








































44

Ann. psychophysiol. 
ISSN 2412-3188 (Online)|2410-1354 (Print) 

APP| Published By AEIRC| https://doi.org/10.29052/2412-3188.v10.i1.2023.XX-XX 

Review Article 

Psychophysiological Responses to 
Childhood Trauma in Adulthood - A 
Review 
Ayesha Faisal , Maryum Firdous  & Hafiza Fatima Zehra
Department of Psychology, Mohammad Ali Jinnah University, Karachi-Pakistan 

Abstract 
Background: In this review, the impacts of childhood trauma are examined, and 
how they influence the thoughts and behaviors of most adults. Some people are 
resilient and develop proper coping mechanisms against it with the help of 
immediate therapeutic counsel. Many indulge in maladaptive coping strategies 
that do more harm than good. These strategies commonly occur in many anxiety 
disorders alongside symptoms that fit diagnostic criteria. However, this review 
will indicate that the impacts of trauma should not be confused with Post 
Traumatic Stress Disorder. 
Methodology: Multiple studies and articles surrounding the topic of trauma and 
its signs were selected for this review and compiled for a better understanding of 
the consequences of trauma.  
Results: Previous studies have shown that trauma comes in many forms, each 
damaging to a child's upbringing, from neglect to sexual abuse. There are several 
types of traumas, each caused by numerous reasons and originating from different 
backgrounds, but there is a clear distinction between each that is elaborated. 
Without properly monitoring the conditions, the mental and biological state of the 
human body can worsen, and the child can develop severe mental illnesses such 
as depression. 
Conclusion: The literature has provided multiple psychotherapies and 
intervention techniques that would treat various conditions and focus on 
improving well-being based on their effectiveness and research on evaluating 
treatment for stress responses. The available literature has been examined, and 
responses occurring in emotional, physical, cognitive, behavioral, and social 
categories are delineated. Suggestions for future research are also discussed in this 
paper. 

Keywords 
Childhood Trauma, Responses to Trauma, Psychophysiological Responses, 

Adult Responses. 

Citation: Faisal A, Firdous M, Zehra HF. 
Psychophysiological Responses to 
Childhood Trauma in Adulthood - A 
Review. APP. 2023; 10(1): 45-54 

Corresponding Author Email: 
maryum.firdous@jinnah.edu 

DOI: 10.29052/2412-3188.v10.i1.2023.44-
53 

Received 16/03/2023 

Accepted 26/05/2023 

Published 01/06/2023 

Copyright © The Author(s). 2023. This is 
an open-access article distributed under 
the terms of the Creative Commons 
Attribution 4.0 International License, 
which permits unrestricted use, 
distribution, and reproduction in any 
medium, provided the original author and 
source are credited.  

Funding: The author(s) received no 
specific funding for this work. 

Conflicts of Interests: The authors have 
declared that no competing interests 
exist. 

https://doi.org/10.29052/2412-3188.v10.i1.2023.
https://orcid.org/0000-0001-5969-8982
https://orcid.org/0009-0005-8578-1057
https://orcid.org/0009-0006-7285-076X
about:blank
about:blank


45 

ISSN 2412-3188 (Online)| 2410-1354 (Print) 

APP| Published By AEIRC| Volume 10 Issue 1 

Introduction 
Childhood trauma has serious outcomes for 
its sufferer and society. It is interpreted in the 
Diagnostic and Statistical Manual of Mental 
Disorders, Fifth Edition (DSM-V) as an 
individual exposed to actual or threatened 
death, serious injury, or sexual violence1. The 
cause of trauma is an intense physical and 
psychological stress response. Several 
studies have shown that, including those by 
Dyregrov and Yule2, the outcome of trauma 
has an everlasting effect on the individual's 
functioning and physical, emotional, social, 
or spiritual well-being. When the child is a 
trauma victim, witnesses it, or hears about it 
happening to a friend or a close relative, it 
greatly impacts their minds. In toddlers, 
motor vehicle tragedies, bullying, terrorism, 
and child maltreatment from physical, 
sexual, and emotional abuse to domestic and 
community violence are common childhood 
traumas that enhance the development of 
pain disorders and post-traumatic stress 
disorder (PTSD). Child mistreatment or 
bullying/ beating will have a greater impact 
on their adulthood. During childhood, it is 
important to explore the pattern of 
interactions between the child and their 
abuser3. 
Single events or series of events can 
contribute to trauma, which leads to physical 
and emotional injury4, 5. Trauma is divided 
into two categories, which can occur in 
children and adults. Event trauma, or Type I, 
requires a single unexpected, immediate, or 
difficult event6. Examples of type I trauma 
can include violence at school, such as school 
shootings, road accidents, and/or fires. 
Process trauma or Type II calls for a display 
to be underway and give way to irritants 
considered too fearful to anticipate4, 7. 
Process trauma, or Type II trauma, includes 
years of war, repeated violations in physical, 
emotional, and sexual abuse, and being a 
victim of domestic abuse. Some factors that 
influence trauma are family or outside 

family members, the relationship between 
the child and person, or the surrounding 
environment4. For example, parents might 
cause more trauma to a child because that 
child witnesses their hostile arguments. 
Mulvihill5 suggested that the ongoing parent 
relationship may also traumatize the child, 
which starts a fear response due to the 
violation of trust. 

Neglect is the most common form of 
childhood maltreatment8. Neglect means 
ignorance or failure by parents and 
caregivers to provide for the psychological 
or physical needs of the child8, 9. Emotional 
harm involves actions of an adult that harm 
a child emotionally, psychologically, or 
spiritually. It involves an attack on the 
child's sense of self-worth8. Physical abuse 
involves any part of a child’s body by use of 
excessive force10. In accordance with Jack et 
al.8, physical abuse includes shaking, 
grabbing, biting, kicking, and stabbing. 
Sexual abuse refers to the non-consensual 
stroking of a child's private regions, 
intercourse, inappropriate speech, sex talk, 
incest, and sexual manipulation. Domestic 
violence between parental figures and 
caregivers or other family members. This 
includes physical injuries or overhearing of 
violence8.  

For the child experiencing the trauma, a 
therapist needs to comprehend the 
complexities of the trauma and the impact it 
has on the development of the brain. 
Maturation of the brain will affect several 
aspects of the child's life, including 
psychological functioning, behavioral, 
social, emotional, and cognitive. The 
structure and development of a child's brain 
negatively impact while experiencing 
trauma. 

The following section describes the most 
common responses to trauma in emotional, 
physical, cognitive, behavioral, and social 



46 

ISSN 2412-3188 (Online)| 2410-1354 (Print) 

APP| Published By AEIRC| Volume 10 Issue 1 

domains. It is important to remember that 
these responses do not have a direct 
indication of any underlying mental illness 
or a disorder. Most survivors are highly 
resilient to trauma and can develop effective 
coping strategies against it11. Most show 
minimal distress and recover with time 

across many stages in life. Even so, 
individuals will have signs that don't 
necessarily fulfill the diagnostic criteria for 
PTSD or acute stress disorder. It is important 
to acknowledge that these responses are 
normal but can be distressing. 

Table 1: Psychophysiological Responses to Trauma 

Psychophysiological responses Types of Trauma 

Emotional responses, such as fight or flight 
response, stress response, dysregulation of 
emotion, and numbing 

Event trauma, domestic violence, neglect, or 
emotional abuse 

Physical responses, such as somatic complaints, 
hyperarousal, and poor sleep quality 

Process trauma, physical abuse, or sexual 
abuse 

Cognitive responses, such as cognitive errors, 
guilt, and shame, inaccurate idealizations, 
rationalizations, or justifications, trauma-induced 
hallucinations or delusions, and dissociative 
disorders 

Process trauma, event trauma, physical 
abuse, sexual abuse, or emotional abuse 

Behavioral responses, such as self-destructive 
behaviors, self-harm, re-enacting the event, and 
avoidance 

Event and process trauma, physical abuse, 
emotional abuse, domestic violence, or 
neglect 

Social responses, such as difficulty maintaining 
relationships, avoiding support, distrust 

Event trauma, neglect, sexual abuse, physical 
abuse, or emotional abuse 

Emotional Responses 
Emotional reactions depend significantly on 
the individual's socio-cultural history, thus 
allowing them to be either emotionally 
resilient to trauma or express strongly 
towards a trigger. Some people learn the 
ability to move on from dramatic events and 
face the stressors. Others are unable to 
handle stressful situations and try to escape 
or seek support from someone familiar. 
These stress responses do work in favor of 
saving us from danger but not so much out 
of context. It is the way we perceive the 
situation that determines our responses. The 
perception is built from childhood, during 
which culture and parental upbringing have 

a huge impact. Perception of the stimuli and 
childhood experiences work together to 
determine the way a person responds. In the 
context of trauma, however, each 
environmental incentive is perceived and 
reacted to as an element of danger. 
Therefore, if the situation resembles a past 
event, the adult survivor will have an 
adverse stress response. For example, an 
adult who’s being scolded severely will 
recall their past abuse and enter a state of 
anxiety or panic. The fight or flight response 
is a natural coping strategy against stressful 
situations that the body aims to protect us 
from the perceived threat. 



47 

ISSN 2412-3188 (Online)| 2410-1354 (Print) 

APP| Published By AEIRC| Volume 10 Issue 1 

The most common emotional reactions are 
anger, fear, sadness, and shame. Sometimes, 
people will have difficulties in recognizing 
their own feelings because of a lack of 
experience with emotional expression in 
their family or community. They may 
associate strong emotions with the trauma 
that elicits intense emotional responses. If a 
child witnesses death in the family, as an 
adult, they may cry in fear of separation from 
significant others. And then there are those 
who deny any connection to the past and 
define their emotions as “numb”12. 
Emotional numbness, in a common 
perspective, refers to how many people shut 
off their emotions over a memory that hurts 
them13. They become disconnected from 
others, isolate themselves, and lose interest 
in activities they used to enjoy. This often 
occurs as a coping against death, grief, 
anxiety, minimizing stress, etc.   

Due to childhood traumas, many people are 
unable to regulate their emotions well. 
Regulation is defined by how quickly one 
can return to their original emotional state 
after facing a stressful situation. A person 
who had been exposed to an aggressive 
family environment in their childhood may 
display more reactive behaviors than those 
adults who grew up in a stable environment. 
Such emotional dysregulation does not go on 
for long but has often led to substance abuse. 
Survivors may indulge themselves in risky 
or self-harm behaviors, disordered eating, 
compulsive behaviors such as gambling, and 
repression or denial of emotions14. 

Emotional expression of traumatic response 
can be followed by two extremes: either 
feeling overwhelmed or feeling numbed12. In 
numbing, the individual will detach all 
emotions from their memories, thoughts, 
and behaviours14. These limited expressions 
of emotions are hard to detect during 
therapy, and the severity of symptoms is 
difficult to determine. 

Cognitive behavioral therapy (CBT) and 
Acceptance and Commitment Therapy 
(ACT) have been seen as effective in treating 
emotional dysregulation and numbing. 
Cognitive behavioral therapy grants 
expression and understanding of emotions, 
while empowering clients to turn their 
thoughts of hopelessness into emotional 
strength15. Acceptance and Commitment 
Therapy teaches mindfulness and helps 
direct attention to living a meaningful life16. 

Physical Responses 
These symptoms include somatic 
complaints, hyperarousal, and poor sleep 
quality11. Somatization refers to emotional 
distress concerning one’s own bodily 
symptoms. Specifically when psychological 
symptoms convert into physical concerns. 
For example, stress causes weakness, 
headaches, stomach aches, and nausea. 
These are usual signs that typically last for a 
short while and do not lead to greater health 
problems. However, it becomes a matter of 
concern when there is a prolonged and 
increased amount of stress18. Sometimes, 
clients will focus primarily on their physical 
symptoms and ignore all medical 
evaluations that fail to confirm their 
ailments. These somatic complaints are more 
prone to occur in those people who have 
trauma. There is no observable cause 
because the stress is heavily exaggerating 
their physical complaints, and neither are the 
people faking it18. Intervention is still 
required to address their concerns, such as 
mindfulness-based interventions and 
relaxation therapy19. Each treatment is 
designed to reduce mental and physical 
tension with a combination of techniques, 
like special breathing or progressive muscle 
relaxation exercises. 

Hyper-arousal is a state of extreme alertness 
caused by the amygdala20, epinephrine, and 
elevated levels of CRH. These are part of the 



48 

ISSN 2412-3188 (Online)| 2410-1354 (Print) 

APP| Published By AEIRC| Volume 10 Issue 1 

diagnostic criteria of Post Traumatic Stress 
Disorder, characterized by signs of sleep 
disturbances, muscle tension, and startled 
responses12, 21. This system may serve to fight 
the trauma, but it also does not give enough 
time to properly assess and respond to a 
stressor. Hyperarousal may prepare the 
body against a life-threatening stimulus, but 
it is also unnecessary when the situation is 
actually safe. Excessive hyperarousal may 
also increase the chances of stroke22. 

Sleep disturbances are also seen constantly 
occurring in the form of nightmares, 
insomnia, difficulty falling asleep, early 
awakening, and restless sleep23,24,25. The 
quality of sleep is interrupted when stressful 
thoughts and memories enter the 
unconscious. Other responses include 
gastrointestinal, cardiovascular, 
neurological, musculoskeletal, respiratory, 
dermatological, urological, and substance 
use disorders11. These symptoms normally 
do not go away and remain even after 
therapeutic intervention. This happens 
because of relapse, a condition in which 
medical symptoms appear again after 
treatment. Oftentimes, clients will stop the 
treatment once the symptoms go away, 
which causes the relapse to happen. A 
triggering event or stress may force the 
individual to return to their old behavior, 
and then they relapse26.  

Cognitive Responses 
When core beliefs and normal life 
assumptions are challenged by dramatic 
incidents, they induce a change in thought 
processing and affect daily life functioning. 
Some examples include cognitive errors, 
inappropriate guilt and shame27, inaccurate 
idealizations, rationalizations, or 
justifications, and trauma-induced 
hallucinations or delusions11, 28. These ways 
of thought instruct decision-making and 
contribute to certain behaviors. People who 
have made mistakes in the past and have 

been shamed will feel immeasurable guilt 
and will often find themselves apologizing 
numerous times for every little detail. The 
degradation of self is a cognitive error, 
alongside rationalizations that involve 
justifying behavior or attitude with 
reasoning, even if it’s already not 
appropriate.  

To understand how cognition is altered, 
Beck and colleagues' cognitive triad model 
(1979)29 is applied. It states only three styles 
of cognitions: thoughts about the self, about 
the world, and the future. In keeping with 
the model, a series of thoughts circulate 
these factors, and an event acts as an 
influence on thought patterns. For instance, 
trauma can make individuals feel vulnerable 
about themselves, see the world as 
dangerous, and assume the future as 
uncertain. Witnessing violence or assault can 
change assumptions that an individual 
keeps of themselves, others, and the 
universe. Depending on whatever the set of 
cognitions is, it influences the individual’s 
ability to use internal and external resources 
effectively. Consequently, cognitions also 
have the capacity to develop depressive and 
anxiety symptoms after trauma21. 

Severe childhood trauma is also closely 
associated as the cause of dissociative 
disorders30. Dissociation is a mental process 
of detachment from the external world and 
divulging only in the internal world. It 
occurs usually in the form of distraction, 
daydreaming, fantasy, and avoidance. And 
in extreme cases, depersonalization, fainting, 
and catatonia could rarely occur. This 
appears as a common ability to lose track of 
a particular action at a specific point in time, 
but for those with severe trauma, it acts as a 
protective element28. Dissociation creates a 
distortion of time and space, a reduced 
perception of pain, and the sense that 
whatever is happening is not real. The 
individual will enter the space to escape the 



49 

ISSN 2412-3188 (Online)| 2410-1354 (Print) 

APP| Published By AEIRC| Volume 10 Issue 1 

trauma and stress, for example, mentally 
teleporting to a different place30. 
Dissociation may also relate to mental 
disorders such as dissociative identity 
disorder (DID), formerly known as multiple 
personality disorder. Severe childhood 
trauma has been seen to be closely associated 
as the cause of dissociative disorders30, 
alongside damage to the hippocampus.  

Behavioral Responses 
Behavioral reactions towards a traumatic 
experience vary from person to person, but 
they all work similarly, with the aim of 
managing the distress caused by it. Stress 
management depends upon the individual's 
way of coping, and there are many 
techniques that people follow, such as 
avoiding the problem altogether or playing a 
game that distracts them. In severe cases, 
however, some people will reduce their 
stress by either substance abuse, compulsive, 
impulsive, or self-harm behaviors. 
Sometimes, others try to be aggressive and 
gain control over their experiences or re-
enact the entire event. Behavioral reactions 
may be learned from the past or act as 
consequences of the past. For example, when 
a situation has gotten out of hand, they 
decide not to make any decisions at all 
(learned helplessness).   

Behavioral responses mainly fall under two 
categories: reenactment reenactment and 
avoidance21, 31. ReenactmentReenactment is 
the act of relieving the traumatic experience 
by recreating it repetitively in their present 
lives31. It is common among children who 
play mimicry of what happened during the 
trauma. Whatever they witness, they tend to 
act it out during playtime and express the 
experience with their friends without the use 
of words. For example, if a child witnesses 
divorce, they may later play a game related 
to marriage and re-enact arguments between 
the couples in role play. Another similar case 
in adults can be isolation due to experiences 

of neglect or from overprotective parents. 
There are many reasons as to why survivors 
do this, one being that perhaps they want to 
master them. Examples of reenactment 
reenactment include self-harm behaviors or 
self-destructive behaviors. Self-harm is an 
act of intentionally bringing injury to oneself 
or a way of coping with overwhelming 
physical distress and helplessness31. Those 
who have experienced repeated childhood 
trauma are highly prone to develop self-
injury as a maladaptive coping mechanism. 
It is commonly associated with eating 
disorders and substance abuse. Self-
mutilation also occurs in a number of 
personality disorders (DID, histrionic, and 
borderline), depression, and schizophrenia. 
Fortunately, most people who commit self-
harm do not actually have the intention to 
kill themselves32. However, it can escalate 
very quickly if therapeutic intervention does 
not occur. Self-destructive behaviors, such as 
substance abuse or reckless driving33, do not 
necessarily impact the individual nor get the 
individual killed on purpose. Many studies 
have shown that substance abuse 
significantly increases after the trauma and 
has a higher chance of relapse because of 
withdrawal symptoms and dependency34. 
The use of substances depends on many 
factors, such as the prominent trauma 
symptoms of the individual and the 
individual's access to specific substances like 
cigarettes or cocaine. The substances give 
them quick relief and comfort from the 
unresolved trauma, so they avoid difficult 
emotions to face14. Stressors trigger 
substance abuse and self-harm. To ensure 
that trauma-induced stress does not occur, 
trauma-informed care has been seen as a 
useful approach. It is a service based on the 
knowledge and comprehension of trauma 
affecting lives35. Actively recording behavior 
and body language, taking note of triggers, 
and making sure the trauma does not 
resurface through any type of interaction. It 
focuses on building strength and providing 



50 

ISSN 2412-3188 (Online)| 2410-1354 (Print) 

APP| Published By AEIRC| Volume 10 Issue 1 

care, support, safety, and empowerment to 
patients36. Its key elements include realizing 
how the trauma is affecting the environment, 
recognizing the signs of trauma from the 
past and the present, and responding to 
individual needs. However, this approach 
may not be widely researched or 
implemented36.  

Avoidance behaviors are done to preclude 
anxiety. Individuals will avoid people, 
places, or situations to avoid unpleasant 
memories, circumstances, and emotions21. It 
is the sense of escaping the problem. Many 
people have not learned the ways to deal 
openly with stress or any stressful situation 
because no one has been taught how. This 
consistent behavioral pattern increases the 
likelihood of avoidance more and more often 
until it becomes problematic. The individual 
tries to avoid traumatic stressors or 
memories in whatever way possible, in the 
hopes that the issue will either go away or 
someone else will resolve it. There are some 
people, though, who face their memories 
and stress (if not immediately) because they 
have the belief that they need to deal with the 
issue one way or another. These kinds of 
people would be considered resilient and are 
able to handle stress. 

Social Responses 
Social or interpersonal relationships are 
protective factors for traumatized children 
and adults alike1. It is important that a stable 
and appropriate support system is 
established in order to help them cope. In 
general, friends and family are important for 
every person’s well-being. However, trauma 
also affects relationships. They are built on 
an emotional exchange, which means that 
those with a close connection to the 
individual with a traumatic past will directly 
experience the survivor’s traumatic stress 
response37, i.e., anger outbursts or too much 
emotional reactivity. 

Survivors are encouraged to seek support 
from their friends and family, but sometimes 
their own negative perceptions cause them 
to avoid support12. Either because they think 
that nobody is trustworthy or that they are a 
burden to others. Survivors may become 
more emotionally withdrawn because of 
their intense emotional and physical 
reactions and to protect others and 
themselves from harm. They feel shame and 
guilt for the way they react, and for the way 
they are, which further reduces the chance of 
them using support systems and resources12. 
The act of seeking support also means 
surrendering control to someone else. In the 
past, they might have been hurt or lost 
something due to a mistake, thus losing 
control over a situation. No individual wants 
to submit themselves to someone because 
they are uncertain of their own safety and 
want to take no risk of getting hurt again38. 
There is also the lack of awareness to seek 
support, or people are not taught to find 
consolation from a good company, such as 
men not seeking social support from their 
friend group because they do not practice an 
intimate relationship, as compared to 
women. 

A final reason why survivors have 
difficulties in maintaining relationships is 
betrayal. Their own trusted caregivers or 
family members were the ones who 
committed the abuse. This creates a sense of 
distrust and causes difficulties in connecting 
with others. They are more cautious and 
observant of others, constantly in fear of 
being harmed again. Betrayal can affect the 
ability to form attachments, yet supportive 
relationships are necessary to recover from 
trauma11, 37. The first step is to tackle the fear 
against it and show them the benefits of 
therapy. Providing proper guidance and 
unconditional support should help them 
gain insight and encourage them to seek 
support from family and friends. 



51 

ISSN 2412-3188 (Online)| 2410-1354 (Print) 

APP| Published By AEIRC| Volume 10 Issue 1 

Conclusion 
There are several adaptive behaviors in 
response to trauma and as a way to cope 
with terrible past events. Emotional 
reactions range from stress responses to 
severely disturbed states of mind, such as 
numbing, regression, denial of emotion, or 
gambling. These emotional responses 
depend on the individual's resilience to 
trauma or how they express themselves 
toward a trigger. Regulation and knowing 
how to regulate strong emotions attached to 
traumatic memories are important for the 
safety of mental health and good coping. 
Physical responses include somatic 
complaints, extreme hyperarousal, and 
medical conditions that require professional 
attention and counseling. Sleep disturbances 
are also seen in individuals with trauma, and 
they suffer from a multitude of problems 
related to it. Due to the trauma, our 
cognitions are greatly impaired, not only 
developing depression but also mental 
issues such as dissociation, guilt, shame, and 
other cognitive impairments. Behavioral 
reactions work towards reducing the stress 
by either avoiding the situation that might 
remind them of the trauma or conducting 
self-injurious behaviors such as drug abuse 
or self-mutilation. Survivors will re-enact the 
trauma as a way of coping. The support of 
family and friends can act as protective 
factors for these victims, but sometimes, 
there are boundaries that keep them from 
recovering. They lose trust in others or 
believe they are a burden, thus rendering 
themselves helpless or hopeless.  

There are many people who do not go to 
therapy. Culturally speaking, people may 
not seek help due to doubt and stigma 
against it. Most people have a hard time 
admitting that they need help, and 
stereotypes against therapy only make them 
less likely to consider taking it. The more 
people know that therapy will do no harm to 

them, the better. Educational campaigns, 
mental health camps, and guidance should 
be employed to ensure people become more 
ready to seek therapy. Patients need trauma-
informed care that should be applied to 
schools, hospitals, and other institutions. All 
therapists and psychologists should seek 
training in trauma-informed care.  

Future researchers can explore how different 
gender experiences trauma, even when they 
experience similar trauma, and how trauma 
impacts attachment styles differently. Future 
researchers should also explore the factors 
that are associated with childhood trauma 
and adult violent behaviors.  

Acknowledgment 
The author would like to acknowledge all 
the Trauma survivors.  

References 
1. Pai, A. V., Suris, A. M., & North, C. S. Post-

traumatic Stress Disorder in the DSM-5:
Controversy, Change, and Conceptual
Considerations. Behavioral Sciences. 2017;
7(4), 7.

2. Dyregrov, A., & Yule, W. A Review of PTSD
in Children. Child and Adolescent Mental
Health. 2006; 11(4), 176–184. =

3. Glaser, D. Child abuse and neglect and the
brain—a review. The Journal of Child
Psychology and Psychiatry and Allied
Disciplines. 2000; 41(1), 97-116.

4. Dripchak, V. L. Post-traumatic play: Towards
acceptance and resolution. Clinical Social
Work Journal. 2007; 35, 125-134.

5. Mulvihill, D. The health impact of childhood
trauma: An interdisciplinary review, 1997-
2003. Issues in Comprehensive Pediatric
Nursing. 2005; 28, 115-136

6. Ogawa, Y. Childhood trauma and play
therapy intervention for traumatized
children. Journal of Professional Counseling:
Practice, Theory, & Research. 2004; 32(1), 19-
29.

7. Shaw, J. Children, adolescents and trauma.
Psychiatric Quarterly. 2000; 71(3), 227- 243.



52 

ISSN 2412-3188 (Online)| 2410-1354 (Print) 

APP| Published By AEIRC| Volume 10 Issue 1 

8. Jack, S., Munn, C., Cheng, C., & MacMillan, H.
Child maltreatment in Canada: National
Clearinghouse on Family Violence. Ottawa,
ON: Public Health Agency of Canada; 2006.

9. Perry, B., Colwell, K., & Schick, S. Neglect in
Childhood. In D. Levinson (Ed.).
Encyclopedia of Crime and Punishment. 2002.
Volume 1 (pp. 192-196). Thousand Oaks: Sage
Publications.

10. Wekerle, C., Wolfe, D. A., Hawkins, D. L.,
Pittman, A. L., Glickman, A., & Lovald, B. E.
Childhood maltreatment, post-traumatic
stress symptomatology, and adolescent
dating violence: Considering the value of
adolescent perceptions of abuse and a trauma
mediational model. Development and
psychopathology. 2001; 13(4), 847-871.

11. Center for Substance Abuse Treatment (US).
Chapter 3 Understanding the Impact of
Trauma. In Trauma-Informed Care in
Behavioral Health Services. 2014. (57th ed.,
pp. 59–85). US Department of Health and
Human Services, Substance Abuse and
Mental Health Services Administration,
Center for Substance Abuse Treatment.
https://www.ncbi.nlm.nih.gov/books/NBK
207191/

12. Robinson, L., Smith, M., & Segal, J. Emotional
and Psychological Trauma - HelpGuide.org.
HelpGuide.org. 2023.
https://www.helpguide.org/articles/ptsd-
trauma/coping-with-emotional-and-
psychological-trauma.htm

13. Kerig, P. K., Bennett, D. C., Chaplo, S. D.,
Modrowski, C. A., & McGee, A. Numbing of
Positive, Negative, and General Emotions:
Associations With Trauma Exposure, Post-
traumatic Stress, and Depressive Symptoms
Among Justice-Involved Youth. Journal of
Traumatic Stress. 2016; 29(2), 111–119.

14. Weinstein, T. What It Means When You’re
Feeling Emotionally Numb. Newport 
Institute. 2023. 
https://www.newportinstitute.com/resourc
es/mental-health/feeling-emotionally-
numb/ 

15. What is Cognitive Behavioral Therapy? 2017.
https://www.apa.org/ptsd-
guideline/patients-and-families/cognitive-
behavioral

16. Bisson J I, Cosgrove S, Lewis C, Roberts N P.
Post-traumatic stress disorder BMJ. 2015;
351:h6161

17. Dimsdale, J. E. Overview of Somatization.
MSD Manual Professional Edition. 2023.
https://www.msdmanuals.com/professiona
l/psychiatric-disorders/somatic-symptom-
and-related-disorders/overview-of-
somatization

18. GoodTherapy. Somatization. 2019.
https://www.goodtherapy.org/learn-about-
therapy/issues/somatization

19. Agarwal, V., Nischal, A., Praharaj, S. K.,
Menon, V., & Kar, S. K. Clinical Practice
Guideline: Psychotherapies for Somatoform
Disorders. Indian Journal of Psychiatry. 2020;
62(8), 263.

20. Nemeroff, C. Paradise Lost: The
Neurobiological and Clinical Consequences
of Child Abuse and Neglect. Neuron. 2016;
89(5), 892–909.

21. Cirino, E. Are You Experiencing 
Hyperarousal. Healthline. 2018. 
https://www.healthline.com/health/mental
-health/hyperarousal

22. Perkins, J. D., Wilkins, S. S., Kamran, S., &
Shuaib, A. (2021). Post-traumatic stress
disorder and its association with stroke and
stroke risk factors: A literature review.
Neurobiology of Stress, 14, 100332.

23. Giannakopoulos, G., & Kolaitis, G. Sleep
problems in children and adolescents
following traumatic life events. World Journal
of Psychiatry. 2021; 11(2), 27–34.

24. Newsom, R. Trauma and Sleep. Sleep
Foundation. 2022.
https://www.sleepfoundation.org/mental-
health/trauma-and-sleep

25. Sinha, S. S. Trauma-induced insomnia: A
novel model for trauma and sleep research.
Sleep Medicine Reviews. 2016; 25, 74–83.

26. Relapse - GoodTherapy. 2018 
https://www.goodtherapy.org/blog/psych
pedia/relapse 

27. Aakvaag, H. F., Thoresen, S., Wentzel-Larsen,
T., Dyb, G., Røysamb, E., & Olff, M. Broken
and guilty since it happened: A population
study of trauma-related shame and guilt after
violence and sexual abuse. Journal of
Affective Disorders. 2016; 204, 16–23.

28. C Wright, A., Coman, D., Deng, W.,
Farabaugh, A., Terachina, O., Cather, C., Fava,



53 

ISSN 2412-3188 (Online)| 2410-1354 (Print) 

APP| Published By AEIRC| Volume 10 Issue 1 

M., & J Holt, D. The Impact of Childhood 
Trauma, Hallucinations, and Emotional 
Reactivity on Delusional Ideation. 
Schizophrenia Bulletin Open. 2020; 1(1).  

29. Beck, A. T., Rush, A. J., Shaw, B. F., & Emery,
G. Cognitive therapy of depression. New
York: Guilford Press. 1979.

30. Mind. What is dissociation? 2023. 
https://www.mind.org.uk/information-
support/types-of-mental-health-
problems/dissociation-and-dissociative-
disorders/about-dissociation/

31. Levy, M. J. A helpful way to conceptualize
and understand reenactments reenactments.
The Journal of Psychotherapy Practice and
Research. 1998; 7(3), 227–235.

32. Mental Health America. Self-injury (Cutting,
Self-Harm, or Self-Mutilation). 2023.
https://www.mhanational.org/conditions/s
elf-injury-cutting-self-harm-or-self-
mutilation

33. Lusk, J. D., Sadeh, N., Wolf, E. J., & Miller, M.
W. Reckless Self-Destructive Behavior and
PTSD in Veterans: The Mediating Role of New
Adverse Events. Journal of Traumatic Stress.
2017; 30(3), 270–278.

34. Dass-Brailsford, P., & Myrick, A. C.
Psychological Trauma and Substance Abuse:

The Need for an Integrated Approach. 
Trauma, Violence, & Abuse. 2010; 11(4), 202–
213.  

35. Wall, L., Higgins, D., & Hunter, C. Trauma-
informed care in child/family welfare
services (CFCA Paper No. 37). Melbourne:
Child Family Community Australia
information exchange, Australian Institute of
Family Studies. 2016.

36. Reeves, E. A Synthesis of the Literature on
Trauma-Informed Care. Issues in Mental
Health Nursing. 2015; 36(9), 698–709.

37. ISTSS. Trauma and Relationships.
International Society for Traumatic Stress
Studies. 2016.
https://istss.org/ISTSS_Main/media/Docu
ments/ISTSS_TraumaAndRelationships_FN
L.pdf

38. Stieg, C. Everyone needs help during the
coronavirus pandemic—here’s the
psychological reason why asking for it is so
hard. CNBC. 2021.
https://www.cnbc.com/2020/04/22/why-
asking-for-help-is-so-hard-and-how-to-get-
better-at-it.html.

about:blank

