Echoes of the Past and Finding Safety in the Present

Exposure to adverse childhood experiences, including trauma, is sadly a common human condition. Adverse childhood experiences (ACEs) may include growing up in poverty, witnessing domestic violence, having a family member who is mentally ill, losing a parent, or being physically, sexually, or emotionally abused as a child.^1,2 In the U.S., 50-60% of adults report having had at least one ACE,^3,4 and research highlights how both vulnerable and resilient we are to the impact of such early adversity. For instance, despite the popular belief that trauma = bad, most people who have experienced a traumatic event (i.e., actual or threatened death, serious injury, or sexual violence) do not develop post-traumatic stress disorder (PTSD).^5,6 Many even report post-traumatic growth, such as greater inner resources, appreciation for life, and improved personal relationships.⁷ However, data also suggest that people exposed to multiple ACEs (≥4) face higher risk of chronic mental and physical health issues,³ emphasizing the measurable harms of negative early experiences.

I observe this co-existence of human tenderness and strength in the face of early adversity daily in my practice. For some people, their suffering from ACEs is immense and evident; they struggle with nightmares, flashbacks, hypervigilance, and other related symptoms that significantly impair their daily functioning. Their level of distress and impairment warrants a diagnosis of PTSD and evidence-based treatments to directly target their conditions. For others with a history of ACEs, their pain and suffering may be more subtle and nuanced. Many of them have built a successful life for themselves, and their achievements are indeed the testament of their resilience. Despite their success, however, many describe lingering pain from the experience of having chronically felt unsafe as a child, and how it still affects how they perceive themselves and the world. Whether or not one’s experience meets the diagnostic criteria of PTSD or other mental illness, their pain deserves appropriate attention and compassion, especially if it hinders their ability to live a life aligned with their values and aspirations.

Perhaps, one of the most challenging times for those with ACEs is when they encounter stressors that somehow remind them of the disproportionate threat they once faced as a child. This is often not a conscious process, and such stressors may elicit similar patterns of emotions and behaviors that the person once learned in their early history, such as feeling small and helpless, becoming excessively worried and frightened, and avoiding or over-preparing to fight the perceived threat. What can be helpful in such situations is bringing more awareness to these patterns, making the once automatic process into a more conscious one. Fear is most powerful when it remains unconscious.

Psychotherapy for people affected by ACEs may involve noticing the unhelpful patterns of behaviors and emotions across multiple areas of one’s life and evaluating the roles these patterns serve. Often, these are strategies that once worked to protect them earlier in their life but are no longer helping. Then, return to the present and realize one’s current internal and external resources as an adult to guide their actions accordingly. Most people have more agency and power as adults than when they were children, so their responses to stressors must adjust accordingly to be adaptive.

Our mind and body may be trying to protect us by echoing the patterns from the past; however, true safety lies in the present. We can acknowledge and have compassion for our child self and the ways of being that carried us forward; and redefine who we are and how we live based on our current values and strengths beyond the effects of ACEs.

Warmly,

Dr. Y

References

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2.          Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998;14(4):245-258.

3.          Hughes K, Bellis MA, Hardcastle KA, et al. The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Public Health. 2017;2(8):e356-e366.

4.          Merrick MT, Ford DC, Ports KA, Guinn AS. Prevalence of adverse childhood experiences from the 2011-2014 behavioral risk factor surveillance system in 23 states. JAMA Pediatr. 2018;172(11):1038-1044.

5.          Bonanno GA, Chen S, Galatzer-Levy IR. Resilience to potential trauma and adversity through regulatory flexibility. Nature Reviews Psychology. 2023;2(11):663-675. doi:10.1038/s44159-023-00233-5

6.          Bonanno GA, Mancini AD. The Human Capacity to Thrive in the Face of Potential Trauma. Pediatrics. 2008;121(2):369-375. doi:10.1542/peds.2007-1648

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13.       MacNeill LA, Pérez‐Edgar K. Temperament and Emotion. In: The Encyclopedia of Child and Adolescent Development. Wiley; 2020:1-12. doi:10.1002/9781119171492.wecad180

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15.       Guerin  Diana Wright, Gottfried  Allen W, Thomas  Craig W. Difficult Temperament and Behaviour Problems: A Longitudinal Study from 1.5                to 12 Years. Int J Behav Dev. 1997;21(1):71-90. doi:10.1080/016502597384992

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