Sources of Pathogenic Learning

Attitudes and behaviors may be learned as a consequence of instruction or indoctrination on the part of parents, but most of what is learned accrues from a haphazard series of casual and incidental events to which the child is exposed. Not only is the administration of rewards and punishments meted out most often in a spontaneous and erratic fashion, but the everyday and ordinary activities of parents provide the child with unintended models to imitate.

These conditions do not activate protective or defensive behaviors as do emotionally disruptive events; they merely reinforce styles of behavior that prove deleterious when generalized to settings other than those in which they were acquired. The roots of behavior—how people think, talk, fear, love, solve problems, and relate to others; aversions; irritabilities; attitudes; anxieties; and styles of interpersonal communication—are all adopted and duplicated by children as they observe the everyday reactions of their parents and older siblings. Children mirror these complex behaviors without understanding their significance and without parental intentions of transmitting them. The old saying, "Practice what you preach," conveys the essence of this thesis. Thus, a parent who castigates the child harshly for failing to be kind may create an intrinsically ambivalent learning experience; the contrast between parental manner and their verbalized injunction teaches the child simultaneously to think kindly but to behave harshly.

The particulars and the coloration of many pathological patterns have their beginnings in the offhand behaviors and attitudes to which the child is incidentally exposed. It is important, therefore, in reviewing this chapter, to remember that children acquire less from intentional parental training methods than from casual and adventitious experience.

People simply do not learn in neatly arranged alley mazes with all confounding effects nicely controlled; the sequence is not only complicated by manifold "extraneous variables" to which learning becomes attached but also subject to highly irregular "schedules of reinforcement."

A matter that should be self-evident, but is often overlooked or simplified in presenting pathogenic influences, relates to our prior notation that most children acquire their ideas and models from two parents, as well as one or more siblings. Children are exposed to and frequently learn different and contrasting sets of perceptions, feelings, attitudes, behaviors, and so on, as well as a mixed set of assumptions about themselves and others. In a manner similar to genetic recombination, where the child's heredity-based dispositions reflect the contribution of both parents, so, too, do the child's experiences and learnings reflect the input and interweaving of what he or she has been subjected to by both parents. For example, one parent may have been cruel and rejecting, whereas the other may have been kindly and supportive. How this mix ultimately takes psychological form and which set of these differential experiences predominates will be a function of numerous other factors. However, we should expect that children will be differentially affected by each parent and that pathogenesis will reflect a complex interaction of these combined experiences. Be mindful that few experiences are singular in their impact; they are modulated by the interplay of multiple forces, but mostly by the commingling and consolidation of two sets of parental influences.

Three types of events may be described to illustrate the concept of pathogenic:

1. Events that provoke undue anxiety in the individual because they make demands beyond his or her capacity or because they otherwise undermine his or her feelings of security and comfort. Persistence of these emotionally disruptive events elicits coping reactions that, ultimately, may lead to the learning of generalized defensive strategies. These strategies may be successful in diminishing certain feelings of discomfort, but they may prove detrimental in the long run to healthy functioning because they may be applied to circumstances for which they are ill-suited.

2. Emotionally neutral conditions that lead to the learning of maladaptive behaviors. These conditions do not activate protective or defensive behaviors as do emotionally disruptive events; they merely teach or reinforce styles of behavior that prove deleterious when generalized inappropriately to settings other than those in which they were acquired. The roots of these difficulties, therefore, do not lie in stress, anxiety, or unconscious mechanisms of defense, but rather in the simple conditioning or imitation of maladaptive behavior patterns.

3. An insufficiency of experiences requisite to the learning of adaptive behavior. Thus, general stimulus impoverishment, or minimal social experience, may produce deficits in the acquisition of adaptive behaviors. The sheer lack of skills and competence for mastering the environment is a form of pathological underlearning, which may be as severe as those disorders generated either by stressful experiences or by defective or maladaptive learning.

The research and theoretical literature on pathogenic sources do not lend themselves to this threefold schema; another format must be used to present this body of work. Nevertheless, remember these distinctions while studying the ensuing pages.

The belief that early interpersonal experiences in the family play a decisive role in the development of psychopathology is well accepted among professionals, but reliable and unequivocal data supporting this conviction are difficult to find. The deficits in these data are not due to a shortage of research efforts; rather, they reflect the operation of numerous methodological and theoretical difficulties that stymies progress. For example, and as discussed in prior pages, most of these data depend on retrospective accounts of early experience; these data are notoriously unreliable. Patients interviewed during their illness are prone to give a warped and selective accounting of their relationships with others; information obtained from relatives often is distorted by feelings of guilt or by a desire to uncover some simple event to which the disorder can be attributed. In general, then, attempts to reconstruct the complex sequence of events of yesteryear that may have contributed to pathological learning are fraught with almost insurmountable methodological difficulties.

To these procedural complications may be added problems of conceptual semantics and data organization; these complications make comparisons among studies difficult and deter the systematic accumulation of a consistent body of research data. For example, what one investigator calls a "cold and distant" parent, another may refer to as "hostile or indifferent"; an "indulgent" mother in one study may be referred to as a "worrier" in another or "overprotective" in a third. Furthermore, descriptive terms such as cold, overprotective, and so on represent gross categories of experience; variations, timing sequences, and other subtleties of interpersonal interaction are lost or blurred when experiences are grouped together into these global categories. The precise element of these experiences, which effectively accounts for maladaptive learning, remains unclear because of the gross or nonspecific categories into which these experiences are grouped. We must know exactly what aspect of parental coldness or overprotectiveness is pathogenic. It is hoped that such specifications will be detailed more precisely in future research. Until such time, however, we must be content with the global nature of these categories of psychogenesis.

In the following sections, we differentiate the sources of pathological learning into two broad categories. The first comprises experiences that exert an influence throughout the child's entire developmental sequence—enduring and pervasive experiences. The second category includes adverse conditions of relatively brief duration that occur at any point in the life span, but exert a profound influence on development—traumatic experiences.

Enduring and Pervasive Experiences

An atmosphere, a way of handling the daily and routine activities of life, or a style and tone of interpersonal relatedness come to characterize the family setting in which the child develops. Events, feelings, and ways of communicating are repeated day in and day out. In contrast to the occasional and scattered events of the outside environment, the circumstances of daily family life have an enduring and cumulative effect on the entire fabric of the child's learning. In this setting, the child establishes a basic feeling of security, imitates the ways in which people relate interpersonally, acquires an impression of how others perceive and feel about him or her, develops a sense of self-worth, and learns how to cope with feelings and the stresses of life. The influence of the family environment is preeminent during all of the crucial growth periods in that it alone among all sources exerts a persistent effect on the child.

In what ways can these enduring experiences be differentiated?

Because the ebb and flow of everyday life consists of many inextricably interwoven elements, any subdivision that can be made must reflect some measure of arbitrariness. You will not fall prey to the errors of etiological simplification if you remember that the following features separated into five categories represent only single facets of an ongoing and complex constellation of events.

Parental Feelings and Attitudes

The most overriding, yet the most difficult to appraise, aspect of learned experience is the extent to which the child develops a feeling of acceptance or rejection by his or her parents. With the exception of cases of blatant abuse or overt deprecation, investigators have extreme difficulty in specifying, no less measuring, the signs of parental neglect, disaffiliation, and disaffection. Despite the methodological difficulties that researchers encounter, the child who is the recipient of the following three rejecting cues has no doubt but that he or she is unappreciated, scorned, or deceived:

1. To be exposed throughout a child's early years to parents who view him or her as unwanted and troublesome can only establish a deep and pervasive feeling of isolation in a hostile world. Deprived of the supports and security of home, the child may be ill-disposed to venture forth with confidence to face struggles in the outer world. Rejected by his or her parents, the child may anticipate equal devaluation by others (Emde, 1989; Maccoby & Martin, 1983). As a defense against further pain, the child may learn the strategy of avoiding others; he or she may use apathy and indifference as a protective cloak to minimize the impact of the negative reinforcements now expected from others. Different strategies may evolve, depending on other features associated with rejection; children may imitate parental scorn and ridicule and learn to handle their disturbed feelings by acting in a hostile and vindictive fashion. Rejected by parents, the child is likely to anticipate equal devaluation by others (Cicchetti & Carlson, 1989; Dodge, Murphy, & Buchsbaum, 1984; Dornbusch, Ritter, Leiderman, & Roberts, 1987; Mueller & Silverman, 1989; Steinberg, Elmen, & Mounts, 1989).

2. Parental attitudes represented by terms such as seduction, exploitation, and deception contribute their share of damage to the child's personality, although it is usually the sense of being unwanted and unloved that proves to have the most pervasive and shattering of effects (Cicchetti & Beeghly, 1987). Children can tolerate substantial punishment and buffeting from their environment if they sense a basic feeling of love and support from parents; without them, a child's resistance, even to minor stress, is tenuous (Billings & Moos, 1982; Lewinsohn, 1974).

3. More important than heretofore considered is the fact that parental feelings and attitudes need not be the same, nor uniformly conveyed by both parents. Differences in parental relationships are the norm for most children. One parent may be attentive and overprotective while the other is hostile or indifferent. In a sense, the recombinant process of hereditary transmission, in which the child receives half of his or her chromosomes from each of two parents, is duplicated at the experiential level as well. Dissimilar aspects of human thought, feeling, and behavior are conveyed by each parent through implicit modeling or direct tuition. The child incorporates these two variant models, either keeping them as separate modes of experience or fusing them in a combinatorial synthesis.

Hence, it is not uncommon for children to acquire attitudes and feelings about themselves that are divided or split, partly reflecting the relationship with their mother, and partly with their father, as well as with older siblings or relatives. As we read the typical background of one or another of several personality disorders, we may find individuals who have experienced two or more of the characteristic histories described. Exposed to a single parent, one who was consistent and whose attitudes and feelings were not subverted or countermanded by other adult models, the child may develop into a pure textbook type. However, for the most part, youngsters reflect the impact of a variety of adult models, resulting in a mixed personality configuration, for example, somewhat narcissistic and somewhat compulsive or partly dependent and partly avoidant and so on. In later chapters pertaining to personality subtypes, we discuss personality disorder mixtures that reflect different, and sometimes conflictual, combinations of parental feelings and attitudes to which the youngster was exposed.

Methods of Behavior Control

What training procedures are used to regulate the child's behavior and to control what he or she learns? As noted earlier, incidental methods used by parents may have a more profound effect than what the parent intended; that is, the child acquires a model of interpersonal behavior by example and imitation as well as by verbal precept. Five of the pathogenic methods of control are discussed in the following sections (Glidewell, 1961; Patterson, 1982; Sears, Maccoby, & Levin, 1957).

Punitive Methods. Parents disposed to intimidate and ridicule their offspring, using punitive and repressive measures to control their behavior and thought, may set the stage for a variety of maladaptive patterns (El Sheikh, Cummings, & Goetsch, 1989; Loeber & Stouthamer-Loeber, 1986).

If the child submits to pressure and succeeds in fulfilling parental expectations (i.e., learns instrumentally to avoid the negative reinforcement of punishment), he or she is apt to become an overly obedient and circumspect person. Typically, these individuals learn not only to keep in check their impulses and contrary thoughts but also, by vicarious observation and imitation, to adopt the parental behavior model and begin to be punitive of deviant behavior on the part of others. Thus, an otherwise timid and hypertense 16-year-old boy, whose every spark of youthful zest had been squelched by harshly punitive parents, was observed to be "extremely mean" and punitive when given the responsibility of teaching a Sunday school class for 7-year-olds.

Should these youngsters fail to satisfy excessive parental demands and be subject to continued harassment and punishment, they may develop a pervasive anticipatory anxiety about personal relationships, leading to feelings of hopelessness and discouragement and resulting in instrumental strategies such as social avoidance and withdrawal. Others, faced with similar experiences, may learn to imitate parental harshness and develop hostile and aggressively rebellious behaviors. Which of these reactions or strategies evolves depends on the larger configuration of factors involved (Ferster, 1973; Lazarus, 1968; Lewinsohn, 1974; Patterson, 1977).

Contingent Reward Methods. Some parents rarely are punitive but expect certain behaviors to be performed before giving encouragement or doling out rewards. Positive reinforcements are contingent on approved performance. Youngsters reared under these conditions tend to be socially pleasant and, by imitative learning, tend to be rewarding to others. Often, however, we observe that they seem to have acquired an insatiable and indiscriminate need for social approval. For example, a 15-year-old girl experienced brief periods of marked depression if people failed to comment favorably on her dress or appearance. In early childhood, she had learned that parental approval and affection were elicited only when she was "dressed up and looked pretty"; to her, failure on the part of others to note her attractiveness signified rejection and disapproval. It would appear, therefore, that contingent reward methods condition children to develop an excessive need for approval; they manifest not only a healthy social affability but also a dependency on social reinforcement.

Inconsistent Methods. Parental methods of control often are irregular, contradictory, and capricious (Maccoby & Martin, 1983; Patterson, 1982). Some degree of variability is inevitable in the course of every child's life, but there are parents who display an extreme inconsistency in their standards and expectations and an extreme unpredictability in their application of rewards and punishments. Youngsters exposed to such a chaotic and capricious environment cannot learn consistently and cannot devise non-conflictive strategies for adaptive behavior; whatever behavior they display may be countermanded by an unpredictable parental reaction.

To avoid the suspense and anxiety of unpredictable reactions, some children may protectively become immobile and noncommittal. Others, imitatively adopting what they have been exposed to, may come to be characterized by their own ambivalence and their own tendency to vacillate from one action or feeling to another. We know that irregular reinforcements build difficult-to-extinguish behavior patterns; thus, the immobility or ambivalence of these youngsters may persist long after their environment has become uniform and predictable.

Protective Methods. Some parents so narrowly restrict the experiences to which their children are exposed that these youngsters fail to learn even the basic rudiments of autonomous behaviors (Baumrind, 1967; C. C. Lewis, 1981). Overprotective mothers, worried that their children are too frail or are unable to care for themselves or make sensible judgments on their own, not only succeed in forestalling the growth of normal competencies but also, indirectly, give their children a feeling that they are inferior and frail. These children, observing their actual inadequacies, have verification of the fact that they are weak, inept, and dependent on others (Millon, 1981; Millon & Davis, 1996; Parker, 1983). Thus, these youngsters not only are trained to be deficient in adaptive and self-reliant behaviors but also learn to view themselves as inferior and become progressively fearful of leaving the protective womb.

Indulgent Methods. Overly permissive, lax, or undisciplined parents allow children full rein to explore and assert their every whim. These parents fail to control their children and, by their own lack of discipline, provide a model to be imitated, which further strengthens their children's irresponsibility. Unconstrained by parental control and not guided by selective rewards, these youngsters grow up displaying the inconsiderate and often tyrannical characteristics of undisciplined children. Having had their way for so long, they tend to be exploitive, demanding, uncooperative, and antisocially aggressive. Unless rebuffed by external disciplinary forces, these youngsters may persist in their habits and become irresponsible members of society (Millon, 1969; Millon, Si-monsen, Birkit-Smith, & Davis,1999).

Family Styles of Communication

The capacity of humans to symbolize experience enables us to communicate with one another in ways more intricate and complex than are found in lower species. Free of the simple mechanisms of instinctive behavior and capable of transcending the tangibles of our objective world, humans can draw from events of the distant past and project to those of the distant future. The symbolic units and syntax of our language provide us with a powerful instrumentality for thought and communication.

Each family constructs its own style of communication, its own pattern of listening and attending, and its own way of fashioning thoughts and conveying them to others. The styles of interpersonal communication to which the child is exposed serve as a model for attending, organizing, and reacting to the expressions, thoughts, and feelings of others. Unless this framework for learning interpersonal communication is rational and reciprocal, the child will be ill-equipped to function in an effective way with others. Thus, the very symbolic capacities that enable humans to transcend their environment so successfully may lend themselves to serious misdirections and confusions; this powerful instrument for facilitating communication with others may serve instead to undermine social relationships. Although illogical ideas, irrational reactions, and irrelevant and bizarre verbalizations often arise because of extreme stress, their roots can be traced as frequently to the simple exposure to defective styles of family communication (Campbell, 1973; Mash & Johnston, 1982; J. R. Morrison, 1980; Tizard & Hodges, 1978).

The effects of amorphous, fragmented, or confusing patterns of family communication have been explored by numerous investigators (Bateson et al., 1956; Lidz, Corneli-son, Terry, & Fleck, 1958; Lu, 1962; Singer & Wynne, 1965). Not only are messages attended to in certain families in a vague, erratic, or incidental fashion, with a consequent disjunctiveness and loss of focus, but when they are attended to, they frequently convey equivocal or contradictory meanings. The transmission of ambivalent or opposing meanings and feelings produces what Bateson refers to as a double bind. For example, a seriously disturbed 10-year-old boy was repeatedly implored in a distinctly hostile tone by his equally ill mother: "Come here to your mother; mommy loves you and wants to hug and squeeze you, hug and squeeze you." The intrinsically contradictory nature of these double-bind messages precludes satisfactory reactions; the recipient cannot respond without running into conflict with one aspect of the message; he is "damned if he does, and damned if he doesn't." Exposed to such contradictions in communication, the youngster's foundation in reality becomes increasingly precarious (Reid, Patterson, & Loeber, 1982; Reiss, 1981). To avoid confusion, the child learns to distort and deny these conflicting signals; but in this defensive maneuver, the child succumbs even further to irrational thought. Unable to interpret the intentions and feelings of others and encumbered with a progressively maladaptive pattern of self-distortions, the child falls prey to a vicious circle of increasing interpersonal estrangement.

Content of Teachings

Parents transmit a wide range of values and attitudes to their children either through direct tuition or unintentional commentary (Dorr, 1985; Emde, 1979; M. Lewis & Saarni, 1985). The family serves as the primary socialization system for inculcating beliefs and behaviors. Through these teachings, the child learns to think about, be concerned with, and react to certain events and people in prescribed ways.

Kinds of teachings that lend themselves to the learning of pathological attitudes and behaviors include these:

• The most insidious and destructive of these teachings is training in anxiety. Parents who fret over their own health, who investigate every potential ailment in their child's functioning, and who are preoccupied with failures or the dismal turn of events teach and furnish models for anxiety proneness in their children (J. C. Coolidge & Brodie, 1974; Parker, 1983; Waldron, Shrier, Stone, & Tobin, 1975). Few incidents escape the pernicious effects of a chronically anxious and apprehensive household. Fantasies of body disease, vocational failure, loss of prized objects, and rejection by loved ones illustrate the range of items to which a generalized disposition this tendency intrudes and colors otherwise neutral events.

• Feelings of guilt and shame are generated in the teachings of many homes. A child's failure to live up to parental expectations, a feeling that he or she has caused undue sacrifices by the parents, or a feeling that he or she has transgressed rules and embarrassed the family by virtue of some shortcoming or misbehavior are events that question the individual's self-worth and produce marked feelings of shame and guilt. Furthermore, the sacrificing and guilt-laden atmosphere of these parental homes provides a model for behavioral imitation. Youngsters who are admonished and reproached repeatedly for minor digressions often develop a deep and pervasive self-image of failure. If children admit their misdeeds and adopt their parents' injunctions as their own, they will come to view themselves as unworthy, shameful, and guilty persons. To protect against feelings of marked self-condemnation, such children may learn to restrict their activities, to deny themselves the normal joys and indulgences of life, and to control their impulses far beyond that required to eschew shame and guilt. In time, even the simplest of pleasures may come to be avoided.

• Other destructive attitudes can be taught directly through narrow or biased parental outlooks; feelings of inferiority and social inadequacy are among the most frequent. Particularly damaging are teachings associated with sexual urges. Unrealistic standards that condemn common behaviors such as masturbation and petting create unnecessary fears and strong guilt feelings; sexual miseducation may have long-range deleterious effects, especially during periods of courtship and marriage.

Family Structure

The formal composition of the family often sets the stage for learning pathogenic attitudes and relationships (Clausen, 1966).

Deficient Models. The lack of significant adult figures in the family may deprive children of the opportunity to acquire, through imitation, many of the complex patterns of behavior required in adult life (Emery, 1982; Ferri, 1976; Millon, 1987). Parents who provide undesirable models for imitation, at the very least, are supplying some guidelines for the intricate give-and-take of human relationships.

The most serious deficit usually is the unavailability of a parental model of the same sex (Hetherington, Cox, & Cox, 1982). The frequent absence of fathers in underprivileged homes or the vocational preoccupations of fathers in well-to-do homes often produce sons who lack a mature sense of masculine identity; they seem ill-equipped with goals and behaviors by which they can orient their adult lives.

Family Discord. Children subject to persistent parental bickering and nagging not only are exposed to destructive models for imitative learning but also are faced with upsetting influences that may eventuate in pathological behaviors (Crockenberg, 1985; Cummings, Pellegrini, Notarius, & Cummings, 1989; Millon, 1987; Rutter & Giller, 1983). The stability of life, so necessary for the acquisition of a consistent pattern of behaving and thinking, is shattered when strife and marked controversy prevail. There is an ever-present apprehension that one parent may be lost through divorce; dissension often leads to the undermining of one parent by the other; an air of mistrust frequently pervades the home, creating suspicions and anxieties; a nasty and cruel competition for the loyalty and affections of children may ensue. Children often become scapegoats in these settings, subject to displaced parental hostilities (Hetherington, 1972). Constantly dragged into the arena of parental strife, the child not only loses a sense of security and stability but also may be subjected to capricious hostility and to a set of conflicting and destructive behavior models.

Sibling Rivalry. Sibling relationships often are overlooked as a major element in shaping the pattern of peer and other intimate competitions (Circirelli, 1982; Dunn & Kendrick, 1981; Wagner, Schubert, & Schubert, 1979). The presence of two or more children in a family requires that parents divide their attention and approval. When disproportionate affection is allotted to one child or when a newborn child supplants an older child as the "apple of daddy's eye," seeds of discontent and rivalry flourish. Intense hostility often is generated; since hostility fails to eliminate the intruder and gains, not the sought-for attention, but parental disapproval, the aggrieved child often reverts to regressive or infantile maneuvers, for example, baby talk or bed-wetting. If these methods succeed in winning back parental love, the youngster will have been reinforced through instrumental learning to continue these childish techniques. More often than not, however, efforts to alter parental preferences fail miserably, and the child may continue to experience deep resentments and a sense of marked insecurity. Such persons often later display a distrust of affections, fearing that those who express them will prove to be as fickle as their parents. Not unlikely also is the possibility that the intense hostility they felt toward their siblings will linger and generalize into envious and aggressive feelings toward other "competitors."

ordinal Position. It seems plausible that the order of a child's birth in the family would be related to the kinds of problems he or she faces and the kinds of strategies he or she is likely to adopt. For example, the oldest child, once the center of parental attention, experiences a series of displacements as new sibs are born; this may engender a pervasive expectation that "good things don't last." However, to counteract this damaging experience, he or she may be encouraged to acquire the skills of autonomy and leadership, may be more prone to identify with adult models, and may learn, thereby, to cope with the complications of life more effectively than his or her less mature siblings. The youngest child, although petted, indulged, and allotted the special affections and privileges due the family baby, may fail to acquire the competencies required for autonomous behaviors. He or she may be prone to dependency and prefer to withdraw from competition; the higher incidence of mental disorder among the last-born child in families lends support to these interpretations (Dohrenwend & Dohrenwend, 1976). Only children appear to be especially resilient to severe emotional difficulty. This may reflect their special status as sole recipient of parental attention, approval, and affection. In his or her singular and unhampered state, the child may learn to view himself or herself as especially gifted. With this confidence in self-worth as a base, the child may venture into the larger society secure in the conviction that he or she will be as well received there as in the parental home. Despite this sound beginning, the child is ill-equipped to cope with the give-and-take of peer relationships because he or she has not experienced the sharing and competition of sibling relationships.

Numerous other features of the family environment, some relating to structural elements (e.g., sex of sibs and presence of problem sibs) and some to roles assumed by family members (e.g., domineering or seductive mothers or inadequate or effeminate fathers), can be specified and their likely effects on learning speculated about. A listing of such events and relationships, however, is too exhaustive for our purposes. A number of these elements are discussed in later chapters when we present characteristic experiential histories.

Traumatic Experiences

It is a common belief, attributable in large measure to popularizations of psychology in our literature and news media, that most forms of psychopathology can be traced to a single, very severe experience, the hidden residues of which account for the manifest disorder. Freud's early writings gave impetus and support to this notion, but he reversed himself in his later work when he was made aware of the fact that patient reports of early trauma often were imaginative fabrications of their past. Current thinking in the field suggests that most pathological behaviors accrue gradually through repetitive learning experiences.

Despite the primacy that enduring and pervasive experiences play in shaping most pathological patterns, there are occasions when a particularly painful event can shatter the individual's equanimity and leave a deeply embedded attitude that is not readily extinguished. An untimely frightening experience, be it abusive or not, or an especially embarrassing and humiliating social event illustrate conditions that can result in a persistent attitude.

The impact of these events may be particularly severe with young children because they usually are ill-prepared for them and lack the perspective of prior experience that might serve as a context for moderating their effects (Field, 1985; Garmezy, 1986; Weissman & Paykel, 1974). If a traumatic event is the first exposure for a youngster to a particular class of experiences, the attitude he or she learns in reaction to that event may intrude and color all subsequent events of that kind. Thus, an adolescent whose first sexual venture resulted in devastating feelings of guilt, inadequacy, or humiliation may carry such feelings within long after the event has passed.

Traumatic events persevere in their learned effects for essentially two reasons. First, a high level of neural activation ensues in response to most situations of marked distress or anxiety. Many diverse neural associations become connected to the event; the greater the level of neural involvement, the more deeply and pervasively will be the learned reaction and the greater the difficulty will be in extinguishing what was learned. Second, during heightened stress, there often is a decrement in the ability to make accurate discriminations within the environment; as a consequence, the traumatized individual generalizes his or her emotional reaction to a variety of objects and persons who are only incidentally associated with the traumatic source. For example, a youngster injured in an auto accident may develop a fear reaction not only to cars but also to all red couch covers (the color of the seat of the car in which he was riding), to men in white jackets (the color of the uniform of the medical intern who attended to him after the accident), and so on. Because of the seemingly illogical nature of these fears (the difficulty of tracing their connection to the accident), they are not readily amenable to rational analysis and unlearning.

Despite the severity and persistence of the effects of certain traumatic events, they tend to be stimulus-specific, that is, limited to stimulus conditions that are highly similar

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