**4. Conclusion**

This chapter aimed to provide an overview of the long-term repercussions of childhood interpersonal trauma that persist in adulthood. This literature review demonstrates the extent to which childhood interpersonal trauma impacts multiple spheres of adult functioning, ranging from classic posttraumatic stress to violence in intimate relationships or sexual dissatisfaction. These outcomes, often considered as direct consequences of early interpersonal trauma, might also be causal mechanisms that trigger or exacerbate the onset of a series of psychological and relational difficulties in adulthood.

As such, trauma-related symptoms often extend beyond posttraumatic stress in an array of complex symptoms including depression, self-destructive behaviors, dissociation, substance abuse, somatic symptoms, and high comorbidity with other psychological disorders [31, 51, 53, 68]. For instance, affect regulation difficulties and posttraumatic stress following childhood interpersonal trauma might enhance the risk of experiencing IPV in adult survivors [52, 100, 210]. Interferences in the sense of attachment security may also preclude maintenance or reestablishment of emotional equanimity during and following trauma, thereby contributing to the formation of posttraumatic stress symptoms [166]. In contrast, if internal or external sources of support can be mobilized during or after a traumatic event, attachment security could act, at least to some extent, as a protective shield against the development of emotional problems following trauma, including posttraumatic stress symptoms [166]. Another example of the intermediate role of childhood interpersonal trauma repercussions to explain posttraumatic stress is the presence of peritraumatic dissociation that occurs during or immediately after a traumatic experience that appears to be strongly and consistently related to the presence of posttraumatic stress symptoms in adulthood [224].

In response to these shortcomings, researchers have suggested that children who grow up with violence, through social learning mechanisms and the influence of temperament or personality factors, may be more prone to develop an aggressive interpersonal style that is related to violence in intimate relationships [218, 219]. According to the bioecological perspective [220], individuals biologically inherit traits and tendencies that are strengthened or weakened by their relational experiences. This suggests that although early victimization continues to have an impact on adult functioning, this influence will be partly explained by other relational risk and protective factors that interact with the experience of early interpersonal trauma [216]. Consequently, a number of researchers have examined situational factors, usually pertaining to communication or conflicts that set the stage for violent interactions between romantic partners [216, 221, 222]. By combining these theoretical perspectives, IPV can thus be considered as a dynamic process that emerges as a result of early and situational relational experiences, learning processes, and biological affective dispositions [216]. Nevertheless, the fact that the strength of the relationship between early interpersonal trauma and adult IPV varies across studies calls for further studies exploring the mechanisms that might explain why some survivors of childhood interpersonal trauma experience IPV during adulthood while others do not [97]. For instance, Arata et al. [223] have suggested that the experience of multiple types of childhood interpersonal trauma, known to generate more important and complex repercussions than a single type of interpersonal trauma, could partly explain these different

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

This chapter aimed to provide an overview of the long-term repercussions of childhood interpersonal trauma that persist in adulthood. This literature review demonstrates the extent to which childhood interpersonal trauma impacts multiple spheres of adult functioning, ranging from classic posttraumatic stress to violence in intimate relationships or sexual dissatisfaction. These outcomes, often considered as direct consequences of early interpersonal trauma, might also be causal mechanisms that trigger or exacerbate the onset of a series of

As such, trauma-related symptoms often extend beyond posttraumatic stress in an array of complex symptoms including depression, self-destructive behaviors, dissociation, substance abuse, somatic symptoms, and high comorbidity with other psychological disorders [31, 51, 53, 68]. For instance, affect regulation difficulties and posttraumatic stress following childhood interpersonal trauma might enhance the risk of experiencing IPV in adult survivors [52, 100, 210]. Interferences in the sense of attachment security may also preclude maintenance or reestablishment of emotional equanimity during and following trauma, thereby contributing to the formation of posttraumatic stress symptoms [166]. In contrast, if internal or external sources of support can be mobilized during or after a traumatic event, attachment security could act, at least to some extent, as a protective shield against the development of emotional problems following trauma, including posttraumatic stress symptoms [166]. Another example of the intermediate role of childhood interpersonal trauma repercussions to explain posttrau-

trajectories.

**4. Conclusion**

psychological and relational difficulties in adulthood.

However, following decades of research and prevention campaigns and despite dreadful consequences and economic effects (15M per year in judicial, health, education, employment, and personal costs in Canada [225]), early interpersonal trauma remains an understudied phenomenon, especially with regard to the identification of protective factors, such as partner support or certain personality traits, that might temper its effects on psychological and relational adult functioning. In addition, early relationships are a crucial part of the psychosocial scaffolding on which adult psycho-relational health rests yet, since personal history, relational experiences, and psychological adjustment are interrelated, future studies must consider multiple variables [13]. The challenges associated with the development of such studies lie in the plethora of intrapersonal, environmental, and interpersonal variables that must be examined but are better studied using longitudinal and systemic research protocols. As such, future studies should aim at following childhood interpersonal trauma survivors throughout as many years as possible, while assessing specific variables in the survivor's close relationships (e.g., parental, social and partner support). Integrative models, including both psychological and relational variables should also be examined in order to better understand the survivor's psychological and social development following childhood interpersonal trauma.

Also, given the substantial proportion of individuals who report any experience of childhood interpersonal trauma, health professionals are likely to encounter patients with trauma history. In this regard, they must acknowledge how these early experiences can shape both psychological and interpersonal functioning in order to properly evaluate and provide a treatment that is well-suited to survivors' needs and capacities. By recognizing the lasting and pernicious effects of childhood interpersonal trauma, therapists will be more able to validate the survivor's traumatic experience. Moreover, with the assistance of a secure and sincere therapeutic alliance, therapists who work with trauma survivors should be able to provide a warm, safe, and empathic environment that will help survivors in cultivating a new conception of interpersonal relationships. Thus, by providing a space to create new representations of the self and of others, therapists will grant survivors with a sense of hope and a feeling that their traumatic experience or actual symptoms do not define who they are.

Being aware that childhood interpersonal trauma survivors may lack self-regulatory or relational skills might also give therapists a sense of the importance of gradual exposure that will allow the survivor to develop new abilities and experiences [24]. In cases where a survivor's romantic relationship is characterized by emotional depth, relationship satisfaction, and adjustment, this particular relationship can also participate in a powerful healing experience. Indeed, healthy romantic relationships can foster a survivor's adjustment by facilitating a reorganization of dysfunctional schemes and cognitive processes that were developed in the context of childhood interpersonal trauma. In the same way as a sincere therapeutic alliance, romantic relationships can provide a space to explore new healthy relationship dynamics that will foster the survivor's psychosocial adjustment through the promotion of positive representations of self, others, and the outside world [176].
