When you think of your childhood, what comes to mind? It might be things like ice cream running down our chin, giggling and running through a water fountain, sledding with your siblings, or having hot chocolate while snuggling on the sofa with your mom and dad. Or you may be among the many people who don’t have these lovely childhood memories, or who have darker memories that crowd out the good ones.
What is complex trauma?
Most of us can recognize trauma in general. When we think of trauma, we often think of momentous, life-changing events. We think of horrific instances of sexual assault, car accidents, natural disaster, and war—events that divide a person’s life into “before” and “after.” These are the experiences that victims can’t help but replay in flashbacks and nightmares.
Complex trauma is an insidious, ‘slow burn’ type of childhood experience that affects a person profoundly.
What we don’t think or talk much about is something called complex trauma. Complex trauma is an insidious, “slow burn” type of childhood experience that affects a person just as profoundly.
These traumas are harder to pinpoint, describe, and remember. They might appear as “snapshots” from childhood, like waiting late into the night for an often-absent parent to come home. They could appear as a general feeling of distrust or detachment. That feeling sneaks into the person’s adult relationships, even when those relationships are with people who aren’t abusive.
Complex trauma is not always about what happened to a person; it’s also about what did not happen. Perhaps the person didn’t receive basic respect, or a sense of consistency from the adults in their lives.
The Adverse Childhood Experiences (ACE) checklist
Over my years of clinical practice, I’ve learned a few things about trauma that I didn’t get from textbooks. One thing really stands out—how common it is.
Of course, I had heard about the high prevalence of childhood trauma from famous studies like the Adverse Childhood Events (ACE) study. ACE was huge survey of over 17,000 people between 1995 to 1997. The participants had physical exams and filled out confidential surveys about their childhood experiences as well as their current health and behavior status.
The surveys contained a list of ten items. In addition to traumatic experiences like physical and sexual abuse, the checklist included things like:
- Did a parent or older adult in the household often swear at you, insult you, put you down, or humiliate you?
- Did you often feel that your family didn’t look out for each other, feel close to each other, or support each other?
- Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?
In this giant sample of participants, 64 percent of people endorsed at least one item. A full 12.5 percent of people experienced four or more. That’s a big deal—four or more of these items paints a picture of profound neglect and victimization for a child, someone who is trying to develop a sense of self in a world where the people they’re most dependent on are the ones hurting them the most. Would you have guessed that one in eight people called experiences like these their childhoods?
Complex childhood trauma is a whole body and whole mind illness.
Early in my training, even knowing these numbers, I’d find myself caught off guard. If I didn’t directly ask a patient about trauma, assuming that they didn’t fit the “profile” or that they would bring it up if they’d experienced it, I would miss it.
But now, even if I miss the signs in the beginning, I can pick up on a patients’ underlying trauma because it always finds a way to show itself. It’s not just nightmares and flashbacks. Complex childhood trauma is a whole body and whole mind illness.
Let’s bring complex childhood trauma into the light. Let’s acknowledge that the effects of trauma can be hard to recognize. Here are three that we often don’t talk about.
Effect #1: Trauma can live a long time in the body and contribute to chronic illness
In addition to psychological scars, complex trauma can hurt the body. Since the first ACEs study came out, showing how common adverse childhood events are, health scientists from many fields have studied links from these events to long-term health.
A 2014 study from the Virginia Commonwealth University School of Medicine found that having a history of ACEs, especially sexual exploitation, was associated with a higher rate of cancer diagnosis. A 2019 review of 155 studies confirmed the link between ACEs and cancer risk, showing that it’s likely because those with ACEs were more prone to obesity and to problematic alcohol and tobacco use.
There is also increasing evidence of a link between ACEs and other diseases like heart, liver, lung, and autoimmune disease, and chronic headaches.
Effect #2: Trauma can poison a person’s relationship to their own sexuality
Growing up in a safe, supportive environment allows a child to learn about their own bodies and sexuality in a healthy, confident way. On the other hand, not having knowledge of or positive role models for sex and relationships can lead to poor outcomes for young people.
Not having knowledge of or positive role models for sex and relationships can lead to poor outcomes for young people.
For example, a study of almost 10,000 adults found that the more ACEs they had, the more likely they were to have had a sexually transmitted disease. Only seven percent of men with no ACEs have ever had an STD, but 39 percent of men with seven ACEs have had an STD. The difference is similarly astounding for women. Women with ACEs have been found to engage in more sexually risky behaviors, such as being up to 2.6 times as likely of having sex where they thought they were exposed to HIV.
When it comes to teen pregnancy, there’s also a linear link. In a large California sample, 16 percent of women with no ACEs had teen pregnancies, whereas that percentage goes up to 53 percent if she had eight ACEs.
Effect #3: Even a person’s relationship with time and reality can be warped by complex trauma.
How do you remember the past? Plan for the future? We all have our baggage and our fears, but those who have experienced complex trauma literally have holes in the past and future. A large study of over 5000 men and women found that those with significant complex trauma (ACEs score of 5 or higher) were six times as likely as those without any ACEs to have have large gaps in their childhood memories.
Even the here and now can feel distant to those with complex trauma.
When looking into the future, young people with ACEs see something fuzzy too. Lack of future-oriented thinking is a feature of depression, and researchers have found that this is part of what drives teens with ACEs to engage in delinquent behaviors.
Even the here and now can feel distant to those with complex trauma. The experience of dissociation is sometimes referred to as an “out-of-body experience,” where a person feels detached from their body or like their experience is surreal. Dissociation can also manifest as insensitivity to pain, loss of muscle control, or even the inability to swallow. Those who have had a significant number of ACEs are more likely to experience dissociation.
An extreme form of dissociation caused by childhood trauma is dissociative identity disorder, sometimes known as “multiple personality disorder.” This is when someone cannot maintain one coherent sense of self and seems to involuntarily switch between different identities. This disorder is very rare.
Understanding leads to healing
The knowledge about the long-term and insidious effects of childhood trauma is extremely sad. It may even make you feel hopeless. How can we reach into the past and undo trauma? What do we do about missed childhoods and uncertain futures?
Understanding complex trauma means that those suffering these symptoms can make sense of why it’s happening to them and view their symptoms with more compassion.
I believe that knowing the link between ACEs and these long-term symptoms is important. It means that healthcare providers can pay more attention to complex trauma in young people, and offer interventions to decrease unhealthy coping behaviors like problematic drinking. It also means that those suffering these symptoms can make sense of why it’s happening to them, so that they (and those around them) can view their symptoms with more compassion.
The three major types of consequences from complex trauma I reviewed above barely scratch the surface. Trauma’s fingers reach deep into every part of the body and mind. To learn more, and to find helpful resources for victims and loved ones, check out the National Child Traumatic Stress Network’s website at nctsn.org. I also recommend reading The Body Keeps the Score by Dr. Bessel van der Kolk. It’s a very readable and compassionate explanation of how the mind, brain, and body are transformed by trauma.
If you are struggling with the after-effects of trauma, here are a few things to remember:
- Know that you’re not alone!
- Understand that there’s a very real reason for why you experience what you do, even today.
- Reach out to your social support system.
Not everyone with a high ACEs score will have a difficult adulthood, just as not everyone with low or no ACEs will have an easy one. Remember, ACEs is a tool to assess risk. If you think you’re experiencing the effects of childhood trauma, you should seek guidance from a mental health professional.
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