A Conceptual Framework for the Long-Term Psychological Effects of Traumatic Childhood Abuse

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Abstract
Although trauma is not an intrinsic part of all child abuse, the impact of some abuse may be best conceptualized from a traumatic stress perspective. The authors first propose three critical elements that make some abuse traumatic. They then describe the response at the time of trauma and the processes that lead to persistence of that response. Reexperiencing and avoidance are proposed as the core trauma responses, and six secondary and associated symptoms are also described. In addition, the influences on long-term adjustment of biological factors, developmental level at the time of abuse, severity of abuse, social context, and prior and subsequent life events are discussed. The authors' conceptual framework is applied to make specific predictions about the relationships between particular abuse characteristics and later symptoms, and research on adults with histories of child abuse and on abused children is reviewed for consistency with these predictions.