Understanding Trauma
More than 70% of adults have experienced a traumatic event at some point in their lives.[1] Trauma exposure is classified as any event that threatens or causes death, injury, or personal integrity.[2] Such experiences can include: emotional, psychological, physical and/or sexual abuse, natural disasters, war, injuries, or neglect. Further, traumatic events can occur as repeated, long-term experiences or as one single incident.[3]
As discussed by Majer et al., (2010), children are particularly receptive to traumatic experiences due to the heightened plasticity of a developing brain,[4] as well as their reliance on the environment for emotional and cognitive development. A child’s environment directly influences gene expression and brain growth; the stress that one’s environment imposes can help or hinder development.[5] While a normal amount of stress is crucial for the strengthening of important neural connections involved in emotional regulation and response to stress,[6] extreme, frequent, or long-lasting stress, will cause the body to adapt by sending a myriad of chemical and hormonal stress signals throughout the brain, altering its functional components.[7,8] Specifically, the overabundance of the stress hormone cortisol, will weaken bodily functions, including immune function, memory, learning, and emotional regulation.[9] Therefore, if childhood trauma occurs and is not properly addressed, it can lead to cognitive impairment and psychological disorders in adulthood.[10]
When a child's environment feels unsafe or threatened, there are various ways they will adaptively react in order to maintain a feeling of safety and protection. Such reactions include the development of extreme reactivity to stimulation, heightened sense of vulnerability, and the addition of attachment & neediness behaviors.[11] Additionally, research done by The National Scientific Council on the Developing Child (2005/2014) found that the adjustment of the stress-response system, through the strengthening of neural connections involved in fear and anxiety, causes the child to become stressed at a lower threshold.[12] Further, if a child doesn’t receive the proper emotional support and comfort following a traumatic experience, it can disrupt normal brain development and cause issues with emotional regulation and response to stress in adulthood.[13]
Symptoms of childhood trauma in adults
The intensity and type of traumatic exposure in childhood affects how it will appear in adulthood.[14] Traumatic experiences involving one’s caretaker pose the greatest risk to harming the child’s psychological state and development.[15] Additionally, traumatic experiences that are repetitive are more detrimental than a single episode;[16] as the rate of negative childhood experiences increases, so does the likelihood that the adult will experience symptoms.[17]
As it can be difficult for an adult to disclose childhood trauma,[18] the best indication of its existence is through the expression of conscious and unconscious symptoms. While the effects of childhood trauma manifest differently in everyone, common symptoms include: difficulty controlling emotions, impulsiveness, an increased response to stress, relationship instability, development of mental illnesses, dissociation, avoidance, and heightened anger.[19,20]
Many adults who experienced childhood trauma also suffer from memory and learning deficits.[21] Additionally, some adults are found to have high blood pressure and increased inflammation.[22] Childhood trauma can also lead to interpersonal relationship problems including the creation of a “disorder of hope”, in which new relationships are either idealized or hated.[23] Moreover, Su & Stone (2020) note that if traumatic experiences involve a toxic relationship with a caregiver or trusted adult, those dynamics can also be reenacted in the adult’s life, such as involvement with an abusive partner or becoming abusive themselves.[24]
Link between childhood trauma and mental health
Traumatic experiences that occur during childhood can cause disruptions in adult psychological function and lead to depression, anxiety, post-traumatic stress disorder (PTSD), and dissociation.[25]
Adverse experiences in early childhood can cause changes to the structural and functional components of the body, including increased sensitivity to stress, increased cortisol, glucocorticoid resistance, and decreased hippocampal volume. All of these changes closely parallel the features present in depression, suggesting traumatic experiences increase the risk of developing depression in adulthood.[26] Consequently, there is a high prevalence of childhood trauma in people with depression. It is also common for anxiety symptoms to develop following a traumatic experience, due to the heightened sensitivity to stress and production of cortisol.[27] Further Berber Çelik Ç, Odacı H (2020), found that childhood trauma can lower self-esteem, indirectly leading to the development of depression and anxiety.[28]
In some cases, typically those involving interpersonal violence or assault, traumatic experiences can lead to post-traumatic stress disorder.[29] PTSD refers to the development of symptoms following a traumatic exposure;[30] these symptoms include the re-experiencing of the traumatic event through nightmares, recollections, intrusive images, or reactions to reminders of the event. It also includes avoiding stimuli related to the traumatic event, increased arousal, and mood and thinking disruptions. To qualify as a diagnosis of PTSD, the duration of these symptoms must transpire for more than one month.[31]
Dissociation also can occur as a result of a childhood trauma, especially if the experience is life-threatening or imposed by a caretaker. Dissociation is a feeling of disconnect towards psychological constructs, including the body, environment, behavior, and memory.[32] Dependent on where the disconnection is occurring, an absence of emotions, disorientation with surroundings, feelings of separation from the body, problems with self-recognition, or disruptions in hearing can transpire.
Treatment
It is never too late to seek help for trauma that occurred during one’s childhood. Although every treatment will not be effective for everyone, options exist.[33] Exposure therapies such as exposure and response prevention (ERP) and prolonged exposure (PE) are some of the modalities used to treat trauma. Individuals are “exposed” to reminders of the traumatic event, but in a safe and comfortable setting. It is common to develop avoidance and fear for stimuli related to one’s traumatic experience, and exposure therapy gradually decreases those negative reactions.[34] Another treatment for trauma is cognitive-processing therapy (CPT). This type of treatment involves recognizing detrimental thought patterns and behaviors related to the trauma, and implementing healthier beliefs about the self, others, and the world. This process can be done through the use of writing assignments and Socratic questioning.[35] Other possible treatments include eye movement desensitization and reprocessing (EMDR), psychoeducation, and support therapy.
Image Sources [36,37]
Q&A
SAS’ Psychotherapist, Dr. Brittany Canfield, discusses childhood trauma
1. In your experience, how does childhood trauma typically present itself in adults?
“Based on the literature, there are many physical and psychological manifestations of childhood trauma in adults. What we often see in clinical settings is individuals coming in to treat unmanageable anxiety symptoms, depression, mood dysregulation, attentional issues, and challenges maintaining daily functioning. For many, the catalyst for treatment is suffering from personal relationships or difficulty managing their workload. Childhood trauma also hides within the confines of addiction, both in substance and behavioral as well as within personality disorders. Common symptoms reported when seeking treatment include the following:
Difficulty falling asleep, staying asleep, or sleep disturbances (i.e. sleepwalking, sleep talking, nightmares, and night terrors).
Anxiety, panic attacks, social anxiety, and obsessive-compulsive symptoms.
Depression, suicidal ideation, history of suicidal ideation, plans, and/or attempts, self-harm, and/or mood dysregulation, often including anger.
Attentional issues such as difficulty focusing, retaining information and/or other issues with recall, increased distractibility, decreased memory, losing time, and/or other symptoms commonly associated with ADHD.
Physical or somatic symptoms called somatization, include but are not limited to frequent headaches, body aches, gastrointestinal issues, chronic fatigue, decreased immune function, and effects related to chronic stress.
Other symptoms may include diminished self-esteem and self-worth, poor outlook, compassion fatigue or burnout, codependence, poor boundaries, disturbances in interpersonal relationships, and the need to stay busy.”
2. Are there any ways to prevent childhood trauma from affecting adulthood? If so, what are the most effective ones?
“While there is no single preventive tool, one of the biggest factors mitigating the impact of childhood trauma is resilience. The research highlights the protective qualities that resilience has on childhood trauma, especially when that includes a stable and safe connection with just one adult during childhood. Support has also been shown to mitigate the impact of trauma in the way the individual is able to process the experience and progress toward posttraumatic growth.”
3. What types of treatments are most effective in helping adults who are suffering from childhood trauma?
“Given the differences in how children and adults process trauma, further explained below, bottom-up therapies accessing the part of the brain that was impacted during the trauma have been shown to be the most successful. These therapies include somatic-based or somatic experiencing therapies, EMDR, sensorimotor therapy, and expressive arts. Individuals may also benefit from more traditional talk therapies such as cognitive-behavioral therapy (CBT), mindfulness-based CBT, and dialectical behavior therapy (DBT), the latter focusing on resource-building. Additionally, therapy will focus on building skills that can assist the individual in regulating their nervous system and learning to utilize other mind-body activities such as yoga, meditation, and polyvagal techniques, all of which have been shown in the research to mitigate the effects of trauma.”
4. Are there any differences in how children process traumatic experiences compared to adults?
“This is an excellent question and a very important aspect of the impact of trauma on the brain in human development. In childhood, the prefrontal cortex is still developing and will continue to do so well into the mid-20s. With that being said, we process trauma from the bottom-up, that is, from the base or "bottom" of our brain. Bottom-up processing includes our sensory system, meaning that we experience and store the trauma from our senses, thus somatically. Other parts of our brain impacted by trauma include our limbic system and peripheral nervous system. When we experience trauma as an adult and often when childhood trauma is not a precipitating factor, we do so from our prefrontal cortex, which allows us to process the trauma using higher cortical thinking including cognitive processes such as reasoning, language, and awareness. You may wonder why this is so important? People who experience childhood trauma often do not have the words to describe or process what they experienced, because the part of the brain that is engaged in those processes was not the primary part of the brain in use when the trauma occurred. This makes it difficult for childhood trauma survivors to even acknowledge that the trauma happened let alone impacted them.”
5. Do you have any advice or anything you want to share with someone who may be suffering from childhood trauma?
“There is often fear and shame associated with childhood trauma, which can prevent individuals from seeking help. We often internalize social stigma (self-stigma) of seeking help out of fear of being invalidated, shamed, pathologized, or perceived as "crazy." You do not have to go at this alone, feel ashamed for what you have gone through, or carry the burden of your childhood trauma well into adulthood. If you have a childhood trauma history, it is recommended that you seek the help of a professional, join a support group, educate yourself on childhood trauma and often complex PTSD, and engage in activities that regulate the nervous system.”
If you have experienced childhood trauma and would like to explore possible treatment options, please reach out to a licensed mental healthcare provider who specializes in trauma recovery.
For more information, click here to access an interview with Psychologist Michele Bedard-Gilligan on trauma & recovery.
Additionally, you may click here to access an interview with Psychologist Bethany Brand on trauma & dissociation.
To access our PTSD Self-Care Tips, click here.
Contributed by: Amelia Worley
Editor: Jennifer (Ghahari) Smith, Ph.D.
References
1 Benjet, C., Bromet, E., Karam, E. G., Kessler, R. C., McLaughlin, K. A., Ruscio, A. M., Shahly, V., Stein, D. J., Petukhova, M., Hill, E., Alonso, J., Atwoli, L., Bunting, B., Bruffaerts, R., Caldas-de-Almeida, J. M., de Girolamo, G., Florescu, S., Gureje, O., Huang, Y., Lepine, J. P., … Koenen, K. C. (2016). The epidemiology of traumatic event exposure worldwide: results from the World Mental Health Survey Consortium. Psychological medicine, 46(2), 327–343. https://doi.org/10.1017/S0033291715001981
2 Bedard-Gilligan, M., & Worley, A. (2022, May 13). Psychologist Michele Bedard-Gilligan on Trauma & Recovery - Psychology and Psychiatry Interview Series. Seattle Anxiety Specialists, PLLC: Psychiatry & Psychology. Retrieved May 17, 2022, from https://seattleanxiety.com/psychology-psychiatry-interview-series/2022/5/5/q6oxgila8beysefwg0qvb7gve9pb46
3 Harms, L. (2015). Understanding trauma and resilience. Macmillan Education.
4 Majer, M., Nater, U.M., Lin, JM.S. et al. Association of childhood trauma with cognitive function in healthy adults: a pilot study. BMC Neurol 10, 61 (2010). https://doi.org/10.1186/1471-2377-10-61
5 Stien, P., & Kendall, J.C. (2004). Psychological Trauma and the Developing Brain: Neurologically Based Interventions for Troubled Children (1st ed.). Routledge. https://doi.org/10.4324/9781315808888
6 Ibid.
7 National Scientific Council on the Developing Child. (2005/2014). Excessive Stress Disrupts the Architecture of the Developing Brain: Working Paper 3. Updated Edition. http://www.developingchild.harvard.edu
8 Stien, P., & Kendall, J.C. (2004)
9 Excessive Stress Disrupts the Architecture of the Developing Brain. (2005/2014)
10 Majer, M., Nater, U.M., Lin, JM.S. et al. Association of childhood trauma with cognitive function in healthy adults: a pilot study. BMC Neurol 10, 61 (2010). https://doi.org/10.1186/1471-2377-10-61
11 Van der Kolk, B. (2003). Psychological Trauma. American Psychiatric Pub.
12 Excessive Stress Disrupts the Architecture of the Developing Brain. (2005/2014)
13 Stien, P., & Kendall, J.C. (2004)
14 Van der Kolk, B. (2003).
15 Everett, B., & Gallop, R. (2001). The link between childhood trauma and mental illness effective interventions for mental health professionals. SAGE.
16 Su, W.-M., & Stone , L. (2020, July). Adult survivors of childhood trauma. Australian Journal of General Practice. Retrieved May 16, 2022, from https://www1.racgp.org.au/ajgp/2020/july/adult-survivors-of-childhood-trauma
17 Ibid.
18 Ibid.
19 Ibid.
20 Thatcher, T. (2018, November 20). Healing childhood trauma in adults. Highland Springs Clinic. Retrieved May 8, 2022, from https://highlandspringsclinic.org/blog/healing-childhood-trauma-adults/
21 Stress disrupts the architecture of the developing brain. (2005)
22 Ibid.
23 Van der Kolk, B. (2003).
24 Su, W.-M., & Stone , L. (2020, July).
25 Van der Kolk, B. (2003).
26 Christine Heim, D. Jeffrey Newport, Tanja Mletzko, Andrew H. Miller, Charles B. Nemeroff, The link between childhood trauma and depression: Insights from HPA axis studies in humans, Psychoneuroendocrinology, Volume 33, Issue 6, (2008), Pages 693-710, ISSN 0306-4530, https://doi.org/10.1016/j.psyneuen.2008.03.008.
27 Robert S Pynoos, Alan M Steinberg, John C Piacentini, A developmental psychopathology model of childhood traumatic stress and intersection with anxiety disorders, (1999), Pages 1542-1554, ISSN 0006-3223, https://doi.org/10.1016/S0006-3223(99)00262-0.
28 Berber Çelik Ç, Odacı H. Does child abuse have an impact on self-esteem, depression, anxiety and stress conditions of individuals? International Journal of Social Psychiatry. (2020)171-178. doi:10.1177/0020764019894618
29 Bedard-Gilligan, M., & Worley, A. (2022, May 13)
30 Ibid.
31 Wilson, J. P., & Keane, T. M. (2006). Assessing psychological trauma and Ptsd. The Guilford Press.
32 Brand, B., & Worley, A. (2022, May 9). Psychologist Bethany Brand on Trauma & Dissociation- Psychology and Psychiatry Interview Series. Seattle Anxiety Specialists, PLLC: Psychiatry & Psychology.
33 Bedard-Gilligan, M., & Worley, A. (2022, May 13)
34 American Psychological Association. (2017, July). What is exposure therapy? American Psychological Association. Retrieved May 10, 2022, from https://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy
35 American Psychological Association. (2017, July). Cognitive processing therapy (CPT). American Psychological Association. Retrieved May 9, 2022, from https://www.apa.org/ptsd-guideline/treatments/cognitive-processing-therapy
36 Bowman, J. (2017, February 9). Socratic questions revisited [infographic] · James Bowman. James Bowman. Retrieved May 17, 2022, from http://www.jamesbowman.me/post/socratic-questions-revisited/
37 R. W. Paul, L. Elder: The Thinkers Guide to The Art of Socratic Questioning, 2007