I’m studying and need help with a Psychology question to help me learn.
Topic: Alex grew up in a violent and abusive home. His father drank to intoxication each night and neglected Alex until he turned three, at which point his father began to physically abuse Alex regularly. Alex’s mother screamed at him any time he cried as a child, and she rarely held or tried to soothe him. What types of behaviors would one possibly see from Alex during childhood? Describe the possible effects of the abuse in terms of the HPA axis, including brain structures and neurotransmitters. How might a psychologist approach working with Alex to address any maladaptive behaviors you identified? When responding to your peers, think about additional issues that might need to be addressed when working with Alex.
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Childhood maltreatment is a major social problem. It is common and can result in serious physical injury or even death. Moreover, its psychological consequences can acutely affect a child’s mental health well into adulthood (Gilbert et al., 2009). Unfortunately for many children like Alex, this goes on in many families every single day. This can affect the child’s childhood and overall development in general. The type of behaviors someone would expect to see from Alex during childhood is resentment and stress which affects their hypothalamic pituitary adrenal (HPA) axis. Early life stressors, such as the ones Alex received, can greatly affect the HPA axis and can lead to deleterious effects. This specific type of maltreatment can lead to externalizing behaviors such as aggression and anxiety as well as severe depression. To a certain extent, Alex could also suffer from PTSD from the treatment of both his mother and father stemming from verbal abuse from his mother and physical abuse from his father. According to a study conducted by the Guangzhou Psychiatric Hospital with 29 age and gendered matched children, HPA axis functioning was significantly increased in depressed patients with childhood neglect compared with depressed patients without childhood neglect (Peng et al., 2014). Childhood trauma increases hypothalamic-pituitary-adrenal (HPA) axis activity, potentially mediating environmental risk for developing severe depression (Heim et al., 2008).
A psychologist should tread lightly with Alex considering the trauma he has gone through. Building rapport with Alex is essential before trying to dive into his past. Essentially figuring out who Alex was and what we he went through at a consistent pace will inform the psychologist of who Alex is now and how to effectively provide the best possible treatment. The psychologists could also use Cognitive behavioral therapy to help Alex as well. In previous studies, patients with histories of emotional and physical abuse have reported greater social anxiety, less satisfaction and greater disability over the course of treatment. Having weekly sessions and tracking Alex’s improvement with opening up and progressing by eliminating those negative factors from his past will help Alex in the long run. Also, if Alex has not been removed from the home and placed in a separate environment from his parents, removing Alex could help him as well. The parents will also need counseling services as well to discuss their childhood pain and why they have felt the need to inflict that pain onto their child.
Gilbert R, Widom CS, Browne K, Fergusson D, Webb E, Janson S. Burden and consequences of child maltreatment in high-income countries. Lancet. 2009;373(9657):68–81
Heim C, Mletzko T, Purselle D, Musselman DL, Nemeroff CB. The dexamethasone/corticotropin-releasing factor test in men with major depression: role of childhood trauma. Biol Psychiatry. 2008;63(4):398–405. doi: 10.1016/j.biopsych.2007.07.002
Peng, H., Long, Y., Li, J., Guo, Y., Wu, H., Yang, Y., Ding, Y., He, J., & Ning, Y. (2014). Hypothalamic-pituitary-adrenal axis functioning and dysfunctional attitude in depressed patients with and without childhood neglect. BMC psychiatry, 14, 45. https://doi.org/10.1186/1471-244X-14-45
Alex’s experiences with maltreatment occurred at a crucial developmental time in his life. Unfortunately, with a neglectful, abusive father and a psychological abusive mother, Alex will likely have formed an insecure-anxious-preoccupied or disorganized attachment with his parents (Godbout, Daspe, Runtz, Cyr, & Briere, 2019; Zilberstein, 2013). Children who are abused or neglected typically form negative schemas of the self and others; they tend to see themselves as helpless, unlovable, or weak while seeing others as dangerous, rejecting, or unavailable. From these perceptions, Alex may begin to exhibit deviant behaviors towards others, yet internalize perceptions of himself in a way that fosters depressive symptoms and anxiety. It is likely that Alex will experience some form of post-traumatic stress disorder (PTSD) in response to the paternal physical and maternal emotional abuse.
Neurobiologically, abuse and maltreatment has been evidenced as altering the functioning of the hypothalamic-pituitary-adrenal (HPA) axis. As one of the major biological stress systems that respond to threats, when the HPA axis perceives stress, the paraventricular nucleus in the hypothalamus secretes corticotrophin releasing hormone (CRH) which then stimulates the anterior pituitary. The anterior pituitary then secretes adrenocorticotrophic hormone and stimulates the adrenal cortex to produce and release cortisol. This process takes several minutes and is eventually reduced through negative feedback. However, if there is repeated exposure to stressors, there is an increase in the level of stress hormones which initiates pathological changes across multiple physiological systems, resulting in stress-related diseases (Neigh, Gillespie, & Nemeroff, 2009) such as heart disease, asthma, diabetes, headaches, and depression and anxiety.
Because Alex struggles with trusting others, it is important for the psychologist to begin with building rapport. Research focusing on the appropriate psychotherapy approaches for differing cognitive morphologies and internalizations found that individuals who are more self-critical respond better to psychoanalysis than those whom are other-critical (this group responds better to psychotherapies; Luyten & Blatt, 2013; Blatt & Levy, 2003). In Alex’s case, he has negative schemas for both the self and others. Because of this, Alex should meet with a psychologist regularly for psychoanalysis sessions wherein the goal is to try and better articulate and differentiate internal associations and decrease thought disorder. This process will likely need to be long-term in order to see effective change. Additionally, the psychologist may need to implement a short-term psychotherapeutic process, such as trauma-focused CBT, to try and teach Alex how to practice and apply coping skills.
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Blatt, S. J., Levy, K. N. (2003). Attachment Theory, Psychoanalysis, Personality Development, and Psychopathology.
Carpenter, L. L., Shattuck, T. T., Tyrka, A. R., Geracioti, T. D., Price, L. H. (2011). Effect of childhood physical abuse on cortisol stress response. Psychopharmacology, 214. 367-375.
Godbout, N., Daspe, M., Runtz, M., Cyr, G., Briere, J. (2018). Childhood maltreatment, attachment, and borderline personality-related symptoms: Gender-specific structural equation models. Psychological Trauma: Theory, Research, Practice, and Policy, 11(1). 90-98.
Luyten, P., Blatt, S. J. (2013). Interpersonal relatedness and self-definition in normal and disrupted personality development: Retrospect and prospect. American Psychologist, 68(3). 172-183.
Neigh, G. N., Gillespie, C. F., Nemeroff, C. B. (2009). The neurobiological toll of child abuse and neglect. Trauma, Violence, & Abuse, 10(4). 389-410.
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