**1. Introduction**

Childhood exposure to maltreatment, or early interpersonal trauma, is considered as an endemic health issue with tragic personal, social and economic repercussions [1, 2]. Recent

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

international and US national studies show its alarming prevalence [3, 4], with 61% of children who have experienced at least one type of interpersonal trauma and more than one-third who report two or more additional types of interpersonal violence. Moreover, numerous studies have shown that exposure to interpersonal trauma during childhood can chronically and pervasively alter social, psychological, and cognitive development [5, 6]. Indeed, childhood interpersonal trauma is associated with a plethora of serious short-term [7, 8] and life-long consequences [9] such as impaired physical and mental health, increased incidence of affect dysregulation, alterations in attention and consciousness, identity impairments, and interpersonal difficulties [10, 1, 4]. In the past few years, this area of research has expanded from depictions of the prevalence of interpersonal trauma in various populations to the documentation of its possible repercussions, and identification of risk and protective factors that contribute to adaptation or lack thereof in the wake of early interpersonal trauma [11].

This chapter aims to present a comprehensive narrative literature review of the repercussions associated with exposure to childhood interpersonal trauma. First, the nature and different forms of childhood maltreatment will be described. Subsequently, a review of the studies documenting disruptions in psychological and interpersonal functioning and the mechanisms explaining the development of each of these repercussions will be unraveled. This review was conducted using two different strategies. First, pertinent keywords in various combinations (e.g., "childhood interpersonal trauma" AND "effects" OR "repercussions"; "child interpersonal maltreatment" AND "personality disorders" OR "psychological disorders" OR "posttraumatic stress disorder"; "childhood maltreatment" AND "interpersonal relationships"; "child abuse" AND "attachment") were used to search PsycINFO and PubMed databases, up to January 2016, for relevant English or French language peer-reviewed articles and books. Subsequently, the references of the identified articles and chapters were examined to find additional pertinent papers. In accordance with the results of the research conducted, the childhood interpersonal trauma aftereffects that will be addressed in this chapter include posttraumatic stress disorder, anxiety disorders, depression, personality disorders, affect dysregulation, substance use disorders, eating disorders, suicidal behaviors, alterations in attention and consciousness, disruptions in attributions, attachment, sexuality and violence in intimate relationships.

### **2. Childhood interpersonal trauma**

Psychological, physical, and sexual abuse, neglect, and witnessing interparental violence before 18 years of age consist of different forms of childhood interpersonal trauma as they result in actual or potential harm to a child's health, survival, development, or dignity in the context of a relationship of responsibility, trust, or power [4]. According to Briere [12], childhood interpersonal trauma can be divided into two categories: acts of omission and acts of commission. Acts of omission refer to the incapacity or refusal of caregivers to adopt interpersonal behaviors essential to the development of a child, such as sustained responsiveness and availability, so that he or she is deprived of care, support, and psychological stimulation [12, 13]. Acts of omission include both psychological and physical neglect. Psychological neglect is defined as the experience of having been ignored or not felt loved nor understood by a caregiver. Physical neglect is defined as not having received regular meals, baths, clean clothes, needed medical attention or having been confined in a room alone for extended periods of time [14]. According to a recent meta-analysis [15], psychological neglect is reported by 18% of the general population and physical neglect by 16%.

international and US national studies show its alarming prevalence [3, 4], with 61% of children who have experienced at least one type of interpersonal trauma and more than one-third who report two or more additional types of interpersonal violence. Moreover, numerous studies have shown that exposure to interpersonal trauma during childhood can chronically and pervasively alter social, psychological, and cognitive development [5, 6]. Indeed, childhood interpersonal trauma is associated with a plethora of serious short-term [7, 8] and life-long consequences [9] such as impaired physical and mental health, increased incidence of affect dysregulation, alterations in attention and consciousness, identity impairments, and interpersonal difficulties [10, 1, 4]. In the past few years, this area of research has expanded from depictions of the prevalence of interpersonal trauma in various populations to the documentation of its possible repercussions, and identification of risk and protective factors that contribute to adaptation or lack thereof in the wake of early interpersonal trauma [11].

72 A Multidimensional Approach to Post-Traumatic Stress Disorder - from Theory to Practice

This chapter aims to present a comprehensive narrative literature review of the repercussions associated with exposure to childhood interpersonal trauma. First, the nature and different forms of childhood maltreatment will be described. Subsequently, a review of the studies documenting disruptions in psychological and interpersonal functioning and the mechanisms explaining the development of each of these repercussions will be unraveled. This review was conducted using two different strategies. First, pertinent keywords in various combinations (e.g., "childhood interpersonal trauma" AND "effects" OR "repercussions"; "child interpersonal maltreatment" AND "personality disorders" OR "psychological disorders" OR "posttraumatic stress disorder"; "childhood maltreatment" AND "interpersonal relationships"; "child abuse" AND "attachment") were used to search PsycINFO and PubMed databases, up to January 2016, for relevant English or French language peer-reviewed articles and books. Subsequently, the references of the identified articles and chapters were examined to find additional pertinent papers. In accordance with the results of the research conducted, the childhood interpersonal trauma aftereffects that will be addressed in this chapter include posttraumatic stress disorder, anxiety disorders, depression, personality disorders, affect dysregulation, substance use disorders, eating disorders, suicidal behaviors, alterations in attention and consciousness, disruptions in attributions, attachment, sexuality and violence in

Psychological, physical, and sexual abuse, neglect, and witnessing interparental violence before 18 years of age consist of different forms of childhood interpersonal trauma as they result in actual or potential harm to a child's health, survival, development, or dignity in the context of a relationship of responsibility, trust, or power [4]. According to Briere [12], childhood interpersonal trauma can be divided into two categories: acts of omission and acts of commission. Acts of omission refer to the incapacity or refusal of caregivers to adopt interpersonal behaviors essential to the development of a child, such as sustained responsiveness and availability, so that he or she is deprived of care, support, and psychological stimulation [12, 13]. Acts of omission include both psychological and physical neglect. Psychological

intimate relationships.

**2. Childhood interpersonal trauma**

Unlike acts of omission, acts of commission involve abusive behaviors such as psychological, physical, or sexual abuse directed toward the child [12]. Psychological abuse describes the repeated experience of humiliation, blame, criticism, rejection, threats, or insults from the caregiver [16]. This form of abuse affects 36–46% of the general population [17, 18]. Physical abuse refers to the experience of physical contacts or constraints perpetrated with the intention of injuring the child. These abusive acts include punching, kicking, slapping, shoving, pushing, and beating with an object [19]. In the general population, 31–42% of men and 21–33% of women report having sustained physical abuse during childhood [17, 18]. According to Canada's legal dispositions, sexual abuse is defined as any sexual contact between a child under 16 years of age and a person at least 5 years older [20]. North American prevalence rates for childhood sexual abuse exhibit considerable variability across studies but tend to confirm that 10% of men and 20% of women report this type of interpersonal trauma [21]. Another form of childhood interpersonal trauma is being exposed to interparental violence. In 2007, according to the *Youth Protection Act*, exposure to interparental violence has been added to the reasons compromising a child's development [22]. Specifically, exposure to this kind of violence is defined as the observation, between the parents or parental figures, of physical aggression, sexual coercion, psychological harassment, or more general constraint or coercion [23]. Data from the *Canadian Incidence Study of Reported Child Abuse and Neglect* indicate that up to 26% of children are exposed to psychological or physical interparental violence [22].

Interestingly, early interpersonal trauma not only produces compelling and long-lasting psychological and relational maladjustment, but it is also related to a greater probability of sustaining additional interpersonal trauma during childhood and later in life. This vulnerability is referred to as *revictimization* [24, 25]. Substantial evidence suggests that individuals exposed to one category of interpersonal trauma during childhood are also likely to have experienced other types of victimization [26]. Research increasingly points to the experience of multiple types of interpersonal trauma, referred to as polyvictimization [3, 27, 28] and cumulative trauma [29]. Some researchers also refer to this phenomenon as complex childhood trauma since it encompasses exposure to multiple, often prolonged or extended developmentally adverse traumatic events that occur early in life [5, 24, 30]. Typically, these constructs refer to the experience of some combination of psychological, physical, and sexual abuse, psychological and physical neglect, and exposure to interparental violence and are operationalized as the total number of different types of interpersonal victimization experienced by a given individual [8, 17, 10, 31].

Studies are generally consistent in finding that experiencing multiple types of childhood interpersonal trauma may be particularly detrimental since it is related to more severe and complex psychological and relational consequences, both in childhood and adulthood, when compared to exposure to a single type of interpersonal trauma [8, 10, 32–34]. Indeed, cumulative or complex interpersonal trauma not only increases the risk of posttraumatic stress symptoms but can also result in an intricate pattern of psycho-relational symptoms [24].
