PROBLEM. Adverse childhood experiences have been found to be a strong predictor of emotional and physical problems in adulthood. However, the long-term sequelae for children who have suffered critical illness and exposure to invasive medical procedures are less well documented.

METHODS. This is a case study of an adult client who sought treatment for depression and attention deficit disorder. The psychotherapy treatment is discussed and the use of eye movement desensitization and reprocessing (EMDR) is described targeting a memory of a medical trauma resulting from a tonsillectomy when the client was 8 years old.

CONCLUSIONS. Significant healing outcomes were attained as a result of the therapy, i.e., decreased depression, less hypervigilance, and increased ability to concentrate, which resulted in the discontinuation of medication for depression and ADHD as well as significant improvement in overall functioning.

Search terms: Childhood trauma, EMDR, psychodynamic psychotherapy

Adverse childhood experiences have been found to be a strong predictor of emotional and physical problems in adulthood (Felitti et al., 1998). In a study of almost 10,000 participants in a medical setting, those with histories of being abused as a child were found to be at 1.6-2.9 times greater risk for cancer, chronic lung disease, skeletal fractures, hepatitis, diabetes, stroke, liver disease, and ischemie cardiac disease. In addition to these findings, the incidence of alcoholism, depression, drug abuse, and suicide was 4-12 times greater than for those without a history of abuse. Risk factors such as smoking, obesity, and promiscuity also increased significantly for adults who have suffered trauma as children.
Perry (2002) says that long-term consequences of childhood trauma include: attachment problems, eating disorders, depression, suicidal behavior, anxiety, alcoholism, violent behavior, mood disorders, and posttraumatic stress disorder. When left untreated, childhood trauma contributes to a multitude of physical and mental health problems throughout the life span. Researchers have found that trauma causes lasting neuronal and hormonal changes which shape brain structures and functioning, which then can have profound effects on all dimensions of development, social, cognitive, biological, and emotional (van der KoIk, 2003).

However, the long-term sequelae for children who have suffered critical illness and exposure to invasive medical procedures are less well documented. Shortterm behavioral responses have been documented during hospitalization. It is thought that the severity of the illness and the developmental level of the child most likely influence the subsequent responses to such events. The younger the child, the more seriously ill and invasive the procedures, the more likely the child is to have ongoing adverse affects and posttraumatic stress disorder (Rennick, Johnston, Dougherty, Platt, & Ritchie, 2002). One study of 43 children from ages 5-12 found that children undergoing cardiac surgery are at risk for developing PTSD, especially if the ICU stay is prolonged (Connolly, McClowry, Hayman, Mahony, & Artman, 2004). Postoperatively, PTSD symptoms increased in 23% of the children, with 12% meeting the criteria for a diagnosis of PTSD. No child had PTSD preoperatively. Wintgrens, Boileau, and Robacy (1997) believe that emergency interventions after accidents and painful, repeated medical procedures are traumas that could lead to posttraumatic stress reactions, but this has not been tested.

In addition to the effects of the trauma on the child, the parents are also affected, which in turn affects the child. Parental uncertainty related to survival of their child has been found to have a profound impact upon the child after a life-threatening childhood illness (Santacroce, 2003). A parent, who has had to face the loss of a child, suffers from an emotional trauma that may interfere with the ability to connect and nurture and the parent may unknowingly distance, which affects caretaking ability. This paper presents a case study of a client who suffered a significant medical trauma when he was 8 years old and his treatment as an adult in psychoanalytic psychotherapy using eye movement desensitization and reprocessing (EMDR) to target that trauma.