Trauma shapes us. It alters brain development which shapes not only the way we think but how we interact with others, what we believe about God, what kind of intimacy we like or dislike, how we raise our children, and even our physical health.
Exactly how trauma shapes these aspects of our lives varies widely based on a multiplicity of variables. In fact, the term trauma itself is very broad, encompassing such things as complex trauma, developmental trauma, PTSD, and more.
In the next few articles I am going to provide a very narrow window into how negative childhood experiences can impact adults. Today we will introduce one of the most significant studies ever done on the subject: the Adverse Childhood Experiences (ACE) study. In future articles I will describe some of the common impacts I have observed over the course of my career as a minister and DV interventionist/advocate, and I will touch on some of the factors that influence resiliency and healing.
In 1985 a physician with the Kaiser Permanente Department of Preventive Medicine named Dr. Vincent Felitti was frustrated with the dropout rates of patients in his San Diego Obesity Clinic. In a talk he gave in 2015 Dr. Felitti said there was one case in particular that started everything.
“A young woman came in,” he recalled. “She was 408 lbs. and she asked us if we could help her with her problem. Our first mistake was in accepting her diagnosis of what the problem was.”
In 51 weeks the staff at the obesity clinic helped this woman go from 408 lbs. to just 132 lbs. Before he could proclaim astounding success however, something happened that he thought was “physiologically impossible.” She regained 37 lbs. in three weeks. When he asked her what was happening she said that she had been sleep eating. She would go to bed with a clean kitchen and wake up the next morning to find food out and dirty dishes in the sink.
Dr. Felitti was willing to accept what had happened. What he was confused about was why and why now. She told him that the sleep eating had started the day that she had been propositioned by a co-worker. Dr. Felitti continued to ask questions and discovered that the young woman had been molested as a child by her grandfather. It would be well worth your time to watch Dr. Felitti tell the story yourself.
His personal research and work eventually led to a partnership with the CDC in the mid 90s to launch the largest study of its kind into the impacts of childhood trauma on adult health outcomes. The study involved more than 17,000 people and was built around a simple 10 question survey. The 10 questions were about three types of adverse childhood experiences: abuse, neglect, and household dysfunction.
Dr. Robert Anda who cofounded and helped design the study would later say “This was the first time that researchers had looked at the effects of several types of trauma rather than the consequences of just one. What the data revealed was mind-boggling. I wept. I saw how much people had suffered and I wept.”
The questions included:
Two thirds of the study participants answered yes to at least one of these questions. Researchers were able to discern noticeable increases in various types of health risk among participants with two and three yesses. But where things really started to jump out was when participants had four or more of these experiences in childhood.
Participant’s with four or more of these “ACEs” saw health and well-being risks skyrocket. They had a 240% greater risk of hepatitis, were 390% more likely to have chronic obstructive pulmonary disease (emphysema or chronic bronchitis), and a 240% higher risk of a sexually- transmitted disease. They were twice as likely to be smokers, 12 times more likely to have attempted suicide, 7 times more likely to be alcoholic, and 10 times more likely to have injected street drugs.
The evidence showed that “people with high ACE scores are more likely to be violent, to have more marriages, more broken bones, more drug prescriptions, more depression, more auto- immune diseases, and more work absences. Persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life, including those for several of the leading causes of death in adults.”
The results of the original study have been duplicated many times. Since the study was done in the mid 90s, the field of neuroscience has exploded and is helping explain why ACEs have such a significant impact on later life and why it’s so important to address these problems as early in a child’s life as possible.
There are too many of us who are affected directly or indirectly by trauma to neglect exploring its social, relational, and mindset impacts. In my experience some of those impacts include.
And these are just a few. In a follow up article, I will be discussing some of these in more depth.
We cannot afford to live, work, and worship in environments that demand a facade of conformation and do not give us the space or empowerment to heal, transform, and grow.
A few years ago I was sitting in a small circle with a couple of young teenagers and a co-facilitator. I was helping spearhead a brand new program for teens who had been exposed to domestic violence. A boy named Caleb with floppy red hair sat straight across from me. He stared sullenly at the floor. In the couple of hours I had spent around him, I had never seen him act interested in anything or anyone. He barely spoke. He shuffled around begrudgingly and only participated in social interaction when forced to.
I had spoken to his mom earlier that week. She was in the midst of a courageous fight for freedom from a violent abuser. She sat in my office and told me some of their story. She had been abused by Caleb’s father when Caleb was just an infant. She had a second child-a girl- and left their father shortly thereafter. She had some short term relationships during the next few years but nothing solid. When Caleb was 9 she married a man with a teenage daughter of his own.
At first things were okay. But within the first year the man began to batter her. She tried to stay and work it out. She thought things might get better. She wanted a stable home for Caleb and her daughter. But one evening things got worse than they had ever been. Her husband chased her around the kitchen with knife. She fled to the only room in the house that still had a lock on the door-the bathroom.
She told me that Caleb stood in the hallway holding his little sister and watching his stepfather beat on the bathroom door screaming obscenities and threats. Caleb was twelve. He felt like he should do something. But he was torn between protecting his mother and sheltering his sister. In the end he felt helpless to do either.
How does this kind of trauma impact a child? In this article I’m going to provide a simple and at times slightly oversimplified description of the neurological impacts that occur and often follow children into their adult lives when not addressed.
Long before the incident that Caleb witnessed at twelve years old, his brain had already been impacted by trauma. Caleb could not even remember his father but the violence he was exposed to was damaging nonetheless. In order to understand why you need to know a little about brain development.
The brain can be visualized in three basic sections: the brain stem, the cerebellum, and the cerebrum. Caleb, like all babies, developed the raw materials of all of these sections in utero. However, the brain stem is what defined his first experience of life. The brain stem is the control center of the body’s vital functions. Body temperature, breathing, blood pressure, sleep, and digestive functioning all get their cues from the brain stem.
The cerebellum contains what is sometimes referred to as the Limbic system. Among other things, this part of the brain receives input from the senses and begins the process of directing the body to respond appropriately. Stimuli enters a part of the Limbic System called the Thalamus and is passed on to the Amygdala. The Amygdala automatically assesses the emotional significance of the stimuli. If it is potentially threatening it sends the information to the hypothalamus which controls stress hormones including adrenaline that are released to prepare the body for fight or flight. Obviously, a baby cannot fight or flee and must depend on a caregiver.
During the first few years of life the cerebellum does its most significant growth. In fact, many neuroscientists believe that the first two years are the most critical in the development of the cerebellum. It develops in what neuroscientists call a “use-dependent” way. Meaning that the environment and stimuli it experiences program it over time.
During those first couple of years, the cerebrum which is responsible for abstract thinking, rational interpretation, and other higher cognitive functions is only minimally functional. A baby does not have the capacity to rationally think through what it is experiencing. The baby receives input and relies on attunement to a primary caregiver (whose cerebrum is informing and coordinating with their cerebellum) to regulate its emotional state.
While Caleb’s brain was in an important stage of development his primary caregiver-his mother-was in serious danger. Caleb experienced sensory input that was highly threatening and he was completely helpless to contextualize, or respond to it. When the fight or flight response is triggered severely or too often it can do significant damage to the brain’s ability to effectively manage input even in adults who were previously healthy. They see danger in normal every day situations, may struggle to react appropriately to stimuli, may struggle to regulate important bodily functions such as sleep patterns, and may find it impossible to focus or function consistently.
Even more so, young children whose brains are still in the early stages of development suffer serious consequences and in domestic violence situations often live in a constant state of high alert. When fight or flight is triggered it interrupts normal functioning and development.
The classic illustration of fight or flight in action is of stumbling across a bear during a walk in the woods. One second your brain and body are calmly processing input and experiencing a complex interconnected web of feelings, thoughts, and responses. The next second you see the bear charging your direction. In that nanosecond, with no conscious thought on your part, your brain shuts down everything and redirects all your energy to survival.
The Thalamus takes what you are seeing sends it to the Amygdala and the Amygdala sends it to the Hypothalamus which triggers the release of cortisol and adrenaline. Your veins open up and your heart rate rises pumping extra blood to the parts of your body you’ll need to survive. Your peripheral vision blurs allowing you to focus only on what is immediately important.
You take off running and your brain continues to enable you to focus on nothing other than surviving this bear attack. Your brain is super effective at this task. If you’re tearing through the woods and a tree branch rips your arm open. Your will likely not even register the pain because your brain has filtered that stimuli out as unimportant.
If you manage to outrun the bear your brain and body will slowly return to normal functioning and you have thoughts such as “where am I?” And “Ow, what happened to my arm?” You may experience some initial feelings that are your brain's way of beginning to process the experience. You may cry or laugh or shake. When you make it back to civilization you will probably tell everyone you know. You may have some nightmares, schedule some counseling sessions, or take a survival class. You will never forget the experience but you will gain the ability to reflect on it without having a physiological response.
Caleb grew up with a bear in his home. During some of the most important developmental years of his life, his brain was constantly being interrupted and his body was being placed in fight or flight mode. He may not have remembered his father but his brain had locked in the trauma and, without access to the normal ways that people in healthy environments have to process such experiences, in some ways his brain had become frozen in time.
As I looked across the circle at Caleb, I knew that his sullen demeanor was a protective wall for a brain that struggled to see anything but threats. Like many children with unprocessed trauma, Caleb struggled to attune to social cues, focus on cerebral tasks, or even participate in athletic or team activities that required brain and body to coordinate with others. The balance between his cerebrum and his Limbic system was skewed heavily toward the survival functions of the latter. The medial prefrontal cortex of the cerebrum is supposed to inform the emotional and survival responses of the Limbic system. When someone raises their voice, the cerebrum coordinates with the Amygdala to discern if they are just trying to be heard or if they are threatening harm. Are these arms wrapped around me hugging me or trapping me? Is that stranger staring at me or simply glancing around the room?
Those kinds of determinations are often made by our brains with little conscious thought on our part. But for Caleb the healthy coordination of his brain has been interrupted by trauma.
That day I wanted desperately to break through his defenses and help him connect body, mind, and community. I picked up a little squishy ball out of a bag of prizes beside me and tossed it gently in his direction without breaking my talk. I motioned for him to throw it back. For the next fifteen minutes We made a game of him trying to surprise me with a throw. I don’t know if he heard anything I said about anger or whatever I was talking about at the time. But his body loosened up. He smiled. His movements became rhythmically attuned to mine as we threw and caught the ball. For a few minutes he came down from high alert and connected. When I speak to churches and nonprofits, I talk about simple, practical ways such as this to connect with and provide healing space for children.
In his fascinating work The Body Keeps the Score, one of the world’s foremost experts on trauma, Dr. Bessel Van Der Kolk writes “Being able to feel safe with other people is probably the single most important aspect of mental health; safe connections are fundamental to meaningful satisfying lives.”
And he is not simply referring to immediate symptoms. He is talking about long term health.
What I have attempted to show in this article is the devastating neurological implications of experiencing family violence in childhood. In my next article I will tackle the practical and sometimes subtle ways that these experiences shape survivors, particularly those who struggle to find the space or resources to properly heal.
This article is going to give a partial answer to three common questions I get about about children and domestic violence.
How do children get exposed to domestic violence? What are the immediate effects? What can I do to help a child who has been through it?
First-how children are exposed to domestic violence. When domestic violence is happening in a household children experience it in a variety of ways. You can break it down into three categories:
While some types of exposure may be more traumatic than others it is important to understand that all of these are extremely damaging and have the potential to cause lifelong challenges. In another post I am going to discuss the neurological implications of experiencing DV. For now let’s move on to some observable symptoms that often accompany exposure. It’s important to note that a some of these symptoms in isolation and moderation can be present in normal healthy childhood.
I’ll try to break these into categories as well for ease of reference.
In future articles, we will explore how these symptoms follow children into their adult lives and the types of challenges that they develop in to.
For now, let me offer a few simple suggestions to those who may be trying to figure out how to help a child who has been exposed to DV.
Empathy, honesty, and respect go a long way with anyone who has experienced trauma and children are no different. You can make a difference and there are lots of reasons to be hopeful for healing. Some of the most resilient, courageous people I have ever met overcame abusive childhoods. When I speak to churches, nonprofits, and business teams about DV, power, and resilience, I carry with me a humbling appreciation for the many survivors who have taught me through their own grit and courage that it is possible to overcome.
My wife, Kristen, is a competitive powerlifter. On her dead lifts she is very close to being in the 300 club. Yes. 300lbs. I regularly get jokes about how she is stronger than I am. I want you to know though that I can lift a car. I’m not exaggerating. I am capable of lifting a car without a jack or a mechanical lift. All I need is a little bit of leverage. I could lift a vehicle of up to 5,000 lbs. with just a fulcrum (think the middle part of a seesaw) and a lever about 12 yards long. The Ancient Greek Archimedes famously said “give me a place to stand and I shall move the earth.”
Leverage plays a role in most relationships whether at home or at work. Leverage is not inherently bad or good. In a relationship context it simply refers to any process that allows one party to exponentially multiply their degree of influence on another party. Intimate partnerships such as a marriage inherently create an enormous amount of leverage between the two people. This leverage can either be used coercively or cooperatively.
In a domestic violence relationship, the batterer uses a variety of coercive tactics to increase their leverage. When people ask why a victim doesn’t leave, what they are really missing is an awareness of just how much leverage the abuser has. Leverage can turn a small amount of force into an incredible amount of stopping energy.
Sometimes a person with a family member or friend in an abusive relationship will tell me “we’ve told her she could come stay with us but she just won’t leave him!” They are often in disbelief that a victim would stay because in their minds the only barrier is having a place to stay. But there are always a large number of visible and invisible ways that the abuse has leverage. The victim may believe that the abuser would hurt another member of the family (in fact, one study found that in 20% of intimate partner homicides the homicide victims were not the domestic violence victims themselves, but family members, friends, neighbors, persons who intervened, law enforcement responders, or bystanders). The victim may believe that the abuser will win custody of the children. The victim may believe that divorce is a sin. These are all forms of leverage that the abuser may be using coercively. And these only scratch the surface.
Domestic violence prevention and intervention centers or shelters are fundamentally in the leverage mitigation business. They provide ways for victims to take leverage away from their abusers. Shelters provide so much more than just a roof. They provide professional counseling to help reduce psychological leverage, life coaching and support groups to help reduce emotional leverage, educational and job resources and transitional housing to help reduce economic leverage, attorneys to reduce legal leverage or leverage related to custody issues, and much more.
Even in intimate partnerships where there is no abuse, many struggles occur because of coercive uses of leverage.
In the corporate world things can be just as bad. Sexual harassment, discrimination, and toxic work environments, often have coercive leverage holding them together.
In many marriages and corporate settings, things are not that severe. No one party is trying to dominate or control the other parties. However, that doesn’t mean that coercive leverage is not being used at all. Before I go any further it’s important to note that I believe that marriage is a true partnership where at any given time or in any given setting either party might be providing leadership while in a corporate setting there is usually a defined hierarchy. Regardless, in both settings one or more parties are prone to manipulate others and may at times use coercive leverage to do so. In fact, those who see themselves as positional authorities (managers, bosses, and-in many cultural and faith traditions-husbands) have often been taught a style of leadership based on coercion that they use even when they have good intentions.
Leverage is not always unhealthy however. Most of us use leverage in some way or the other every day. Leverage is an important tool for progress. So how do we know when leverage is unhealthy? Here are a couple of giveaways that you may be experiencing or practicing unhealthy leverage: