The trauma theory of schizophrena

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The trauma theory of schizophrenia Transcendence therapy for Schizophrenia

Schizophrenia is a severe and chronic mental disorder that affects how a person thinks, feels, and behaves. It is characterized by distortions in perception, cognition, emotion, and behaviour, often accompanied by hallucinations, delusions, and negative symptoms. One of the possible causes of schizophrenia is trauma, especially childhood trauma, which can disrupt the development of the brain and increase the risk of psychosis. The trauma theory of schizophrenia proposes that traumatic experiences can trigger biological, psychological, and social factors that contribute to the onset and maintenance of schizophrenia. In this article, we will review the evidence for the trauma theory of schizophrenia and explore how it can inform a therapeutic model for the healing of schizophrenia.

Definition and diagnosis of schizophrenia

Schizophrenia is a mental disorder that affects how a person thinks, feels, and behaves. People with schizophrenia may experience delusions, hallucinations, disorganized speech or behaviour, and negative symptoms such as reduced emotion, motivation, or speech. These symptoms can interfere with their ability to function in daily life, work, study, or socialize[1].

To diagnose schizophrenia, a mental health professional will use a diagnostic checklist based on the criteria from the International Classification of Diseases-10 (ICD-10) or the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5). According to the ICD-10, schizophrenia is diagnosed if the person has one or more of the following symptoms for at least one month:

• Hallucinatory voices giving a running commentary on the person’s behaviour, or discussing the person among themselves, or other types of hallucinatory voices coming from some part of the body.
• Thought echo, thought insertion or withdrawal, and thought broadcasting.
• delusions of control, influence, or passivity, clearly referred to body or limb movements or specific thoughts, actions, or sensations.
• Persistent delusions of other kinds that are culturally inappropriate and completely impossible, such as religious or political identity, or superhuman powers and abilities.

Or if the person has any two of the following symptoms for at least one month:

• Persistent hallucinations in any form, when accompanied by fleeting or half-formed delusions without clear affective content, or by persistent over-valued ideas, or when occurring every day for weeks or months on end.
• Breaks or interpolations in the train of thought, resulting in incoherence or irrelevant speech.
• Catatonic behaviour such as marked stupor, excitement, posturing, negativism, rigidity, or waxy flexibility.
• Negative symptoms such as marked apathy, paucity of speech, blunting or incongruity of emotional responses.

According to the DSM-5, schizophrenia is diagnosed if the person has two or more of the following symptoms for a significant portion of time during a one-month period [2]:

• delusions
• hallucinations
• Disorganized speech
• Grossly disorganized or catatonic behaviour
• Negative symptoms

And at least one of these symptoms must be delusions, hallucinations, or disorganized speech. The person must also have a decline in their social or occupational functioning since the onset of the disorder. The symptoms must not be due to substance use, medication, another medical condition, or another mental disorder[3].

trauma theory of schizophrenia: main concepts and evidence

The trauma theory of schizophrenia is a model that proposes that exposure to traumatic events, especially in childhood, can increase the risk of developing schizophrenia or psychotic symptoms later in life [4]. According to this theory, trauma can cause changes in the brain and body that affect the levels and functions of neurotransmitters, hormones, and immune system. These changes can impair cognitive processes such as memory, attention, and executive function, and trigger or worsen positive symptoms such as hallucinations and delusions [5]. The theory also suggests that the type and severity of trauma may influence the specific psychotic symptoms that manifest, and that some symptoms may reflect the content of the traumatic experiences. For example, some people with schizophrenia may hear voices related to abuse or neglect they endured as children [6]. The trauma theory of schizophrenia is supported by various studies that have found associations between childhood trauma and schizophrenia, as well as gene-environment interactions and brain structural and functional alterations in people with schizophrenia who have a history of trauma [7]. However, the theory does not imply that trauma is the sole or direct cause of schizophrenia, as other factors such as genetics, prenatal stress, and cannabis use may also play a role [8]. The theory also acknowledges that not all people who experience trauma develop schizophrenia, and that not all people with schizophrenia have a history of trauma. Therefore, the trauma theory of schizophrenia is a complex and multifactorial model that aims to explain how trauma can contribute to the vulnerability and expression of schizophrenia in some individuals.

The evidence to back up the trauma theory of schizophrenia

The trauma theory of schizophrenia is based on the evidence that people with schizophrenia report higher rates of childhood trauma than the general population, and that trauma affects the brain structure and function in ways that may contribute to psychosis. Some examples of the evidence are:

• A meta-analysis of 36 studies found that childhood trauma was associated with a 2.8-fold increased risk of psychosis, and that the risk increased with the severity and frequency of trauma (Varese et al., 2012).
• A study of 60 patients with schizophrenia and 26 healthy controls found that childhood trauma was associated with reduced volume of the hippocampus, a brain region involved in memory and emotion regulation, and that this reduction mediated the relationship between trauma and psychotic symptoms (Popovic et al., 2019).
• A study of 22 patients with schizophrenia and 22 healthy controls found that childhood trauma was associated with altered functional connectivity of the parietal cortex, a brain region involved in working memory and attention, during a cognitive task (Schmitt et al., 2016).

These studies suggest that trauma may impair the development and function of brain regions that are implicated in schizophrenia, and that these impairments may increase the vulnerability to psychosis. However, it is important to note that trauma is not a sufficient or necessary cause of schizophrenia, as many people who experience trauma do not develop psychosis, and many people who develop psychosis do not report trauma. trauma is likely one of many factors that interact with genetic and environmental influences to affect the risk of schizophrenia.

Recognizing childhood trauma

Childhood trauma is a term that refers to any adverse or potentially harmful experiences that occur during the developmental period of a person’s life (American Psychiatric Association, 2013). Childhood trauma can take many forms, such as physical, sexual, or emotional abuse, neglect, exposure to violence, or loss of a loved one. These experiences can have lasting effects on the psychological and physical well-being of the survivors, such as increased risk of mental disorders, chronic health problems, and impaired social functioning (Briere & Scott, 2015).

One of the possible consequences of childhood trauma is dissociation, which is a disruption or discontinuity in normally integrated psychological functions, such as memory, consciousness, perception, sense of self and agency, or sensorimotor abilities (Şar, 2020). dissociation can be seen as a coping strategy that allows people to distance themselves from a trauma that may otherwise be unbearable. dissociation can affect any psychological faculty, but it often involves memory impairments, such as amnesia or fragmentation of traumatic memories.

Dissociated memories in childhood trauma are memories that are not consciously accessible or retrievable, even though they remain stored in the brain and influence the person’s behaviour and emotions (therapist.com, n.d.). Some gaps in memory can result from deeply distressing experiences, especially in childhood, that were too extreme to process. Children are especially likely to use dissociation to manage the inescapable pain of family problems that lead to complex, developmental, and relational trauma. Such problems can include ongoing abuse, neglect or disorganized, avoidant, or insecure attachment (Tull, 2023).

Neglect is a form of trauma that involves the failure to provide adequate care, attention, or emotional support to a child. Neglect can have severe and long-lasting effects on the child’s development, such as impaired brain growth, cognitive deficits, emotional dysregulation, and attachment difficulties (Briere & Scott, 2015). Neglect can also contribute to dissociation by creating a sense of detachment from oneself and others, as well as a lack of coherent identity and agency.

There is also a form of trauma, which is seen by the child as self-inflicted, and can be hidden behind a wall of shame and denial. This can happen when it is the child’s decision to create the trauma event. For example, where in the child’s eyes, it was their own actions which caused their trauma to occur. Such events can also be hidden behind dissociative memories.

Dissociated memories can make it difficult for survivors of childhood trauma to recognize or acknowledge their traumatic experiences. They may have only partial or vague recollections of what happened to them, or they may have no conscious memory at all. They may also experience flashbacks or intrusive thoughts that are triggered by reminders of the trauma. These symptoms can cause confusion, distress, and impairment in daily functioning.

Some examples of dissociated memories in childhood trauma are:

• A woman who was sexually abused by her father as a child but has no conscious memory of the abuse. She only remembers feeling afraid of him and avoiding his presence.
• A man who was physically abused by his mother as a child but has repressed his memories of the abuse. He only remembers feeling angry and rebellious towards her.
• A woman who was emotionally neglected by her parents as a child but has minimized the impact of the neglect. She only remembers feeling lonely and isolated.
• A man who witnessed his father being killed in a car accident as a child but has dissociated his memories of the event. He only remembers feeling numb and detached.

The problem of false memories

One of the most controversial topics in psychology is the phenomenon of recovered memories of childhood trauma, especially sexual abuse. Some people claim that they have no recollection of being abused as children until they undergo some form of therapy or encounter a trigger that unlocks their repressed memories. Others argue that these memories are false and fabricated, either by the influence of the therapist or by the person’s own imagination.

One theory that attempts to explain how childhood trauma can sometimes be hidden behind false memories is the betrayal trauma theory (Freyd, 1996). According to this theory, children who are abused by someone they depend on or trust, such as a parent or a caregiver, may dissociate from the traumatic event and forget it to preserve their attachment to the abuser. This is a survival strategy that allows the child to cope with the conflicting emotions of love and fear, and to avoid the consequences of confronting or exposing the abuser.

However, this theory also suggests that these dissociated memories are not permanently erased, but rather stored in an inaccessible part of the mind. They may resurface later in life when the person encounters a cue that reminds them of the abuse, or when they feel safe enough to explore their past. These recovered memories may be accurate or distorted, depending on various factors such as the age of the child at the time of the abuse, the frequency and severity of the abuse, the presence or absence of corroborating evidence, and the influence of external sources such as therapists, media, or other survivors.

The validity and reliability of recovered memories of childhood trauma are still debated among researchers and clinicians. Some studies have found evidence that supports the existence of genuine recovered memories, such as cases where the abuse was documented or corroborated by independent sources (e.g., Goodman et al., 2003; Williams, 1994). Other studies have shown that false memories of childhood events can be easily created or implanted by suggestive techniques or misinformation (e.g., Loftus & Pickwell, 1995; Porter et al., 1999). The challenge is to distinguish between true and false memories, and to avoid causing harm to either the survivors or the accused.

It can be seen, therefore, that establishing the link between trauma and schizophrenia is not always going to be straightforward. Indeed, the case which inspired this article, did not discover their “root” trauma, which happened at the age of six months, until a period of 14 years had elapsed from the start of therapy. This trauma was hidden behind dissociation, and then two sets of false memories, through which the “trauma child” hid from itself its shame at having rejected its mother. This suggests that recovered memories, can be false, but also that they can hide other true memories which the child is trying to protect itself from or is in denial of.

Critiques and limitations of trauma theory of schizophrenia

trauma theory is not without its critiques and limitations. Some of the challenges that trauma theory faces are:

• The difficulty of establishing causality between trauma and schizophrenia, given the multifactorial nature of the disorder and the presence of other genetic and environmental factors that may interact with trauma (Kansteiner, 2004).
  The lack of consensus on the definition and measurement of trauma, as well as the potential for recall bias, underreporting, or over-reporting of traumatic experiences by individuals with schizophrenia or other mental disorders (Kansteiner, 2004; Leys, 2000).
• The possibility of reverse causation, whereby pre-existing psychotic symptoms or vulnerability may increase the likelihood of experiencing trauma or perceiving events as traumatic (Leys, 2000).
• The ethical and epistemological problems of applying postmodern trauma theory to schizophrenia, which may entail a denial of objective reality, a fetishization of trauma as a sacred object, a confusion of victim and perpetrator roles, and a disregard for empirical evidence and therapeutic practice (Rothe, 2016).
• The oversimplification of the relationship between trauma and schizophrenia, which may neglect the diversity and complexity of individual experiences, coping strategies, resilience factors, and cultural contexts that may mediate or moderate the impact of trauma on psychosis (Weilnböck, 2008).

Therefore, while trauma theory may offer some insights into the understanding and treatment of schizophrenia, it also requires further refinement and validation, as well as a critical examination of its assumptions and implications.

Comparing the trauma theory with the other theories of Schizophrenia

Schizophrenia is a complex and heterogeneous disorder that affects about 1% of the world population. It is characterized by a range of symptoms, such as hallucinations, delusions, disorganized thinking, negative symptoms, and cognitive impairments. The causes of schizophrenia are not fully understood, but various theories have been proposed to explain its aetiology and pathophysiology. In this paragraph, we will compare and contrast the main theories of schizophrenia with the trauma theory of schizophrenia.

The main theories of schizophrenia can be broadly classified into biological, psychological, and sociocultural perspectives. The biological perspective focuses on the genetic, neurochemical, neuroanatomical, and immunological factors that may contribute to the development and expression of schizophrenia. For example, some studies have identified specific genes or gene variants that are associated with increased risk of schizophrenia, such as DISC1, NRG1, COMT, and MTHFR. Other studies have suggested that abnormalities in neurotransmitter systems, especially dopamine and glutamate, may underlie the psychotic symptoms of schizophrenia. Furthermore, some brain imaging studies have revealed structural and functional alterations in brain regions involved in cognition, emotion, and perception, such as the prefrontal cortex, hippocampus, amygdala, and thalamus. Additionally, some researchers have proposed that schizophrenia may be influenced by prenatal or perinatal infections, inflammation, or stress that affect brain development.

The psychological perspective emphasizes the role of cognitive processes, personality traits, and emotional factors in schizophrenia. For example, some cognitive theories suggest that schizophrenia is related to impairments in attention, memory, reasoning, and metacognition. These impairments may lead to difficulties in interpreting reality, filtering out irrelevant information, and coping with stress. Other psychological theories propose that schizophrenia is linked to maladaptive personality traits or defence mechanisms, such as schizotypy, paranoia, or dissociation. These traits or mechanisms may reflect an attempt to cope with adverse experiences or emotions. Moreover, some emotional theories argue that schizophrenia is associated with dysregulation of affective states, such as depression, anxiety, or anhedonia. These states may result from negative self-evaluation, social isolation, or lack of motivation.

The sociocultural perspective highlights the impact of environmental factors, such as family dynamics, social support, cultural norms, and stigma on schizophrenia. For example, some family theories suggest that schizophrenia is influenced by dysfunctional communication patterns or high expressed emotion (EE) in the family environment. These patterns or EE may create stress or conflict for the individual with schizophrenia and affect their symptom severity or relapse rate. Other social theories propose that schizophrenia is related to social disadvantage, discrimination, or marginalization. These factors may limit the opportunities or resources for the individual with schizophrenia and affect their quality of life or recovery. Furthermore, some cultural theories argue that schizophrenia is shaped by cultural beliefs, values, or expectations. These beliefs,
values, or expectations, may influence how the individual with schizophrenia perceives their symptoms or seeks help.

The trauma theory of schizophrenia is a relatively recent perspective that proposes that exposure to traumatic events or situations is a key causal factor in the onset or exacerbation of schizophrenia. According to this theory, trauma can be physical (e.g., abuse), sexual (e.g., rape), psychological (e.g., bullying), or environmental (e.g., war). trauma can occur in childhood or adulthood and can have acute or chronic effects. The trauma theory of schizophrenia suggests that trauma can induce biological changes in the brain (e.g., alterations in neurotransmitters or hormones), psychological changes in the mind (e.g., distortions in cognition or emotion), and social changes in the environment (e.g., disruptions in relationships or roles) that increase the vulnerability or trigger the symptoms of schizophrenia.

The trauma theory of schizophrenia shares some similarities with other theories of schizophrenia but also has some differences. For example:

• The trauma theory of schizophrenia is compatible with the biological perspective in that it acknowledges the role of genetic factors and brain abnormalities in schizophrenia. However, the trauma theory of schizophrenia also emphasizes the role of environmental factors and epigenetic mechanisms in modulating gene expression and brain function.
• The trauma theory of schizophrenia is consistent with the psychological perspective in that it recognizes the role of cognitive processes and emotional factors in schizophrenia. However, the trauma theory of schizophrenia also stresses the role of experiential factors and coping strategies in shaping cognition and emotion.
• The trauma theory of schizophrenia is congruent with the sociocultural perspective in that it considers the role of family dynamics and social support in schizophrenia. However, the trauma theory of schizophrenia also highlights the role of interpersonal factors and attachment styles in influencing family dynamics and social support.

In conclusion, the trauma theory of schizophrenia is a comprehensive and integrative perspective that incorporates elements from various other theories of schizophrenia but also adds new insights into its aetiology and pathophysiology. The trauma theory of schizophrenia has important implications for the prevention, diagnosis, and treatment of schizophrenia, as well as for the understanding and acceptance of people with schizophrenia.

 

References

[1] Definition | Background information | Psychosis and schizophrenia | CKS | NICE
https://cks.nice.org.uk/topics/psychosis-schizophrenia/background-information/definition/

[2] DSM-5 Diagnostic Criteria for Schizophrenia
https://medicalcriteria.com/web/schizophrenia/

[3] Schizophrenia Criteria: What Makes A Person Schizophrenic?
https://www.mind-diagnostics.org/blog/schizophrenia/schizophrenia-criteria-what-makes-a-person-schizophrenic

[4] Bateson, G., Jackson, D. D., Haley, J., & Weakland, J. (1956). Toward a theory of schizophrenia. Behavioural Science, 1(4), 251–264. https://doi.org/10.1002/bs.3830010402

[5] Bloom, S. L. (2019). trauma theory. In R. Benjamin, J. Haliburn, & S. King (Eds.), Humanising mental health care in Australia: A guide to trauma-informed approaches (pp. 3–30). Routledge/Taylor & Francis Group. https://doi.org/10.4324/9780429021923-1

[6] Medical News Today. (2022). trauma and schizophrenia: What is the link? Retrieved from https://www.medicalnewstoday.com/articles/trauma-and-schizophrenia

[7] Rokita, K. I., Dauvermann, M. R., Mothersill, D., Holleran, L., Holland, J., Costello, L., Cullen, C., Kane, R., McKernan, D., Morris, D. W., Kelly, J., Gill, M., Corvin, A., Hallahan, B., McDonald, C., & Donohoe, G. (2021). Childhood trauma, parental bonding, and social cognition in patients with schizophrenia and healthy adults. Journal of Clinical Psychology, 77(1), 241–253. https://doi.org/10.1002/jclp.23023