Applied Psychology OPUS

The Impact of Childhood Adversity on Later Anxiety

Samantha Pratt

The psychological impacts of a traumatic event can be injurious to a person’s adjustment. The DSM-IV defines a traumatic event as one in which an individual experiences or witnesses a perceived or actual threat of death or serious injury to the physical integrity of self or others that results in a sense of helplessness, intense fear, or horror (APA, 2000). This clinical definition of a traumatic event implies that trauma must be an experience that elicits an extreme reaction as a direct result of perceived threat. However, there is little mention of trauma that results from adverse experiences that do not involve an immediate perceived threat.

Evidence demonstrating the association between adverse experiences (those experiences not clinically deemed traumatic) and adolescent and adult psychopathology is extensive (Clark, Caldwell, Power, & Stansfeld, 2010; Ford, Clark, & Stansfeld, 2011; Grover, Ginsburg, & lalongo, 2005; McLaughlin, Conron, Koenen, & Gilman, 2009; McLaughlin, Kubzansky, Dunn, Waldinger, Vaillant, & Koenen, 2010; Mersky, Topitzes, & Reynolds, 2013). In particular, researchers have conducted a wide breadth of studies on the impact of childhood adversity, which they define as not only traumatic experiences (i.e. physical abuse, verbal abuse, mental abuse, witnessing violence within the home, and severe illness) but also chronic stressors (i.e. family conflict, parental separation, parental education, parental mental health, neglect, poverty, loss, drug use in the family) that have a significant negative effect on the child (Benjet, Borges, & Medina-Mora, 2010; Ford et al., 2011; Grover et al., 2005; McLaughlin & Kubzansky et al., 2010).

The aforementioned connections between childhood events and the impact of those events on adult adjustment are derived from some psychoanalytic theory (Freud, 1966). Freud’s theory argues that there are risk factors in childhood that largely impact psychological development in adulthood, including psychopathology (1966). The link between childhood adversity and psychopathology has been analyzed across studies (Clark et al., 2010; Ford et al., 2011; Grover et al. 2005; McLaughlin et al., 2009; McLaughlin et al., 2010; Mersky et al., 2013). Anxiety (i.e. prominent anxiety, panic attacks, obsessions, or excessive worry) is one construct that researchers frequently associate with childhood adversity (APA, 2000). Studies also suggest that the prevalence of anxiety may be moderated by the amount of adverse experiences to which a child is exposed (Ford et al., 2011; Jacob, 2012). Rooted in psychoanalytic theory, this  literature review will examine and understand the ways in which childhood adversity impacts anxiety in later years, as well as the moderating role of multiple adverse experiences.
 
Childhood Adversity and Anxiety

Interestingly, the impact of childhood adversity on anxiety in later years is largely analyzed in the literature on five types of adversity: social adversity, negative family environment, abuse, loss, and school functioning (Benjet et al., 2010; Ford et al., 2011; Grover et al., 2005; McLaughlin et al. 2009; McLaughlin et al., 2010; Mersky et al., 2013). These subtopics have been correlated with anxiety in later years and have been shown to impact onset of anxiety in various stages of development (Benjet et al., 2010; Clark et al., 2010; Ford et al., 2011; Grover et al., 2005; McLaughlin et al., 2010). Research consistently considers later years to be the period of development after childhood, but the definition of childhood varies across studies (Clark et al., 2010; Ford et al., 2011; Mersky et al. 2013). Some studies have focused on the onset of anxiety issues specifically in adolescence and early adulthood (Clark et al., 2010; Mersky et al. 2013), while other research looked at the correlation between childhood adversities and mid-life affective disorders (Clark et al., 2010; Ford et al., 2011). Nevertheless, all studies demonstrated a correlation at all measured stages (Clark et al., 2010; Ford et al., 2011; Mersky et al. 2013), Clark et al. (2010) found that associations between psychopathology and childhood adversity were stronger in adolescence than in early adulthood and mid-life. However, not all subtopics of childhood adversity were significantly correlated with anxiety at all life stages (Grover et al., 2005; McLaughlin et al., 2010).

Across studies, some specific childhood adversities proved to have little or no impact on anxiety in later years. Social adversity—more specifically defined as financial difficulties, low economic status, parental unemployment, and lack of parental education—is the one type of adversity for which associations with later life anxiety were weak (Grover et al., 2005). Only lack of parental education indicated anxiety in early and mid-life (McLaughlin et al., 2010). The fact that social adversity was a poor indicator of anxiety disorders may only be a significant result of certain studies due to their sample not being heterogeneous enough (Grover et al., 2005). Unlike social adversity, negative family environment had strong associations with anxiety in later years (Grover et al., 2005; Benjet et al., 2010, McLaughlin et al., 2010; McLaughlin et al., 2009). Adversities under the negative family environment category such as lack of family cohesion, illness in home, and parental mental illness were predicative of later anxiety issues (Benjet et al., 2010; Grover et al., 2005; McLaughlin et al., 2010). However, parental marital issues, neglect, and parental criminal behavior were not shown to be predictive (Benjet et al., 2010). Furthermore, negative family environment could be considered a chronic stressor with the ability to increase risk of anxiety disorders over time (Grover et al., 2005).

In addition, abuse, loss, and academic achievement were all predictive of anxiety. Physical abuse, sexual abuse, and emotional abuse were aspects of abuse associated with increased odds of anxiety (Benjet et al., 2010; McLaughlin et al., 2009). Academic achievement difficulties were also linked to higher anxiety, especially in adolescence and those in early adulthood (Grover et al., 2005; McLaughlin et al., 2010). Similarly, loss of relationships was highly predictive of issues with anxiety across various stages of life. Death of a family member or friend, parent separation, sibling separation, and hospitalization of family members are all components of the loss construct (McLaughlin et al. 2010; Grover et al., 2005). Though, unlike the other aforementioned forms of childhood adversity, loss in the form of separation was indicative of lower anxiety as opposed to higher anxiety in early adolescence (Grover et al., 2005). This negative correlation is incongruent with the idea that adversities always have negative a negative impact on psychological disorders.

Multiple Adverse Experiences and Anxiety

Additionally, studies have consistently shown that it is not only the type of adversity faced that has an impact on anxiety, but also the number of adversities faced in childhood (Benjet et al., 2010; Ford et al., 2011; Grover et al., 2005; McLaughlin et al., 2009; Mersky et al., 2013). Cumulative adversity is measured throughout studies by tallying the number of adversities that each participant reports (Ford et al., 2011; Jacob, 2012). Though very little research begins with the intention of analyzing the impact of multiple adversities on the onset of anxiety (Benjet et al., 2010; Mersky et al., 2013), data acquired during investigation of the association between childhood adversity and anxiety demonstrated that, irrespective of the type of adversity, multiple adversity groups increased the odds of anxiety in later years (Benjet et al., 2010; Clark et al. 2010; Ford et al., 2011; Grover et al., 2005; Mersky et al., 2013).

Despite differences between studies in the average number of adversities faced by participants (Benjet et al. 2010; Clark et al., 2010; Ford et al., 2011; McLaughlin et al., 2009), research was consistent in reporting that a significant percentage of each sample experienced more than one adversity in childhood (Benjet et al. 2010; Clark et al. 2010; Ford et al., 2011; McLaughlin et al., 2009; Mersky et al., 2013). The likelihood of reporting anxiety was further increased when participants reported more than three childhood adversities (McLaughlin et al., 2009). The adversity subgroups most frequently reported comorbid with one another were negative family environment and abuse (Benjet et al., 2010); however, certain components within each subgroup also co-occur (e.g., parental absence and divorce) (Clark et al., 2010).  

Moreover, cumulative adversities increase sensitization to stress, which has a bidirectional relationship with anxiety disorders (McLaughlin et al., 2009; McLaughlin et al., 2010). High stress reactivity to major life events was especially prevalent in participants who experienced three or more childhood adversities (McLaughlin et al., 2009). Men, in particular, who faced three or more childhood adversities demonstrated high stress reactivity to minor life events (McLaughlin et al., 2009). Those who faced social adversity and had negative family environments in childhood had definite higher levels of stress sensitization in adulthood (McLaughlin et al., 2010), which lead to a higher likelihood of anxiety (McLaughlin et al., 2009; McLaughlin et al., 2010). Still, this association between cumulative adversities and anxiety as mediated by stress sensitization is largely influenced by level of exposure to adversities (McLaughlin et al., 2009). The greater the exposure to childhood adversities, the more stress respondents reported when faced with later stressful life events (Espejo, Hammen, Connolly, Brennan, Najman, & Bor, 2006; McLaughlin et al., 2009), thus increasing the likelihood of anxiety.

Furthermore, higher levels of adversity in childhood can lead to more than just anxiety issues. Studies have shown that there are high rates of comorbidity in adolescence and early adulthood (Espejo et al., 2006; Mersky et al., 2013). Depression often also manifests along with anxiety as a result of childhood adversities (Espejo et al., 2006; Dunn, Abbott, Croudace, Wilkinson, Jones, Herbert, & Goodyer, 2011). Major depressive episodes, PTSD, and anxiety disorders are often triggered when those who experience major life stressors in adulthood have also experienced childhood adversities (McLaughlin et al., 2009). The comorbidity of the mood disorders, PTSD, depressive disorder, and anxiety may largely impact the results of various studies when it goes uncontrolled for because of how it could potentially influence correlations indicated in the findings (McLaughlin et al., 2009; McLaughlin et al., 2010; Mersky et al., 2013).

Conclusion

As the research has shown, childhood adversity increases issues with stress and anxiety later in life. The rise in levels of adversity also increases stress sensitivity and likelihood of developing an anxiety disorder. Current research uses both longitudinal studies and retrospective self-reports to establish correlations, but the cause and effect of early life adversity on anxiety and stress is not clearly established because of the issues with comorbidity with other psychological disorders due to childhood stressors. In addition, the direction of causation between predictor domains and anxiety cannot be determined in studies that include children with pre-existing anxiety conditions and that use a retrospective analytic method. There is also an inconsistency in the age at which impact is measured, which leaves gaps in comparing literature that measures onset of effects at different levels. These limitations of previous studies demonstrate a need to understand why childhood adversities and anxiety are related. Future studies should clearly establish directionality. They should also control for comorbid psychological disorders.

References

Benjet, C., Borges, G., & Medina-Mora, M. E. (2010). Chronic childhood adversity and onset of psychopathology during three life stages: childhood, adolescence and adulthood. Journal of Psychiatric Research, 44(11), 732-740.

Clark, C., Caldwell, T., Power, C., & Stansfeld, S. A. (2010). Does the influence of childhood
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Dunn, V. J., Abbott, R. A., Croudace, T. J., Wilkinson, P., Jones, P. B., Herbert, J., & Goodyer, I. M. (2011). Profiles of family-focused adverse experiences through childhood and early adolescence: The ROOTS project a community investigation of adolescent mental health. BMC psychiatry, 11(1), 109.

Espejo, E. P., Hammen, C. L., Connolly, N. P., Brennan, P. A., Najman, J. M., & Bor, W. (2007). Stress sensitization and adolescent depressive severity as a function of childhood adversity: a link to anxiety disorders. Journal of abnormal child psychology, 35(2), 287-299.

Ford, E., Clark, C., & Stansfeld, S. A. (2011). The influence of childhood adversity on social relations and mental health at mid-life. Journal of Affective Disorders, 133(1-2), 320-327.
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Grover, R. L., Ginsburg, G. S., & lalongo, N. (2005). Childhood predictors of anxiety symptoms: A longitudinal study. Child Psychiatry and Human Development, 36(2), 133-153.

Jacobs, J., Agho, K., Stevens, G., & Raphael, B. (2012). Do childhood adversities cluster in predictable ways? A systematic review. Vulnerable Children and Youth Studies, 7(2), 103-115.

McLaughlin, K. A., Conron, K. J., Koenen, K. C., & Gilman, S. E. (2010). Childhood adversity, adult stressful life events, and risk of past-year psychiatric disorder: A test of the stress sensitization hypothesis in a population-based sample of adults. Psychological Medicine, 40(10), 1647-1658.

McLaughlin, K. A., Kubzansky, L. D., Dunn, E. C., Waldinger, R., Vaillant, G., & Koenen, K. C. (2010). Childhood social environment, emotional reactivity to stress, and mood and anxiety disorders across the life course. Depression and Anxiety, 27(12), 1087-1094.

Mersky, J. P., Topitzes, J., & Reynolds, A. J. (2013). Impacts of adverse childhood experiences on health, mental health, and substance use in early adulthood: A cohort study of an urban, minority sample in the U.S. Child Abuse & Neglect, , No Pagination Specified.