Introduction
Trauma isn’t always as straightforward as a single, life-altering event. Many people grow up facing repeated emotional wounds within their own homes such as abuse, neglect, or simply not feeling safe. When these experiences happen during childhood and go on for years, the compounded impact can be deeply rooted and complex. This form of trauma, often called complex or developmental trauma, shapes how we see ourselves, relate to others, and cope with life’s challenges.
For many, the effects of childhood trauma don’t fade with time. Instead, they can show up in unexpected ways when activated. Sometimes trauma responses present through anxiety, relationship struggles, or feeling stuck in patterns that don’t seem to make sense. The Adverse Childhood Experiences (ACE) study provides critical insight into how early trauma affects not only our mental health but our physical health as well. It's important to understand how complex trauma develops, the responses that trauma activates, and how the ACE study has reshaped our understanding of the link between childhood adversity and adult health outcomes.
What is Complex/Developmental Trauma?
Complex trauma results from repeated and prolonged exposure to adversity, often occurring in the very relationships that are supposed to provide safety and security. This might include growing up with an emotionally unavailable or abusive parent, witnessing domestic violence, or living in an unpredictable environment due to mental illness or substance use in the household. The trauma becomes complex because it disrupts the child’s sense of safety and stability over time.
The National Child Traumatic Stress Network (NCTSN) defines complex trauma as a type of trauma that “involves multiple traumatic events that are severe, pervasive, and often involve harm or abandonment by caregivers”1. These experiences can impair a child’s ability to form healthy attachments, regulate emotions, and establish a sense of self. As a result, adults who experienced complex trauma may struggle with self-esteem, trust, and emotional regulation.
When a child is repeatedly exposed to such stress, their developing brain adapts to prioritize survival. This means they might become hypervigilant, overly attuned to others’ emotions, or numb themselves as a coping strategy. Trauma can show up with survival strategies of the nervous system including fight, flight, freeze, or fawn. In adulthood, these adaptations can manifest as difficulties in relationships, trouble managing emotions, and a general sense of feeling unsafe or unworthy.
The ACEs Study: How Early Experiences Impact Adult Health
The ACE study, a landmark research project conducted by the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente, surveyed over 17,000 adults about their childhood experiences of abuse, neglect, and household dysfunction. Researchers identified 10 types of adverse experiences, such as physical or emotional abuse, parental separation, or living with a family member who struggles with addiction. Each experience counts as one point toward an individual’s total ACE score.
Findings from the ACE study revealed that the more adverse experiences a person had (measured as their ACE score), the greater their risk for a wide range of physical and mental health issues later in life. For example, individuals with a high ACE score are more likely to experience:
Physical Health Problems: Conditions such as heart disease, diabetes, and autoimmune disorders are more prevalent in those with higher ACE scores2.
Mental Health Challenges: Anxiety, depression, PTSD, and substance use disorders are significantly more common among individuals with a history of childhood trauma3.
Relationship Difficulties: The study also highlighted how early trauma can make it challenging to form healthy relationships, resulting in patterns of mistrust, difficulty setting boundaries, or emotionally intense relationships4.
The ACE study has been instrumental in shifting the conversation around trauma, demonstrating that early adversity has a tangible and lasting impact on our physical and emotional health. Understanding this framework helps us see trauma not as a personal failing but as a biological and psychological response to overwhelming circumstances.
Long-Term Effects of Complex Trauma in Adulthood
Complex trauma can have a pervasive impact on a person’s life, influencing not only their mental health but also their physical well-being and social functioning. Here is how it often manifests in adulthood:
Emotional and Mental Health: Adults with complex trauma histories often struggle with chronic anxiety, depression, PTSD, or a general sense of emptiness. They may find themselves re-experiencing old wounds in the form of intense emotions or intrusive memories. These emotional responses are often rooted in trauma’s impact on the brain’s ability to regulate emotions and manage stress5.
Physical Health: Chronic exposure to stress hormones like cortisol can wear down the body over time, leading to physical manifestations such as chronic pain, fatigue, digestive issues, and a weakened immune system. A study by the American Journal of Preventive Medicine found that individuals with four or more ACEs were twice as likely to be diagnosed with heart disease and 1.6 times more likely to experience diabetes6.
Relationship Challenges: Trusting others can feel unsafe or overwhelming. Those with complex trauma histories may find it difficult to establish boundaries, feel the urge to push others away before they get hurt, or become overly dependent on relationships as a source of self-worth.
Self-Worth and Identity: When children are repeatedly exposed to unsafe or invalidating environments, they may internalize the belief that they are unworthy or unlovable. This can lead to patterns of self-blame, perfectionism, or people-pleasing in adulthood.
These challenges don’t have to define a person’s future. While the impacts of complex trauma can be long-lasting, they are not irreversible. Healing is possible—and there is hope.
Healing from Complex Trauma: Steps Toward Recovery
Healing from complex trauma is a deeply personal journey that often involves rediscovering safety—both in our bodies and in our relationships. This process is not about “fixing” oneself but rather learning to navigate life with more compassion, self-understanding, and resilience. Some therapeutic approaches that can support healing include:
EMDR (Eye Movement Desensitization and Reprocessing): This evidence-based therapy helps individuals process traumatic memories, reducing their emotional intensity and making them feel more manageable.
Somatic Therapy: Trauma can be stored in the body, leading to physical sensations like tightness, pain, or numbness. Somatic therapy helps clients reconnect with their bodies, release stored tension, and restore a sense of safety and presence.
Pain Reprocessing Therapy (PRT): Particularly effective for those who experience chronic pain related to trauma, PRT helps rewire neural pathways to reduce pain sensitivity and address the emotional underpinnings of physical symptoms.
Building a Support Network: Healing doesn’t happen in isolation. Finding safe, supportive relationships can provide a new template for connection, helping to counterbalance past experiences of betrayal or neglect.
No matter where someone is on their healing journey, reaching out for help is a courageous first step. Trauma doesn’t have to be a life sentence and with support and the therapy, it’s possible to rewrite one’s story and move forward with a more peaceful way of living.
Conclusion
Complex trauma is a complex subject, but ultimately, it is about human resilience. It’s about recognizing that the ways we’ve adapted to survive can be unlearned and reshaped. With understanding, compassion, and support, people can heal from the wounds of their past and create lives filled with meaningful relationships and self-acceptance.
If you or someone you know is struggling with the effects of trauma, know that there is hope and help available. The path to healing is not linear, but with each step forward, you’re building a future that’s no longer defined by the past.
References:
Footnotes
National Child Traumatic Stress Network. "Understanding Child Trauma." Retrieved from NCTSN Website. ↩
Felitti, V. J., Anda, R. F., et al. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258. ↩
Anda, R. F., et al. (2006). The Enduring Effects of Abuse and Related Adverse Experiences in Childhood: A Convergence of Evidence from Neurobiology and Epidemiology. European Archives of Psychiatry and Clinical Neuroscience, 256(3), 174–186. ↩
Chapman, D. P., et al. (2004). Adverse Childhood Experiences and the Risk of Depressive Disorders in Adulthood. Journal of Affective Disorders, 82(2), 217-225. ↩
Teicher, M. H., & Samson, J. A. (2016). Annual Research Review: Enduring Neurobiological Effects of Childhood Abuse and Neglect. Journal of Child Psychology and Psychiatry, 57(3), 241–266. ↩
Hughes, K., et al. (2017). The Effect of Multiple Adverse Childhood Experiences on Health: A Systematic Review and Meta-Analysis. The Lancet Public Health, 2(8), e356-e366. ↩
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