Women who have experienced childhood trauma become mothers earlier than those with a more stable childhood environment, according to a new study conducted by the University of Turku and the University of Helsinki in Finland.
The trauma children experience from living in war zones, natural disasters, or perhaps even epidemics, can have unexpected effects that resurface later in their lives.
During the Second World War, thousands of Finnish women and girls volunteered to aid in the war effort as part of the paramilitary organization Lotta Svärd. Tasks within the organization varied greatly, and many of the women performed duties that exposed them to the trauma of war.
Toward the end of the war, girls as young as 14 years of age were entrusted with some of the more demanding jobs usually reserved for adults.
Researcher and lead author of the study Robert Lynch from the University of Turku used extensive data collected on these volunteers to study the effects of childhood trauma on adults.
The study showed that young girls and women who served in the war became mothers earlier and had more children compared to women of the same age who did not participate in the war effort.
“If we can measure the effects of trauma on basic things such as the timing of motherhood, then it almost certainly has major effects on many of our other important behaviors, such as overall aversion to risk, sociality or the pace of sexual development,” explains Lynch.
“This study is groundbreaking because it overcomes many of the pitfalls of research on humans that has made it difficult to know whether trauma is actually the root cause of starting a family at a younger age.
The extensive dataset made it possible for us to compare women before and after the war and also take family background into account by comparing sisters. This is strong evidence in support of the idea that trauma affects reproductive schedules,” adds senior author John Loehr from the University of Helsinki.
The study has clear relevance for the millions of children and adults worldwide who experience trauma through wars. However, relevance likely also extends to other sources of trauma, such as natural disasters or even the current COVID-19 epidemic.
Evolutionary theory predicts that individuals experiencing an unstable environment with high mortality are better off reproducing sooner rather than taking the risk of not having the chance later.
“There appears to be a sensitivity window that extends from childhood into early adulthood where behavior adjusts to match the circumstances experienced. The consequences can be far-reaching, even after the situation stabilizes.
A childhood trauma can influence people’s adult lives in ways that they are unaware of, such as the timing of their motherhood,” explains Academy Professor Virpi Lummaa from the University of Turku.
Childhood trauma, including sexual and physical abuse, but also emotional abuse, emotional neglect and physical neglect (1), is a risk factor of developing mental disorders. Approximately 30% of mental disorders are accounted for exposure to childhood trauma (2).
Substance use disorders (SUD) are among the most frequent mental disorders following traumatic events. SUD occur when the use of a drug (e.g., alcohol, cannabis or cocaine) leads to clinically significant impairment, including health problems, social withdrawal, and failure to meet major responsibilities at work, school or home (3).
SUD are more prevalent in men than in women. For example, seven out of hundred men develop an alcohol use disorder at some point in their life, but only one out of hundred women (4). As SUD are less common in women, women with SUD are generally understudied (5).
Among both men and women with SUD, childhood trauma is highly prevalent. In patients with alcohol use disorders, 22–74% report at least one type of childhood abuse or neglect (6, 7). Female patients more often report severe forms of childhood trauma, particularly sexual abuse (8).
A history of childhood trauma impacts on the development, severity and course of SUD. Patients with alcohol use disorders exposed to childhood trauma develop the disorder at an earlier age (9, 10) and show more severe alcohol abuse (9, 11) than patients without childhood trauma.
Posttraumatic stress disorder (PTSD) is another mental disorder that is closely related to childhood trauma. PTSD is characterized by intrusive memories and nightmares of the trauma, hypervigilance (indicating enhanced threat sensitivity), and avoidance of places, activities or things that could remind a person of the traumatic event (3). Individuals with both SUD and PTSD manifest more severe clinical symptoms and lower psychosocial functioning (12).
In contrast to SUD, PTSD is more common among women: Three out of hundred women develop PTSD at some point of their life, but only one out of hundred men (4). After exposure to a potentially traumatic event, women are more likely to develop PTSD than men (13, 14).
This finding might be explained by biological sex differences, but also by the fact that women are more often exposed to severe forms of interpersonal trauma, particularly sexual abuse (15, 16).
Among patients with alcohol dependence, women show about twice as high rates of a current PTSD (26–27%) than men (14–24%) (17, 18). Similar relationships between gender and SUD have been found for other substances than alcohol.
Women with opioid use disorder, cocaine use disorder, cannabis use disorder or sedative use disorder showed twice as high prevalence rates of a current PTSD (50–53%) compared to men (14–32%) (19, 20).
Given that childhood trauma and PTSD are closely related to SUD (21), particularly in women, trauma exposure should be systematically assessed in this patient group. Thereby, the co-occurrence of different types and severities of childhood trauma should be considered, as most patients with trauma exposure report multiple types of events (6).
The systematic assessment of these profiles of childhood trauma in women with SUD may inform about current mental health problems and related treatment needs. However, no study has identified profiles of childhood trauma in women with SUD and trauma exposure, or has examined how these profiles are related to current health-related outcomes.
So far, childhood trauma profiles have been predominantly examined in male patients with SUD (22–24). Among patients with alcohol dependence, six childhood trauma profiles could be distinguished that comprised different types and severities of trauma (22).
The patients’ trauma profiles were differently associated with current severity of addiction-related problems in the domains of drug use, psychiatric symptoms, family relationships and social relationships.
These results in male patients with alcohol dependence indicated that profiles of childhood trauma may better inform about current severity of addiction-related problems than the common distinction between trauma exposure versus no trauma exposure.
Among male patients with SUD or polysubstance abuse, five childhood trauma profiles could be distinguished that were related to psychiatric problems (24). Tubman et al. (25) distinguished three profiles of childhood trauma in adolescents with SUD that were associated with severity of current psychiatric symptoms.
Although childhood trauma in SUD is closely related to PTSD, profiles of childhood trauma have rarely been examined in patients with SUD and comorbid PTSD. One study (26) assessed three different types of childhood trauma (psychological maltreatment, physical abuse, and sexual abuse) in a sample of trauma exposed clinic-referred adolescents.
The authors assigned the participants to three different trauma groups, according to different combinations of the measured trauma types. Adolescents with both psychological maltreatment and physical abuse showed greater PTSD symptoms than the remaining groups.
In summary, childhood trauma profiles have been identified in different SUD patient groups that were associated with important mental health outcomes in all of the studies that have been conducted so far.
These studies exclusively or predominantly included male patients, and PTSD comorbidity was not assessed. In women with SUD, childhood trauma profiles have not been examined so far. Furthermore, among patients with SUD and comorbid PTSD, childhood trauma profiles are unknown for both male and female patients.
Therefore, the first aim of this research was to investigate profiles of childhood trauma in women with SUD and PTSD. The second aim was to examine the relationships between these childhood trauma profiles and addiction characteristics or current clinical symptoms.
We hypothesized that childhood trauma profiles with a greater number and/or severity of childhood trauma types would show unfavorable addiction characteristics and greater current clinical symptoms, compared to profiles with a lower number and severity of childhood trauma.
In a sample of women with SUD and PTSD, childhood trauma profiles with a greater severity and a higher number of childhood trauma were related to earlier initiation of substance use, earlier age at escalation of substance use and greater severity of a broad range of current clinical symptoms.
According to these findings, childhood trauma profiles can provide a differentiated view about important addiction characteristics and current severity of a wide range of clinical symptoms. This information is essential to inform treatment needs in women with SUD and PTSD.
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More information: Robert Lynch et al, Child volunteers in a women’s paramilitary organization in World War II have accelerated reproductive schedules, Nature Communications (2020). DOI: 10.1038/s41467-020-15703-0