*Trigger Alert: proceed with caution; discussions of childhood trauma
The Adverse Childhood Experiences (ACEs) study conducted in the late 1990’s by the Centers for Disease Control (CDC) and Kaiser-Permanente involved 17,000 participants.
The results linked childhood trauma—including chronic stress, abuse and neglect—with later addiction, chronic pain/illness/disease, and even early death. The higher the trauma score, the more likely the result of problems in later life. Another study in 2019 involving 144,000 adults again conclusively correlated childhood trauma with negative health and behavior outcomes.
In the harsh light of this data, it is important to remember that many people who were traumatized as children do quite well throughout their lifetimes. We each embody a unique combination of nature and nurture, as well as our amazing brains—muscles that continue to learn and change.
The early adverse (traumatic) experiences for which the ACE study screened fall into three categories: abuse, neglect, and household dysfunction. Abuse included physical, emotional and sexual abuse; neglect included emotional and physical; and household dysfunction included, domestic violence toward mother, parental substance use, household mental illness, parental separation or divorce, suicide or death, and incarceration of a relative.
Exposure to childhood stress affects all people of all social and income levels. On-going stress that exceeds a child’s ability to cope, especially in the absence of supportive caregivers, is termed toxic stress by Jack P. Shonkoff of Harvard. Excessive stress can interrupt brain development, as well as the cardiovascular system, the immune system, and metabolic regulatory systems. (Feel free to skip ahead, if needed, to the good news at the end of this post.)
Some of the critical factors that determine levels of trauma are:
Age of onset: the older the better
Chronicity: one-time hits are better
Predictability: the more predictable the better
Nature of the Trauma: acts of nature and accidental harm are better than acts with intent to harm
If Involving a Person: a stranger is better than someone entrusted with our care
In addition to the items screened for in the ACE questionnaire, we know that other factors adversely affect development including violence in the community, poverty, and racism. Our body’s stress response is awakened by threats inside or outside the home, and will respond equally if we ourselves are in danger, or if we observe harm to someone we love.
Continual stress can keep us unnecessarily hypervigilant. Well beyond the actual threat, we can remain on high alert, with our system running too fast, as if a brick is weighing on the accelerator of a parked car.
A brief look at the actual structure of the brain helps us further understand the trauma response. The limbic system is a central network shared by all mammals. In animals, it is primarily associated with self-preservation and foraging. In humans, it is involved in behavioral and emotional responses, especially when we perceive our survival is at stake. These include: fight and flight responses, as well as freeze (which is thwarted flight/fight); eating; reproduction; and caring for our young.
The limbic system houses the hypothalamus, a busy part of the brain concerned with homeostasis. It regulates thirst and hunger, pain and pleasure responses, aggressive behaviors and more. The hypothalamus also regulates breathing, arousal in relation to emotional events, blood pressure, pulse—all parts of the autonomic nervous system. The autonomic nervous system is composed of the sympathetic and parasympathetic nervous systems – activating and calming respectively. The hypothalamus also communicates with the pituitary gland which is involved in metabolism and growth.
Another part of the limbic system is the hippocampus where short-term memory, significant enough to keep, is stored as long-term memory. The hippocampus is primarily responsible for consolidating learning and memory. When a child experiences too little love and nurturing, the hippocampus may be the first responder. And in the presence of too much trauma for too long, the hippocampus shrinks.
The hippocampus works with the amygdala, and other parts of the brain—thalamus and hypothalamus—to regulate hunger, thirst, and mood. The basal ganglia aids and abets as it processes rewards and helps in the formation of habits and movement and all learning.
The amygdala, also part of the limbic system, is primarily involved in fear conditioning, emotional regulation/gut response, and memory. The amygdala has the amazing ability to receive information about potentially frightening things before we are consciously aware of the threat! This gets our fight/flight responses in motion literally before we even think about it—thinking that happens, after the fact, in the cerebral cortex. Yay amygdala!
Sadly, with chronic stress or fear, the amygdala shrinks. This increases anxiety and primes the fight/flight response. However, it is also important to remember that anxiety and other difficulties are rarely independent functions; they involve other networks and neurological sites that may provide better discernment and stability. It is also important to remember that, with survival as our primary goal, we are incredibly adaptive. As in healthy families and groups, an optimal possibility is that a more adaptive part of the brain can sub in for one that does not function as well.
Other structures near the limbic system connect to and support its work: the cingulate gyrus, the ventral tegmental area, and the prefrontal cortex. The prefrontal cortex is part of the frontal lobe and could be called the thinking center of the brain. When there is trauma or too much stress, the thinking part of the brain becomes less active as do areas that regulate emotion. Their capacity is directed to the limbic system—the fear center—which goes into high gear and takes charge.
Interestingly, another part of the brain that loses capacity in trauma is the hippocampus, where short-term memory converts to long-term. This could help explain the flashbacks or triggers inherent in post-traumatic stress. If the trauma story is never properly stored as memory, it may be too readily available to pop up in the present as if it is happening all over again. (Also see Triggers and the Window of Tolerance)
And . . . here it is . . . The Good News!
THE GOOD NEWS
We have learned so much over the last 20 years during a renaissance of research in neuroscience. While we now have specific information about how trauma can damage the brain, we also know that neuroplasticity can foster growth and neural rewiring.
The damage done in childhood in the absence of safe nurturing relationships often requires that those same needs be met, again, in relationship, in order to heal. Attachment theory tells us that with consistent healthy connection, we can neurologically begin repair and growth in the prefrontal cortex. This part of our brain mediates, among other things, self-regulation, trust, and empathy.
To add optimism to optimism, the hippocampus and the amygdala are reparable, and can then better help us process the positive emotions elicited by rewarding stimuli! We can “grow” our hippocampus via stress reduction, physical exercise, and mental exercise. Neural feedback has facilitated healing the amygdala, as well as a practice of calming meditation and, yes, VACATION.
Science continues to give us good hope and evidence that healing can and does occur. It requires effort, time, and repetition. Bessel van der Kolk, author of The Body Keeps the Score posits three paths to healing:
1.) Talking, connecting, and re-connecting with others can help us begin to understand what happened in our earlier lives. This top-down healing involves using higher brain functions for deeper, structural healing. Keeping a journal and writing creatively—songs, stories, poems—can help us not only hold on to what we are leaning, but also formulate the next questions that will guide our healing.
2.) Medication is often a necessary part in calming activating reactions and responses.
3.) Body work is critical for bottom-up healing. This assures that the body will experience feelings of mastery, freedom, and calm that contradict and override earlier feelings of rage, helplessness, or immobility. This could include dance, meditation, yoga, and role play.
Changes in brain chemistry and circuitry—our nervous systems—can result in calmer, happier, more integrated, and more connected lives. Healthier and safer relationships provide the impetus toward recovery, hope, and healing. (And the primary healing agent in therapy? The relationship between client and therapist, of course!)
Practice makes progress. And imperfect progress will be supported by the compassion we can hold for ourselves, also held for us by trusted comrades when needed. Psychotherapy with a trauma-informed therapist can hasten and guide safe healing.
Read on for ways to manage overwhelming emotion, impulsivity, or destructive behavior:
Coping Strategies: CARESS and Grounding.
Resources
The Body Keeps the Score: Brain, Mind, and Body Healing of Trauma, Bessel van der Kolk
The Brain that Changes Itself, Norman Doidge
The Center on the Developing Child at Harvard Universityhttps://developingchild.harvard.edu