Beyond event-based trauma: a developmental perspective

These findings should be interpreted considering that the retrospective assessment of traumatic events, although anchored in the most significant variable for their psychological consequences (i.e. the subjective memory and feeling of having undergone these events), ^{Reference Danese and Widom3,Reference Poletti, Gebhardt and Raballo4} may probably catch only isolated, acute occurrences, while potentially overlooking deeper, less apparent dimensions of trauma. Beneath the surface threshold of easily observable and recollectable events, the main hidden part of traumatic experiences is composed of a structural and pervasive ecology of relational adversity, ^{Reference Schuder, Lyons-Ruth and Osofsky5} hampering the psychological development of the child through ages and stages. For example, starting from the crucial sensorimotor period, both sensorimotor exploration and interpersonal attunement are mediated by parental sensitivity and the quality of emerging attachment between the infant and the caregiver. Persistently inadequate parental stimulation and responsiveness (i.e. menacing the child’s security and neglecting needs) may interfere with the ontogenesis of a solid sense of self in relation to the implicit feeling of agency (i.e. the implicit subjective experience of intentionally controlling one’s own acts that arises when the predicted outcome matches the actual one), not supporting the infant’s sensorimotor exploration of their environment and limiting experiences of joint attention in which the infant implicitly learns to perceive themselves as capable of capturing and directing the caregiver’s attention. ^{Reference Poletti and Raballo6}

Polyvictimisation as developmental disruptor

From this perspective, the earlier the exposure to such an environment, the greater the potential longitudinal psychiatric risk. Nonetheless both exposure and risk may fall below the coarse granularity of event-based definitions of trauma, as they do not necessarily sediment in biographically macroscopic aspects such as major episodic memories or explicit recollections. Instead, these adverse experiences may subtly inscribe themselves in the implicit and procedural domains of memory, shaping the child’s relational patterns, emotion regulation and developmental trajectory in ways that are often difficult to articulate or quantify. Indeed, the later developmental risk is mediated by more severe intermediate consequences for psychological development, particularly in areas such as attachment, sense of agency, relational trust, interpersonal sensitivity and emotion regulation. Notably, these psychological consequences of traumatic environments tend to coalesce and manifest during infancy and childhood, often masked by dissociative and defensive mechanisms. They may later emerge as overt psychopathological symptoms during adolescence, a well-known critical sensitive period for identity formation and the consolidation of personality traits. From this vantage point, ‘polyvictimisation’ ^{Reference Stangeland, Aakvaag, Baumann-Larsen, Wentzel-Larsen, Ottesen and Zwart1} is not merely a series of discrete abusive events. Rather, it represents a structurally fragmenting environment that profoundly disrupts critical developmental processes. Each stressor, be it direct interpersonal harm, chronic emotional neglect or the subtle instability of a dysfunctional household, contributes to a layered ecosystem of insecurity extended across time. Over time, these experiences shape an individual’s pattern of implicit self, attachment, relational patterns, internal narratives and emotion regulation strategies that may collapse when facing the developmental challenges of adolescence, thereby increasing the risk of later developing several psychiatric manifestations, such as psychosis, adjustment and stress disorders, personality disorders and substance use disorders. ^{Reference Stangeland, Aakvaag, Baumann-Larsen, Wentzel-Larsen, Ottesen and Zwart1,Reference McKay, Cannon, Chambers, Conroy, Coughlan and Dodd2} This is because such cumulative layering may undermine or gradually erode the capacity for resilience and adaptive growth, making the emergence of psychiatric symptoms in young adulthood less an isolated ‘outcome’ and more a natural consequence of prolonged developmental derailment.

Rethinking the dose–response model of trauma

Integrating this broader conceptualisation also helps reinterpreting the apparent dose–response relationship between trauma and risk of later psychiatric manifestations. Rather than merely signifying more traumas leading to more severe pathology, it illuminates how each additional type of adversity acts as another thread in a complex weave of developmental multiple-layer derailment. In this perspective, the presence of multiple adverse and/or potentially traumatic events or conditions serves as a discrete indicator of the likelihood of continuous, daily exposure in childhood to an adverse environment. The retrospective memory of individuals prompted by interviewers to recall past experiences may better retrieve discrete situations rather than the overall affective atmosphere and subjective experience in which they were constantly immersed while growing up. This should lead clinicians to consider that recalled adverse childhood events just represent a proxy of the psychological and continuous experience lived by the child. In other words, moving beyond event-based definitions of trauma to embrace a broader, relational and developmental framework may enhance our ability to identify and address the full spectrum of trauma’s impact, targeting these deeply embedded developmental disruptions.

Intergenerational transmission of risk

In recent papers ^{Reference Poletti, Preti and Raballo7–Reference Raballo, Poletti and Preti9} we outlined that families affected by psychiatric illness could represent a peculiar ecological niche in which the intergenerational transmission of severe mental disorders is boosted by the hyper-aggregation of genetic plus early and late environmental risk factors, including chronic exposure from early years to enduring non-protective familial conditions, somehow connected to parental mental illness. With such an understanding, early intervention on a modifiable risk factor such as parenting is a strategically intuitive way to pragmatically attempt reducing the intergenerational transmission of severe mental disorders, limiting the potential impact of parental mental illness on shaping familial environment at risk of aggregating adversity for children (i.e. polyvictimisation). The implementation of such preventive intervention supporting parenting and offered to an a priori at-risk category (parents with a severe mental illness) could be the first step before attempting interventions at the population level, lacking data on their feasibility and efficacy.

Trauma-informed supported parenting can strive to restore relational continuity, bolster regulatory capacities and re-establish developmental momentum. In other words, clinical and public health strategies can focus on creating supportive relational environments and culturally informed community structures. Doing so acknowledges that healing is not merely about addressing individual ‘traumatic incidents’, but rather realigning disrupted developmental processes and reintegrating fragmented experiences.

In conclusion, seeing trauma as a pervasive, developmental phenomenon rather than an isolated insult enriches the interpretation of this study’s findings, guiding more nuanced prevention efforts, tailored interventions and policies that address the deep relational and ecological roots of mental health challenges.