present all the time. The scores

of each response are totaled to create an overall score. Scores are then used to determine the

severity of depression. Scores ranging between 0-14 are minimal, 14-20 mild, 20-29 moderate,

anything ranging between a 29-63 is considered severe depression.

Results

Multiple t-tests will be conducted to analyze the data from both the Behavioral Risk

Factor Surveillance System survey and the Beck Depression Inventory. One t-test will analyze

the data of male responses and the other will analyze the data of female responses. I predict that

data will be statistically significant for both men and women. Higher ACEs will lead to a higher

score on the depression scale. When comparing men to women, women will score significantly

higher in ACEs, which will contribute to higher rates of depression.

Banducci, A. N., Gomes, M., MacPherson, L., Lejuez, C. W., Potenza, M. N., Gelernter, J., &

Amstadter, A. B. (2014). A preliminary examination of the relationship between the 5-

HTTLPR and childhood emotional abuse on depressive symptoms in 10-12-year-old

youth. Psychological Trauma: Theory, Research, Practice, and Policy, 6(1), 1-7.

doi:[Link]

Bryant, D. J., Oo, M., & Damian, A. J. (2020). The rise of adverse childhood experiences during

the COVID-19 pandemic. Psychological Trauma: Theory, Research, Practice, and

Policy, 12, S193-S194. doi:[Link]

Douglas, K. R., Chan, G., Gelernter, J., Arias, A. J., Anton, R. F., Weiss, R. D., Kranzler, H. R.

(2010). Adverse childhood events as risk factors for substance dependence: Partial

mediation by mood and anxiety disorders. Addictive Behaviors, 35(1), 7-13.

doi:[Link]

Dozois, D. J. A., Dobson, K. S., & Ahnberg, J. L. (1998). A psychometric evaluation of the beck

depression Inventory–II.  Psychological Assessment,  10(2), 83-89.

doi:[Link]

Ford, D. C., Merrick, M. T., Parks, S. E., Breiding, M. J., Gilbert, L. K., Edwards, V. J., . . .

Thompson, W. W. (2014). Examination of the factorial structure of adverse childhood

experiences and recommendations for three subscale scores. Psychology of

Violence,  4(4), 432-444. doi:[Link]

Hanson, R. F., Saunders, B., Kilpatrick, D., Resnick, H., Crouch, J. A., & Duncan, R. (2001).

Impact of childhood rape and aggravated assault on adult mental health. American

doi:[Link]

Herrenkohl, T. I., PhD., Klika, J. B., Herrenkohl, R. C., PhD., Russo, M. J., & Dee, T., M.S.W.

(2012). A prospective investigation of the relationship between child maltreatment and

indicators of adult psychological well-being. Violence and Victims, 27(5), 764-76.

doi:[Link]

Herrenkohl, T. I., Hong, S., Klika, J. B., Herrenkohl, R. C., & Russo, M. J. (2013).

Developmental impacts of child abuse and neglect related to adult mental health,

substance use, and physical health. Journal of Family Violence, 28(2), 191-199.

doi:[Link]

Schneider, R., Baumrind, N., & Kimerling, R. (2007). Exposure to child abuse and risk for

mental health problems in women.  Violence and Victims, 22(5), 620-31.

doi:[Link]