Societal and clinical awareness of the role trauma can play over the lifespan –in particular, early-life trauma – has increased dramatically over the course of the past 40 years, especially after the American Psychiatric Association added the diagnosis of Posttraumatic Stress Disorder (PTSD) to the DSM in 1980. This official acceptance of the challenges that physical and emotional trauma can evoke occurred primarily in response to negative psychosocial consequences manifested by Vietnam combat veterans. Within a few years, however, it was recognized that survivors of childhood neglect, emotional/psychological abuse, physical abuse, and sexual abuse, as well as adult survivors of the same, also tend to manifest posttraumatic distress.
It was clear by the mid-1990s that traumas endured in childhood and adolescence, whatever form in which those traumas were experienced, can and often do negatively impact emotional regulation, identity, self-worth, relationships, somatization, dissociation, and worldview of survivors. Moreover, we came to understand that when trauma symptoms and their underlying causes go unrecognized, those symptoms tend to compound and reverberate over the lifespan in various (and sometimes surprising) ways.
For instance, research tells us that the more times a child has been traumatized, the greater the likelihood of adverse trauma reactions later in life. This same research finds that individuals with four or more significant traumatic experiences prior to age 18 are:
- 1.8 times as likely to smoke cigarettes
- 1.9 times as likely to become obese
- 2.4 times as likely to experience ongoing anxiety
- 2.5 times as likely to experience panic reactions
- 3.6 times as likely to be depressed
- 3.6 times as likely to qualify as promiscuous
- 6.6 times as likely to engage in early-life sexual intercourse
- 7.2 times as likely to become alcoholic
- 11.1 times as likely to become intravenous drug users
As you can see, there is an undeniable link between early-life trauma and numerous adult-life symptoms and disorders. Basically, trauma survivors tend to adapt and cope as best they can with their unresolved trauma and posttraumatic symptoms (anxiety, depression, hyper-vigilance, over-reacting, etc.) Often, they do this without ever realizing that their later-life behaviors are connected to their early-life traumas.
Unfortunately, for a substantial number of these individuals, the coping mechanisms used to avoid the pain of trauma are effective for a while but over time become problematic, thereby compounding the original aftereffects of the as-yet unresolved trauma. Substance and process (behavioral) addictions are primary among the various coping mechanisms utilized. At Seeking Integrity, the Los Angeles based sex/porn addiction and chemsex addiction rehab I run, almost everyone who walks in the door for treatment has a significant history of unresolved childhood trauma. That said, addictions are not the only long-term issue; there can be other (often less obvious but no less problematic) issues.
Consider Miller, a 41-year-old accountant with a history of substance abuse and compulsive sexual behaviors. Sober from his addictions for three years, Miller finds that certain relational aspects of his life are still out-of-control and causing problems. Most notably, he complains of an inability to trust others, even those who’ve earned his trust, and a strong tendency to overreact to perceived slights, no matter how minor. He says these issues are impacting his romantic life and work life in negative ways.
Now in therapy, Miller initially insists he had a perfectly normal childhood with no neglect or abuse, though a deeper dive into his history reveals an alcoholic father and an enmeshed, controlling, narcissistic mother. Eventually, he admits that when he was eight or nine his parents had a horrible fight (about his father’s drinking) and his mother threatened to leave. He says that he hid in his room and prayed that his mother would follow through on her threat, but he did not then (and does not now) understand why he wanted her gone.
When pressed, Miller admits that sometimes his relationship with his mother felt too close. Like most victims of covert/emotional incest, he eventually describes aspects of his relationship with her as ‘icky.’ Nevertheless, he says that most of the best moments in his childhood involve his mother, even though she made him uncomfortable and he never felt like he could trust her.
Asked for an example of why he could never trust his mother, Miller shares the following anecdote.
My mom would promise something that she knew I wanted but there were always strings attached. By the time I was a teenager I referred to this (but only in my head) as ‘the bait and switch.’ I would be busy doing something or have plans to do something and she would offer up something fun, like going to McDonald’s for lunch. I would tell her I was meeting friends in an hour (or whatever it was I was planning to do), and she would assure me we’d be back in plenty of time. Then we would stop at the dry cleaners (It’s on the way!), her favorite department store (They’re having a sale!), and several other places (Just for a few seconds!). We might or might not ever make it to McDonald’s, and we would certainly not be home anywhere near the promised time. And the fact that I was utterly miserable the entire time was my fault, not hers.
In a later session, Miller states that as a boy he was never allowed to have (let alone express) feelings. He was expected to smile, make good grades, do well in sports, and otherwise keep his mouth shut. Being afraid, or confused, or ashamed, or in any way needy was not acceptable – regardless of how detached his father was, and how enmeshed, narcissistic, and untrustworthy his mother was.
With no modeling for the expression and processing of emotions, Miller did what every person does in this situation. He created ways to cope. In elementary school, he used books and fantasy to ignore and avoid his feelings. In middle school, he discovered alcohol, masturbation, and marijuana. By the time he reached high school, he was living a double-life – model student by day, addict by night. On the surface he was successful and happy; below the surface he was anxious, depressed, and riddled with shame.
For a long time Miller maintained this façade because he was able to numb his emotional discomfort with alcohol, drugs, and sexual behavior. By his mid-30s, however, his addictive behaviors caught up with him. He’d collected two DUIs and been arrested in a prostitution sting, was demoted at work, and had driven away everyone who’d ever tried to love him.
With nowhere else to turn Miller entered therapy, where he was guided toward rehab and 12-step recovery for substance use and compulsive sexual behavior. As stated earlier, he is now three years sober from these issues but still struggling with life and relationships. And it looks as if his struggles are mostly the result of his underlying inability to trust others and his tendency to overreact to any perceived slight, whether that slight is real or imagined.
In other words, Miller, now that he is sober, is manifesting symptoms of posttraumatic stress disorder. His unresolved early-life trauma issues continue to negatively impact his ability to feel his feelings. He does not have the healthy coping skills needed to productively express and process emotional discomfort. Because of this, he can’t maintain romantic relationships or even lasting friendships, and he sometimes lashes out for no apparent reason at the people around him, especially the people he dates or works with, even when he truly likes and respects them.
Before recovery, Miller’s addictions kept him from connecting in healthy ways with others. Now that he is sober, the early-life trauma issues that drove his addiction continue to prevent intimacy and trust. So he acts out, which exacerbates his troubles.
Is there a solution for Miller? Certainly, though his path to healing is neither easy nor fun. Now that he is solidly sober, he must explore and process his early-life trauma. This means he will need to be fully honest about issues like emotional and psychological neglect, covert incest, addiction within the family, inconsistent parenting, repression of emotions, and other forms of abuse. He must peel back the complex layers of his childhood trauma so he can know what he experienced and how it has affected him – both as a boy and as an adult.
Early-life attachment-based trauma, as Miller has clearly experienced, has significant and long-lasting effects. The most obvious manifestations tend to be addiction and serious psychological disorders. Less obvious manifestations are what we currently see with Miller – a tendency toward isolation, disappointment, and unwarranted outbursts of anger or other strong emotions. And these less obvious manifestations can, over time, be just as damaging to the individual (and those around the individual) as the more obvious symptoms.
Essentially, individuals like Miller feel insecure in most if not all aspects of life. Even when life is going well, they feel an ongoing sense of danger with related feelings of mistrust and hyper-vigilance. Worse still, they typically don’t see the connection between childhood trauma and their adult-life relational issues. Instead, they simply think of themselves and their symptoms as crazy, which exacerbates their already shame-filled self-image.
Unfortunately, until Miller’s unresolved trauma is addressed in a highly controlled therapeutic setting, his relational issues will continue to manifest. He will continue to feel shame, and he will continue to act out in ways that drive other people away.
For more information about trauma and treatment of trauma, plus referrals to clinicians who specialize in this work, visit the website of the International Association of Trauma Professionals at https://www.traumapro.net/. For a quick assessment of childhood trauma, generate an Adverse Childhood Experiences Score (ACES). This easy-to-use ten question tool can be found at this link.