Trauma by any other name

Think of the word trauma. What comes to mind? I’m guessing that many of you are thinking of combat veterans, sexual assault survivors, or folks who’ve experienced disasters like car accidents, fires, or shootings. You are absolutely correct!

This narrow definition leaves out a lot of people though. Trauma also includes those of you who experienced neglect or divorce, who witnessed violence, substance use, or mental illness, who dealt with the incarceration of a parent, or who survived any kind of abuse or family instability.

If for any reason you ever experienced the world as an unsafe or dangerous place for an extended period, then you have experienced trauma.

Thankfully, most of you came out pretty much unscathed, maybe even stronger because of it. You might even be able to laugh about some of the things that happened to you.

Some of you, however, continue to experience life as an endurance contest. You can’t control your emotions. You’re easily angered or hurt. You’re often sick or just not feeling 100%. You find it hard to take care of yourself. You struggle to maintain healthy and fulfilling relationships.  

Some of you might still experience the world and other people as dangerous or unsafe. You might even secretly view yourself as damaged goods.

Adverse childhood experiences

It wasn’t until the 1980s that physicians and researchers began to examine the connection between so-called adverse childhood experiences (ACEs) and adult health issues. Things like anxiety, depression, substance abuse, obesity, troubled relationships, among others, were correlated to childhood experiences unacknowledged and certainly unexamined.

Even one of the lead ACE researchers, Vincent Felitti, stumbled accidentally on this line of study. He was performing a standard intake with an individual in an obesity program when a Freudian slip launched him into studying the ill-effects of childhood trauma.

Rather than ask the client, “How old were you when you became sexually active?” he mistakenly asked her, “How much did you weigh when you became sexually active?” Her response: forty pounds.

She tearfully revealed that she was raped by her father when she was four years old. His eyes opened, Felitti began connecting the dots: a traumatic childhood correlates to an unhealthy adulthood.[i]

Over time, ACEs have been segmented into 10 buckets:

  • Physical abuse
  • Sexual abuse
  • Emotional abuse
  • Physical neglect
  • Emotional neglect
  • Mother treated violently
  • Household substance abuse
  • Household mental illness
  • Parental separation or divorce
  • Incarcerated household member 

The more commonly cited post-traumatic stress disorder, however, excludes a majority of these ACE categories. PTSD, you see, is only diagnosable in individuals who have experienced actual or threatened death, serious injury, or sexual assault. There currently is no accepted category in which to place individuals grappling with the lingering impact of childhood trauma.  

Only within the last ten years have researchers and clinicians suggested broadening the definition of trauma. The proposal for developmental trauma disorder would include those who have “experienced or witnessed multiple or prolonged adverse events over a period of at least one year beginning in childhood or early adolescence.”[ii]

That’s academic lingo for having a tough childhood. 

If you're interested in learning your ACE score, here is an article from NPR that includes the quiz and information about what it means and doesn't mean to you. 

Trauma lingers on

The emergence of a new understanding of trauma is important for a few reasons. First, adverse experiences impact brain development. Trauma lingers because it literally changes how your brain functions. Because of physical changes resulting from trauma your self-development is changed. Your ability to reason and process information is altered.

From a biological standpoint, trauma affects how your limbic region functions. It modifies how your hypothalamus, pituitary, and adrenal glands regulate cortisol. It also disrupts neurotransmitters associated with arousal and endogenous opioid systems. These can contribute to a lifetime of anxiety, frustration, misunderstanding, fear, isolation, and ill-health.

Human beings are adaptable animals and most of you who live through adverse experiences find healthy and manageable coping strategies. You grow up to lead productive and fulfilling lives. However, humans are individually unique. Not all of you respond in the same way to stress.

Because of individual, genetic, or environmental circumstances you each respond in a singular way. Plus, research has shown that individuals who experience a greater number of ACEs face an increased likelihood of health problems later in life.

Interestingly, even those who exhibit identifiable negative symptoms (depression, emotional instability, substance abuse, etc.) develop coping strategies that help them survive. But a fulfilling life is about more than mere survival.

There is a necessary and vital distinction between merely surviving and thriving.

A focus on sheer physical survival, a largely unconscious process managed by your limbic system, can hinder your emotional, physical, and cognitive abilities. Your brain can help you to cope with adverse experiences, but doing so requires energy.

And energy devoted to survival cannot be diverted to activities associated with living a more fulfilling and thriving life. These might include things like practicing healthy eating habits, enjoying meaningful hobbies, or developing close friendships.

Until you have reprocessed and cleared the lingering impact of trauma there is a greater likelihood that you will not experience the fulfilment of leading a thriving life.

Thankfully, trauma is a treatable condition. In fact, there is increasing anecdotal evidence that working through trauma leads to what is known as post-traumatic growth. The rewards of working through the darkness of trauma far outweigh the reality of merely surviving another day.

In my next post, I will explore some of the ways that childhood trauma affects you in adulthood.   

[i], as viewed on July 13, 2017.

[ii] Bessel van der Kolk, MD, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, Viking, 2014.