Childhood trauma from a patient and a psychoanalyst perspective: linking chronic depression to relational multiple trauma

The relationship between multiple childhood trauma, as well as adversity, and chronic depression has been reported repeatedly. However, there is a lack of clinical differentiations of these findings. We complemented patient self-ratings, using the Childhood Trauma Questionnaire (CTQ), with psychoanalysts' perspectives in order to provide finer grained clinical differentiations of the trauma behind chronic depression. These differentiations connect the trauma scales with early relational experiences. We developed a bespoke instrument derived from psychoanalytic trauma concepts. A subsample of 52 cases of chronically depressed patients alongside their 24 psychoanalysts was taken from the LAC depression study, in order to complement patient and psychoanalyst ratings. Our results confirm the connection between multiple childhood trauma and chronic depression. Besides relational trauma, the psychoanalysts' perspective found separation trauma and transgenerational transmission of trauma to be significant. These traumatic relationships seem to precede and accompany adverse life events and/or traumatic experiences. They may even prevent adequate coping and/or processing of such experiences. Patient interview material from study intake and five-year follow-up further provides an insight into the changes the trauma narratives undergo throughout time. These changes emerged due to a joint reconstruction of the meaning of traumatic experiences throughout the course of the psychoanalytic process.