Abuse and Its Psychological Effects: Insight From Dr. Kate Harkness

"If you start to think of yourself as someone who is not worthy of being treated well, you will tend to gravitate towards people who don’t treat you very well. This then reinforces those beliefs and becomes a sort of downward spiral."

Dr. Kate Harkness is a Psychology professor at Queen's University. Her research focus is the role of stress and early trauma in the etiology and ongoing pathology of major depression in adolescence and adulthood. Her work focuses on neurohormonal, social cognitive, and motivational/reward factors that increase the sensitivity to, and generation of, stress in major depression.

SWY: What does your research focus on?

There are a few different areas of research that I am doing right now, but the one that is most relevant to Starts With Youth is the effects of childhood maltreatment, so physical, sexual, and emotional abuse, on depression. I'm particularly interested in how childhood maltreatment leads to depression, and what are some of the intervening mechanisms. It's pretty well established that childhood maltreatment is an extremely strong risk factor for depression, but I'm interested in why that is; what exactly is it doing to the body, brain and mind that makes it such a strong risk factor.

SWY: What does psychology research show about the effects of growing up in a home with domestic abuse? How are children affected when they are a witness to domestic violence in their homes as opposed to being a direct victim of abuse themselves?

I don’t think we actually know the answer exactly to what are the different effects of being the victim of the abuse personally versus witnessing the abuse; that's still something we need to continue researching a lot more. But what I think is really important to understand is that witnessing domestic violence can have just as strong an effect as actually being the victim of abuse oneself. So witnessing domestic violence is also an extremely strong risk factor for mental illnesses in adolescence and adulthood. Kids who are the witnesses of domestic violence tend to develop those illnesses earlier than kids who don’t, and can tend to have a more severe and chronic course. So that definitely is a very strong risk factor, but I can't tell you exactly what are the differential effects to being the victim versus witnessing because we just don’t know enough about that right now.

SWY: What are the main effects of abuse on the brain? Is it a specific area of the brain that is affected or are there more broad effects?

It is pretty broad, so I'm going to talk about systems of the brain that are impacted. So one system that is really strongly impacted by either witnessing domestic violence or being the victim of abuse is the hypothalamic-pituitary-adrenal axis (HPA axis). That is essentially the stress-response center of the body, and for people who are either the victims of abuse or have very high levels of stress when they are children, that system gets tuned in a way that it actually is blunted as people grow up and it becomes less sensitive - which is a bad thing. It may be one of the reasons why there is such a strong risk for illnesses such as depression. The other reason why that's a bad thing is that our HPA axis tunes the immune system. We get the release of a lot of pro-inflammatory markers in the body and the brain, and that is also bad. So when we are talking about specific brain areas those two areas, the HPA axis and the immune system, affect an area of the brain called the hippocampus that is important for things like memory, which is probably what it is most famous for, but particularly emotional memories. There are very, very high concentrations of receptors for stress hormones in the hippocampus and what happens when people are under severe stress, like childhood maltreatment, those receptors actually down-regulate. Essentially, there is killing off of cells in that area of the brain. We see that that particular area of the brain is smaller in people with a history of childhood trauma than in people without; both that area of the brain and a very connected part of the brain called the amygdala, which is important for setting the emotional tone of memories.

SWY: How does abuse affect a child’s psychological development?

One thing that's important to know is that the brain and the mind are really kind of the same thing; they aren't two separate entities. It's hard to talk about brain effects without talking about these psychological effects as well. Not too surprisingly, kids who grow up in families with a lot of violence tend to, not always, be at higher risk for developing negative beliefs about the world, themselves, and the future. What we found in some of our research is that kids who are abused tend to develop beliefs about themselves that they are worthless of love, that other people are out there to hurt them, and that the world is a dangerous place. You can imagine that if you have a worldview like that, that you will be more prone to developing depression when faced with stressful events later in your development. We have also found that people who have experienced a lot of stress early in their life tend to be more likely to be victimized later on in life as well. We found kids who are abused by their parents in childhood are more likely to be bullied by peers at school, they are more likely to be sexually victimized in their relationships with partners; it tends to follow them along. One of the things that researchers think is that it's because if you start to think of yourself as someone who is not worthy of being treated well, you will tend to gravitate towards people who don’t treat you very well. This then reinforces those beliefs and becomes a sort of downward spiral.

SWY: How can abuse experienced throughout childhood impact someone throughout their entire life?

There has been a lot of research showing that one of the strongest risk factors for sexual assault and [other abuse] later on in life is having been the victim of childhood abuse. It's not even only a strong risk factor for being the victim of sexual assault and other sorts of victimizations, but it’s also a strong risk factor for being the perpetrator. Again, I think it's because it tunes the brain and the mind to think that this is the way that people interact; that this is what one should expect from people and is what is expected from you. This is how we learn to be in the world and have relationships with people: from those early relationships that we form with our caregivers. If those go awry, that kind of sets us up for things going awry later on as well. These effects are long-lasting. This doesn’t mean that they can't be changed, but the risk for being re-victimized can persist throughout adulthood.

SWY: What do you think needs to be done to prevent children and youth from experiencing abuse? What do you think we need to do as a community to protect kids?

I think there is a three-pronged approach to answer this question. We talk a lot about preventing abuse, and that is obviously extraordinarily important and what we should be focusing on, but there are also millions of people who were the victims of abuse and we can’t forget them. We need to be helping them to get over that trauma. So in terms of helping people who have been the victims of abuse - they can't change the fact that they were victims, but they can change the way they let that history of victimization impact their current relationships. That's where things like Cognitive Behavioral Therapy (CBT), for example, can be extraordinarily helpful. Not to forget about the abuse or think that it was a positive thing, but to say "this happened, it was a terrible thing and I didn’t deserve it, but that doesn’t mean that I have to continue to be a victim. How can I change my current behaviours and current relationships so that they are more adaptive going forward?" I would definitely encourage someone who has been the victim of abuse to seek out help because that help is available.

Now going back to childhood, to prevent the abuse from happening in the first place. This is not my area of research specifically, so I will be talking about what other people have done. There are really wonderful programs that actually [facilitate] going into people's homes and helping them to be better parents; if these are available in people's communities they can access those. A lot of communities are really great at identifying families at risk and giving them those sorts of programs, which can help prevent children needing to be taken out of a dangerous environment, if we are able to work with the families to improve their parenting. What people who do this sort of research say is that they really want to improve; they are not bad people, these are just people who get into bad patterns and likely were the victims of abuse themselves and need support. When that support is given, often there are very good outcomes. For example, Public Health in Kingston offers home visitation programs.

"They are not bad people, these are just people who get into bad patterns and likely were the victims of abuse themselves and need support."

As a society, I think there are a lot of things we should be doing. Some of the main societal risk factors for child maltreatment are food insecurity, unemployment, and underemployment. Things that create stress for families are going to raise that stress level for parents, and when parents don’t necessarily have the resources to be able to deal with that, that can sometimes, unfortunately, result in negative behaviours towards the children. So these are some supports we should be providing as a community.

Another risk factor for abuse is when people have children and families when they are not ready to do so. So providing free and accessible family planning education and resources for people so that they aren't in a position where they are having kids and they aren't prepared.

SWY: You mentioned Cognitive Behavioural Therapy (CBT) earlier, can you give a brief explanation of what that is?

There are a lot of different things that go under this umbrella, but generally, these are talk therapies, where the person and the therapist (this can be in a group or an individual setting) are addressing the sorts of negative beliefs that people have about themselves, other people, and the world that are causing them trouble in their current functioning. They talk about whether these negative beliefs are accurate representations of reality or not, and how to potentially come to more realistic thoughts and beliefs about the world. This is the cognitive part. The behavioural part of CBT talks about how to change maladaptive patterns and behaviour. For example, people with depression often withdraw from social contact, from things that they used to enjoy doing. They may engage in behaviours that push people away. So the behavioural part of CBT helps people to reengage with the world and the sorts of things that give them a sense of pleasure and mastery and engage in more adaptive and functional ways of being with people and their relationships.

SWY: Is there anything you would like to add to raise awareness about abuse, trauma, and violence and the effects it has on youth?

Something more on the risk factor side of things is that violence and those adverse childhood experiences have a much stronger role than people ever really realize. I focused more on depression because that's what I research, but the impacts of these experiences go far beyond that. Child abuse, in particular, is a risk factor for every single mental disorder that we know about, even the ones that we tend to think about as primarily brain diseases like Schizophrenia, bipolar disorder, etc. Having childhood maltreatment raises the risk of those disorders at least 2-3 fold. This also raises the risk for a large number of physical health problems as well that can be chronic. I don’t think that this is just something to be concerned about within a family unit, it is something that we as a society should be worried about. The impacts of childhood abuse, in particular, cost the Canadian economy billions of dollars a year. If we were able to put money into prevention and treatment of just that one thing, the amount of savings that we would have as a society would be extraordinary. I don’t think people understand that this isn't just a personal problem, this is something that we should all be concerned about as Canadians.

"I don’t think people understand that this isn't just a personal problem, this is something that we should all be concerned about as Canadians."

Also, unfortunately, childhood maltreatment doesn’t really discriminate. The people that I have worked with have been of all socioeconomic (SES) groups, so this isn't just something that low SES groups need to worry about; it’s something that we see across the spectrum of people in Canada. It tends to be something more secretive and easier to hide in those higher SES groups, but it is definitely there and everyone needs to be concerned about it.

There is also something called a silent risk factor; which is emotional abuse. People tend to focus a lot on physical and sexual abuse, and people assume that these are worse or more severe types of abuse. However, through the research we've done, emotional abuse is actually a stronger risk factor for depression and anxiety than physical abuse. Emotional abuse rarely comes to the attention of authorities because you can't see it. I think that more attention needs to be paid to identifying and preventing emotional abuse.

It is really important to understand that actually most kids turn out really well. So another big area that needs to be more focused on in the research is, "What is difference between the kids who have these terrible experiences who actually don’t develop negative outcomes later? Are there certain things that are buffering those negative experiences? Is there something about their genetic constitution, their personality?" We can learn a lot from those kids who are doing really well. The largest factor that seems to be helpful [in terms of resilience] is having a supportive person in your life, and that could be anybody. A supportive teacher or friend or someone who contradicts the ability for those [negative] beliefs to get deeply ingrained. If you have that one person saying that 'you are lovable and worthy', that can be extraordinarily helpful, and can also give people a model of a good relationship and can help that person get out of that difficult position. Having social support, and a continuing source of strong social support throughout life is the strongest buffer of stress, just generally, over the course of one's entire lifetime.

"The largest factor that seems to be helpful [in terms of resilience] is having a supportive person in your life, and that could be anybody."

There are also some constitutional factors such as temperamental factors and genetic factors. There do seem to be people who are more temperamentally predisposed to have a more resilient personality and approach to stress. People who see adversity as a growth opportunity, for example. It is sometimes hard to get over once the stress reaches a certain threshold, as we see through the diathesis-stress model. The diathesis would be a vulnerability factor, so temperament and personality, and the stress is whatever is happening in your environment. Even the hardiest, most resilient person, may not be able to get over the stress once it reaches a certain threshold.

Thank you Dr. Harkness for participating in this interview and giving insight to the psychological mechanisms that contribute to, and result from, abuse!