When you think of your early years, what comes to mind? It might be things like diving into a fresh bowl of watermelon on a hot summer day, giggling as your parents pushed you on the swings at the local playground, biking around the block with your siblings, or gathering for a cozy winter movie night with the whole family. Or you may be among the many people who don't have these lovely memories, or who have darker memories that crowd out the happy ones.

What is complex ?

Most of us can recognize what trauma looks like. When we think of trauma, we often think of momentous, life-changing events. We think of horrific instances of , car accidents, natural disasters, and war—events that divide a person’s life into “before” and “after.” These are the experiences that victims are often plagued by in the form of flashbacks and .

What we don’t think or talk much about is something called complex trauma. Complex trauma is a subtle, "slow burn" type of childhood experience that affects a person just as profoundly.

Complex trauma is difficult to pinpoint, describe, and recall. They might appear as “snapshots” from childhood, like waiting at the window late into the night for an often-absent parent to come home. They could appear as a general feeling of distrust or detachment, a feeling that sneaks into the person’s adult relationships, even when those relationships are with people who aren't harmful.

Complex trauma is not always about what happened to a person; it’s also about what did not happen. Perhaps the person wasn’t given basic respect or a sense of reliability from the adults in their lives.

The (ACE) Checklist

Over my years of clinical practice, I’ve learned a few things about trauma that weren't in the textbooks. One thing really stands out—how common it is.

Of course, I had heard about the high prevalence of childhood trauma from famous studies like the Adverse Childhood Events (ACE) study. ACE was a survey of over 17,000 people between 1995 to 1997. The participants partook in physical exams and filled out private surveys about their childhood experiences as well as their current health and behavior status.

The 10 items on the survey included questions about physical and sexual abuse, as well as:

Did a parent or older adult in the household often swear at you, insult you, put you down, or humiliate you?

Did you often feel that your family didn’t look out for each other, feel close to each other, or support each other?

Did you live with anyone who was a problem drinker or or who used street drugs?

In this huge sample of participants, 64 percent of people endorsed at least one item. A full 12.5 percent of people experienced a whopping four or more. That’s a big deal—four or more of these items include profound neglect and victimization for a child, someone who is trying to develop a sense of self in a world where the people they’re most dependent on are the ones harming them the most. Would you have guessed that one in eight people called experiences like these their childhoods?

Early in my training, even knowing these stats, I'd find myself caught off guard. If I didn't directly ask a patient about trauma, assuming that they didn't fit the “profile” or that they would bring it up if it happened to them, it would go undiscussed.

Now, even if I miss the signs in the beginning, I can pick up on a patients’ underlying trauma because it always finds its way to the forefront. It’s not only about nightmares and flashbacks—complex childhood trauma affects the entire body and mind. Let's acknowledge that the effects of trauma can be hard to recognize. Here are three that we often don’t discuss.

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Effect #1: Trauma can burrow down deep into the body, contributing to .

Complex childhood trauma can cause physical scars in addition to psychological. Since the first ACEs study came out, showing how common negative childhood events are, health scientists from many fields have studied how these events affect long-term health.

A 2014 study from the Virginia Commonwealth University School of Medicine found that having a history of ACEs, especially sexual exploitation, was associated with a higher rate of a cancer diagnosis. A 2019 review of 155 studies confirmed the link between ACEs and cancer risk, showing that it’s likely because those with ACEs were more prone to and to problematic alcohol and tobacco use.

There is also increasing evidence of a link between ACEs and other diseases like heart, liver, lung, and autoimmune disease, and chronic headaches.

Effect #2: Trauma can be harmful to a person’s relationship with their own .

Growing up in a safe, caring environment allows a child to learn about their own bodies and sexuality in a healthy, confident way. But not having knowledge of or positive role models for sex and relationships can lead to poor outcomes for young people.

A study of almost 10,000 adults found that the more ACEs they had, the more likely they were to have had a sexually transmitted disease. Only 7 percent of men with no ACEs have ever had an STD, but 39 percent of men with seven ACEs have had an STD. The difference is similarly mind-boggling for women. Women with ACEs have been found to engage in more sexually risky behaviors, such as being up to 2.6 times as likely of having sex where they thought they were exposed to HIV.

When it comes to teen , there's also a linear link. In a large California sample, 16 percent of women with no ACEs became pregnant as , whereas that percentage rose to 53 percent if she had eight ACEs.

Effect #3: Even a person’s understanding of time and reality can be distorted by complex trauma.

How do you remember the past? Plan for the future? We all have our baggage and our fears but those who have experienced complex trauma literally have holes in the past and future. A large study of over 5,000 men and women found that those with significant complex trauma (ACEs score of 5 or higher) were six times as likely as those without any ACEs to have large gaps in their childhood memories.

When looking towards the future, young people with ACEs see something fuzzy too. Lack of future-oriented thinking is a feature of , and researchers have found that this can drive teens with ACEs to engage in delinquent, dangerous behaviors.

Even the present can feel distant to those with complex trauma. The experience of is sometimes referred to as an “ ,” where a person feels as if they have come away from their body. Dissociation can also manifest as insensitivity to pain, loss of muscle control, or even the inability to swallow. Those who have had a significant number of ACEs are more likely to experience dissociation.

, sometimes known as “multiple ,” is an extreme and rare form of disassociation that occurs because of childhood trauma. This is when someone cannot maintain one consistent sense of self and seems to involuntarily switch between different identities.

Understanding leads to healing

The knowledge about the long-term and insidious effects of childhood trauma is extremely sad. It may even make you feel hopeless. What can we do to undo the effects of trauma? How can we remedy missed childhoods and uncertain futures?

I believe that knowing the link between ACEs and these long-term symptoms is important. It can help healthcare providers pay more to complex trauma in young people, and offer interventions to avoid unhealthy coping behaviors like excessive drinking. It also means that those suffering can form a better sense of why it’s happening to them, so that they (and those around them) can view their symptoms with more .

These three major types of consequences from complex trauma are just the tip of the iceberg. Trauma’s fingers reach deep into every part of the body and mind. To learn more, and to find helpful resources for victims and loved ones, check out the National Child Traumatic Stress Network. I also recommend reading The Body Keeps the Score by Bessel van der Kolk. It’s a very readable and compassionate explanation of how the mind, brain, and body are reconstructed by trauma.

If you are struggling with the after-effects of trauma, know that you’re not alone. Understand that there's a valid reason for why you experience what you do, even today. Reach out to your social support system. Not everyone with a high ACEs score will have a difficult adulthood, just as not everyone with low or no ACEs will have an easy one. Remember, ACEs are a tool to assess risk. If you think you're experiencing the effects of childhood trauma, you should seek guidance from a mental health professional.

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