Key Signs That Can Help You Recognize a Client’s History of Neglect

Neglect may not always be as blatant as other forms of trauma. Here, Janina Fisher, PhD, and Ruth Lanius, MD, PhD, share a few common signs that might indicate that a patient has experienced early childhood neglect:

Dr. Fisher: Neglect can often go with chronic parasympathetic hypoarousal.
What we often see in survivors of neglect is less anxiety, less hyperarousal, less sympathetic arousal, and more parasympathetic numbness, disconnection from affect, and inability to express themselves in words.

Dr. Lanius: This is how our clients with a chronic history of neglect actually present. They’re shut down. They’re slowed. Their cognitions are slowed. Their movements are slowed. Often, their heartrate is low, and they’re completely disconnected from their inside world. They’re disconnected from the world. They don’t make eye contact and they’re really essentially feeling dead to the world in the most extreme case.

Dr. Fisher: Internalized neglect manifests itself in difficulty with self-care, difficulty prioritizing themselves.

Three Behavior Patterns Rooted in the Neurobiological Impacts of Neglect

When neglect is a factor, the regions of the brain involved in complex cognitive processes aren’t always properly stimulated. That can inhibit development of those regions – leading to several behavioral consequences. Margaret Sheridan, PhD, Martin Teicher, MD, PhD, and Bessel van der Kolk, MD, share three behavior patterns that may commonly result:

Dr. Sheridan: If you look at very severe exposure, something like frank neglect exposure all the way through these kinds of more like a lack of enriching exposures, you do see the same brain areas are impacted and the same behavioral outcomes are impacted with regard specifically to executive function.

Dr. Teicher: The parts of the brain that are involved in attachment have developed to diminish the drive for attachment as a protective mechanism. These individuals will then present later in life with all sorts of problems forming and keeping a secure attachment.

Dr. van der Kolk: If you are a neglected person, you develop a brain that can accommodate neglect. What you see clinically is there is a lack of vitality and a lack of pleasure in your interactions.

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