Childhood trauma and maltreatment — structured clinical viva

Exposure vs diagnosis. Physical and emotional abuse are maltreatment exposures; map polyvictimisation and ACE domains for cumulative risk, then diagnose psychiatric sequelae (e.g. PTSD, depression) separately from the protection plan.[1][2]

Assessment. Trauma-informed private child interview, non-leading questions, verbatim documentation, school collateral, suicide/self-harm and sibling risk. Reasonable suspicion → statutory notification. Do not invent section numbers; state principle and multi-agency action.[4]

Mechanisms (brief). Toxic stress / biological embedding and ecophenotype concept (earlier, more severe, more comorbid courses within diagnoses) as group-level framing — not MRI diagnosis of abuse.[6]

Treatment. Safety first. TF-CBT with PRACTICE components once a safe non-offending caregiver and environment allow; RCT evidence for TF-CBT in abuse-related PTSD. Trauma-informed care principles across the system. Medication only as adjunct for comorbidity with monitoring.[3][4][5]