Childhood Sexual Abuse May Be A Risk Factor For Later Psychotic Illness

Main Category: Psychology / Psychiatry
Also Included In: Pediatrics / Children’s HealthMental HealthSchizophrenia
Article Date: 02 Dec 2010 – 0:00 PST

An Australian study suggests that children who are sexually abused, especially if it involves penetration, appear to be at higher risk for developing schizophrenia and other psychotic disorders, according to a report in the November issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

Previous studies have established that abused children are more likely to develop depression, anxiety, substance abuse, borderline personality disorders, posttraumatic stress disorder and suicidal behavior, according to background information in the article. “The possibility of a link between childhood sexual abuse and later psychotic disorders, however, remains unresolved despite the claims of some that a causal link has been established to schizophrenia,” the authors write

Margaret C. Cutajar, D.Psych., M.A.P.S., of Monash University, Victoria, Australia, and colleagues linked data from police and medical examinations of sexual abuse cases to a statewide register of psychiatric cases. Rates of psychiatric disorders among 2,759 individuals who had been sexually abused when younger than age 16 were compared with those among 4,938 individuals in a comparison group drawn from electoral records.

Over a 30-year period, individuals who had experienced childhood sexual abuse had significantly higher rates than those in the comparison group of psychosis overall (2.8 percent vs. 1.4 percent) and schizophrenia disorders (1.9 percent vs. 0.7 percent). Participants experienced abuse at an average age of 10.2, and 1,732 (63 percent) of cases involved penetration of a bodily orifice by a penis, finger or other object. Those exposed to this type of abuse had higher rates of psychosis (3.4 percent) and schizophrenia (2.4 percent).

“The risks of subsequently developing a schizophrenic syndrome were greatest in victims subjected to penetrative abuse in the peripubertal and postpubertal years from 12 to 16 years and among those abused by more than one perpetrator,” the authors write. “Children raped in early adolescence by more than one perpetrator had a risk of developing psychotic syndromes 15 times greater than for the general population.”

The results establish childhood sexual abuse as a risk factor for psychotic illness, but do not necessarily translate into abuse causing or increasing the risk of developing such a disease, the authors note. Many cases of childhood sexual abuse never come to light, and the overall population of abused children maybe significantly different from those whose abuse is detected by officials.

“Establishing that severe childhood sexual abuse is a risk factor for schizophrenia does have important clinical implications irrespective of questions of causality and irrespective of whether those whose abuse is revealed are typical,” the authors conclude. “Children who come to attention following childhood sexual abuse involving penetration, particularly in the peripubertal and postpubertal period, should receive ongoing clinical and social support in the knowledge that they are at greater risk of developing a psychotic illness.”

“Such treatment in our opinion should focus on improving their current functioning and adaptation to the demands of the transition from adolescent to adult roles rather than primarily on the abuse experience itself. Such an approach should benefit all victims, irrespective of whether they have the potential to develop a psychotic illness.”

(Arch Gen Psychiatry. 2010;67[11]:1114-1119.)

Archives of General Psychiatry

Sugar May Lessen Aggression

By RICK NAUERT PHD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on December 1, 2010

Have you ever wanted to calm someone down? Researchers say a spoonful of sugar may do the trick — at least for a short time, and if the friend is not a diabetic.

Investigators discovered people who drank a glass of lemonade sweetened with sugar acted less aggressively toward a stranger a few minutes later than did people who consumed lemonade with a sugar substitute.

Researchers believe it all has to do with the glucose, a simple sugar that provides energy.

“Avoiding aggressive impulses takes self-control, and self-control takes a lot of energy. Glucose provides that energy in the brain,” said Brad Bushman, Ph.D., an Ohio State University professor and a co-author of the study.

“Drinking sweetened lemonade helped provide the short-term energy needed to avoid lashing out at others.”

The finding is more than just a medical curiosity, Bushman said.

In two published papers, he and his colleagues did several studies showing that people who have trouble metabolizing, or using, glucose in their bodies show more evidence of aggression and less willingness to forgive others.

The problem is that the number of people who have trouble metabolizing glucose — mainly those with diabetes — is rising rapidly to put it mildly. From 1980 through 2008, the number of Americans with diabetes has more than tripled (from 5.6 million to 18.1 million).

“Diabetes may not only harm yourself — it is bad for society,” Bushman said.

“The healthy metabolism of glucose may contribute to a more peaceful society by providing people with a higher level of energy for self-control.”

Bushman conducted the lemonade study with C. Nathan DeWall and Timothy Deckman of the University of Kentucky and Matthew Gailllot of SUNY-Albany. It appears online in the journal Aggressive Behavior and will be published in a future print edition.

In the study, 62 college students fasted for three hours to reduce glucose instability. They were told they were going to participate in a taste-test study, and then have their reaction times evaluated in a computerized test against an opponent.

Half of the participants were given lemonade sweetened with sugar, while the others were given lemonade with a sugar substitute.

After waiting eight minutes to allow the glucose to be absorbed in their bloodstream, the participants took part in the reaction test.

The reaction test has been used and verified in other studies as a way to measure aggression. Participants were told they and an unseen partner would press a button as fast as possible in 25 trials, and whoever was slower would receive a blast of white noise through their headphones.

At the beginning of each trial, participants set the level of noise their partner would receive if they were slower. The noise was rated on a scale of 1 to 10 — from 60 decibels to 105 decibels (about the same volume as a smoke alarm).

Each participant randomly won 12 of the 25 trials.

Aggression was measured by the noise intensity participants chose on the first trial — before they were provoked by their partner.

Results showed that participants who drank the lemonade sweetened with sugar behaved less aggressively than those who drank lemonade with a sugar substitute.

Those who drank the sugar-sweetened beverage chose a noise level averaging 4.8 out of 10, while those with the sugar substitute averaged 6.06.

“To our knowledge, this is the first study to find that boosting glucose levels can reduce actual aggressive behavior,” Bushman said.

“To be sure, consuming sugar should not be considered a panacea for curbing aggression. But the results do suggest that people who reportedly ‘snap’ with aggression may need some way to boost their mental energy, so they can override their aggressive impulses.”

In two other studies in the same paper, the researchers showed how problems metabolizing glucose may translate to problems on a societal level. Using 2001 data, the researchers found that the diabetes rates for each of the 50 states were linked to violent crime rates.

Those states with higher diabetes rates also tended to have higher rates of murder, assault, rape and robbery, even after controlling for poverty rates in each state.

“This suggests that diabetes did not predict violent crime simply because poverty contributes to both diabetes and violent crime,” he said. “There is a real correlation between diabetes and violence.”

In a separate analysis, the researchers tested whether another medical problem related to glucose metabolism was linked to violence worldwide.

They examined the prevalence, in the populations of 122 countries around the world, of a deficiency in an enzyme called glucose-6-phosphate dehydrogenase. This enzyme is related to glucose metabolism. It is the most common enzyme deficiency in the world, afflicting more than 400 million people.

Countries with higher levels of the disorder also had more violent killings, even outside of war.

“Taken together, these studies offer different types of evidence linking low glucose and other problems metabolizing glucose with aggression and violence,” Bushman said.

The findings were further corroborated in another series of studies, published recently in the journal Personality and Individual Differences.

In that paper, Bushman and DeWall, along with University of Kentucky researcher Richard Pond, had participants complete a commonly used and well-accepted checklist that measures the number and severity of Type 2 diabetes symptoms, such as numbness in the feet, shortness of breath at night, and overall sense of fatigue. In three separate studies, the same participants completed different measures of their willingness to forgive others.

On all three measures, people with higher levels of diabetic symptoms were less likely to forgive others for their transgressions.

In a fourth study, participants took part in a prisoner’s dilemma game, which is often used to understand how people deal with conflict. In this version, participants had to choose whether to cooperate or compete against an unseen partner in a computer game.

“We were especially interested in how participants responded when their partner behaved in an uncooperative, antagonizing manner when the game began,” Bushman said. “Would they forgive their partner or would they refuse to cooperate?”

Results showed that those who scored higher on diabetic symptoms were less likely to forgive an initially uncooperative partner, when compared to those who scored lower on diabetic symptoms.

“These studies are more evidence that diabetic symptoms may cause difficulty in how people relate to each other on a day-to-day basis,” Bushman said.

“It’s not an excuse, diabetes does not mean people have to act aggressively, but it may shed some light on why these behaviors occur.”

“With the rate of diabetes increasing worldwide, it is something that should concern all of us.”

Source: Ohio State University

Eating Disorders: Identifying Warning Signs in Children

Melinda Hutchings

Posted: November 30, 2010 01:19 AM

In Western society, we have relative freedom of choice when it comes to thoughts and action. Yet the prevalence of eating disorders continues to climb, and the percentage of young people partaking in destructive behaviors is reaching disturbing proportions.

Today an ABC news article highlighted a recent report from the American Academy of Pediatrics which warns doctors that eating disorders are happening to children at an alarming rate.

“People tend to have this idea of who gets eating disorders, but an eating disorder doesn’t discriminate between age, gender, race, or class,” says Johanna Kandel, founder and director of the Alliance for Eating Disorders Awareness, based in Florida.

“Some research says that as much as ten percent of those with eating disorders are under the age of ten. What I’m finding at the alliance is that the number of parents seeking help for their 7-, 8-, 9-year-olds is escalating rapidly,” she says.

The articles goes on to mention how a 2009 analysis found that in the last decade, hospitalizations for eating disorders more than doubled among children under twelve and now account for four percent of all such hospitalizations.

“Pediatricians need to be aware of the early symptoms of eating disorders because they are the medical professional that a child is mostly likely to see in any given year,” says Dr. Jim Lock, director of the Eating Disorder Program at Packard Children’s Hospital. “They are the gatekeepers.”

In a recent media interview, I was asked whether it is my personal belief that negative body image in children is perpetuated by images portrayed in the media. I believe young girls and boys are susceptible to falling into disordered eating patterns if they are suffering low self esteem, and a common trigger is images of extreme thinness.

The average child in the UK, US and Australia sees between 20,000 and 40,000 television advertisements per year. They are bombarded with images about how they should look and what they should own. Children struggle to keep up, suffering from anxiety, stress and lower satisfaction in themselves. (1)

In Australia, societal pressure is taking its toll on our young people. More than two thirds of 15 year old girls are on a diet (2) and a quarter of children diagnosed with anorexia nervosa are boys (3).

Now more than ever, it is important that parents and caregivers become aware of the early warning signs and observe their child’s behavior around food.

Here are five tips that will help you identify if your child is developing an eating issue:

1. Eat with your child as often as you can so that you become familiar with their eating habits; lead by example in terms of eating a healthy, balanced meal.
2. Watch for changes in your child’s eating habits, especially anything that appears unusually strict and lasts for several weeks.
3. Listen to the language your child uses around food. If they start talking about diets, calorific content or complain that they are fat (when they’re not) this indicates a negative shift in their feelings towards food.
4. Watch for a change in disposition. If your child displays hostility around meal times they could be experiencing internal conflict towards food.
5. If your child eats large amounts of food constantly but doesn’t realise how much they are eating, or isn’t enjoying it, especially during times of stress, this could indicate obsessive eating.

In my book Why Can’t I Look the Way I Want; Overcoming Eating Issues, there is a chapter dedicated to the early warning signs. These signs are subtle and can be passed off as ‘normal’ behavior – unless you know what to look for. Some common warning signs are avoiding eating with the family or in public, becoming obsessed with food preparation, adopting a tag such as ‘vegan’ in order to cut out entire food groups under the guise of being ‘healthy’, ritualistic behavior such as cutting food into tiny pieces, insisting that meals are eaten at a particular time each day and a fixation on using the same crockery and cutlery.

There are also warning signs before the warning signs. If your child is constantly complaining of headaches or fatigue and appears to have trouble coping at school, this could indicate that something deeper is going on. It is worth finding out what is causing this change in your child in the event there is a psychological issue that needs to be addressed.

Whilst images in the media can heighten our children’s anxiety when it comes to self image and body image, becoming vigilant about the early warning signs means there is a very real chance of catching the behavior early on. Early intervention is critical in reframing the mindset before a full blown eating disorder takes hold.

(1) Williams, Z 2006, The Commercialisation of Children, Compass, London
(2) Patton, G.C., Selzer, R., Coffey, C.,Carlin J.B. and Wolfe, R. (1999), ‘Onset of adolescent eating disorders: population based cohort study over 3 years’, British Medical Journal, vol. 318, pp. 765-8
(3) Paxton, S. (1998), ‘Do men get eating disorders?’, Everybody – Newsletter of Body Image and Health Inc., vol. 2, August, p. 41

Discovery Of Biological Changes In Patients Who Are Suicidal And Depressed May Lead To Novel Treatments

On November 29, 2010, in Depression, Immunology, by Christopher Fisher, PhD

Depressed and suicidal individuals have low levels of the stress hormone cortisol in their blood and saliva. They also have substances in their spinal fluid that suggest there is increased inflammation in the brain. These findings could help to develop new methods for diagnosing and treating suicidal patients.

Dr. Daniel Lindqvist from the Psychoimmunology Unit at Lund University is presenting these results in his PhD thesis. He is part of a research group led by Dr Lena Brundin, which sees inflammation in the brain as a strong contributory factor to depression. This is a new theory that challenges the prevalent view that depression is only due to a lack of the substances serotonin and noradrenaline.

“However, current serotonin-based medication cures far from all of the patients treated. We believe that inflammation is the first step in the development of depression and that this in turn affects serotonin and noradrenaline”, says Daniel Lindqvist.

One of the articles in his thesis shows that suicidal patients had unusually high levels of inflammation-related substances (cytokines) in their spinal fluid. The levels were highest in patients who had been diagnosed with major depression or who had made violent suicide attempts, e.g. attempting to hang themselves.

The research group at the Division of Psychiatry in Lund is now getting ready to conduct a treatment study based on its theory. Depressed patients will be treated with anti-inflammatory medication in the hope that their symptoms will be reduced.

The researchers believe that the cause of the inflammation that sets off the process could vary. It could be serious influenza, or an auto-immune disease, such as rheumatism, or a serious allergy that leads to inflammation in the body. A certain genetic vulnerability is probably also required, i.e. certain gene variants that make some people more sensitive than others.

Other studies in Daniel Lindqvist’s thesis show that patients with depression and a serious intention of committing suicide had low levels of the stress hormone cortisol in their blood. The cortisol levels were also low in saliva samples from individuals several years after a suicide attempt. This has been interpreted to mean that the depressed patients’ mental suffering led to a sort of ‘breakdown’ in the stress system, resulting in low levels of stress hormones.

“It is easy to take and analyse blood and saliva samples. Cortisol and inflammation substances could therefore be used as markers for suicide risk and depth of depression”, says Daniel Lindqvist.

Material adapted from Lund University.

Seasonal Affective Disorder: How to Beat ‘Winter Depression’

Lloyd I. Sederer, MD

Posted: November 23, 2010 08:32 AM

It was about 25 years ago when Sam consulted me about what had become almost a clockwise event in his life, and an unwelcome one. He lived in northern New England and was an executive in the hospital industry. For a number of years as the days grew short in the fall so did his mood. By late October, or early November, his energy began to wane and his usual can-do attitude became riddled with doubt. He felt depressed and discouraged. He fought to deliver at his usual high level of performance, but it was really hard to do. Regardless of what he did there was no relief until April or May when the depressive shroud lifted and he was back to being his usual self.

Seasonal Affective Disorder (SAD), sometimes called “winter depression,” became widely recognized as a psychiatric diagnosis in the mid-1980s. Medical literature on this condition dates back to the early 1970s and was familiar to its sufferers well before the mid-1980s. SAD is more than having lower energy in the doldrums of winter — it is a clinical depression – but one characterized by seasonal variation and that returns like a bad dream for more than one year. That was what Sam had and there was relief in sight.

When I told Sam that he could try bright lights to help his depressive symptoms, he liked that idea. He was not keen on medications and while better disposed to therapy, particularly problem solving therapy, the prospect of waking early and sitting before a lamp and doing his paperwork fit far more into his already overscheduled routine. And it also made sense to him since when nature’s light dwindled so did his usual internal blaze.

A very reliable questionnaire for depression that individuals can use is called the “Patient Health Questionnaire-9” (the PHQ-9). This simple test asks you nine questions about mood, energy, sleep, appetite, concentration and feelings about yourself. Each question asks the respondent to score from “not at all” to “nearly every day” so there is a composite score that can be as high as 27. Over 10 is suggestive of a depression, and over 20 is highly suggestive of a severe depression. Almost like a blood pressure, this short questionnaire can identify a problem with very high confidence.

What makes SAD different is not its symptoms of depression, but its seasonal nature. It is a seasonal depression. Sometimes there is a seasonal heightening of mood in the spring (though this is far less common). What also makes SAD different is that it can be treated with light.

I suggested to Sam that he get hold of full spectrum lights and sit before them for at least a half hour first thing in the morning. Back then the technology was far less advanced and the devices far clunkier than they are today. After a couple of weeks he noticed he felt better. He looked forward to his light treatments — even getting a morning head start on the unending paper work that seems to bedevil all of us, not just administrators. When spring came he carefully and slowly decreased his use of the lights and nature took over. But when October came the following fall he had his light box ready to go. He needed it and it served him well.

Twenty-five years later has led to considerable research on SAD and what are optimal wavelengths of light that should be delivered at what times of day for how long. Early morning light for 30 minutes, with the convenience of administering at home, seems to work best for most people, but not all. The best time to begin is usually shortly before a person normally awakes, but there can be considerable variation from person to person at the very least related to when someone goes to sleep. The choice of wavelength and device are best discussed with the doctor who is making the diagnosis and treating the depressive condition.

Right now, all around the northern hemisphere, some people are noticing that the shortening of days is affecting their mood. When seasonal mood problems reach the level of a clinical depression, something needs to be done — and can be done. What often gets left off the list of treatments for depression, which typically are antidepressant medications and therapy (especially cognitive-behavioral therapy or CBT), is light. For many with SAD, light treatment will be safe, effective and affordable. If you think you have this condition, talk to your doctor about lighting up your day, and your mood.

The opinions expressed herein are solely my own as a psychiatrist and public health advocate.