Traumatic Experience and the Mediating Effects of Coping Styles on Psychopathology


by Victoria Moore

Edited by Ernest J. Bordini, Ph.D.

Originally published in Clinical Psychology E-Magazine, Fall 2021

All Rights Reserved Clinical Psychology Associates of North Central Florida  CPANCF.COM   

352 336-2888


Childhood trauma and child maltreatment


Childhood trauma can be defined as the adverse experience or witness by a child of a distressful or painful event or series of events that can negatively impact their mental and physical well-being (Blue Knot Foundation, 2020). Child maltreatment encompasses various forms of abuse and/or neglect, endangering the development and future cognitive functioning of the individual (Vanmeter et al., 2020).


Many researchers and professionals utilize the Childhood Trauma Questionnaire (CTQ) to help assess child maltreatment and trauma. This brief internationally used survey to classify and describe childhood traumas has had some psychometric studies published with generally acceptable reliability, validity and internal consistency (Bernstein et al., 2003) (Humphreys et al., 2020).  The Childhood Trauma Questionnaire breaks child maltreatment down into five categories, as follows (Humphreys et al., 2020):  Emotional Abuse, Physical Abuse, Sexual Abuse, Emotional Neglect and Physical Neglect.


The Adverse Childhood Experiences – International Questionnaire (ACE-IQ) developed by the World Health Organization encompasses trauma associated with environmental violence, including but not limited to the following (World Health Organization, 2018): Alcohol and/or drug abuser in the household; Incarcerated household member; Chronically depressed, mentally ill, institutionalized or suicidal household member; Household member treated violently; One or no parents; Parental separation or divorce; Bullying; Community violence; Collective violence






Measure on the CTQ


Emotional Abuse

Verbal assaults on a child’s sense of worth or well-being or any humiliating or demeaning behavior directed toward a child by an adult or older person”

People in my family called me stupid, lazy or ugly”


-The child was called names by the family

-The parents wished the child were never born

-The child felt hated by the family

-The family said hurtful things to the child

-The child felt emotionally abused

Physical Abuse

Bodily assaults on a child by an adult or older person that posed a risk of or resulted in injury”

People in my family hit me so hard that it left bruises or marks”


-The child was hit hard enough to see a doctor

-The child was hit hard enough to leave bruises

-The child was punished with hard objects

-The child was physically abused

-The child was hit badly enough to be noticed

Sexual Abuse

Sexual contact or conduct between a child younger than 18 years of age and an adult or older person”

Someone threatened to hurt me or tell lies about me unless I did something sexual with them”

-The child was touched sexually

-The child was hurt or threatened if they did not do something sexual

-The child was molested

-The child was sexually abused

Emotional Neglect

The failure of caretakers to meet children’s basic emotional and psychological needs, including love, belonging, nurturance, and support”

*(R) “I knew there was someone to take care of me and protect me”


-(R) The child felt loved

-(R) The child was made to feel important

-(R) The child was looked out for

-(R) The child felt close to the family

-(R) The family was a source of strength for the child

Physical Neglect

The failure of caretakers to provide for a child’s basic physical needs, including food, shelter, clothing, safety, and health care. Poor parental supervision is also included if it places a child’s safety as risk”

(R) “There was someone to take me to the doctor if I needed”


-The child did not have enough to eat

-The parents were drunk or high

-The child wore dirty clothes

-(R) The child was taken care of

-(R) The child got taken to the doctor

(Bernstein et al., 2003)

(Humphreys et al., 2020)

(Majer et al., 2010)

(Bernstein et al., 2003)

(Majer et al., 2010)

(Humphreys et al., 2020)


            *(R) indicates a reverse order item










Brief summary of the effect that childhood trauma has on cognitive development and cognitive functioning in adulthood


There has been largely correlational research supporting the impact of trauma on cognitive development. Studies have hypothesized that structure, function and epigenetics are altered by trauma’s impact on the increased neuroplasticity present in childhood, a period of vital growth and development. Models have suggested that in response to heightened, chronic stress, the body regularly activates its hypothalamic-pituitary-adrenal (HPA) axis, pre-frontal cortex (PFC) and sympathetic-adrenomedullary (SAM) system to maintain homeostasis (Vanmeter et al., 2020) (Vaughn-Coaxum et al., 2018). For more on the physiology of stress see other articles on our website: Stress, Health, Physiology, Mood, Behavior and the Fight-Flight Response ( and Long-term Stress Physiology (


Constant activation is believed to weaken defense and increased risk for physical and mental illness, including cardiovascular and autoimmune diseases (Piotrowski et al., 2020)For more on cardiovascular disease and medical/psychiatric illness see: Cardiovascular Disease, Mood Disturbance, and Cognitive Deficits (


Chronic stress, including emotional abuse, has been correlated with deficiencies in cognitive ability, including working memory and attentional regulation (Vaughn-Coaxum et al., 2018). Furthermore, the prevalence of stress-induced responses in childhood are likely to prime the affected individual to perceive greater threats in the face of stressful situations later in life, diminishing their ability to properly react to and cope with these stressors (Vaughn-Coaxum et al., 2018)


Childhood trauma and associated cognitive impairment have been implied by the onset of a variety of emotional and behavioral problems (Blue Knot Foundation, 2020) (Majer et al., 2010). Studies indicate that the experience of child maltreatment is significantly correlated with depressive symptoms, and that repeated exposure increases the likelihood that one will develop internalizing or externalizing disorders (Piotrowski et al., 2020). A history of childhood trauma has been found to significantly increase the risk of depression, PTSD, anxiety, substance abuse disorders, antisocial behavior, obsessive-compulsive symptoms, chronic fatigue syndrome (CFS) and the development of psychosis and psychiatric hospitalizations (Huffhines et al., 2020) (Humphreys et al., 2020) (Majer et al., 2010) (Piotrowski et al., 2020) (Renkema et al., 2020) (VanMeter et al., 2020).


For more on childhood depression see: Identifying and Helping with Childhood and Adolescent Depression (, and for more on anxiety and PTSD see Anxiety Disorders: The Basics - Generalized Anxiety Disorder, PTSD, Panic Disorder, and Phobias (


History of child maltreatment is significantly more prevalent in patients with an “ultra-high risk (UHR)” of developing psychosis, but this has not been consistently found to be directly linked to the onset of psychosis, supporting the concept that trauma may not be a predominant factor associated with the development of psychotic disorders (Piotrowski et al., 2020).


There has been limited research on more specific or potentially mediating factors involved in this correlation (Vanmeter et al., 2020). There has been some research suggesting maladaptive coping mechanisms mediate the association between trauma and the risk of developing emotional and behavioral problems (Huffhines et al., 2020). The tendency for trauma-exposed individuals to adopt these maladaptive coping mechanisms may further contribute to changes in cognitive functioning and perpetuate predispositions toward psychopathology (Piotrowski et al., 2020).


Coping mechanisms


Coping can be defined as the employment of cognitive and behavioral efforts to deal with the stress associated with internal or external demands (Choi et al., 2015) (Piotrowski et al., 2020). Coping efforts aim to manage, reduce or resolve stress by regulating emotional, behavioral, cognitive and physiological responses to demanding events in one’s environment (Vanmeter et al., 2020).


Categories of coping styles/mechanisms

Text Box: Coping Style	Definition	Responses	Examples
Problem-Focused	Taking action to directly address and reduce the stress associated with a problematic situation	-Seeking help
-Instrumental social or emotional support
-Positive thinking/reframing/humor
-Mindfulness/Breathwork	-Seeing a therapist
-Confiding in friends or family and seeking help
-Viewing the problem as positive or temporary
Emotion-Focused	Focusing on emotional arousal to reduce the stress induced by a problematic situation	-Crying
-Verbal/physical aggression
-Rumination on negative thoughts
-Focus on and venting of emotion	-Crying to elicit comfort or assistance
-Kicking or punching a wall to release painful emotions
Avoidant	Engaging in activities that separate one’s thoughts and emotions from the stress induced by a problematic situation – also known as disengagement coping	-Denial
-Avoidant thinking
-Social isolation
-Social diversion
-Wishful thinking/fantasizing
-Drug/alcohol abuse
-No action	-Denying a problem exists
-Wishing the problem never occurred
-Self-medicating or drinking excessively to dissociate from the stressor
(Vanmeter et al., 2020)	(Piotrowski et al., 2020) (Vanmeter et al., 2020)	(Humphreys et al., 2020) (Vanmeter et al., 2020)
(Vaughn-Coaxum et al., 2018)	(Vanmeter et al., 2020)
(Vaughn-Coaxum et al., 2018)




Coping styles develop in childhood under the influence, instruction and role-modeling of caregivers as well as exposure to media, peers and other socialization experiences. Exposure to positive and effective ways of coping with stress induced by problematic situations is critical in developing healthy coping skills and the development of a conceptual framework for addressing stress independently in the future. Caregiver neglect, poor parenting, modeling of poor coping skills or caregiver failure to provide adequate coping mechanisms for the child to utilize may result in the adoption of negative coping styles and subsequent cognitive dysregulation (Vanmeter et al., 2020).


Chronic stress along with the absence of healthy, adaptive coping styles likely serves to perpetuate the adoption of maladaptive behavior, increasing the risk for psychopathology. Limited experience with adaptive, effective and positive problem-focused coping and exposure to ineffective coping are likely to contribute to traumatized tendencies to adopt emotion-focused and avoidant coping styles. The likelihood of adopting these maladaptive coping strategies increases with the frequency, severity and number of traumas experienced (Vanmeter et al., 2020; Vaughn-Coaxum et al., 2018). Furthermore, individuals with severe trauma histories, especially those involving sexual abuse, commonly utilize avoidant coping styles, using defense mechanisms as safeguards to suppress painful memories of their toxic childhood environments. While this may provide short-term relief, the use of emotion-focused and avoidant coping styles may have lasting, detrimental consequences for both mental and physical health (Choi et al., 2015) (Vanmeter et al., 2020) (Vaughn-Coaxum et al., 2018).


History of trauma has not consistently been found to be correlated with the use of problem-focused coping styles, with some researchers suggesting that trauma-exposed individuals are no more or less likely to engage in problem-focused coping (Vaughn-Coaxum et al., 2018). However, the use of effective problem-focused coping has been found to be associated with positive mental health outcomes, adaptive psychological adjustment and a lower risk for internalizing and externalizing problems (Vanmeter et al., 2020) (Vaughn-Coaxum et al., 2018) (Huffhines et al., 2020). An effective problem-focused approach has been shown to buffer stress responses present in victims of sexual abuse, suggesting that problem-focused coping is associated with the most positive outcomes and the least risk for developing psychopathology (Huffhines et al., 2020).  


Emotion-focused coping has been found to be significantly correlated with maladaptive adjustment and the onset of psychopathology. Studies indicate that engaging in emotion-focused coping is associated with depression, anxiety and other internalizing and externalizing disorders. Maladaptive emotion-focused coping may serve as a mediating factor in the association between childhood trauma and emotional and behavioral problems (Humphreys et al., 2020) (Vanmeter et al., 2020) (Vaugn-Coaxum et al., 2018).


Maladaptive avoidant coping styles have also been linked to negative long-term health outcomes, exacerbating and increasing the risk for symptoms of severe psychopathology, including depression and PTSD (Piotrowski et al., 2020) (Vanmeter et al., 2020) (Vaugn-Coaxum et al., 2018). Despite this, studies indicate that avoidant coping mechanisms can act as safeguards for individuals with especially severe or traumatizing pasts, primarily victims of sexual abuse, chronic abuse and severe neglect (Huffhines et al., 2020). In severe cases, avoidant behavior may temporarily suppress stress and result in lower risk for psychiatric hospitalizations; however, it remains that emotional and behavioral disengagement increase the risk for psychopathology in trauma-exposed youth (Huffhines et al., 2020) (Piotrowski et al., 2020).




Overall, research suggests that even when demographic and biological factors are considered, maladaptive coping is a moderating variable in the association between childhood trauma and the development of psychopathology, (Choi et al., 2015; Vanmeter et al., 2020). Chronic stress, the inability to properly cope with that stress and the consequent adoption of emotion-focused and avoidant coping strategies are likely factors that mediate the link between child maltreatment and internalizing and externalizing problems, especially depression and PTSD (Vanmeter et al., 2020).


Other factors associated with coping methods that trauma-exposed individuals adopt include the severity and frequency of the trauma experienced (Vaughn-Coaxum et al., 2018). Individuals with histories of chronic stress and trauma may become conditioned to be in a constant state of activation, which can contribute to perceptions of people and situations as more threatening or hostile than those of non-afflicted individuals. This perception amplifies the tendency to adopt emotion-focused coping mechanisms, increasing the risk for developing psychopathology, primarily depression, anxiety and PTSD. Emotion-focused coping mechanisms are thus another likely factor mediating the link between childhood trauma and internalizing and externalizing symptoms, in all cases (Vanmeter et al., 2020) (Vaughn-Coaxum et al., 2018).




Strategies for reducing the risk and development of psychopathology include employing interventions aimed at reducing the engagement in negative emotion-focused coping in individuals with histories of childhood trauma and maltreatment (Vanmeter et al., 2020). Moreover, implementing the development of healthier, more effective forms of coping, such as the problem-focused techniques stated in the table above, are likely also key to ameliorating the lasting effects of childhood trauma and child maltreatment.


Individuals with PTSD and more severe histories of trauma report higher levels of post-trauma related guilt, another factor that likely mediates the relationship between trauma and avoidant coping mechanisms. Remediations with such individuals should therefore also involve interventions for trauma-related guilt (Street et al., 2005).


Programs such as the Nurse Family Partnership and the Positive Parenting Program aim to educate families and caregivers on the proper care necessary to raise healthy individuals (Humphreys et al., 2020).


Licensed psychologists at Clinical Psychology Associates of North Central Florida (CPANCF.COM) and elsewhere are skilled in using a variety of cognitive-behavioral and other psychotherapeutic approaches for the accurate diagnosis of PTSD and other trauma-related disorders for dealing with trauma-related symptoms, and for developing more effective coping mechanismsCosts can vary, not all providers take insurance, and in these times, there unfortunately may be limited availability of in-network providers, large copayments or large deductibles.


If you cannot afford or are unable to access private care and you feel that you or a loved one have experienced childhood trauma or maltreatment, you can use to find free or reduced-cost healthcare services near you.  In Alachua County, 24/7-hour support is also provided by Alachua County’s Crisis Hotline at 352.264.6789. The National Suicide Hotline is also available nation-wide at 1.800.273.8255.


Seeking help is the first effective step toward the difficult but worthwhile process of healing.



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Blue Knot Foundation. (2020). What is childhood trauma? National Centre of Excellence for Complex Trauma.

Choi, K. C., Sikkema, K. J., Velloza, J., Marais, A., Jose, C., Stein, D. J., Watt, M. H., Joska, J. A. (2015). Maladaptive coping mediates the influence of childhood trauma on depression and PTSD among pregnant women in South Africa. Archives of Women’s Mental Health, 18, 731-738.

Huffhines, L., Jackson, Y., Stone, K. J. (2020). Internalizing, externalizing problems and psychiatric hospitalizations: examination of maltreatment chronicity and coping style in adolescents in foster care. Journal of Child & Adolescent Trauma.

Humphreys, K. L., LeMoult, J., Wear, J. G., Piersiak, H. A., Lee, A., Gotlib, I. H. (2020). Child maltreatment and depression: a meta-analysis of studies using the Childhood Trauma Questionnaire. Child Abuse & Neglect, 102.

Majer, M., Nater, U. M., Lin, J. S., Capuron, L., Reeves, W. C. (2010). Association of childhood trauma with cognitive function in healthy adults: a pilot study. BMC Neurology, 10(31).

Piotrowski, P., Frydecka, D., Kotowicz, K., Stancyzkiewicz, B., Samochowiec, J., Szczygiel, K., Misiak, B. (2020). A history of childhood trauma and allostatic load in patients with psychotic disorders with respect to stress coping strategies. Psychoneuroendocrinology, 115.

Renkema, T. C., Haan, L., Schirmbeck, F. (2020). Childhood trauma and coping in patients with psychotic disorders and obsessive-compulsive symptoms and in un-affected siblings. Child Abuse & Neglect, 99.

Street, A. E., Gibson, L. E., Holohan, D. R. (2005). Impact of childhood traumatic events, trauma-related guilt, and avoidant coping strategies on PTSD symptoms in female survivors of domestic violence. Journal of Traumatic Stress, 18(3), 245-252. doi: 10.1002/jts.20026

VanMeter, F., Handley, E. D., Cicchetti, D. (2020). The role of coping strategies in the pathway between child maltreatment and internalizing and externalizing behaviors. Child Abuse & Neglect, 101. doi: 10.1016/j.chiabu.2019

Vaughn-Coaxum, R. A., Wang, Y., Kiely, J., Weisz, J. R., Dunn, E. C. (2018). Associations between trauma type, timing, and accumulation on current coping behaviors in adolescents: results from a large, population-based sample. J Youth Adolescence, 47, 842-858. doi: 10.1007/s10964-017-0693-5

World Health Organization (2018). Adverse childhood experiences international questionnaire (ACE-IQ). Guidance for Analysing ACE-IQ.


Victoria Moore wrote the current article as part of her office internship with Clinical Psychology Associates of North Central Florida. University of Florida students are eligible for credit through the University of Florida Psychology Department.


Ernest J. Bordini, Ph.D. is a clinical and forensic neuropsychologist serving children, adolescents and adults in our Gainesville and Ocala Offices. He is Executive Director of Clinical Psychology Associates of North Central Florida. Gainesville, Florida 352.336.2888 and owner/editor of For more information visit CPANCF.COM or FORENSICNEUROPSYCHOLOGY.COM  He has been named Distinguished Psychologist by the Florida Psychological Association.