A Pilot Study Investigating the Role of Gender in the Intergenerational Relationships between Gene Expression, Chronic Pain, and Adverse Childhood Experiences in a Clinical Sample of Youth with Chronic Pain

Chronic pain is a highly prevalent and costly issue that often emerges during childhood or adolescence and persists into adulthood. Adverse childhood experiences (ACEs) increase risk for several adverse health conditions, including chronic pain. Recent evidence suggests that parental trauma (ACEs, post-traumatic stress disorder (PTSD) symptoms) confers risk of poor health outcomes in their children. Intergenerational relationships between parental trauma and child chronic pain may be mediated by epigenetic mechanisms. A clinical sample of youth with chronic pain and their parents completed psychometrically sound questionnaires assessing ACEs, PTSD symptoms, and chronic pain, and provided a saliva sample. These were used to investigate the intergenerational relationships between four epigenetic biomarkers (COMT, DRD2, GR, and SERT), trauma, and chronic pain. The results indicated that the significant biomarkers were dependent upon the gender of the child, wherein parental ACEs significantly correlated with changes in DRD2 expression in female children and altered COMT expression in the parents of male children. Additionally, the nature of the ACE (maltreatment vs. household dysfunction) was associated with the specific epigenetic changes. There may be different pathways through which parental ACEs confer risk for poor outcomes for males and females, highlighting the importance of child gender in future investigations.

In the shadow of Apartheid: intergenerational transmission of Black parental trauma as it emerges in the analytical space of inter-racial subjectivities

Using the construct of projective identification and integrating it with the body of literature on intergenerational transmission of unsymbolized parental trauma, I describe the case of an adult black South African woman called Sibulelo. It is suggested that Sibulelo has unconsciously identified with the disavowed parents and grandparents trauma that they suffered as a result of the system of Apartheid. Such trauma is expressed through her feelings of being dis-located in time and space, as if she is living outside of herself, unplugged from life, and living someone else’s life. The paper details the unfolding therapeutic process in relation to my whiteness in the context of her blackness. This brings into sharp focus an exploration of black-white racialized transference-counter-transference matrix in the context of intergenerational trauma. It is a reflective paper and opens up my own counter-transference, thus foregrounding the notion of therapeutic inter-subjectivity. A further contribution to psychoanalytic theory concerns the role of recognition and being seen as a powerful process in facilitating the symbolization of trauma. In addition, if there is no interruption of the cycles of intergenerational trauma, and therefore no symbolization, it becomes an unconscious familial compulsion to repeat. Moreover, this therapy case highlights the idea that as a traumatised family living within a bruised culture of intergenerational transmission of trauma, such repetition of trauma becomes a cultural compulsion to repeat what has not been spoken or named.