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Am J Psychiatry 1991; 148:10-20
Copyright © 1991 by American Psychiatric Association
Childhood traumas: an outline and overview
LC Terr
Department of Psychiatry, University of California, San Francisco.
Childhood psychic trauma appears to be a crucial etiological factor in the
development of a number of serious disorders both in childhood and in
adulthood. Like childhood rheumatic fever, psychic trauma sets a number of
different problems into motion, any of which may lead to a definable mental
condition. The author suggests four characteristics related to childhood
trauma that appear to last for long periods of life, no matter what
diagnosis the patient eventually receives. These are visualized or
otherwise repeatedly perceived memories of the traumatic event, repetitive
behaviors, trauma-specific fears, and changed attitudes about people, life,
and the future. She divides childhood trauma into two basic types and
defines the findings that can be used to characterize each of these types.
Type I trauma includes full, detailed memories, "omens," and
misperceptions. Type II trauma includes denial and numbing, self-hypnosis
and dissociation, and rage. Crossover conditions often occur after sudden,
shocking deaths or accidents that leave children handicapped. In these
instances, characteristics of both type I and type II childhood traumas
exist side by side. There may be considerable sadness. Each finding of
childhood trauma discussed by the author is illustrated with one or two
case examples.
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