Adverse Childhood Experiences (ACEs) such as abuse, neglect, and household dysfunction are potentially traumatic events in childhood that have been linked to increased risk to negative outcomes in adulthood. Aversive community environments can also have a traumatic impact. These include factors such as communities with high poverty rates, violence, poor housing quality, and limited supports/ resources.
Childhood mental health concerns have been on the rise over the last 10 years but significantly increased since 2020. Stressors associated with the COVID-19 pandemic and racial inequality have only exacerbated underlying mental health concerns in our youngest patients.
A rocky childhood. A violent assault. A car accident. If these are in your past, they could be affecting your present health.
These are all examples of traumatic events — which, in psychological terms, are incidents that make you believe you are in danger of being seriously injured or losing your life, says Andrea Roberts, a research scientist with the Harvard T.H. Chan School of Public Health. Research shows that these events can trigger emotional and even physical reactions that can make you more prone to a number of different health conditions, including heart attack, stroke, obesity, diabetes, and cancer.
Traumatic events encompass anything from a sexual assault or childhood abuse to a cancer diagnosis. Child abuse is particularly likely to affect your adult life because it occurs at a time when your brain is vulnerable — and it often occurs at the hands of people who are supposed to be your protectors, says Roberts. “By abuse, we often mean things that are a lot milder than things people typically think of as abuse. It might include being hit with a hard object, like a whip, a belt, or a paddle,” says Roberts. “The behavior doesn’t necessarily need to be illegal to induce a traumatic response.”
A child’s perception of events is as important as what actually occurred. “While a child’s life may not have actually been in danger, the child may have seen it as life-threatening,” says Dr. Kerry Ressler, a psychiatry professor at Harvard Medical School.
People who experience traumatic events sometimes develop post-traumatic stress disorder (PTSD), a psychiatric condition that affects 5% to 10% of the general population, says Dr. Ressler. It’s more common in women, affecting twice as many women as men. And it also occurs more frequently in people who have certain risk factors, including those living in poverty, soldiers in active combat, and first responders, he says. PTSD can develop after a person experiences violence or the threat of violence, including sexual violence. It may affect people who have a close relative who experienced those things as well, says Dr. Ressler. These traumatic events are generally incidents that are considered outside the ordinary and are exceptional in their intensity.
Your risk for mental and physical health problems from a past trauma goes up with the number of these events you’ve experienced. For example, your risk for problems is much higher if you’ve had three or more negative experiences, called adverse childhood experiences (ACEs), says Roberts.
These include
While severely traumatic events are believed to have the greatest effect on long-term health, other stressful events that don’t necessarily meet the psychological definition of trauma can still cause problems. This might include a sudden death in the family, a stressful divorce, or caring for someone with a chronic or debilitating illness, says Roberts. These milder events might lead to a mental health disorder, such as anxiety or depression. “Trauma pushes your ability to cope, so if you have a predisposition toward anxiety, for example, it may push you over the edge,” says Roberts.
In addition, incidents like these can also produce PTSD-like symptoms in certain people. “When people go through traumatic or complicated grief, they can experience pretty similar symptoms to those they might experience with trauma, such as intrusive thoughts,” says Dr. Ressler.
Most of the research related to trauma and chronic disease risk has focused on childhood trauma, says Dr. Ressler. Early childhood trauma is a risk factor for almost everything, from adult depression to PTSD and most psychiatric disorders, as well as a host of medical problems, including cardiovascular problems such as heart attack and stroke, cancer, and obesity.
These effects likely reflect two factors:
Behavioral changes resulting from trauma. People who are suffering from traumatic memories may try to escape them by participating in risky behaviors such as drinking, smoking, drug use, or even overeating for comfort. “Those can all be used as a coping mechanism, a way of dealing with emotional dysregulation that occurs when someone has been traumatized,” says Roberts. These habits, in turn, lead to health problems.
Physical effects related to trauma. The problem goes beyond unhealthy habits. Experts believe that there is actually a direct biological effect that occurs when your body undergoes extreme stress. When you experience something anxiety-provoking, your stress response activates. Your body produces more adrenaline, your heart races, and your body primes itself to react, says Roberts. Someone who has experienced trauma may have stronger surges of adrenaline and experience them more often than someone who has not had the same history. This causes wear and tear on the body — just as it would in a car where the engine was constantly revving and racing, she says. Stress responses have also been demonstrated in people who have experienced discrimination throughout their lives. “It ages your system faster,” says Roberts.
Chronic stress can increase inflammation in the body, and inflammation has been associated with a broad range of illness, including cardiovascular disease and autoimmune diseases, says Roberts. Early trauma disrupts the inflammatory system. This can lead to long-term aberrations in this system and chronic health problems triggered by constant inflammation. Typically, the more trauma you’ve experienced, the worse your health is.
People who have experienced trauma may also struggle with getting help. “One of the most common outcomes of trauma is avoidance,” says Dr. Ressler. “It makes sense. If you experience something traumatic, you want to avoid thinking about it and going to places that remind you of it.” Unfortunately, health settings — with their doctors, therapists, and counselors — are triggers for many people because when someone experiences a traumatic event, he or she often ends up in the health care system.
In addition, if you’ve experienced trauma, you may believe that health care providers will want you to talk about it and dredge up feelings from the past. For these reasons, people who have experienced trauma may avoid medical care.
Some people may be in denial about the role past trauma is playing in their life. “I would say that a lot of people are unaware of how trauma is affecting them,” says Roberts. One of the hallmarks of trauma is the fact that people often use defense mechanisms to protect themselves from stress. Denial is one of those, as is trying to normalize past problems. “People may say things like, ‘oh, everybody I know got hit as a child,'” says Roberts.
Seek out resourcesTo get more information about trauma and PTSD or to find treatment resources, here are three very good, well-vetted websites from leading professional organizations:
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If you suspect that past trauma is affecting your life, there is help. This is a treatable problem. “You don’t have to be stuck,” says Dr. Ressler. “There is a good chance that you can move past this.”
Taking steps to address the problem may also help others in your life. Very often people who have experienced trauma pass problems on to others in their family through a process called observational learning, he says. So, helping yourself may help those around you. Consider these steps.
Work with a therapist. A trained therapist can help you reframe what happened to you and help you move past it. “One of the most successful treatments is exposure therapy, where the idea is to expose yourself in small doses to the thing that was most traumatizing, with someone there to support you,” says Roberts. Treatment may also include medication to address any mental health disorders you are experiencing.
Take care of yourself. There are numerous lifestyle measures that can help you reduce stress and anxiety. These include yoga, tai chi, and meditation. Regular exercise can also help you manage stress and other symptoms.
Reach out to others. Research has shown that maintaining strong social ties with friends and family members is crucial to good mental health.
“Unfortunately, all of these things are hard to do when in depressive states,” says Roberts.
That’s why many people may need to start with therapy, and then add other strategies later on.
When many of us think of childhood, we imagine happy, carefree times. Tender feelings of safe, loving relationships with parents and grandparents are often remembered. Those of us who are parents ourselves know there is nothing more precious than the birth of a child and the dreams associated with watching that child grow and thrive into adulthood.
Adults also know that growing up can be painful. The wounds of childhood can persist throughout life, embodied in every muscle and organ of our bodies. Children experience trauma in similar ways as adults, including from abuse, poverty, war, injury, or other adverse events. But there is more to trauma than meets the eye.
There are subtle, often invisible, ways children suffer from trauma, the most common being the loss of human connection. Relational trauma can be experienced by children who feel misunderstood, inferior, unaccepted, emotionally neglected, or socially disconnected. These feelings damage children’s emotional health.
Today, college freshmen rate their emotional health compared to others their age at 50.7%, the lowest level ever (Eagan, et al, 2014). Numerous studies have highlighted the declining emotional health of U.S. students, including a steady rise in anxiety, depression, and mental illness (Pryor, et al., 2010; Douce & Keeling, 2014). While these statistics are a cause for concern, the good news is that researchers are beginning to better understand the links between poor mental health, relational trauma, and the brain. As a result, therapies are improving.
In recent years, neuroscientists and psychologists have studied various types of trauma and its effects on children. We know, for example, that when children experience trauma, their growth and development is disrupted. To heal and move forward, research shows that the brain must be stimulated in fresh, creative ways. More than ever, a child needs support from adults who can authentically and respectfully interact with them.
In a groundbreaking new book, Relational and Body-Centered Practices for Healing Trauma: Lifting the Burdens of the Past,psychologist Sharon Stanley, PhD, demonstrates the importance of sharing traumatic experiences in the presence of those who can see, hear, and feel the many ways our bodies communicate truth. Written primarily for helping professionals, this book also reminds us of the significant role parents, teachers, and mentors play in helping children heal from adverse events or relational trauma. In fact, the neuroscienceresearch and practices that Stanley shares should be at the heart of every healthy adult-child relationship. Gleaned from her book are three important ways all adults can become healers for the children in their lives.
The goal of rituals is to create human connections. When parents and teachers create safe spaces for children to express themselves, explore their feelings, and become aware of the sensations in their bodies, children feel what it means to be human. Stanley suggests that ceremony changes the brain in ways that convert fear to love, facilitating growth and development.
For example, when a child aches in his stomach, feels tension in her jaw, or experiences tight sensations in his chest, we can help that child more consciously connect these sensations to a deeper self-knowing. We do this through authentic listening and a sense of respect for how a child feels and experiences those feelings in his or her body. We are consciously present, helping children reflect and gain embodied self-awareness.
Through compassionate relationships based in somatic empathy, a child’s brain changes in ways that repair the effects of trauma.
The three practices listed above are everyday ways all adults can nurture deep connections with children and teenagers and help them heal from trauma. But often, children need the help of experienced psychological professionals to overcome adverse events and relational trauma in their lives. The good news is that neurobiological research with somatic, embodied healing practices is breaking new ground each year.
Stanley has trained hundreds of practitioners for over a decade in what she calls “somatic transformation.” For helping professionals who want to understand the neurobiological underpinnings of trauma and new ways to work with those affected by trauma, I highly recommend Stanley’s book, based on the most recent research and transformative practices available.
As parents and teachers, we must all become more aware of the subtle cues of relational trauma in our children and in ourselves. Through numerous case studies, Stanley demonstrates that it is never too late to heal the wounds of our own childhoods through body-based somatic healing. When we heal ourselves, we have greater capacity to be in authentic empathy-based relationships with our children.
Douce, L.A, & Keeling, R.P. (2014) A strategic primer on college student mental health. (Washington DC: American Council on Education).
K. Eagan, et al., (2014) The American Freshman: National Norms Fall 2014(Los Angeles: CA: Higher Education Research Institute, UCLA, 2014)
J.H. Pryor, et al., (2010) The American Freshman: National Norms Fall 2010(Los Angeles, CA: Higher Education Research Institute, UCLA, 2010).
S. Stanley, (2016) Relational and Body-Centered Practices for Healing Trauma: Lifting the Burdens of the Past (New York: Routledge).
Marilyn Price-Mitchell, PhD, is the author of Tomorrow’s Change Makers: Reclaiming the Power of Citizenship for a New Generation. A developmental psychologist and researcher, she works at the intersection of positive youth development and education.
https://www.psychologytoday.com/us/blog/the-moment-youth/201605/the-wounds-childhood-can-be-healed
How can we better understand the impact of trauma, and help survivors find the love, friendship and support they and their partner deserve?
Whether the trauma was physical, sexual, or emotional, the impact can show up in a host of relationship issues. Survivors often believe deep down that no one can really be trusted, that intimacy is dangerous, and for them, a real loving attachment is an impossible dream. Many tell themselves they are flawed, not good enough and unworthy of love. Thoughts like these can wreak havoc in relationships throughout life.
When early childhood relationships are sources of overwhelming fear, or when absent, insecure or disorganized attachment leaves a person feeling helpless and alone, the mind needs some way to cope. A child may latch onto thoughts like
These ideas may help a person cope when they hurt so badly every day and just need to survive. But they do not help the emerging adult make sense of their inner world or learn how to grow and relate to others. Even if the survivor finds a safe, loving partner later in life, the self-limiting scripts stay with them. They cannot just easily toss them and start over. These life lessons are all they have (so far) to survive the best way they know how.
Many times, trauma survivors re-live childhood experiences with an unresponsive or abusive partner (an important topic for another article). This often happens without the ability to see the reasons why they feel compelled to pursue unhealthy relationships. Beneath awareness is a drive to revisit unresolved trauma, and finally make things right. Of course, childhood wounds cannot be repaired this way unless there are two willing partners working on changing those cycles. But if these forces remain unnoticed, survivors can get caught in a cycle of abuse.
Even with a safe partner, a trauma survivor may
Partners of trauma survivors may want desperately to help. But partners need to “be clear that it is not your problem to fix and you don’t have the power to change another human being,” says Lisa Ferentz, LCSW in a post for partners of trauma survivors. Rather, know that both of you deserve to connect with resources to help you find comfort and healing.
It is important to recognize unhealed trauma as a dynamic force in an intimate relationship. It can super-charge emotions, escalate issues, and make it seem impossible to communicate effectively. Issues become complicated by:
In a relationship, a history of trauma is not simply one person’s problem to solve. Anything that affects one partner impacts the other and the relationship. With guidance from therapy, partners begin to see how to untangle the issues.
Many people do not even realize that they have had traumatic experiences. Trauma-informed therapy works by helping couples begin to see how they experienced traumatic abuse or neglect, and how it still affects them, and impacts their current relationships. This approach enables the therapist to provide specific insights to help couples separate past issues from present ones. Progress often comes more readily through a combination of individual sessions and work as a couple.
Trauma-informed therapy helps partners give each other the gift of what I and other therapists call psychoeducation – learning to understand each individual’s story, how it impacts their relationship, and how to process thoughts and emotions in healthier ways.
Trauma survivors and their partners have different needs for support. How can one respond when the other is grappling with mental health issues? How do you calm things down when overwhelming emotions get triggered?
It takes therapy for couples to find answers that are most healing for them. But some general tips for trauma survivors and their partners that can help are:
Building a healthy bond with a trauma survivor means working a lot on communication. Grappling with relationship issues can heighten fear and may trigger flashbacks for someone with a history of trauma.
Learning how to manage communication helps couples restore calm and provide comfort as their understanding of trauma grows. For example, couples can:
Communication can also help a partner comfort a loved one during a flashback. Techniques include:
Healing childhood wounds takes careful, hard work. But it is possible to replace old rules bit by bit. Finding a therapist who can recognize and acknowledge the hurt, which the survivor has carried alone for so long, is key to repairing deep wounds.
Partners may decide to work individually with their own trauma-informed therapist, while working with another as a couple, to provide the resources they need. When a survivor of early trauma can finally find comforting connection with a therapist, and then with their partner, the relationship between the couple can begin to support deep healing as well.
The more we understand about the impact of trauma, the more we can help those touched by it to go beyond surviving, and find the healing security of healthier loving relationships.
“Helping a Partner Who Engages in Self-Destructive Behaviors” by Lisa Ferentz, LCSW
“Trauma-Informed Care; Understanding the Many Challenges of Toxic Stress” by Robyn Brickel, M.A., LMFT
Sidran Institute (resources for traumatic stress education and advocacy)
Wired for Love: How Understanding Your Partner’s Brain and Attachment Style Can Help You Defuse Conflict and Build a Secure Relationship by Stan Tatkin, PsyD, MFT
Allies in Healing: When the Person You Love Was Sexually Abused As a Child by Laura Davis
Trust After Trauma: A Guide to Relationships for Survivors and Those Who Love Them by Aphrodite Matsakis
Mindsight: The New Science of Personal Transformation by Daniel Siegel
http://brickelandassociates.com/trauma-survivor-relationships/
