Running head: PTSD AND CHILDHOOD PHYSICAL ABUSE

University of Southern California

School of Social Work
SOWK 503 2015
Post-Traumatic Stress Disorder & Childhood Physical Abuse: Analyzing the Biological,
Psychological & Social Impact
By:
Daniel R. Gaita, Kathryn Bullock & Katie M. Austin
December 12, 2015
Professor Siegal

PTSD AND CHILDHOOD PHYSICAL ABUSE

Abstract
As societies continue to develop and humanity continues to evolve, the social work field has
proven itself instrumental in delving deeper into the root causes of social dysfunction, behavioral
challenges, cognitive development, and environmental factors that impact every individual,
locally as well as globally. Research studies and repeated data outcomes continually demonstrate
that young children who are exposed to physical abuse or witness interpersonal violence in the
home are at a higher risk for developing post-traumatic stress disorder (PTSD) (Lieberman,
Ippen & Van Horn, 2006; Cohen, & Mannarino, 1996), depression, heart disease, drug abuse, as
well as experiencing incarceration and premature death (Felitti et al., 1998). Herein, the authors
will investigate the impact that childhood physical abuse has on the development of PTSD and
its consequential impacts on biological, psychological, social, and environmental outcomes for
individuals and society.

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Post-Traumatic Stress Disorder & Childhood Physical Abuse: Analyzing the Biological,
Psychological & Social Impact
I. Definitions
A. Post-Traumatic Stress Disorder (PTSD)
The Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM5) (American
Psychiatric Association, 2013) is the most widely accepted nomenclature used by both clinicians
and researchers for the classification of mental disorders. For that reason, we will rely upon its
definition of PTSD for the purposes of this work. Diagnostic criteria for PTSD include a history
of exposure to a traumatic event that meets specific stipulations and symptoms from each of four
symptom clusters: intrusion, avoidance, negative alterations in cognitions and mood, and
alterations in arousal and reactivity (American Psychiatric Association, 2013).
B. PTSD Symptom Clusters
Intrusion symptoms. Intrusion symptoms are defined as the re-experiencing of symptoms via
recurrent and intrusive distressing recollections of the/an event(s) (American Psychiatric
Association, 2013). Re-experiencing includes memories of the traumatic event, recurrent dreams
related to it, flashbacks or other intense or prolonged psychological distress.
Avoidance symptoms & negative alterations in cognitions and mood. Avoidance symptoms
are displayed as a variety of symptoms such as loss of interest, restricted range of affect,
detachment from loved ones, avoidance of thoughts and feelings related to the trauma,
sense of foreshortened future, and inability to recall an important aspect of the event
(American Psychiatric Association, 2013). Avoidance refers to distressing memories, thoughts,
feelings or external reminders of the event. Negative cognitions and moods represent myriad
feelings, such as having a persistent and distorted sense of blame of self or others, estrangement

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from others or markedly diminished interest in activities, and in some cases an inability to
remember key aspects of the event.
Increased arousal symptoms. Symptoms such as irritable behavior, reckless or destructive
behavior, hyper vigilance, exaggerated startle response, problems with concentration, and
sleep disturbances often accompany marked alterations in arousal and reactivity associated
with trauma (American Psychiatric Association, 2013). Thus, arousal is marked by aggressive,
reckless or self-destructive behavior; sleep disturbances, hyper-vigilance or other related
problems.
C. Childhood Physical Abuse
For the purposes of this work, the authors will cover the effects of only one form of child
abuse, physical abuse. There are 2.9 million reports of child physical abuse every year in the
United States (Safe Horizon, n.d.). Whereby children are subjected to, or are victims of, trauma
associated with being: pushed, grabbed, shoved, slapped, or hit so hard that marks were left, or
physically injured. Often, this type of physical abuse is accompanied by psychological abuse in
which a child is frequently sworn at, insulted, put down, or made to fear for his or her physical
safety. Additionally, research has linked this type of physical abuse with associated experiences
wherein a child witnesses his or her mother also being abused, beaten, kicked, slapped, punched,
or threatened with a knife or gun (Felitti et al., 1998). It will be this area of child abuse that the
authors investigate with respect to the onset and impacts of post-traumatic stress disorder.
II. Biological Aspects
A. Physical
The stress produced from childhood physical abuse can potentially derail an individuals
human development throughout his or her entire life if he or she does not have the necessary

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emotional and physical support (Gunnar, 2011). Physical abuse in childhood creates stress on the
body that can predispose these children to a raised non-specific inflammatory profile (Ferrara,
2014). In other words, these children have increased chances of developing diseases caused by a
decrease in their immune function (Ferrara, 2014). Studies indicate that 28% of children exposed
to physical abuse will exhibit a chronic health condition within three years of the abuse (Centers
for Disease Control and Prevention, 2013). This type of PTSD also has the potential to become
hard coded into the genome, resulting in epigenetic memory of the events (Ferrara, 2014). This
change in DNA has the potential to lead to health problems later in life (Ferrara, 2014). Some of
these health problems include infection, obesity, asthma, cardiovascular disease, hypertension,
hyperlipidemia, metabolic abnormalities, ischemic heart disease, cancer, chronic lung disease,
skeletal fractures, and liver disease (Anda et al., 2006; Brown, Anda, & Henning, 2009; Duncan,
Saunders, Kilpatrick, Hanson & Resnick, 1996; Lang, Laffaye, & Satz, 2006; Myers, 2002;
Felitti et al., 1998; Anda et al., 2006).
B. Neurobiological
Synaptogenesis, the formation of synapses in the nervous system, is affected by the
quality of care given in early childhood (Applegate, 2005). If a child were physically abused
during early childhood, then their neural circuits would receive a negative effect (Applegate,
2005). These early childhood experiences of physical abuse also impact the adult number of
synapses in the frontal lobe, which is the area controlling reason and comprehension (Nelson,
2011). Among the neural circuits negatively affected are the amygdala, which manages fear
responses, and the prefrontal cortex, which regulates mood as well as emotional and cognitive
responses (Anda et al., 2006).

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Furthermore, continual physical abuse produces abnormal changes in an individuals

hypothalamic-pituitary adrenal (HPA) axis function, or changes in the bodys hormones (Ferrara,
P., 2014). Changes in the HPA axis lead to elevated corticosterone stress hormone levels, which
reduce the number of hippocampal neurons (Teicher, Anderson, & Polcari, 2012). There are
many psychiatric disorders associated with reduction in hippocampal neurons, such as PTSD,
depression, and schizophrenia (Teicher et al., 2012).
III. Psychological Aspects
Repeated studies continue to link childhood physical abuse to the development of PTSD
and other symptoms. Hence, researchers continue to witness the growing list of negative health
outcomes and high probability of engagement in harmful behaviors in this population due to the
development of PTSD (Godfrey, Lindamer, Mostoufi, & Afari, 2013). The high level of stress
experienced from childhood physical abuse can be reflected through numerous psychological
factors. Considerable amounts of literature repeatedly associate significantly increased
vulnerability to depression and anxiety disorders with those experiencing markedly increased
levels of childhood physical abuse (Penza, Heim, & Nemeroff, 2003).
In addition, individuals who have experienced childhood physical abuse are susceptible
to trauma spectrum disorders, which is the condition of having multiple psychiatric disorders
at once (Anda et al., 2006, p. 182). Some of these disorders include PTSD, substance abuse,
dissociative disorder, depression, schizophrenia, anxiety and borderline personality disorder
(Anda et al., 2006). Certainly, these individuals can also experience multiple disorders at
different times during their development process, and in different conditions (Cicchetti & Toth,
1995). For instance, an individual with PTSD as a result of physical child abuse may stop

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experiencing anxiety after he or she develops a substance abuse disorder. Consequently, that
individual might then develop depression as a result.
IV. Social Aspects
A common characteristic of individuals with PTSD who have experienced childhood
physical abuse is difficulty managing stress and controlling anger, impeding their ability to form
substantial, long-term, attachments or relationships throughout their lives (Anda et al., 2006). For
example, many individuals that experience PTSD are unable to obtain or maintain gainful
employment, which further relegates them to poverty and its cycle of repeated and continual
oppression through loss of dignity and self-respect. This inability to regulate anger for these
individuals is also linked to intimate partner violence (IPV) (Iverson, McLaughlin, Adair, &
Monson, 2014). Conversely, these individuals (particularly women) who have experienced
childhood physical abuse are also more susceptible to become victims in IPV in adulthood
(Iverson et. al, 2014).
Moreover, attainments of standardized levels of educational achievement are often
delayed due to repeated trauma and the impact it has on cognitive development. This has a
multiplier effect on society and holds the abused back from higher levels of education due to
symptoms suffered as a result of child abuse. With marked and diminished interest or
participation in previously enjoyed activities, many victims of abuse find themselves socially
isolated and develop a quick temper, which can lead to aggressive behavior with little or no
provocation (American Psychiatric Association, 2013).
Moreover, research continues to repeatedly demonstrate how those that suffer from
physical childhood abuse are also more likely to experience increased behavioral health risks;
such as promiscuous sexual activity with multiple partners, alcoholism, drug abuse, smoking,

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violence and criminal activity (Anda, 2006; Brown, 2009; Duncan, 1996; Lang, 2006; Myers,
2002; Felitti et al., 1998). As the data and evidence mount through repeated research and
longitudinal studies, it is becoming obvious that childhood physical abuse is not only a precursor
to problematic behavior as a child and developing adolescent, but also poses a probable threat to
adult behavior through manifestation of far greater and dangerous activity if the damage done is
not treated through effective evidence-based interventions.
V. Social Work Implications & Policy Advocacy
Social workers must adhere to the National Association of Social Workers (NASW) code
of ethics when assisting clients. This code emphasizes cultural competency, social diversity,
respect, impartiality, and providing justice to individuals who are socially and politically
dominated or exploited (NASW, n.d.). When a social worker assists a client who has experienced
physical childhood abuse, it is critical to determine if they are in immediate danger of
experiencing further abuse in their current environment, such as a child with abusive parents or
an adult victim of IPV.
If they were in eminent danger, then the social worker would need to take action to bring
that individual into a safe environment. Next, the social worker must assess, or refer the child to
specialists who can assess, the individuals biological, psychological, and social development.
The social worker would then take into consideration the clients physical and social
environments to aid in therapy progress.
Social workers promote policy advocacy for PTSD victims of physical child abuse
through preventative measures and rehabilitation. For instance, offering parenting classes to
prevent physical child abuse and providing rehabilitative treatment to prevent abusers from
further acts of abuse. These preventative and rehabilitative programs are often attained by social

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workers efforts through lobbying and collaborating with communities, politicians, and even
businesses. There are various types of organizations that social workers are able to launch these
programs and policies within, such as private non-profit, private for-profit, and public agencies.
VI. Theoretical/Developmental Perspectives
A. Psychodynamic Theory
Psychodynamic theory explores the concept that what an individual endures in his or her
childhood will influence his or her personality as an adult. Humans are born with the ambition to
develop self, and predisposition to the individuals external environment can define the
individuals future self (Borden, 2009, p. 93). When psychodynamic theory is applied to
childhood abuse, the theory explains that if a child experiences abuse, then his or her future is
predisposed to abuse. Additionally, the child him or herself may continue abuse onto other
children.
Psychodynamic theory aids in the understanding of childhood abuse, which can lead to
PTSD. Individuals that suffer from PTSD pertaining to childhood physical abuse might
experience problems regulating emotions and interpersonal relationships (Woller, Leichsenring,
Leweke, Kruse, 2012, pp. 70). Psychodynamic theory further explores the depth of trust and
relationship issues that develop later in life when a child experiences PTSD (Woller et. all, 2012,
pp. 70).
There are limitations to psychodynamic theory in regards to childhood abuse, more
specifically to PTSD. One limitation is that not all children who suffer from abuse will fail to
overcome the trauma; this is a weakness to applying psychodynamic theory to childhood abuse.
For example, if two children both experience abuse as a child they are both predisposed to abuse
in the future (Borden, 2009). However, one child may not experience abuse in the future if

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proper steps were taken to aide the child, this might include some form of therapy with a social
worker. The difficulty with this is that often times abuse is not discovered until a child is much
older. While childhood abuse is a lasting trauma, it can be overcome. Strength to applying
psychodynamic theory to individuals with PTSD from physical childhood abuse is that children
who experience abuse might have different personality traits than non-abused children as an
adult that can be understood through the application of this theory. These traits might include, but
are not limited to, aggression, anger, fear, and violence.
B. Attachment Theory
The stress that a child might experience after a traumatic event could limit the childs
ability to attach to another individual. Attachment theory is the individuals ability to develop a
strong bond to that of another individual (Bowbly, 1979, p.127), which is important when
children have experienced a traumatic event such as abuse. A physically abused child may
experience an array of emotions and personality changes after a traumatic event. However,
through attachment, the child will be able to seek out support for his or her needs. Children who
experience trauma such as childhood abuse are at risk for a heightened level of detachment,
depression, and anxiety disorders (Penza, 2003, p.15).
Children that suffer from childhood abuse that results in PTSD have issues in regards to
basic attachment relationships (Woller, et all. 2012, pp. 70). Attachment theory explains
childrens attachment styles and the age that these styles will be seen (Bowbly, 1979). If there is
an interruption of this such as childhood abuse then the individuals who attachment style will be
disrupted. Through the heightened level of detachment (Penza, 2003), an individual with PTSD
may not be able to develop and stay on track with normal attachment development.

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One of the greatest limitations to attachment theory the lack of specification on how the
attachment can still form if it is interrupted. More specifically being if a child experiences abuse
what can be done to keep the child on target for attachment development. Conversely, a
significant strength to attachment theory in regards to childhood abuse is the explanation of
attachment development.
C. Object Relations Theory
Object relations theory explores the experiences a child has in his or her infancy and
early childhood years and how this will impact his or her relations with other people (Flanagan,
2011). Applying this theory to childhood abuse demonstrates that a physically abused child will
seek out other relationships that provide that same experience. More specifically, if a mother
abuses a child, that child might then have problems in relationships with other women. However,
it is possible to change these interactions through changing the external factors that contributed
to the abuse in an individuals childhood. The external factors might include things such as the
removal from the environment in which the abuse occurred.
It is important in applying object relations theory to keep in mind the concept that this
specific theory explores the psychological side as well as the physical side (Flanagan, 2011).
Therefore, just like our body digests food that we put in our mouths, our mind processes
experiences with others (Flanagan, 2011, pp. 121). If a child experiences child hood abuse that
experience is fed into the mind and stored there. It is remembered, which leads to PTSD.
One limitation to applying object relations theory to childhood abuse is that is focuses on
how early childhood experiences will affect the child in adulthood. While some might not view
this as a limitation, it is limiting. It focuses on early childhood experiences and not experiences
throughout childhood. Furthermore, it does not focus in great detail on how to change the childs

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experience so that they do not affect the child in adulthood. It is possible to change behaviors and
PTSD side effects through counseling and other forms of therapy. If this is done, it would be
important to identify triggers with the individual and how to cope once a trigger is experienced.
However, strength of applying this theory to childhood physical abuse is the explanation that
childhood experiences do impact every individual throughout their lives. Therefore, looking into
childhood experiences can help evaluate an individuals physical and emotional condition as an
adult.

VII. Conclusion
The culmination of research, studies, and data cited herein clearly demonstrate the strong
prevalence, likelihood, and probability of development of PTSD following childhood physical
abuse. As the DSM-5 details, PTSD is the result of exposure to actual or threatened serious
injury, violence, traumatic events, or even witnessing or learning about traumatic events
(American Psychiatric Association, 2013, pp. 272-273).

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We have also learned that PTSD symptoms such as negative alterations in cognition,
irritable behavior, angry outburst, recklessness, self-destructive behavior, sleep disturbances,
impairment in social functions are commonly observed in children exposed to abusive and
traumatic environments. Additionally, there are the accompanying symptoms of fear, guilt,
sadness, shame, confusion, and avoidance of social functions, people, conversations, or even
interpersonal situations that arouse recollections of the trauma/abuse (American Psychiatric
Association, 2013, pp. 274-275)
Additionally, we have learned that PTSD is also associated with high levels of physical,
social, and economic disability and that these tend to result in higher levels of medical
utilization. Furthermore, the associated impaired functions exhibited by those suffering from
PTSD transcend social, interpersonal, developmental, educational, physical health, and
occupational domains (American Psychiatric Association, 2013, pp. 278-279).
Equally as worrisome is the high probability (80%) that individuals with PTSD are more
likely to develop at least one other mental disorder, such as depression, bipolar, anxiety, or
substance abuse, with comorbid substance use disorder and conduct disorder more common
among males than females. There is also considerable comorbidity between PTSD and major
neurocognitive disorders with symptoms overlapping between these and other disorders
(American Psychiatric Association, 2013, pp. 280)
The research results are clear, repeated, and provide the information relied upon to link
childhood physical abuse to onset of PTSD and myriad disabling symptoms that accompany the
disorder. Further, we have detailed how these symptoms manifest in the neurological, biological,
psychological, and social realms of human development across the lifecycle.

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While treatment is not the topic of this analysis, our efforts and information herein
would be remiss if we failed to highlight the efficacy of cognitive behavioral therapy (CBT)
techniques being used today to enable social workers to free victims of childhood physical abuse
from the long-term and lingering symptoms suffered as a result (Institute of Medicine, 2008;
Kuehn, 2008; Cahill, & Foa, 2007; Rausch, & Foa, 2005).

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