trauma research paper topics

94 Psychological Trauma Essay Topic Ideas & Examples

🏆 best psychological trauma topic ideas & essay examples, ⭐ simple & easy psychological trauma essay titles, 📑 good research topics about psychological trauma, ❓ psychological trauma research questions.

• Psychological Trauma, Development and Spirituality During the growing stages of a child, the brain is also developing and its growth depends on daily experiences. There is a particular stage of brain development in a child when traumatic experiences can gravely […]
• Psychodrama in Treating Trauma and Addiction In all cases, it is problematic for the individual to reconcile with the anxiety they feel and to cope with the problems with trust.
• Childhood Trauma Long-Term Psychological Outcomes Moreover, ethical considerations are to be implemented during study conduction, which will limit certain challenger correlated with the lack of focus on privacy, confidentiality, and consent.
• Psychiatry: PTSD Following Refugee Trauma The psychiatrists finally recognized PTSD in the first version of the Diagnostic and Statistical Manual of Mental Disorders after the mass occurrence of similar symptoms in Vietnam veterans.
• Physical and Psychological Trauma in Women Therefore, giving these women the power to control their reproductive organs and stopping barbaric cultural practices will greatly reduce the rate of physical and psychological trauma among women.
• Victims of Disasters: Psychological Traumas It was noted in various individuals that experienced the same situation as Victim A that when interviewed by television crews while at the emergency center such individuals were actually seen as recovering slower from PTSD […]
• Trauma and Its Psychological and Behavioral Manifestations Van der Kolk states that in most cases, the reliving and re-experiencing of the trauma affect the survivor’s emotional response and determines how well he or she copes with the symptoms.
• Psychological Trauma Care in Military Veterans He is hesitant to open up to anyone and spends time in the company of his marine friends. The clinician must be direct and candid when talking to the patient about the risks of their […]
• Psychological Trauma: Physical and Behavioral Symptoms The complaints and reactions of a 22-year-old client with a history of sexual abuse give a good illustration of the physical symptoms of trauma.
• Psychological Problems: Trauma and Lessons It is important to understand how a human brain works and deals with traumas to help people and overcome their challenges. An internship is a chance to investigate all aspects of the brain and understand […]
• Post-Traumatic Stress Disorder – Psychology Post-traumatic stress disorder is thought to be as a result of either corporeal disturbance or emotional disturbance, or more often a mishmash of both.
• Somatic Intervention in Trauma Psychotherapy Different parts of the world, as neuroscientists argue, have varying ways of training the mind and hence significantly different levels of the ability to control the functions of the brain.
• Abnormal Psychology: Posttraumatic Stress Disorder In addition, some of this research indicates that the differences in the degree of the disorder are due to the varying nature of the trauma experienced by that individual.
• Exploring Psychological Trauma and Its Effects
• Psychological Trauma, Stress, and Social Support
• Healing Childhood Psychological Trauma and Improving Body Image Through Cosmetic Surgery
• Psychological Trauma and Behavioral Sciences
• Tattoos and Psychological Trauma
• Immediate Management of Acute Psychological Trauma in Conflict Zones
• Psychological Trauma and Court Cases
• The Psychological Trauma in Children and Adolescents
• Signs and Symptoms of Psychological and Emotional Trauma
• Play Therapy for Psychological Trauma in Kids
• The Psychological Trauma Caused by Night Terrors in Childhood
• Peripersonal Space and Bodily Self-Consciousness: Implications for Psychological Trauma-Related Disorders
• Predictive Processing and the Varieties of Psychological Trauma
• Emotional and Psychological Trauma: What Is It and How to Heal?
• Psychological Trauma and Memories
• Is Psychological Trauma Considered an Injury in Court?
• Psychological Trauma as a Transdiagnostic Risk Factor for Mental Disorder
• Why Men and Women May Respond Differently to Psychological Trauma
• Psychological Trauma and Access to Primary Healthcare for People From Refugee and Asylum-Seeker Backgrounds
• The History of Psychological Trauma
• Psychological Trauma in Different Mechanisms of Traumatic Injury
• Most Common Symptoms of Psychological Trauma
• Psychological Trauma and Its Surprising Link to Depression
• How Psychological Trauma Is Linked to Chronic Pain
• Post-traumatic Stress Disorder: The Neurobiological Impact of Psychological Trauma
• Effects of Psychological Trauma on the Brain
• Psychological Trauma and Mental Health Care
• Torturing and Repeated Psychological Trauma
• Psychological Trauma and Recovery
• Understanding the Impact of Psychological Trauma
• Psychological Trauma Surrounding Children During War
• How to Cope With Psychological Trauma
• The Association Between Previous Psychological Trauma and Mental Health Among Gastric Cancer Patients
• Psychological Trauma and Life
• Early Response to Psychological Trauma
• Psychological Trauma and PTSD
• Role of Psychological Trauma in the Cause and Treatment of Anxiety and Depressive Disorders
• How Psychological Trauma Impacts the Body
• Psychological Trauma: A Historical Perspective
• An Analysis of Psychological Trauma Interventions
• Psychological Trauma and Substance Abuse
• Review of Psychological Trauma: Theory, Practice, and Policy
• Psychological Trauma in EMS Patients
• PTSD and the “Building Block” Effect of Psychological Trauma
• Can We Salvage the Concept of Psychological Trauma?
• Psychological Trauma and the Developing Brain
• Group Interventions for Treatment of Psychological Trauma
• Psychological Trauma and Physical Health
• Background Feelings of Belonging and Psychological Trauma
• Psychological Trauma Symptoms and Warning Signs
• Is Psychological Trauma a Mental Illness?
• Can Military Basic Training Cause Psychological Trauma?
• How Is Psychological Trauma Diagnosed?
• What Are the Side Effects of Psychological Trauma?
• Can Psychological Trauma Cause Back Pain?
• Has Anyone Experienced Psychological Trauma Because of COVID-19?
• What Is the Difference Between Psychological Trauma and Emotional Trauma?
• Can Repetitive Psychological Trauma Cause Mental Fatigue?
• How Long Can Psychological Trauma Last?
• What Happens to the Brain After Psychological Trauma?
• How Can a Victim Recover From the Psychological Trauma Experienced When Being Bullied?
• Could Slavery Have Caused Psychological Trauma in Generations of Black Americans?
• How Effective Is Rogerian Therapy in the Treatment of Psychological Trauma?
• Why Is the Psychological Trauma of Slavery Ignored?
• Can Psychological Trauma Cause Nerve Damage?
• What Is the Worst Kind of Psychological Trauma?
• Is Aphantasia Caused by Some Sort of Psychological Trauma?
• Which Circumstances Qualify as Psychological Trauma?
• What Are the Effects of Psychological Trauma on the Body?
• How Is EMDR Therapy Used to Heal Psychological Trauma?
• Can Psychological Trauma Cause Physical Symptoms?
• What Is the Connection Between Migraines and Psychological Trauma?
• Do Psychological Traumas Change a Person’s Interests?
• Can Psychological Trauma Cause Memory Loss?
• What Are the Symptoms of Psychological Trauma?
• How Does Psychological Trauma Change Someone?
• What Is the Most Prevalent Type of Psychological Trauma?
• Can Psychological Trauma Lead to Schizophrenia?
• Do Some Minds Resist Psychological Trauma More Than Others?
• What Part of the Brain Is Affected by Psychological Trauma?
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126 Psychological Trauma Essay Topic Ideas & Examples

Inside This Article

Psychological trauma is a common and widespread issue that affects millions of people around the world. Trauma can result from a wide range of experiences, such as physical or emotional abuse, natural disasters, accidents, or witnessing violence. It can have a profound impact on a person's mental health and well-being, leading to symptoms like anxiety, depression, PTSD, and other psychological disorders.

If you are looking for inspiration for an essay on psychological trauma, here are 126 topic ideas and examples to consider:

• The impact of childhood trauma on adult mental health
• The psychological effects of domestic violence on survivors
• Trauma and its effects on brain development
• The role of resilience in overcoming trauma
• Trauma and its connection to substance abuse
• The impact of trauma on relationships and social connections
• Trauma and its effects on physical health
• The psychological effects of natural disasters on survivors
• Trauma and its connection to homelessness
• The role of therapy in treating trauma survivors
• The impact of trauma on children's development
• Trauma and its effects on memory
• The psychological effects of war and conflict on survivors
• Trauma and its connection to self-harm and suicidal ideation
• The role of mindfulness and meditation in healing from trauma
• Trauma and its effects on sleep and nightmares
• The psychological effects of sexual assault on survivors
• Trauma and its connection to eating disorders
• The impact of trauma on academic performance and achievement
• Trauma and its effects on personality development
• The role of art therapy in treating trauma survivors
• Trauma and its connection to PTSD
• The psychological effects of bullying on survivors
• Trauma and its effects on self-esteem and self-worth
• The impact of trauma on social skills and communication
• Trauma and its connection to phobias and anxiety disorders
• The role of exercise and physical activity in healing from trauma
• Trauma and its effects on emotional regulation
• The psychological effects of car accidents on survivors
• Trauma and its connection to chronic pain and physical symptoms
• The impact of trauma on trust and intimacy in relationships
• Trauma and its effects on cognitive abilities and decision-making
• The role of medication in treating trauma survivors
• Trauma and its connection to dissociative disorders
• The psychological effects of medical trauma on survivors
• Trauma and its effects on parenting and child-rearing
• The impact of trauma on career choices and job performance
• Trauma and its connection to perfectionism and control issues
• The role of spirituality and religion in healing from trauma
• Trauma and its effects on body image and self-perception
• The psychological effects of natural disasters on first responders
• Trauma and its connection to survivor guilt and shame
• The impact of trauma on social support and community resources
• Trauma and its effects on sexual identity and orientation
• The role of family therapy in treating trauma survivors
• Trauma and its connection to cultural identity and heritage
• The psychological effects of military trauma on veterans
• Trauma and its effects on risk-taking behaviors and impulsivity
• The impact of trauma on coping mechanisms and defense mechanisms
• Trauma and its connection to attachment styles and relationships
• The role of group therapy in treating trauma survivors
• Trauma and its effects on emotional intelligence and empathy
• The psychological effects of workplace trauma on employees
• Trauma and its connection to codependency and enabling behaviors
• The impact of trauma on body language and nonverbal communication
• Trauma and its effects on social justice and advocacy
• The role of trauma-informed care in treating trauma survivors
• Trauma and its connection to cultural trauma and historical trauma
• The psychological effects of medical trauma on healthcare providers
• Trauma and its effects on social norms and expectations
• The impact of trauma on coping skills and resilience
• Trauma and its connection to personality disorders
• The role of trauma narratives in healing from trauma
• Trauma and its effects on emotional boundaries and self-care
• The psychological effects of community trauma on residents
• Trauma and its connection to institutional trauma and systemic oppression
• The impact of trauma on creativity and artistic expression
• Trauma and its effects on body language and posture
• The role of animal-assisted therapy in treating trauma survivors
• Trauma and its connection to intergenerational trauma and family systems
• The psychological effects of environmental trauma on survivors
• Trauma and its effects on emotional regulation and impulse control
• The impact of trauma on social identity and group dynamics
• Trauma and its connection to self-compassion and self-forgiveness
• The role of narrative therapy in treating trauma survivors
• Trauma and its effects on social media use and online behavior
• The psychological effects of financial trauma on survivors
• Trauma and its connection to cultural appropriation and identity theft
• The impact of trauma on gender identity and expression
• Trauma and its effects on body awareness and somatic experiencing
• The role of dance therapy in treating trauma survivors
• Trauma and its connection to racial trauma and microaggressions
• The psychological effects of technological trauma on survivors
• Trauma and its effects on social isolation and loneliness
• The impact of trauma on community resources and support systems
• Trauma and its connection to toxic relationships and abusive dynamics
• The role of exposure therapy in treating trauma survivors
• Trauma and its effects on emotional intimacy and vulnerability
• The psychological effects of natural disasters on animals and pets
• Trauma and its connection to emotional neglect and abandonment
• The impact of trauma on social justice movements and activism
• Trauma and its effects on grief and loss
• The role of play therapy in treating trauma survivors
• Trauma and its connection to environmental justice and climate change
• The psychological effects of political trauma on survivors
• Trauma and its effects on emotional boundaries and assertiveness
• The impact of trauma on social hierarchies and power dynamics
• Trauma and its connection to intercultural communication and conflict resolution
• The role of attachment theory in treating trauma survivors
• Trauma and its effects on body image and self-esteem
• The psychological effects of medical trauma on patients
• Trauma and its connection to narrative identity and storytelling
• The impact of trauma on community resilience and recovery
• Trauma and its effects on social media activism and advocacy

These topic ideas and examples can serve as a starting point for writing an essay on psychological trauma. Whether you are exploring the effects of trauma on an individual, a community, or society as a whole, there are countless ways to approach this complex and important topic. By delving into the psychological, emotional, social, and cultural aspects of trauma, you can gain a deeper understanding of its impact and explore ways to promote healing, resilience, and recovery.

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Trauma Recovery Lab

The 20 most inspiring papers on trauma recovery (or related mental health topics)

Which papers have made you really enthusiastic? Which articles have changed your thinking? Which publications do you re-read regularly?

We’ll have a #traumaresearch chat about these questions on Wed 28/Thurs 29 March ( your local time ). But an hour is short, not everyone is able to join, and it may be nice to start a little thread that informs the chat and remains available afterwards (it’s also possible that I’m just a little too curious to wait another week :-)). So please leave a comment with your favorite(s).

It doesn’t matter whether a paper is high-impact / often cited or not. The only thing that counts is that you are a fan. And if you have time, please tell us why you like it.

To start off (let’s aim for the 20 most inpirational papers): one of my favorites is the review by Salmon & Bryant on the influence of developmental factors on posttraumatic stress. I read it in the early stages of my PhD research and keep getting back to it because it’s so rich (and quite unique) in explaining how children process information, depend on parents’ coping behavior, and understand emotions in the context of trauma:

Salmon, K., & Bryant, R. (2002). Posttraumatic stress disorder in children: The influence of developmental factors Clinical Psychology Review, 22 (2), 163-188 DOI: 10.1016/S0272-7358(01)00086-1

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24 thoughts on “ The 20 most inspiring papers on trauma recovery (or related mental health topics) ”

Hi Eva, great topic and great idea! Here’s mine:

Breen, L. J., & O’Connor, M. (2009). Acts of resistance: breaking the silence of grief following traffic crash fatalities. Death Studies, 34(1), 30-53

I read this article when I was looking for research that was challenging ever present belief that grief happens in stages and phases. What inspired me about this paper is that 1) its Australian 2) It brings to life that idea that people who experience traumatic grief are actively “resisting” those stage/phase/medical models of grief, and 3) It also brings to life the natural resilience that people have in the face of great trauma and loss. We so often underestimate this – and the idea that people are actively negotiating around these stage ideas… Here’s a link to the article: http://ro.ecu.edu.au/ecuworks/6538/

I have to also add this: While technically not an article, The Truth about Grief, by Rita Konigsberg http://thetruthaboutgrief.com/ – is one of the best reviews about grief around – it gets to the heart of how absolutely pervasive and unhelpful the the stage theories of grief have been.

What a nice question to ask. And challenging to answer, because so many articles are inspiring. I have to think of Sack, W. H., Him, C., & Dickason, D. (1999). Twelve-year follow-up study of Khmer youths who suffered massive war trauma as children. Journal of the American Academy of Child and Adolescent Psychiatry, 38(9), 1173-1179. doi:10.1097/00004583-199909000-00023. I think this is a landmark article, especially because it confronts us with the stochastic nature of PTSD course. Beautiful 4-wave prospective long-term follow-up data. The results described in a very transparent fashion. The sample was obviously treated carefully, and attrition across the 12 years was relatively low. The numerous articles that have been published about the sample touch upon a large number of relevant issues, such as development, acculturation, grief, depression, and resilience. Highly recommended.

The paper which gave legs to my research is,

Bremner, J. D. (2006). Traumatic stress: effects on the brain. Dialogues in clinical neuroscience, 8(4), 445–461.

Bremner presents a clear picture of the physiological effects of traumatic stress on the brain and was instrumental to my understanding of how my PTSD symptoms manifested. I highly recommend this paper for anyone who wants to gain a better understanding of how the biology of PTSD lends to a better understanding of the behaviors of PTSD sufferers.

Thanks Kerrie, Geert, and Mark! Great to read why you liked these papers, I knew the study by Sack & al (should re-read it actually) but not the other two, am looking forward to reading them.

I have struggled with an answer for many days. As my research has mostly entailed examining controversial aspects of PTSD, I settled on “Progress and Controversy in the Study of Posttraumatic Stress Disorder” written by Richard McNally and published in the Annual Review of Psychology (vol. 54) in 2003. Many other articles have challenged me as well (Rosen and Lilienfeld 2008; Spitzer, First, & Wakefield, 2007; North et al., 2009; McHugh and Treisman, 2006), but the McNally article stands above the rest for me. It not only provides an excellent introduction to many of the ongoing controversies, but also pushed me to critically examine many “knowns” about the disorder. For scientific knowledge to advance there must be ongoing critical examination of our beliefs and ideals and McNally showed me not how important this is, but how to go about doing it.

Thanks Steven! Papers that are both thought-provoking and instructive are quite rare I think, great to have this one on the list.

For all, this is the link to the free PDF of McNally’s paper: http://bit.ly/HkDVQw

I am nearly 4 months into my phd, so very new to the trauma literature. However, I would say that the article that has been one of the more insightful readings is ‘Positive Adjustment to Threatening Events: An Organismic Valuing Theory of Growth Through Adversity’ by Joseph and Linley (2005, Review of General Psychology, 9, 262-280). The ability of the theory to account for alterations in subjective well-being and psychological well-being, thereby attending to PSTD and PTG respectively, is of great appeal. Furthermore, as someone who is increasingly orientated towards an interpretivist paradigm and narrative analysis, I find the theory compliments this and provides a concise yet flexible interpretation of the impact of trauma and how I might begin to understand the processes involved. Only time will tell how inspirational this article proves to be for my research.

Hi Laura, fantastic that you left a comment, I’m sure not many PhD students would feel confident enough after 4 months (PhD students, please feel welcome to join, would be great to hear about your thoughts and inspirations). I’m a fan of papers that help our theoretical thinking, curious to see what you will think in a couple of years!

For all, I couldn’t find a free PDF (if you know of it, please leave the link), this is the link to the abstract: http://bit.ly/H10Rnv

Thanks Eva for this challenge 🙂 There are, of course very many important papers which makes it difficult the name the most important one. But I would choose a “very old” paper (you were probably not born when it was published….): Terr, L. C. (1991). Childhood traumas: an outline and overview. American Journal of Psychiatry, 148, 10-20. In this paper Lenore Terr, one of the pioneers of our field, divides childhood trauma into two basic types (type I vs. type II). This conception was and still is very important, both from a clinical and a research point of view.

Hi Markus, thanks for that! I appreciate you’re estimation of my age 😉 Terr’s paper is one of my favorites as well; it’s not only very informative, the style of writing is also very attractive.

For all, Terr’s paper is available in a free PDF: http://bit.ly/H12vFw

Five Essential Elements of Immediate and Mid-Term Mass Trauma Intervention: Empirical Evidence. Stevan E. Hobfoll; Patricia Watson; Carl C. Bell; Richard A. Bryant; Melissa J. Brymer; et al. Psychiatry 70(4). Winter 2007. pp. 283 – 315.

This article defines the essential elements needed in responding to the needs of individuals post-disaster. These concepts have been molded to form “Psychological First Aid” (NCTSN/NCPTSD)and the more recent intermediate/long-term intervention “Skills for Psychological Recovery” (NCTSN/NCPTSD). The article represents a major shift from critical incident reporting post-disaster to meeting natural hierarchy of human needs which include 1) a sense of safety, 2) calming, 3) a sense of self– and community efficacy, 4) connectedness, and 5) hope.

http://focus.psychiatryonline.org/article.aspx?Volume=7&page=221&journalID=21

I am a newly minted clinical counselor having served my internship and continuing as an employee in a no-fee agency serving teen and adult survivors of sexual trauma. My education offered little in the way of training for this type of work, so it has been my own initiative and suggestions from peers that led me to the articles I am suggesting. These choices may reveal my naivete in the field, which is why I appreciated the first collection of “influential” articles and look forward to the collection of “inspiring” articles.

1. van der Kolk, BA, Pelcovitz, D, Roth, S, Mandel, FS, McFarlane, A, and Herman, JL. (1996). Dissociation, Affect Dysregulation and Somatization: The complex nature of adaptation to trauma. American Journal of Psychiatry, 153(7), Festschrift Supplement, 83-93. http://bit.ly/GUVI6C

2. Shore, AN. (2001). The Effects of Early Relational Trauma on Right Brain Development, Affect Regulation, and Infant Mental Health. Infant Mental Health Journal, 22; 201-269. http://www.trauma-pages.com/a/schore-2001b.php

These first two gave me a good foundation in the neuroscience of trauma and PTSD. I like to have as much information as possible, so while some therapists/counselors don’t care too much about the neuroscience, I find that it helps me make sense of symptoms. Being able to explain it simply to clients sometimes helps them feel less “defective.”

3. Lamagna, J and Gleiser, KA. (2007). Building a Secure Internal Attachment: An Intra-Relational Approach to Ego Strengthening and Emotional Processing with Chronically Traumatized Clients. Journal of Trauma & Dissociation, Vol. 8(1); 25-52. doi:10.1300/J229v08n01_03

Click to access lamagna_gleiser.pdf

While my overall theoretical framework is integral, my work with clients is a relational intersubjective model (derived from Kohut, Fosha, Stolorow, Orange, et al). This particular article, by students of Fosha, extends her Accelerated Experiential-Dynamic Psychotherapy to include work with parts (Schwartz, R), subpersonalities (Assagioli, R), complexes (Jung, CG), or ego states (Watkins & Watkins), however one conceives of these parts of the psyche that get split off in childhood trauma. I’ve found it useful.

Hi William, thanks for these papers and links!

I think this is a really interesting and helpful article on possible psychological reactions in children, and their families, who have experienced a medical event (illness, injury):

Kazak, A. E., Kassam-Adams, N., Schneider, S., Zelikovsky, N., Alderfer, M. A., & Rourke, M. (2006). An integrative model of pediatric medical traumatic stress. J Pediatr Psychol, 31(4), 343-355.

This paper describes different phases following pediatric injury and illness and addresses goals of intervention. I also found the summary of assumptions underlying the model useful (the existence of a range of normative responses, the similarities accross illness and injury groups, the importance of a developmental an socio-ecological perspective, and understanding both competent and less functional reactions in families).

Thanks Eva for this question, it’s really nice to read the opinion of others on their favourite paper!

This paper was my number two! Thanks Anne for listing it here.

It’s so difficult to choose between the many articles. I’ve decided to focus on one that isn’t about innovative findings but one that illuminates how to find valid new findings.

‘Schnurr, P.P. (2007). The rock and hard places in psychotherapy outcome research. Journal of Traumatic Stress, 20(5), 779-792.’

Though she is neither the first nor the last to talk about trials designs, I find it an easy to read article that discusses many key concepts in psychotherapy trial design. It’s a good help when you ponder about your own design and contains a ton of practicalities.

Thanks Joris, that’s a very interesting one. Unfortunately, I can’t retrieve a free pdf for all, this is the link to the abstract: http://bit.ly/HSeA03

Great topic Eva! As promised, my inspiration – while somewhat off topic but with major implications for mental health generally and the link to physical wellbeing – is the work being conducted by Julian Thayer et al. The abstract for one notable review on the heart-brain connection is available at:

http://www.ncbi.nlm.nih.gov/pubmed/18771686

You may also like these two favorites that were shared in the comments on the 20 most-cited papers:

By Kay Walker: This paper is impressive and specific to trauma in indigenous Australians, a needy and important group. Laura M Hart1*, Anthony F Jorm1, Leonard G Kanowski1, Claire M Kelly1 and Robyn L Langlands2 (2009) Mental health first aid for Indigenous Australians: using Delphi consensus studies to develop guidelines for culturally appropriate responses to mental health problems. BMC Psychiatry, 9:47 doi:10.1186/1471-244X-9-47. (PDF: http://bit.ly/GYevs2 ) * Corresponding author: Laura M Hart [email protected] Author Affiliations 1 Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia 2 School of Psychology, Victoria University of Wellington, Wellington, New Zealand.

By David: I find with my clients that they often have no conscious recollection of the traumatic events that encouraged their perceptions/cognitive processes/ behaviour patterns to become rigid, and I can certainly track my own pathology back to before the time I developed explicit memories. I believe the incidence of what Judith Herman characterises as Complex PTSD is a lot more common than is generally accepted (even by those affected), and I perceive a causal link between categories of trauma and clusters of maladaptive personality processes… (link to the book on Amazon: http://amzn.to/16jd15 )

For me this is a classic in my population health work. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study http://www.sciencedirect.com/science/article/pii/S0749379798000178

It inspires because it makes such a strong case for public health approach to prevention and child development.

Dear all, My favourite paper will expose me as an absolute nerd, as it’s quite technical. It’s Steel, Z., Chey, T., Silove, D., Marnane, C., Bryant, R.A., & Van Ommeren, M. (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: A systematic review and meta-analysis. Journal of the American Medical Association, 302(5), 537-549. I like this paper because it’s illuminative on the whole discussion what mental health of asylum seekers and refugees is influenced by most: by traumatic events or by current stressors. Sample size is very high and the answer according to this meta-analysis is: torture and cumulative traumatic events form the greatest influence of refugees’ mental health. So, to anyone who’s interested in mental health for this population, I can really recommend this paper. And (coincidentally!) it’s Australian :). Best wishes to all and especially you Eva, Jackie

The first study that’s on my mind is the elaborate study of Kai Erikson where he describes the individuals within their community before and after the massive Buffalo Creek disaster in 1972. He portrays the dynamics in a mountain community after a disaster, that are still relevant in disasters nowadays. For example in the introduction of the 2006 Edition he makes a comparison with the Katrina disaster.

I realize that this is not a paper, however, it is a book that reads as a novel; maybe something for a long flight or a lazy holiday. This book was an eye-opener and an inspiration. For me it is one of the classics everybody who is working in a disaster struck community – doing research, in charge of the mental health programs, being a policymaker etc. etc.– has to read…

Erikson KT. Everything in its path: Destruction of community in the Buffalo Creek Flood. 1976 (Edition 2006) NY: Simon & Schuster Paperbacks.

Great suggestion Annelieke, thanks!

Great list! Seen this was published, there could be some interesting reports on Havening for PTSD coming out?

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Trauma, Attachment and Culture

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Research has consistently highlighted an increased prevalence of mental health problems, such as post-traumatic stress disorder (PTSD), depression, and anxiety, following both man-made and natural disasters. Secure attachment and mentalizing have been previously identified as potential protective factors ...

Keywords : Trauma, Attachment, Mentalizing, Culture, PTSD

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• Impacts of trauma on child development
• The use of creative arts in treating childhood trauma
• How does parental care relate to childhood trauma?
• The trauma of child sexual abuse
• Prevalence and impact of child traumatic stress
• Perpetrators of trauma

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• How to use art to express trauma
• Current status of trauma treatment
• The biology of trauma
• Cultural perspective of trauma
• Impact of traumatic brain injury
• Effectiveness of traumatic brain injury rehabilitation

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• Correlation of brain injuries trauma and seizures
• Correlation of child sexual abuse and chronic trauma
• What is urban trauma?
• Chronic trauma effects of war
• Chronic urban trauma: Violence induced trauma
• Correlation between childhood trauma and chronic depression in adulthood

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• Correlation between childhood  trauma and chronic fatigue syndrome
• Chronic trauma in impact sports
• Traumatic and chronic depression among patients with anxiety disorders
• Gender difference in traumatic episodes
• Impacts of chronic diseases on trauma
• The impact of COVID-19 traumatic stressors on mental health

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• Impact of COVID 19 on traumatic trends
• Complex Trauma in children and adolescents
• Complex trauma in adults
• Trauma island psychological damage of female genital mutilation
• Complex trauma among psychiatrically impaired children
• Trauma in the family business

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Intergenerational Transmission of Trauma: The Mediating Effects of Family Health

Associated data.

Data are not publicly available due to IRB protocols for the study.

Family health is important to the well-being of individual family members and the collective family unit, and as such, may serve as a mediator for the intergenerational transmission of trauma (ITT). This study aimed to understand the intergenerational impact of parent’s adverse and positive childhood experiences (ACEs and PCEs) on their children’s adverse family experiences (AFEs) and how family health mediated those relationships. The sample consisted of 482 heterosexual married or cohabiting couples (dyads) in the United States who had a child between the ages of 3 and 13 years old. Each member of the dyad completed a survey, and data were analyzed using structural equation modeling. Parental ACEs were associated with more AFEs. The fathers’, but not the mothers’, ACEs were associated with worse family health. Parental PCEs were associated with better family health, and family health was associated with lower AFE scores. Indirect effects indicated that parental PCEs decreased AFEs through their impact on family health. Family health also mediated the relationship between the father’s ACEs and the child’s AFEs. Interventions designed to support family health may help decrease child AFEs.

1. Introduction

The American Psychological Association defines trauma as “an emotional response to a terrible event” [ 1 ]. Types of trauma are generally separated into two categories: interpersonal (e.g., abuse) and non-interpersonal (e.g., natural disasters or accidents) [ 2 ]. Childhood trauma subtypes vary in the research; however, childhood trauma scales typically include subsections for interpersonal trauma such as physical abuse, sexual abuse, emotional maltreatment, and neglect, and subsections for non-interpersonal trauma such as illness or death [ 3 , 4 ]. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-V), individuals can experience trauma in four ways: by directly experiencing a traumatic event, witnessing a traumatic event, learning of a violent or accidental traumatic event that happened to a close family member or friend, or from extreme or repeated exposure to harsh details of a traumatic event [ 5 ].

Additionally, certain demographics, such as race, gender, and age, are important in the study of trauma. Individuals from non-White racial/ethnic backgrounds are more likely to experience trauma than White individuals are, demonstrating the importance of accounting for race in trauma research [ 6 ]. Results for gendered differences in experiencing trauma vary in existing research; however, some research identified gendered differences in number of trauma exposures and different types of trauma (e.g., exposure to domestic violence is more prevalent among males and sexual abuse is more prevalent among females) [ 6 , 7 , 8 ]. Additionally, research has identified gendered differences in trauma symptoms, specifically symptoms of post-traumatic stress disorder (PTSD) [ 7 ]. The age of first trauma is particularly important, as it can impact healthy development; for example, individuals who are extremely traumatized typically experience trauma earlier in childhood than those with less trauma [ 9 ].

Trauma experienced in childhood has significant implications for healthy child development and psychopathology in adulthood [ 3 , 4 , 6 , 9 ]. Brain imaging studies have shown that all types of childhood trauma are related to decreased volume of the frontal cortex, an area of the brain associated with reasoning, emotion, and language [ 4 ]. Essentially, the traumatic stressors children experience cause brain injury, increasing the risk of psychopathology in adulthood [ 4 ]. Epidemiological studies often focus on common mental disorders as outcomes of childhood trauma, including internalizing psychopathology (e.g., mood and anxiety disorders) and externalizing psychopathology (e.g., substance use disorders) [ 6 ]. A parent’s psychopathology can increase the risk of childhood trauma among their children, thus revealing the cyclical nature of trauma transmission between parents and children [ 6 ].

Families play a central role in child development and in the intergenerational transmission of trauma (ITT) [ 6 ]. Factors that impact ITT include family functioning, parenting ability, parent–child relationship quality, cognitive appraisal of trauma, PTSD, and severity of a parent’s childhood trauma [ 10 , 11 , 12 , 13 , 14 ]. Trauma (including childhood trauma) experienced by parents can negatively affect their parenting ability while also increasing the risk of transmitting trauma to their children [ 14 ]. The purpose of this study is to examine how parents’ trauma, experienced in childhood, measured through adverse childhood experiences (ACEs), when also accounting for their positive childhood experiences (PCEs), affects their children’s experiences of trauma, as measured through adverse family experiences (AFEs). A second purpose is to examine whether the family’s health mediates the relationship between childhood experiences and later childhood trauma.

1.1. Risk Factors for Adverse Family Experiences

Measures of childhood trauma, such as ACEs and AFEs, are key to understanding ITT. ACEs measure an individual’s cumulative experience of various forms of abuse, neglect, and household dysfunction during their childhood, which can be potentially traumatic [ 15 , 16 , 17 ]. ACEs are related to behavioral and health problems in adulthood [ 15 , 18 ]. Studies about the role of ACEs in the intergenerational and community transmission of trauma have primarily focused on large-scale trauma such as the Holocaust; PTSD among veterans of war; and historical, systematic, and generational trauma [ 19 , 20 , 21 , 22 ]. However, as trauma research has developed, ACEs and trauma are now being applied to the general population. Previous findings indicate that parents who experience trauma have diminished capabilities to empathize with their child’s emotions due to an altered perception of the world and the individuals they interact with [ 19 , 20 ]. Diminished parenting skills may result in decreased trust and feelings of safety for their children from a lack of emotional stability [ 20 ]. In turn, children mirror their parents’ instability, and the process of ITT continues.

AFEs items were derived from ACE questionnaires but use an environmental perspective regarding family or household dysfunction and risk factors in the family unit [ 23 ]; AFEs introduced four new items in addition to five derived ACE items [ 24 , 25 ]. While AFE items are similar to ACE items, there are two important differences: AFEs do not include questions about the child’s personal experience of physical, emotional, or sexual abuse by guardians or caregivers, and parents respond about their child’s experience rather than their own [ 25 ]. AFEs provide more understanding of the child’s environmental experience; however, parental ACEs may determine how AFEs exist in families. Exposure to AFEs is associated with negative childhood development, including decreased physical health, mental health, and well-being [ 26 ]. A poor-quality, high conflict, and unsupportive family environment may cause chronic stress to the entire family [ 27 ]. Empirical evidence confirms that the family environment is critical to shaping childhood development, perhaps more than any other environment.

1.2. Promotive Factors for Adverse Family Experiences

Recent research has examined the role of cumulative positive or promotive experiences in childhood, including benevolent childhood experiences (BCEs) [ 28 ], positive childhood experiences (PCEs) [ 29 ], advantageous childhood experiences (counter-ACEs) [ 30 ], and various resilience questionnaires and frameworks. Positive experiences during childhood have been shown to promote better adult health even in the presence of high ACEs [ 28 , 29 , 30 ].

In addition to PCEs, a healthy family environment in adulthood may be important to reducing children’s AFEs. Family health is defined as “a resource at the level of the family unit that develops from the intersection of the health of each family member, their interactions and capacities, as well as the family’s physical, social, emotional, economic, and medical resources” [ 31 ]. Better family health could also be viewed as an advantageous family experience, or “counter-AFE”, as it helps to increase the positive experiences of a whole family. However, until the recent creation of the Family Health Scale, there were few measures of family health [ 32 ]. In research using the Family Health Scale, parental PCEs promote better family health, whereas their history of ACEs may harm the family’s health [ 33 ]. Other studies have shown that healthy family functioning (which is related to family health, but focused on family routines and habits) can help increase the positive development of children in the family. This includes joint family activities, healthy parental supervision, and healthy interactions in the family [ 26 ]. Thus, family health may be a pathway through which parental childhood experiences influence whether trauma is transmitted to the child.

1.3. Family Systems Theory and ITT

The family unit is a unique organizing structure of health and well-being, and during a crisis, it may serve as an important mediator for children’s risk and resilience [ 34 ]. Family systems theory provides a framework to understand the role of family health in ITT. Family systems theory posits that family members are interdependent, and one family member’s well-being can have a significant impact on another member’s well-being [ 13 ]. Understanding this interdependence can help explain the cyclical nature of ITT—specifically how childhood trauma can determine later relationship quality with partners and children, which can then increase family dysfunction via negative relationship quality [ 13 ]. Thus, family systems theory represents the interdependence of trauma transmission between all family members.

1.4. Aims and Purpose

There is a gap in the literature regarding family health as a mediator between childhood experiences and AFEs and understanding the relationship between parental PCEs and child AFEs. Therefore, the purpose of this study is to understand the intergenerational impact of parent ACEs and PCEs on their children’s AFE scores, and how family health mediates those relationships. Specifically, this study aims to answer the following research questions: (1) Do parent’s adverse and positive childhood experiences predict their children’s AFEs? We hypothesized that there would be a positive relationship between both the mother’s and father’s ACEs and the child’s AFEs, and an inverse relationship between the mother’s and father’s PCEs and the child’s AFEs. (2) Does family health mediate the relationship between parent’s childhood experiences and children’s AFEs? We hypothesized that family health would mediate the relationship between childhood experiences and AFEs. This study is important because it considers family health as a mediator in the intergenerational transmission of trauma by considering the roles of both adverse and positive childhood experiences in the family health of the second-generation household.

2. Materials and Methods

2.1. sampling and procedures.

The sample consisted of 482 married or cohabitating couples (dyads) who were living in the United States at the time of the survey. Each couple had a child between the ages of 3 to 13 years old. Only heterosexual dyads were included in this study due to a low response rate from same-sex dyads. The sample was recruited via a Qualtrics panel. To obtain a more representative sample, a proportion of the sample was required to have at least one partner in the dyad who was a racial minority or at least one partner who had less than a high school degree. Each member of the dyad completed a 20 min survey. Approval for this study came from the Brigham Young University Institutional Review Board (IRB), and all participants were compensated with Qualtrics credits. Compensation varied for participants based on the difficulty to recruit certain participants, especially those from minority groups.

2.2. Measures

2.2.1. adverse family experiences.

AFEs were measured using the 9-item AFE module from the National Survey of Children’s Health 2011–12 [ 23 ]. The AFE items were a subset of the Behavioral Risk Factor Surveillance System (BRFSS) ACE Module created to measure a family-oriented perspective of adverse experiences during childhood. Mothers responded to the questions about their oldest child who was between 3 and 13 years. The items examined family dysfunction and risk factors within the family unit, such as “Did your child ever live with anyone who was mentally ill or suicidal, or severely depressed for more than a couple of weeks?” and “Was your child ever the victim of violence or witness any violence in [his/her] neighborhood?” and “Since your child was born, how often has it been very hard to get by on your family’s income, for example, it was hard to cover the basics like food and/or housing”. [ 23 ]. Response options for seven of the nine items were in a dichotomous Yes (coded as 1) No (coded as 0) format, while the other items were on a 4-point frequency scale from Never to Very often . Never and Not very often responses were coded as 0, and Somewhat often and Very often responses were coded as 1. Responses were summed to create a cumulative score ranging from 0 to 9.

2.2.2. Adverse Childhood Experiences Questionnaire

The ACE items were derived from the BRFSS ACE module [ 17 ]. BRFSS annually gathers data through states in the U.S. by random telephone surveys [ 17 ]. The ACE module includes 11 items that measure risk factors prior to the age of 18. Constructs of the items include various forms of abuse, neglect, and general household dysfunction, such as “Did you live with anyone who was depressed, mentally ill, or suicidal?” and “Were your parents separated or divorced?” and “How often did anyone at least 5 years older than you or an adult, force you to have sex?” [ 15 , 16 , 17 ]. Response options include Yes , No , and I don’t know for each item. The Yes responses were summed to create a cumulative score ranging from 0 to 8. Separate scores were created for mothers’ and fathers’ ACEs.

2.2.3. Family Health Scale—Short Form

The FHS-SF is a 10-item scale created to measure overall family health, with sample items including: “We support each other”, “We help each other make healthy changes”, and “My family did not have enough money at the end of the month after bills were paid”. [ 32 ]. Response options were recorded on a 5-point Likert scale ranging from Strongly agree to Strongly disagree , and negatively worded items were reverse coded. Responses were summed to create a cumulative score ranging from 0 to 10. Both parents reported on their family’s health in adulthood at the time of the study. The FHS-SF measure was included in the final models as a single latent variable comprising both partners’ responses. Prior research indicated that the scale is most reliable as a single measure with multiple reporters from the same family rather than using separate measures for each responder and has a Cronbach’s alpha of 0.88 when including responses from both partners [ 35 ].

2.2.4. Positive Childhood Experiences

PCEs were measured using the 10-item BCE questionnaire [ 28 ], and 3 items from the PCE questionnaire [ 29 ]. Key themes of these items include social support, perceived safety, and positive and stable quality of life. Sample items included: “Did you have at least one caregiver with whom you felt safe?” and “Did you have beliefs that gave you comfort?” and “Were you able to talk with your family about your feelings?” [ 28 , 29 ]. Response options included Yes or No . The Yes responses were summed to create a cumulative score ranging from 0 to 13, with a higher score equaling more PCEs. Separate scores were created for mothers’ and fathers’ PCEs.

2.3. Data Analysis

Data were cleaned, and item distributions were analyzed using Stata 17. A structural equation modeling framework was used to examine model relationships. Family health was included in the measurement model as a latent variable and showed good model fit based on the root mean square error of approximation (RMSEA = 0.051) and comparative fit index (CFI = 0.981). A structural model was fit by regressing child AFEs on family health, father’s ACE score, mother’s ACE score, father’s PCE score, and mother’s PCE score. Family health was regressed on the mother’s and father’s ACEs and PCEs. Controls (child’s age, child’s gender, mother’s age, and mother’s race) were added to the final model by regressing all covariates of interest on the demographic controls. Model fit was examined using the following model fit cutoffs: RMSEA < 0.08 and CFI > 0.90 indicated adequate fit [ 36 , 37 , 38 ]. Indirect effects were examined using 5000 bootstraps to ensure robust standard errors [ 39 ]. All models were estimated using robust weighted least squares, which is appropriate for categorical data. Missing data were minimal (<1% across all items), and full information maximum likelihood (FIML) was used to account for missing items. The results presented include standardized betas.

Most participants (90.4%) were married, and 12% were in an interracial relationship. The mothers’ mean age was 35.6 years. About 73.4% of the mothers were White, and 14.11% had a high school education or less. The fathers’ mean age was 38.9 years. About 74.9% of the fathers were White, and 17.01% of fathers had a high school education or less. Mean ACE scores for mothers and fathers were 2.1 and 2.08, respectively, while mean PCE scores were 10.98 and 10.91, respectively. The children’s gender distribution was 41.7% female and 58.3% male, and the average age of children reported was 9.75 years old. Lastly, the average child AFE score was 0.92 (see Table 1 for full descriptive results of the sample).

Sample Demographics.

The final model ( Figure 1 ) had good model fit (RMSEA = 0.042; CFI = 0.963). Both fathers’ ACEs and mothers’ ACEs were associated with an increased number of child AFEs. Fathers’, but not mothers’, ACEs were associated with worse family health. Mothers’ and fathers’ PCEs were not directly associated with AFEs. Both mothers’ and fathers’ PCEs were associated with better family health. Family health was associated with lower AFE scores. Indirect effects indicated that parental PCEs decreased AFEs by impacting family health. Family health also mediated the relationship between fathers’ ACEs and children’s AFEs. However, family health did not significantly mediate the relationship between mothers’ ACEs and children’s AFEs ( Table 2 ).

Structural equation model: Parental ACE and PCE associations with family health and child AFE. Notes: RMSEA = 0.042; CFI = 0.963. * p < 0.05, ** p < 0.001.

Significant family-health-mediated indirect pathways.

4. Discussion

The results confirmed intergenerational transmission of trauma (ITT) from both mothers and fathers to their children, especially via the relationship between mothers’ ACEs and children’s AFEs (consistent with hypothesis one). Contrary to our first hypothesis, parental PCEs were not directly related to the child’s AFEs. Fathers’ ACEs were predictive of worse family health, but there was no association between mothers’ ACEs and family health. Both mothers’ and fathers’ PCEs were predictive of positive family health. Further, consistent with hypothesis two, family health mediated the relationships between both parents’ PCEs and father’s ACEs with the child’s AFEs. The findings support the intergenerational transmission of ACEs from both mothers and fathers to their children and are consistent with previous findings on the intergenerational transmission of ACEs [ 14 ], but they also support the mediating role of positive effects in childhood and adulthood in reducing ITT.

4.1. Fathers’ ACEs and Family Health

Fathers’ ACEs were predictive of worse family health more so than mothers’ ACEs. Fewer studies exist about the effects of fathers’ ACEs in family functioning. Existing research demonstrates that genetics and environment have a strong influence on ACE exposure among males, while female exposure was largely driven by environment [ 40 ]. Given that ACEs increase risk of psychopathology in adults [ 6 ], research also shows that men are more likely to experience externalizing symptoms of psychopathology such as substance abuse or reckless activities [ 40 , 41 ]. Both mental illness and externalizing symptoms may harm the family’s social and emotional health processes and resources, undermining their family health. Research further indicates that the parenting styles of fathers are related to the perceived harsh parenting style that the father was raised under in his childhood [ 42 ]. This result may occur because psychological distress mediates the relationship between higher ACE scores and fathering behavior [ 43 ]. Additionally, the socialization of gendered parenting roles may influence the impact of either parent’s ACEs on their parenting ability; for example, fathers’ ACEs decrease instrumental (e.g., caregiving) and expressive (e.g., emotional support) parenting ability, while research on mother’s ACEs influence on instrumental parenting typically has found no relationship [ 43 ].

Generally, maternal mental health is screened and monitored regularly during prenatal and postnatal healthcare. Pediatricians often focus on the mother–child dyad as the key determinant of family health [ 41 ]; however, creating a mother–father–child triad may facilitate a more family-centered approach to AFE prevention. Therefore, a potential intervention is to include fathers in pediatric visits and postnatal mental health assessments. Pediatricians may increase fathers’ involvement by addressing both the mother and father during appointments, assessing relationship health between parents, demonstrating the value of fathers at clinical practices, and educating fathers on childcare and parenting [ 41 ]. Given that fathers’ ACEs were found to be more indicative of family health status, the integration and development of fathers’ mental health resources could be a tool to improve family health [ 41 , 44 ].

4.2. Parental PCEs and Family Health

While mother’s and father’s PCEs did not have significant direct relationships with the child’s AFEs, both parents’ PCEs were associated with better family health, which was negatively related to the child’s AFEs. This indicates that PCEs may decrease ITT from parents to children through family health. The fathers’ PCEs were more strongly associated with higher levels of family health compared to the mothers’ PCEs, which is supported by evidence showing that increased involvement from fathers mitigates poor physical outcomes in children, such as obesity rates, cognitive development, and ITT [ 45 , 46 ]. Strong family health can include access to physical, social, emotional, financial, and medical resources; healthy habits; strong emotional and social health processes; and external social support [ 32 ]. According to the findings of the current study, PCEs were predictive of these resources within families. Additionally, the framework of family systems theory supports existing evidence of the relationships between PCEs and family health. Previous research demonstrated that PCEs more significantly influenced family health than ACEs [ 33 ]. The quality of marital relationships in families may also reduce the parent–child transmission of trauma, especially from parents with posttraumatic and secondary traumatic stress symptoms [ 11 ]. Therefore, family environments that are low in conflict and have high emotional support are promotive factors that help reduce the child’s AFEs [ 27 ]. With the apparent interconnectedness of the family unit, promotive factors such as PCEs and good family health may help to reduce AFEs.

4.3. Family Health as a Mediating Factor

Lastly, consistent with family systems theory, family health mediated the relationship between the father’s ACEs and their child’s AFEs as well as between both parents’ PCEs and the child’s AFEs. Based on the results of this study, improving family health may help reduce ITT. For example, the COVID-19 pandemic provided a unique opportunity to study disruptions to the family system such as stressors and traumatic experiences caused by infectious disease and government restrictions. In a summary of articles about family dynamics during COVID-19, findings suggest that the pandemic disproportionately affected at-risk individuals and families, specifically among those with lower-quality family relationships and limited resources [ 47 ]. Apart from COVID-19 stressors and trauma, lower-SES children are at greater risk of experiencing environmental trauma from lack of resources, which then increases their risk of psychopathology [ 48 ]. Previous research has identified parent psychopathology as a risk factor for their children experiencing trauma [ 6 ]. Since low SES and experiencing trauma (such as AFEs) are risk factors for psychopathology (a risk for childhood trauma), interventions targeting lower SES or disadvantaged families may help improve family health, especially since AFEs are more common among lower-income families [ 49 ].

Involving the entire family to strengthen family systems could improve family health and functioning as well as reduce ITT [ 50 ]. Family health interventions exist at the primary, secondary, and tertiary prevention level, and given the heritable nature of trauma, secondary or tertiary interventions for parents may serve as primary prevention for trauma transmission to their children. Successful primary prevention examples include home visits from social service professionals and community health workers [ 51 , 52 ], and community-based coalitions such as the Communities That Care system, which uses community needs assessments to address risk and protective factors within a community that emphasize child resilience such as school and sport programs and other community opportunities that support healthy parent and child interactions through local programs such as parent training, community gardening, or community cooking classes [ 51 ]. A secondary prevention such as the 2021 American Families Plan from the Biden administration impacts low-SES individuals and families. This plan focuses on improving the economic well-being of U.S. residents by increasing the child tax credit and access to affordable education [ 53 ]. Improving the economic well-being may decrease the risk of children experiencing trauma, thus reducing ITT. Another example, which can act as a primary, secondary, or tertiary prevention method is the Family Empowerment Program—a therapy program that focuses on the family system by partnering with an interdisciplinary team of professionals who provide the family with resources and treatment [ 54 ]. Additionally, family-friendly workplace policies allow employees to fulfill their family and work obligations through telecommuting, flexible time off, and paid childcare. Future studies should examine promising family-friendly practices shown to increase motivation and productivity in the workforce for both men and women and should incorporate AFE and other risk measures across a wide spectrum of worksites, including many small business and service industries which are less likely to offer such benefits. All levels of prevention targeting family health are key to reducing the risk of AFEs and transmission of trauma from parents to children.

4.4. Limitations

This study had several limitations, some of which were due to the circumstances of the COVID-19 pandemic. The situational effects of COVID-19 such as quarantine and social isolation may have affected the report of PCEs, ACEs, and AFEs reported in this study. An additional limitation was the low variability in PCE scores among the couple dyads, which prevented us from examining PCEs as a moderating variable. Another limitation based on the methodology of the study was that the AFE information was based on the mothers’ reports rather than on direct reports from the children. Parents may be less likely to report adversity in their children’s lives and may be a less accurate representation of a child’s perception of family life [ 55 ]. While future research may determine AFE reports directly from children, our study focused on young children who may have been too young to answer for themselves. In the current study, only mothers’ report of AFEs was used because in a few cases fathers and mothers reported on different children. Recent research indicates that mothers typically fill the responsive or nurturing role in heterosexual relationships and may be more aware of their children’s potentially traumatic experiences, while fathers more often take a protective role [ 24 , 56 ]. However, the mothers may have reported their child’s AFEs differently from the fathers’ reports, which may have affected the results. Future research accounting for both mothers’ and fathers’ responses to AFE items is important. Additionally, the ACE and AFE measures used do not represent all forms of trauma, such as homelessness. Finally, the data were cross-sectional limiting the ability to establish causality between family health and the children’s AFEs.

5. Conclusions and Future Research Directions

This research provides further implications for promoting advantageous childhood and family experiences through family health. Further research is needed to build on the results found in the current study. Since the results were likely affected by the ongoing COVID-19 pandemic, a replication study should be conducted post-pandemic to determine the generalizability of the results in less stressful conditions. A post-pandemic study might demonstrate the pathways between family health and ITT without the constant stress of a worldwide pandemic, while further contributing research on the impact of pandemic stressors and trauma on family health and transmission of trauma. Additionally, longitudinal data would be imperative to confirming directionality of results and the impact of adverse and positive childhood experiences on family health over time. Future research focusing on differences in mothers’ and fathers’ ACE transmission could provide a better understanding of why fathers’ experiences were more impactful and how father-focused interventions may promote better family health. This research could also identify differences in ACEs and family health in households where one or both parents experienced ACEs. The results of this study indicate that family health does mediate the relationship between the fathers’ ACEs and the children’s AFEs, demonstrating the necessity of interventions to promote family health and inhibit the intergenerational transmission of ACEs.

Funding Statement

This research received no external funding. A.C. received an internal grant from the Brigham Young University Women’s Research Initiative.

Author Contributions

Conceptualization, E.M.R., M.D.B. and A.C.; methodology, A.C.; formal analysis, A.C.; writing—original draft preparation, E.M.R., M.J.B., M.D. and S.V.; writing—review and editing, E.M.R., M.D.B. and A.C.; supervision, A.C.; project administration, A.C. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board (or Ethics Committee) of Brigham Young University (protocol code E2020-469 and 2 October 2021).

Informed Consent Statement

Informed consent in the form of implied consent for an electronic survey was obtained from all subjects involved in the study.

Data Availability Statement

Conflicts of interest.

The authors declare no conflict of interest.

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The Debate Over Trauma in the New DSM Revision

Why definitions matter for clinical care..

Posted May 30, 2024 | Reviewed by Abigail Fagan

• What Is Trauma?
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• The DSM shapes how we define trauma in psychology and psychiatry within the U.S.
• Posttraumatic stress disorder requires exposure to a "Criterion A" traumatic event as part of the diagnosis.
• People can develop PTSD-like symptoms from non-Criterion A events, like racial discrimination or cancer.

When I use the word "trauma," something different may come to mind for each of you, highlighting its subjective nature and how a traumatic event may impact each of us differently. However, in the world of traumatic stress research and clinical practice, defining trauma and finding the line of what counts (or doesn’t count) as a traumatic event becomes critical to correct diagnosis and resulting treatment.

Post-traumatic stress disorder ( PTSD ) is a unique mental health condition in that it requires the existence of an event to precipitate the onset of PTSD symptoms. Specifically, as outlined in the Diagnostic and Statistical Manual , 5th edition text revision (DSM-5-TR 1 ), in order to be diagnosed with PTSD, an individual first has to be exposed to a traumatic event (i.e., Criterion A). That event must fall outside the realm of normal human experience and include things like exposure to actual or threatened death, serious injury, or sexual violence through the direct experience or witnessing of the event, learning about it happening to a loved one, or through repeated exposure as part of one’s job. The DSM-5 made efforts to restrict the definition of trauma to ensure the definition distinguished the extreme nature of Criterion A events from lower magnitude stressors.

Importantly, the rules and stipulations of what counts as a trauma based on the DSM-5-TR can mean that very difficult life experiences that may lead to trauma responses are left out, such as being confronted with the death of a loved one to cancer or being witness to a debilitating chronic illness of one’s child. The current definition of Criterion A trauma also does not account for experiences of racial discrimination , leaving out highly impactful and distressing life events that have been shown to lead to the same symptom profile as PTSD.

The debate on Criterion A within the trauma field is well laid-out in a recent review article by Marx and colleagues 2 in which they describe four potential paths that the PTSD trauma definition could take moving forward:

• Expanding Criterion A
• Narrowing Criterion A
• Eliminating Criterion A
• Keeping Criterion A unchanged

A recent meta-analysis by Georgescu et al. 3 highlights a main argument behind the expansion of Criterion A by finding that across 124 studies, the pooled average of potential PTSD symptoms following non-Criterion A events (such as racial discrimination or cancer) was comparable to those observed in studies of PTSD from Criterion A events. These results suggest that by maintaining a narrow definition of trauma, we may be missing people with PTSD symptom profiles that are clinically significant. Is defining trauma actually necessary or can the focus be on who displays PTSD symptoms? This is a primary question raised among those who also consider the full elimination of Criterion A from the PTSD diagnosis. Alternatively, experts advocating for narrowing Criterion A suggest that the exclusion of any indirect exposures from qualifying for Criterion A can clarify the difference between traumatic and nontraumatic stressors and limit misclassification of PTSD or diagnosis drift. However, as Marx et al. 2 point out, there is still a great deal we need to discover about how changes to the DSM-5 definition of trauma may affect our understanding of PTSD as a disease, its underlying mechanisms, and who is most likely to develop or recover from PTSD.

As a trauma researcher, it is easy for me to get in the weeds about these paths and their implications because while strict adherence to diagnostic criteria ensures rigor and reproducibility across studies, narrow definitions can result in missed opportunities to capture clinically relevant symptom presentations. Each option has its drawbacks.

This debate necessarily translates to the clinical space as well. The diagnosis we determine for a client should lead to an evidence-based treatment that aligns with that condition. If PTSD is present, but missed, the focus of the treatment may be misaligned with the primary symptoms and could lead to delayed recovery for the client. In the current diagnostic landscape, adjustment disorder and other trauma and stressor-related disorders are viable options for diagnosis when Criterion A is not present. Ultimately, as a clinician, the key should be thorough assessment of both traumatic experiences and difficult life events not captured in trauma inventories, like racial discrimination, childbirth, or non-traumatic loss, and how those may influence psychological symptom presentation. Understanding common experiences of the population you serve is key. If you do not ask, you will not know. Instead of getting caught in the debate, we can learn from it, and still make choices about how we conceptualize and treat clients based on their symptoms while keeping the whole person – and all the experiences that have come with them – in mind.

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Marx, B. P., Hall‐Clark, B., Friedman, M. J., Holtzheimer, P., & Schnurr, P. P. (2024). The PTSD Criterion A debate: A brief history, current status, and recommendations for moving forward. Journal of Traumatic Stress , 37 (1), 5-15. https://doi.org/10.1002/jts.23007

Georgescu, T., Nedelcea, C., Letzner, R. D., Macarenco, M. M., & Cosmoiu, A. (2024). Criterion a issue: What other events lead to the onset of posttraumatic stress disorder symptoms? A meta-analysis. The Humanistic Psychologist .

Abigail Powers Lott, Ph.D., ABPP, is a board certified psychologist and Assistant Professor in the Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine. She serves as Co-Director of the Grady Trauma Project and Clinical Director of the Grady Trauma Recovery Center.

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