ABSTRACT

It is misleading to think of the effects of severe physical or sexual abuse (or both) in childhood exclusively in terms of posttraumatic stress disorder (PTSD). Almost two thirds of children with documented abuse, severe enough to warrant removal from the home, do not show PTSD but instead a variety of other psychiatric syndromes. In terms of understanding these diverse reactions, ranging from dissociative identity disorder and borderline personality disorder to depression, substance abuse, and attention-deficit/hyper-activity disorder, research indicates that fundamental alterations of the stress-management systems of the brain and body seem to be involved.

This chapter reviews current knowledge about these basic systemic changes secondary to early trauma and severe stress while offering an intriguing reconceptualization of their significance. The authors argue that though extremely costly socially and physiologically, and potentially leading to maladaptive strategies in a benign social world, the altered functioning of brain and body, seen in severely abused children, is potentially valuable in fostering survival in a hostile and abusive world.