Drawing on the work of numerous psychiatrists and psychopharmacologists and my own observations, I describe how most common psychiatric drugs are not only toxic but can be chronically traumatic, which I define in some detail throughout this paper. In addition to observing this occurrence among numerous of my patients over the past 20 years, I surveyed 9 mental health clinicians who had taken antidepressant drugs long-term. Of these 9, 7 (77%) experienced bothersome toxic drug effects and 2 (22%) had become clearly worse than they were before they had started the drugs. Based on others' and my observations I describe the genesis of this worsened condition which I call the Drug Stress Trauma Syndrome. These drug effects can be and are often so detrimental to the quality of life among a distinct but significant minority of patients that they can no longer be considered trivial or unimportant. Instead, they are so disruptive to many patients' quality of life that their effect becomes traumatic, and are thereby agents of trauma. These observations and preliminary data may encourage others to look into this matter in more depth.

For several decades the conceptualization and treatment of mental health problems, including psychosis, have been dominated by a rather narrow focus on genes and brain functions. Psychosocial factors have been relegated to mere triggers or exacerbators of a supposed genetic predisposition. This paper advocates a return to the original stressvulnerability model proposed by Zubin and Spring in 1977, in which heightened vulnerability to stress is not, as often wrongly assumed, necessarily genetically inherited, but can be acquired via adverse life events. There is now a large body of research demonstrating that child abuse and neglect are significant causal factors for psychosis. Ten out of eleven recent general population studies have found, even after controlling for other factors, including family history of psychosis, that child maltreatment is significantly related to psychosis. Eight of these studies tested for, and found, a dose-response. Interpreting these findings from psychological and biological perspectives generates a genuinely inte grated bio-psycho-social approach as originally intended by Zubin and Spring. The routine taking of trauma histories from all users of mental health services is recommended, and a staff training program to facilitate this is described.

OBJECTIVE:Little information is available about the contribution of multiple adverse childhood experiences (ACEs) to the likelihood of reporting hallucinations. We used data from the ACE study to assess this relationship.METHODS:We conducted a survey about childhood abuse and household dysfunction while growing up, with questions about health behaviors and outcomes in adulthood, which was completed by 17,337 adult HMO members in order to assess the independent relationship of 8 adverse childhood experiences and the total number of ACEs (ACE score) to experiencing hallucinations. We used logistic regression to assess the relationship of the ACE score to self-reported hallucinations.RESULTS:We found a statistically significant and graded relationship between histories of childhood trauma and histories of hallucinations that was independent of a history of substance abuse. Compared to persons with 0 ACEs, those with 7 or more ACEs had a five-fold increase in the risk of reporting hallucinations.CONCLUSION:These findings suggest that a history of childhood trauma should be looked for among persons with a history of hallucinations.

ethods: A retrospective cohort study was conducted from 1995 to 1997 among 17,337 adult HMO members in San Diego, California. Participants completed a survey about abuse or household dysfunction during childhood, and multiple other health-related issues. Multivariate logistic regression was used to examine the relationships between severity of CSA (intercourse vs no intercourse) and long-term health and social problems (substance use and abuse, mental illness, and current problems with marriage and family) by gender of victim. Models controlled for exposure to other forms of adverse childhood experiences that co-occur with CSA. Among men, the relationship between the gender of the CSA perpetrator to the outcomes was also examined.

Background: Childhood sexual abuse (CSA) is a worldwide problem. Although most studies on the long-term consequences of CSA have focused on women, sexual abuse of both boys and girls is common. Thus, a comparison of the long-term effects of CSA by gender of the victim will provide perspective on the need for future research, prevention activities, and treatment of survivors.Methods: A retrospective cohort study was conducted from 1995 to 1997 among 17,337 adult HMO members in San Diego, California. Participants completed a survey about abuse or household dysfunction during childhood, and multiple other health-related issues. Multivariate logistic regression was used to examine the relationships between severity of CSA (intercourse vs no intercourse) and long-term health and social problems (substance use and abuse, mental illness, and current problems with marriage and family) by gender of victim. Models controlled for exposure to other forms of adverse childhood experiences that co-occur with CSA. Among men, the relationship between the gender of the CSA perpetrator to the outcomes was also examined.Results: Contact CSA was reported by 16% of males and 25% of females. Men reported female perpetration of CSA nearly 40% of the time, and women reported female perpetration of CSA 6% of the time. CSA significantly increased the risk of the outcomes. The magnitude of the increase was similar for men and women. For example, compared to reporting no sexual abuse, a history of suicide attempt was more than twice as likely among both men and women who experienced CSA (p < 0.05). Compared with those who did not report CSA, men and women exposed to CSA were at a 40% increased risk of marrying an alcoholic, and a 40% to 50% increased risk of reporting current problems with their marriage (p < 0.05).Conclusions: In this cohort of adult HMO members, experiencing CSA was common among both men and women. The long-term impact of CSA on multiple health and social problems was similar for both men and women. These findings strongly indicate that boys and girls are vulnerable to this form of childhood maltreatment; the similarity in the likelihood for multiple behavioral, mental, and social outcomes among men and women suggests the need to identify and treat all adults affected by CSA. (c) 2005 American journal of Preventive Medicine.

OBJECTIVE:We examined the relation between eight types of adverse childhood experience (ACE) and three indicators of impaired worker performance (serious job problems, financial problems, and absenteeism).METHODS:We analyzed data collected for the Adverse Childhood Experiences Study from 9633 currently employed adult members of the Kaiser Foundation Health Plan in San Diego.RESULTS:Strong graded relations were found between the ACE Score (total number of ACE categories experienced) and each measure of impaired worker performance (p < .001). We found strong evidence that the relation between ACE Score and worker performance was mediated by interpersonal relationship problems, emotional distress, somatic symptoms, and substance abuse.CONCLUSIONS:The long-term effects of adverse childhood experiences on the workforce impose major human and economic costs that are preventable. These costs merit attention from the business community in conjunction with specialists in occupational medicine and public health.

Background: Research examining the association between childhood abuse and depressive disorders has frequently assessed abuse categorically, thus not permitting discernment of the cumulative impact of multiple types of abuse. As previous research has documented that adverse childhood experiences (ACEs) are highly interrelated, we examined the association between the number of such experiences (ACE score) and the risk of depressive disorders. Methods: Retrospective cohort study of 9460 adult health maintenance organization members in a primary care clinic in San Diego, CAwho completed a survey addressing a variety of health-related concerns, which included standardized assessments of lifetime and recent depressive disorders, childhood abuse and household dysfunction. Results: Lifetime prevalence of depressive disorders was 23%. Childhood emotional abuse increased risk for lifetime depressive disorders, with adjusted odds ratios (ORs) of 2.7 [95% confidence interval (CI), 2.3–3.2] in women and 2.5 (95% CI, 1.9–3.2) in men. We found a strong, dose–response relationship between the ACE score and the probability of lifetime and recent depressive disorders (P< 0.0001). This relationship was attenuated slightly when a history of growing up with a mentally ill household member was included in the model, but remained significant (P< 0.001). Conclusions: The number of ACEs has a graded relationship to both lifetime and recent depressive disorders. These results suggest that exposure to ACEs is associated with increased risk of depressive disorders up to decades after their occurrence. Early recognition of childhood abuse and appropriate intervention may thus play an important role in the prevention of depressive disorders throughout the life span. Published by Elsevier B.V.

Information about the relationship of experiencing abuse or witnessing domestic violence in childhood to the risk of intimate partner violence (IPV) in adulthood is scant. The relationship of childhood physical or sexual abuse or growing up with a battered mother to the risk of being a victim of IPV for women or a perpetrator for men was studied among 8,629 participants in the Adverse Childhood Experiences Study conducted in a large HMO. Each of the three violent childhood experiences increased the risk of victimization or perpetration of IPV approximately two-fold. A statistically significant graded relationship was found between the number of violent experiences and the risk of IPV. Among persons who had all three forms of violent childhood experiences, the risk of victimization and perpetration was increased 3.5-fold for women and 3.8-fold for men. These data suggest that as part of risk assessment for IPV in adults, screening for a history of childhood abuse or exposure to domestic violence is needed.

OBJECTIVEThe study examined how growing up with alcoholic parents and having adverse childhood experiences are related to the risk of alcoholism and depression in adulthood.METHODSIn this retrospective cohort study, 9,346 adults who visited a primary care clinic of a large health maintenance organization completed a survey about nine adverse childhood experiences: experiencing childhood emotional, physical, and sexual abuse; witnessing domestic violence; parental separation or divorce; and growing up with drug-abusing, mentally ill, suicidal, or criminal household members. The associations between parental alcohol abuse, the adverse experiences, and alcoholism and depression in adulthood were assessed by logistic regression analyses.RESULTSThe risk of having had all nine of the adverse childhood experiences was significantly greater among the 20 percent of respondents who reported parental alcohol abuse. The number of adverse experiences had a graded relationship to alcoholism and depression in adulthood, independent of parental alcohol abuse. The prevalence of alcoholism was higher among persons who reported parental alcohol abuse, no matter how many adverse experiences they reported. The association between parental alcohol abuse and depression was accounted for by the higher risk of having adverse childhood experiences in alcoholic families.CONCLUSIONSChildren in alcoholic households are more likely to have adverse experiences. The risk of alcoholism and depression in adulthood increases as the number of reported adverse experiences increases regardless of parental alcohol abuse. Depression among adult children of alcoholics appears to be largely, if not solely, due to the greater likelihood of having had adverse childhood experiences in a home with alcohol-abusing parents.

SUMMARY This article introduces a special volume on misinformation about child sexual abuse. Despite extensive research findings on the long-term effects and consequences of child sexual abuse, misinformation on this topic is widespread. Several forces have worked to support and disseminate this erroneous information. Because it is difficult to comprehend the horror of sexual crimes against children, society's denial and disbelief have often unwittingly supported the agendas of those who want to discount or minimize the impact of these crimes. The media has also contributed to the aura of skepticism surrounding claims of sexual abuse and its mental health impact, and has reported favorably on controversial and unproven claims such as the “false memory syndrome”. In the hope of countering misinformation and thus raising the level of discourse to the engagement of real scientific issues, a number of well known and respected researchers and clinicians examine various facets of the problem.

SUMMARY This article describes a seemingly sophisticated, but mostly contrived and often erroneous “false memory” defense, and compares it in a brief review to what the science says about the effect of trauma on memory. Child sexual abuse is widespread and dissociative/traumatic amnesia for it is common. Accused, convicted and self-confessed child molesters and their advocates have crafted a strategy that tries to negate their abusive, criminal behavior, which we can call a “false memory defense”. Each of 22 of the more commonly used components of this defense is described and discussed with respect to what the science says about them. Armed with this knowledge, survivors, their clinicians, and their attorneys will be better able to refute this defense of disinformation.

The authors critically review the main strategies that false-memory proponents have used to challenge the admissibility of testimony regarding recovered abuse memories in the courts: that the laboratory evidence fails to prove the existence of repression, that people rarely forget trauma, and that scientific studies claiming amnesia for trauma and abuse are fraught with a variety of methodological weaknesses. False-memory proponents who have advanced these arguments have made serious logical errors in their arguments and have misused the available scientific evidence. The authors review 68 data-based studies specifically on amnesia and later recovery of memories for childhood sexual abuse, each of which presents evidence favoring amnesia and recovered memories for sexual abuse in certain individuals. These studies were conducted using a variety of methodological approaches and progressive improvements in research design that addressed and answered each criticism advanced by false-memory proponents. These studies also include a number of recent studies using a clarifying interview strategy that demonstrated that the mechanisms operative in substantial forgetting and later recovery of abuse memories typically include a mixture of dissociative amnesia, cognitive avoidance, and misappraisal of the abuse, and rarely include ordinary forgetting. Data-based studies on the accuracy of recovered memories have demonstrated that recovered memories are no more or less accurate than continuous memories of childhood abuse and generally are reliable, except when a specific pattern of suggestive influences may have contaminated the memory. The authors offer a set of evidentiary criteria by which the court can assess suggestive influences. The authors also review the Frye-Daubert standards that have been applied in the courts. They argue that the current weight of the available scientific evidence on amnesia for childhood sexual abuse clearly meets the Daubert standards of admissibility.

ABSTRACT Based on clinical experience and review of the clinical and legal research literature, the author proposes that a cluster of several of six clinical findings is a potential indicator of internal corroboration that trauma occurred, especially that of child sexual abuse. These six clinical findings include: the presence of a high risk disorder or illness; post-traumatic stress disorder; age regression, flashbacks, abreactions or other re-experiencing of the trauma; repetitions, repetition compulsions or re-enactments; characteristics of the memories themselves; and other patterns, dynamics, and connections. The author welcomes the experience and feedback of clinicians who assist survivors of trauma, especially that of child sexual abuse.

Patients with addictive disorders often report difficulty remembering trauma, although research shows traumatic experiences as being common antecedents of the onset of addictive illness. Based on clinical experience and review of the clinical and legal research literature, the author proposes that a cluster of six clinical findings is a potential indicator of internal corroboration that trauma occurred, especially child sexual abuse. These six clinical findings include: the presence of a high-risk disorder or illness; posttraumatic stress disorder; age regression, flashbacks, abreactions, or other re-experiencing of the trauma; repetitions, repetition compulsions, or reenactments; characteristics of the memories themselves; and other patterns, dynamics, and connections. This framework can serve as a useful and clinical paradigm for all illnesses, including the addictive disorders.