Over the years I’ve discovered that a significant proportion of adult clients who present with depression have a history of childhood abuse.  The abuse may have been sexual, physical and/or emotional.   At first I attributed this to the fact that I specialize in abuse and many clients who come to me saying they are depressed are using that as a presenting issue because they aren’t ready to discuss the abuse.  But what I now understand is that most adult survivors of childhood abuse do suffer from some form of depression.  An article in Psychology Today published in 2003 stated that, “In almost every case of significant adult depression, some form of abuse was experienced in childhood, either physical, sexual, emotional or, often, a combination.”   Depression runs in families.  So does abuse.  “Studies show that one in four girls and one in eight boys are sexually abused before the age of 18, and one in twenty children are physically abused each year.”   But sexual and emotional abuse, in particular, is woefully underreported.  Most abused children grow up in an atmosphere of denial – denial by the adults around them and, for the most part, denial within themselves as a means of survival.  Ultimately it is the secrecy around the abuse that helps to foster the depression.  Additionally, neurobiology has expanded our understanding of how emotions affect brain chemistry.  Traumatic events – such as any form of childhood abuse (sexual, emotional, physical) or neglect, changes the chemistry of the brain.  These events can reshape wiring patterns and reset responses to them so that even a small degree of stress can produce an overabundance of stress hormones that in turn create anxiety and depression.        Depression has been recognized as both a chemical imbalance in the brain and a turning of more aggressive feelings – i.e. anger – inward.   Self-criticism is anger turned inwards.  In a recent study by Florida State University researchers, people who were verbally abused as children grew up to be self-critical adults prone to depression.  Verbal abuse includes insults, swearing, threats of physical abuse and spiteful comments or behavior.  “Over time, children believe the negative things they hear, and they begin to use those negative statements as explanations for anything that goes wrong.”   And while neither sexual nor physical abuse necessarily supply the critical words, the non-verbal communication of these actions say that the child is worthless.  In fact, the non-verbal communication of these acts is even more powerful than the spoken words, but that in no way diminishes the fact that verbal abuse creates lasting damage as well.   As clinicians, it is our job to help the depressed client recognize the abuse; recognize the effect it has had on them and help them find an avenue back to self-love through understanding.