More on Trauma in Youth and Schizophrenia

By David Laing Dawson

This blog is in response to a comment made on an earlier blog called As For Trauma Causing Schizophrenia: No! No! No! 

The comment was how do you account for this study? And how can you claim that trauma cannot be causative of schizophrenia? https://www.sciencedaily.com/releases/2012/04/120419102440.htm

This is the answer:

There is no doubt severe trauma in childhood can have long lasting effects. But can trauma be a specifically causative element in the development of the full illness schizophrenia? And is it either a necessary causative element or a contributing factor?

Data mining and surveys come up with many associations, some weak, some strong. Fair enough. But we have to examine the definitions of each and every term and understand that association is not necessarily causative. And in this situation we must be very careful what we publicize because any association between trauma and schizophrenia provides support for parent blaming.

I am back to eating butter after something like 20 years of favouring margarine. This because for many years data mining found associations with butter and other animal fats and cardiovascular disease, and only recently further data mining and studies have shown that, au contraire, we need fat, and margarine may be worse than butter. Now I slather butter on my corn and biscuits without guilt. As someone else has pointed out, there is a very strong association between major road accidents and the presence of ambulances.

The word paranoia is used in many of those studies. I don’t know how they define it or determine it. Adolescents suffering from anxiety often experience what they call ‘paranoia’ but we refer to as ‘ideas of reference’. They feel their peers are always talking about them, judging them. Some avoid school because of this. Sometimes this feeling becomes a conviction and then it may be prodromal of a psychotic illness.

Bullying is interesting. I have 30 years of experience dealing with families in which a child is reported as being bullied by his peers. There are some distinct subcategories in this: In one subset, when the details are elicited, it turns out the boy in question is as much a perpetrator as a recipient. They taunt one another. But this particular boy tells his mother that Jason called him a “…..” in order to get a reaction from his mother, or to avoid something, or simply to get in front of the call that is going to come from Jason’s mother or the school.

A second subset is the Asperger/ASD child. They are common targets for bullying, precisely because of the way they react to unfairness, teasing, slights, and taunts. It is not kind and it is not good but they have become targets for bullying precisely because of the social deficits they already exhibit. My own survey reported on this site indicates that at least a third to a half of people diagnosed with schizophrenia have had autistic symptoms since infancy. So I would definitely expect a higher proportion of bullied children to develop a psychotic illness. The bullying is not causative, but the prodromal symptoms of the illness “invite” bullying.

Auditory hallucinations are not, in and of themselves, schizophrenia. People, girls, who have suffered prolonged sexual abuse report a higher incidence of auditory hallucinations. This certainly could be understood as persistent trauma of a particularly disorienting kind causing impairment in the brain’s otherwise quite miraculous ability to (usually) locate the locus of a thought or feeling, as well as causing all the other symptoms of PTSD as well.

On the other hand preteen and teen girls with ASD or prodromal symptoms of schizophrenia are vulnerable to predators within a family and neighborhood.

In sum, there are weak associations, though all suffer from our poor definitions and lack of clarity of diagnosis. None are strong enough to be considered causative. And if this were an association between salt intake and hypertension, to publish early causes little harm. (although even here we now have the problem of some people having too little salt in their diet, and other studies showing high salt intake may have nothing to do with hypertension).

But because this overall weak association with all its definition and cause/effect problems could support the existing serious prejudice of parent blaming for schizophrenia, I have to stick with my simple, “No. Neither psychological trauma nor poor parenting cause the serious illness we call schizophrenia.”

Though, of course, either could make it worse.

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13 thoughts on “More on Trauma in Youth and Schizophrenia

  1. I agree with this wholeheartedly. I have a son who had an acute psychotic episode in his second year of college. He recovered with medication, returned to school, and then had another episode. He has been diagnosed with schizoaffective disorder (a close cousin to schizophrenia). Although I was not a perfect mother, my son did not suffer any childhood traumas. We never used corporal punishment on our kids. He was raised in an upper middle class family, had friends, did well in school, had family vacations. He would tell you the same, in case there are those wondering if I am painting an inaccurate picture. Or you could ask his identical twin brother who is leading a normal life. We don’t need to go backwards in blaming parents (particularly mothers) for this devastating illness.

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    1. Yes I agree with Dr Dawson’s take on this. But still a lot of dangerous mother blaming goes on even in medical circles, despite the lack of evidence that mothers have nothing to do with it. . So many people who have had very grave trauma do not develop schizophrenia. The incidence of Sz does not change and the age of onset is remains steady. that should be some kind of clue one would have thought.

      Being driven mad is not something I think happens. If so very different people would succumb to madness. SZ is unfortunately a brain disease like so many other cerebral afflictions.e.g Huntingdon’s Chorea . etc But SZ can often be stabilized and we should be grateful for that. Little comfort but better than nothing .

      Even identical twins are not exactly the same. Some believe that that means one has experienced different things terms of abuse. It does not !

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      1. Doesn’t it make sense that severe trauma might interact with biological vulnerability to produce schizophrenia? And that trauma might be very early, as in the womb. I maintain that schizophrenia is not a brain disease, but a brain vulnerability influenced by epigenetics.

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  2. Thank you for your response, Dr. Dawson, but I must disagree. The study did not show weak associations, rather, there was a three-fold increased likelihood in the incidence of psychotic symptoms in individuals with childhood trauma. The press release reports, “Those that were severely traumatised as children were at a greater risk, in some cases up to 50 times increased risk, than those who experienced trauma to a lesser extent.” Also, the confidence intervals for rape and physical abuse were statistically significant. Other measures, including bullying, were not, but still over 1.

    So it is beyond me why you see no causative association between early trauma and schizophrenia, or at least regard it as an important risk factor. Another paper states, “In the last decade, a substantial number of population-based studies have suggested that childhood trauma is a risk factor for psychosis. In several studies, the effects held after adjusting for a wide range of potentially confounding variables, including genetic liability for psychosis.” (Schafer, et al. Dialogues Clin Neurosci. 2011; 13(3): 360–365.)To dismiss these as just data mining studies seems disingenuous to me. Besides, they are not all meta-analyses; regard the following study. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0170178

    This is not about bad parenting or “mother blaming” as your commenters state. It’s about identifying real risk factors for psychosis beyond pure biology.

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    1. Reply from Dr David Laing Dawson posted by M Ross

      Bruce, you offered a citation to support your last comment. So I read the study carefully, especially the actual results. This was indeed a study and not data mining, but one depending on specific surveys and scales administered to subjects after diagnosis plus controls. The subjects with the diagnoses of schizophrenia, schizophreniform psychosis, and schizoaffective psychosis numbered 77. (Oddly the schizoaffective diagnosis was applied to only one). The controls, presumably free of all psychiatric symptoms and diagnoses, numbered 55. This study is from Capetown.

      Now if I were the Minister of Health for South Africa and I believed this study represented general reality I would insist on ramping up the child protective services, and parent education programs immediately. For the data shows, if taken at face value, that 25 to 30 percent of all their children (and that may be 35 – 40% considering these are self-selected people willing to fill out multiple forms and questionnaires) are severely abused. That is, if true, a distressing figure. A third of all the children being raised in Capetown are significantly abused.

      The authors conclude themselves that there is no difference between the reporting of abuse between the controls and the people diagnosed as suffering from schizophrenia in their study. They then they show their bias by explaining that the high number across the board may be confounding the data.

      When I look at the figures they report and summarize ( 25% of controls and 30% of subjects report significant abuse ) I do notice the 5% difference. With the small sample size this 5% is NOT significant.

      But even if it were significant I could explain that 5% quite easily. I would have expected a higher number in this study. The subjects by definition have been psychotic for over three months. And I have spent many hours of my life sitting with two bewildered parents and a psychotic young man blaming his two parents for everything that has gone wrong in his life, accusing them of outrageous behaviour, from poisoning to mind control. For two things are certain with a young person becoming psychotic: One, the parents are perplexed, confused, bewildered by the words and behaviour of their offspring, and two, the first and common target of delusional blame (the young psychotic’s explanation) is the mother and the father.

      The actual findings of this study are null. But the authors spend many paragraphs before and after the data is presented supporting the very hypothesis the study does NOT support.

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      1. So many studies fit into what the person wants to find.I would be suspicious of such a study in terms of numbers and motivation.
        Bruce Wilson I do not really think that you are really too versed in epidemics. But since i do not know I hesitate to go there. You say

        “I maintain that schizophrenia is not a brain disease, but a brain vulnerability influenced by epigenetics” Consider the matter further… in a little more in depth.

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      2. The authors state that this was a small study and not conclusive by itself. I don’t believe it is a null study but instead one that supports the authors’ hypothesis. i.e. “Our results suggesting that childhood trauma might act largely independently of pre-existing genetic liability, obstetric complications and substance abuse count against a simple cumulative model of the shared effect of adversities on the risk of psychosis.” They also call for further study.

        I am not denying a biological component or vulnerability in schizophrenia. Here is a literature review of the link between schizophrenic symptoms and trauma. http://www.psychrights.org/Articles/ACTAChildhoodTrauma2005.pdf The authors state, “Some environmental factors may show synergism with genetic risk, i.e. genes and environment reinforce each other, so that for example their separate weaker effects become a joint strong effect; other environmental factors may have a strong effect in isolation that however in combination with genetic risk is reduced (antagonism), and yet other environmental effects may “compete” with genetic risk factors to cause psychosis (parallelism).”

        My point in this discussion is that it is foolish (I believe) to downplay or deny any role of trauma in the pathogenesis of schizophrenia, especially if it is out of concern for a misguided concept of “blaming the mother.” It’s time to get beyond that.

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  3. Patricia Forsdyke, I am a medical writer and quite versed in epidemics. The concept of “brain disease” can be applied to any of a number of psychiatric disorders, including depression or addiction or ADHD. It’s a reductionist approach that I feel must come to an end. There is a complex interplay between biology and environment that must always be considered. I know people with schizophrenia who have undergone trauma therapy (along with appropriate medication) and have had their symptoms diminish dramatically, even to the point where they’ve been able to reduce their meds. I maintain that ignoring trauma or denying it as Dr. Dawson does is a big mistake.

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    1. Mea culpa. I meant epigenetic NOT epidemics . Like many illnesses the true underpinnings are yet to be pegged. But there are many false trails and one surely must accept that trauma in many forms is ever present in our complicated lives and is certainly unhelpful but may not produce illnesses. It may not be the defining bit in terms of causation of an illness like Schizophrenia and allied disorders. An artist once said ” I paint what I see and not what I expect to find” Perhaps this applies to science as well painting. Interesting that you bring up reducing medication. I have seen a fair bit of tragedy from that.

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    1. From Dr David Laing Dawson posted by M Ross

      Bruce, you cite another article, this time the précis of a very complicated study. I would have to see the full study to make sense of it, but even the précis ends with the line, “After factoring in (some variables) the significance is reduced to marginal.”

      But let me come at this issue another way. We already know that significant childhood abuse/trauma contributes causally to: self harm, school failure, inability to form stable relationships, underachievement, isolation, distrust, addiction, criminal behavior, violence, perpetuating the abuse in the next generation, incarceration, depression, suicide….

      So even if we did find through a 30 year prospective study (because self-reporting of childhood events, especially when the subject is currently psychotic, is entirely unreliable) – even if we did find a small causal link, that abuse of a genetically or epigenetically vulnerable child increases the risk of the development of schizophrenia by, say, 5 or 10 %, what does that get us? What does that get us beyond vilifying the 90 to 95% of parents of a schizophrenic who did their best?

      We already know that abusing children is a bad thing. We don’t have to keep trying to prove this. If we have money to spend it should be on 1.) Social/educational programs to prevent childhood neglect and/or abuse.
      2.) Education, family planning, contraception to prevent the birth of unwanted children.
      And 3.) Other kinds of potentially fruitful research on autism and schizophrenia

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  4. You wrote, ” What does that get us beyond vilifying the 90 to 95% of parents of a schizophrenic who did their best?” Dr. Dawson, the trauma connection is not about blaming parents. As you know, many forms of early trauma have little to do with parenting. I don’t think that the incidence of schizophrenia in individuals exposed to early trauma is as low as you say it it, but yes,, a long-term, prospective study would be needed to answer this question.

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