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Nowhere to go from here

<p>Nowhere to go from here</p>
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Why The Age You Experienced Trauma Matters

Trauma knocks us down and changes our lives forever. Sexual assault, violence, neglect, emotional abuse – these experiences steal our sense of safety, flood our bodies with stress, and can take years to recover from whether we’re 5 or 55. There is something about childhood trauma, though, that not only shapes our mental health but our sense of who we are. There are no perfect answers to explain why trauma, even exposure to the same trauma, affects some people differently than others. According to the American Psychological Association, factors like family support, ongoing life stressors, prior trauma exposure, and psychiatric comorbidities all impact our ability to recover after a traumatic event. When children experience trauma while their brains are still developing, they may have fewer protective factors — and therefore risk more life-lasting consequences. If you experienced trauma as a child, this could explain why it seems to leak into everything you do in ways you might still be discovering. This is not to say experiencing trauma as an adult doesn’t have devastating, life-long consequences, or that your traumatic experience counts “less” if it happened later in life. But it is true that adults who experienced less childhood trauma often have stronger foundations to deal with the trauma adulthood throws their way. If you’re an adult who feels like your childhood trauma is who you are (instead of something that happened to you) here are four reasons this might be the case. Early Childhood Trauma Impacts Our Attachment Style The first relationship we have is between us and our caregivers. For most people, this means our parents. When you’re new to the world and trying to figure out what the heck is going on (being a baby is confusing!) how your caregiver initially responds to your needs sets a framework for your future relationships. We’re talking about big questions, like: Am I lovable? Am I safe? Will someone meet my needs? Do I even deserve to have my needs met? If you’re neglected during these early years or if your primary caregiver isn’t safe, it changes your answers to these foundational questions. This doesn’t mean someone with a secure attachment won’t be rocked by a breakup, struggle with grief, or take years or even decades to recover from a traumatic loss – but, if your needs were met clearly and regularly early in life, you may have an easier time navigating these relational changes. Although you may question it sometimes, overall you know: I am loved. I am worthy. I deserve to get my needs met. If for some reason you didn’t develop a secure attachment, your core beliefs may be different. For example, if you have an anxious attachment style, you may find yourself constantly questioning your worth in a relationship and fearing abandonment. If this is you, you might believe: I am unworthy of love, nobody loves me, I have to constantly prove myself to get my needs met. If you’re someone with an avoidant attachment style, you might struggle to be vulnerable with a partner. If this is you, your narrative might sound like: I am the only one who can meet my needs, everyone will let me down, emotional connection and vulnerability are dangerous. No one is doomed by their attachment style (I promise!), and it’s important to note attachment traumas aren’t always caused by abuse. The death of a caretaker, outside stressors, cultural factors, and other life circumstances can all impact how our attachment develops. Regardless, these early experiences can affect the quality of our relationships later on, which makes this type of early childhood trauma profound. Early Childhood Trauma Impacts Our Brain Development More than two-thirds of children will experience at least one traumatic event before the age of 16. Just like attachment trauma sets a framework for how we view relationships, early childhood trauma significantly impacts our brain development, rewiring our sense of safety, identity, and ability to regulate our emotions. A video by BrainFacts.org does a great job explaining how trauma impacts a child’s developing brain. As the video explains, some stress during our childhood is normal and even welcomed. It’s how we learn to solve problems, tolerate uncomfortable emotions, and develop skills to deal with stress later on. But if you were a child who was constantly under stress, perhaps because you lived in an abusive home, this likely disrupted the development of certain brain structures and actually increased your risk of developing stress-related diseases later in life. Specifically, our amygdala, prefrontal cortex, and anterior cingulate cortex – parts of our brain that help us sense danger, regulate emotions, and develop cognitive functions like empathy, impulse control, and decision-making – can all be impacted by childhood trauma. Childhood Trauma Changes Our Internal Narratives Even adults who’ve experienced trauma grapple with the why. Why would this happen to me? How could it have been avoided? What did I do wrong? For children who are still developing their ability to understand complex topics, this “why” is even more confusing – and part of what makes childhood trauma so insidious. If you were a child when you experienced trauma, depending on where you were developmentally, it’s likely your brain didn’t have the ability to make sense of your traumatic experience. For example, if you experienced a traumatic event between the ages of 2 and 7, that’s when you’re still developing the ability to see things from the perspective of others – so you literally think the world revolves around you. That means after experiencing a trauma, you literally couldn’t create an explanation you weren’t at the center of, so you concluded it had to be your fault. This self-blame, even if it’s subconscious, could be why childhood trauma survivors often struggle with their self-esteem and experience negative self-talk. Especially in cases of emotional abuse, the narrative of the abuser often becomes the internal narrative of the child, something many trauma survivors need to unlearn in adulthood. While adults who experience emotional abuse aren’t immune to its effects, they might have a strong enough positive, internal narrative to understand the behavior has more to do with the other person, and that the blame doesn’t fall on them. Many People Who Experience Childhood Trauma Are Retraumatized Perhaps the saddest fact about childhood trauma is this already vulnerable population is more at-risk of being retraumatized. This doesn’t happen to everyone. Some children may experience a “one-off” trauma, like getting into a car crash or the tragic death of a loved one. These traumatic events are devastating and, of course, can leave life-long impacts, but with the right support, most children can return to their previous levels of functioning and even develop resiliency skills in the process. For other children, the conditions that initially exposed them to trauma are often a breeding ground for more trauma exposure. For example, a teenager who spends most of his time outside the home to avoid an abusive parent may find himself more at-risk of violence on the streets. If a parent who neglects their child doesn’t teach them about boundaries with strangers, this child is now more at-risk of being revictimized by other adults. These repetitive traumas (and the chronic stress that comes with them) put young people more at risk for developing post-traumatic stress disorder (PTSD), or even complex PTSD. The more adverse childhood experiences (ACEs) you have, the more likely you are to experience negative outcomes. Childhood Trauma Is Not Who You Are For those still navigating a childhood trauma recovery journey, I hope that understanding why childhood trauma sticks to us the way it does increases the compassion you have for yourself. When you look back at yourself as a child – a child whose brain was still developing, whose environment led to more trauma, and who developed an attachment style they didn’t choose – please remember it was not your fault, and as an adult, you deserve all the support and love you need to heal.

Dr. Ally
Dr. Ally @drally
contributor

Dr. Ally's Guide to Adverse Childhood Experiences and Trauma

I’m sure, by now, most of you have heard of ACEs, otherwise known as adverse childhood experiences. The term was first coined by the Kaiser Permanente health care organization in Southern California and referred to any incidents in childhood that may result in trauma or any other type of difficulty. To us, with our 2022 sensibilities, this seems obvious. But into the mid-1980s, the connection between emotional experiences and health was seen as unscientific. It was downright pseudoscience. This means there were so many generations before our own that believed their emotional experiences had no impact on their health. That makes all the holiday arguments make a little more sense, right? However, now we have an almost universal understanding that our experiences can shape our emotions which can create real change in our biology. And that experiencing adversity at any point in life, particularly in childhood, can impact health outcomes long-term. So what exactly are ACEs? The study highlighted ten adverse childhood experiences of note: physical abuse verbal abuse sexual abuse physical neglect emotional neglect witnessing a parent who is an alcoholic or substance abuser having a mother who is a victim of domestic violence having a family member diagnosed with a mental illness having a family member incarcerated experiencing the divorce of your parents You may not have experienced any of the big 10 ACEs mentioned in the Kaiser study but there are other adversities that can impact your health. Looking through the lens of the social-ecological model, we can experience ACEs on four levels: societal, community, relationship, and individual. On a societal level, we can experience racism and prejudice, or poverty. On a community level, we may experience or witness violence in our neighborhood, noise pollution, or toxins in our environment. On a relationship level, we may experience bullying or a lack of acceptance. Then, on an individual level, watching a sibling being abused, the abuse of a parent or caregiver, experiencing and recovering from severe accidents, or being involved with the foster care system or juvenile justice system. Ultimately, the experience of trauma on any level can result in the release of stress hormones like cortisol. The chronic release of these types of hormones, which we call chronic stress, can cause negative effects on multiple physical systems. Chronic stress can impact cardiovascular function, immunity, brain development, and how we process our emotions. ACEs are specifically linked to an increase in adult alcoholism, depression, a sedentary lifestyle, difficulties with employment, cancer, heart disease, diabetes, suicide, and engaging in violence or being a victim of violence. And according to research in the field of epigenetics, we then pass down these genetic alterations to our children. So now that I’ve painted this dire and unchangeable portrait, what do we do about adverse childhood experiences? We survive them and thrive in spite of them. Since our bodies are little adaptation machines, we can create an environment that will encourage healing and change our DNA. Firstly, develop a team that works for you. Your team has all kinds of people. A psychologist or psychiatrist, your medical doctor and medical team, your supportive friends, loving family members, and the person who just makes you laugh on social. This is all your team. None of us got here alone and we all need the support of others to get where we want to go. Then, we want to look at managing our cortisol levels so we can just decrease our experience of stress. One of my favorite ways to decrease cortisol is to engage in acts of kindness. Doing something kind for someone else increases our production of oxytocin which naturally downregulates our levels of cortisol. This means doing something nice for someone or even just chatting on the phone. There’s that old chestnut meditation, which slows down our stress response and helps us recuperate. Then there’s my favorite: finding meaning and connecting it to your purpose. This is one thing I do with all of my coaching clients. Aligning with why you are here is one way to stay focused on creating a sustainable and hopeful future and helps you avoid focusing on an unchangeable and possibly painful past. Where you focus goes, your mood will follow.

Community Voices

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Monika Sudakov

The ACEs Questionnaire Is Missing These Types of Trauma

From 1995 to 1997, over 17,000 participants from within the Kaiser Permanente organization throughout Southern California underwent one of the most comprehensive research studies ever conducted attempting to link the presence of childhood abuse , neglect , and other trauma with negative health outcomes later in life. The ACEs study, or adverse childhood experiences, determined that there is a direct correlation between childhood trauma and chronic diseases including heart disease, cancer, diabetes, autoimmune diseases of all kinds, as well as a myriad of mental health conditions. The study involved the use of a questionnaire featuring 10 types of childhood trauma identified as most common within the sample community involved in the study. The findings indicated that the higher your ACEs score, meaning the more of these traumas you endured in childhood, the higher your risk for developing disease later in life. The questions included can be found here. While the ACEs Study revolutionized the ways in which the medical community viewed the impact of trauma on wellness thereby emphasizing the need for mental health care and better education about trauma amongst those involved with childcare of any kind, there are some limitations to the study and the inventory that need to be addressed in order for the true nature of the impact of trauma during childhood upon health later in life to be adequately understood. First, the demographics of the community that were interviewed for the initial study were predominantly white middle-class individuals with access to health insurance and therefore proper comprehensive health care. This doesn’t negate the study per se, but it does limit its usefulness on a broader scale. If nothing else, I believe it actually underestimates the cause and effect of childhood trauma on health later in life, particularly among minority populations which tend to be poorer, underinsured, and more vulnerable to innumerable stressors. Second, the original inventory of questions fails to take into account a myriad of traumas that are equally valid and likely just as damaging over time. These include but are not limited to: racial trauma, homophobia, transphobia, xenophobia, war, poverty, immigration, bullying, medical trauma, religious and spiritual trauma, intergenerational trauma, ableism, and pandemics. Some of these may be societal in nature but not only do they affect a child’s sense of security and safety, but they can also severely affect a caregiver’s stress and ability to be attuned and functional. Third, the questions are not specific enough to address more nuanced types of abuse and neglect , such as emotional incest and attachment disruptions. There is more and more evidence that indicates that even when from the outside children appear to be cared for — i.e., have housing, food, a good education, and parents who appear to be involved — what children actually experience behind closed doors can be far from idyllic. The ambiguity of this kind of attachment injury is difficult for children to recognize and often behavioral issues that arise from this type of trauma is designated as something stemming from within the child, like attention-sensitive/hyperactivity disorder (ADHD) or disruptive mood dysregulation disorder. In her book “Mother Hunger,” Kelly McDaniel astutely points out that the ACEs questionnaire fails to include “having an abusive or frightening mother” but does include witnessing a mother being abused which perpetuates a narrative that mothers are always victims and never the perpetrators of abuse . Additionally, it fails to recognize that men can be victims as well, which only reinforces a patriarchal view of the world where men are the aggressors and women the prey. My personal history of childhood covert incest and emotional neglect from my mother is a perfect example of how my experience isn’t encompassed by the inventory. I score a 5 out of 10, which is high enough, but my more impactful trauma isn’t reflected in the inventory as it was originally conceived. There is no way a questionnaire designed for widespread use by professionals across various sectors could adequately encompass the seemingly innumerable permutations that trauma takes. But, I do think it is time for an overhaul that is somewhat more involved and incorporates both less obvious types of abuse or neglect as well as societal ones. Too many of us struggle unnecessarily with undiagnosed trauma and chronic illness that doesn’t appear to have a source because we simply don’t have the vocabulary or awareness of how what we experienced as children was in fact trauma . This can lead to self-blame, comparative suffering, and loss of hope. If your trauma doesn’t fit the criteria of the ACEs questionnaire, that doesn’t mean it didn’t happen, that it wasn’t damaging, that it wasn’t bad enough to get help, or that you are overreacting. In the grand scheme of the developing world of a more holistic approach to trauma -informed medical treatment, we are still within the infancy of not just understanding how what happened to us and/or what we didn’t get affects us on a biological level, but the degree to which childhood trauma on both a micro and macro level determine our mental and physical wellness throughout our lifespans.

Community Voices

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How Dissociation and Compartmentalization Help Kids Cope With Trauma

Trauma is widespread, and many people experience some form of trauma in the course of their lives. I myself am a survivor of complex trauma and can attest to its tenacity and destructiveness. I’m also a therapist who has seen, time and again, that healing trauma really is possible: through talking, writing, transparency and sharing stories. This is why I have decided to share some of the things I have learned, both personally and professionally, for Mental Health Awareness Month in May. My childhood began in revolutionary Iran, where the chaos of political events created a rise in violence, fear and childhood sexual abuse . I was never safe outside or inside my home and always in a state of panic and high alert. As a result, I learned to lock away my pain — quite literally — in different “rooms” within my own mind. Later on, in graduate school, I would learn that this process is called compartmentalization, but back then, I just thought of my different experiences as different rooms in an imaginary place I called “The House of Stone.” The House of Stone was my sanctuary, and I would spend long hours picturing my life there, where I was loved and cared for by magical creatures. When you’re a child and left unprotected by those who are supposed to protect you, the only way to bear life is to flee it. This process, called dissociation, exists in all of us to some extent. My inner world made me feel safe, but it came at a cost: the more attached I became to my House, the more lost I felt in the outer world of gunshots, bombs and the usual pain of growing up. I couldn’t connect to kids at school, and nobody wanted to be friends with someone who talked to herself and stared off into space. I tried to explain to a few schoolmates what I saw in my mind, but no one could relate. I had no choice but to retreat deeper, in order to avoid shame, confusion and despair. The word trauma comes from the Greek word for “wound,” but I’ve always thought that trauma is less of a wound and more of a set of compartments we develop to normalize life and avoid feeling pain. As a therapist, I’m endlessly fascinated by the wisdom of a child in crisis and the lengths they will go to meet their need for safety. We all do this. All people, whether or not they function “normally” in the world, have developed some habits of dissociation and compartmentalization. You might ask yourself where in your life you feel lost, conflicted and/or disconnected from yourself, and where some of these “walls” between your inner parts might be. Take a simple example. Every time I’m in an elevator, I notice people dissociating. They stare at the walls, and their eyes tell me they aren’t in their bodies — they’re somewhere else. If you asked these people where they went, they probably wouldn’t know. They’re unconsciously dealing with the discomfort of a tight space with strangers by creating another “room” within their minds. But of course, no one thinks this is odd, since everyone does it. In fact, if someone else in the elevator tried to ask questions or talk about the weather, the first person might feel annoyed, although he wouldn’t actually say, “Hey, let me dissociate till the doors open.” It’s a small moment of flight we all agree on. But for a child in crisis, there’s no moment when the elevator doors open, and so children have to go to great lengths to build thicker and thicker walls, often in ways that adults can’t understand, and in ways that continue on into later life. For most of us, our walls have ears. In other words, though our experience is compartmentalized, there’s also some clue about what’s happening on the other side of the barrier. For example, you might notice that you self-sabotage in some area of your life: you really want a job or relationship , but you are aware that you keep doing things that stand in the way of that goal. Healthy adults can sense — as though hearing a muffled sound from across a wall — that there is more to their experience than they are currently aware of. They can then go to therapy or talk with friends to overcome this division. But for people with complex trauma , their walls don’t have ears. Those ears were cut off, by design, long ago, because hearing what was on the other side of the wall would have been too painful. For these people, whole chunks of experiences or memories might be locked away without the person knowing they ever existed. For such people, it might seem absurd to think that another part of them remembers or feels completely differently. But it is precisely this admission that allows them to heal, slowly, and find their inner listening again. I am a person with complex trauma . As such, I know how disorienting it can be to admit that there exists within me different parts, different wishes, different identities — and even different ages and genders! What enabled me to accept this truth and to flourish was learning to be open to the idea of an “inner democracy:” to think of myself as having not just one self, but rather, a whole society of selves that must learn to coexist. I have also had the good fortune to meet wise and open-minded people who have encouraged and respected this process rather than shaming me. And so I’ve made it my life’s mission to destigmatize complex trauma and dissociation in my work as a therapist, writer and advocate for the youth. I can honestly say now that my walls have ears again, and that I even enjoy listening to my different (though still sometimes conflicting) parts. When we learn to listen within, we can learn to listen more deeply to others. We can honor each other’s parts and promote true healing. I wish this for all of you, and for a Happy Mental Health Awareness Month!

Community Voices

No matter the depth of damage and pain we experience, our truest selves have the capacity to vanquish those demons, never completely gone, but enough to have full, productive lives. That is not to say we ever forget or heal entirely from true trauma. I don’t believe in “forgive and forget…just let it go.” If something scars one deeply enough that the pain is carried for the rest of one’s life, it is then part of who we are, and we can’t “forget” or “let go” pieces of our own selves.

Those who’ve lost loved ones, suffered physical, emotional or sexual abuse, or poverty and neglect, survivors of war, natural disasters - all experiences that leave us profoundly and permanently changed, into something new and strong or broken and shattered; or, for many of us, some combination thereof. From my perspective, it’s a position of profound privilege or denial to say that we are not forever and irrevocably changed by those moments, be they one, or hundreds. These events and emotions need to be acknowledged - seen, felt and heard - by ourselves, if no one else, before they can be set aside and managed as solely background info and context to who we are today.

Open up that little box, buried deep inside, where all the painful things get shoved and sealed away. Open that box, remember, grieve, rage, weep, let the emotions rack you, flow through you, and ebb away. When they’ve ebbed, gently close the box, tuck it back away to revisit another day. The next time you open it will be a little easier, as will each time after that. Think of that box as containing radioactive waste – each time its opened, some leaks out and goes away – leaving you and your toxic box a tiny bit lighter each time. But if it is never opened, it fills and fills, pressured from inside, to release suddenly one day in the most unexpected of ways or circumstances. Sometimes, people aren’t even aware that that little box of buried pain is the cause of their current response or reaction to something seemingly unrelated.

What we can do is find ways to live with and manage the pain, so that it becomes only painful memories and not defining moments in our lives, forever changing our potential or path forward for the worse. For me, the more I wrote, discussed, analyzed and revisited these stories, the less pain and power they held for me. When I began writing this, (shortly after leaving home at sixteen) my hand shook so it was nearly illegible and I struggled to keep my hand controlled enough to write for more than a few minutes at a time, before being overtaken by full body shakes. While there are still stories in here that evoke those physical responses, they are progressively fewer and less intense.

I have discovered that no matter how far one is pushed, and how many handicaps are thrown in one’s way, the human spirit is unbelievably strong.

 #memoir   #AdverseChildhoodExperiences   #MentalHealth #AbuseSurvivors #Anxiety #Depression

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Community Voices

I was born of a tornado, birthed by a turbulent, powerful and unpredictable storm. Raised in an earthquake – ever shifting, fracturing, unstable – I never stood on solid ground. My siblings and I, tempest tossed seeds – fragile, unformed, lacking roots – bound by genetics and bonds formed of chaos. Forged in battering winds and destroying fire, we all learned to dance across ever shifting sand under our feet – pulled hither and yon by implacable ocean tides. Like redwood seeds - enduring and beautiful beings – birthed only from fiery destruction.
                Spirits embodied by Willow, Ivy, Orchid, Sunflower, Dandelion, Hemlock, each of us possessed of wildly different strengths and flaws. Twisted and broken in places, still we grew and survived into our predestined forms, shaped but not destroyed by the whirlwind from whence we came.

#memoir #AdverseChildhoodExperiences #AbuseSurvivors #Anxiety #Depression #MentalHealth


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