Adverse Childhood Experiences Quotes

Adults with Adverse Childhood Experiences are on alert. It’s a habit they learned in childhood, when they couldn’t be sure when they’d face the next high-tension situation. After her terrifying childhood illness, Michele never felt at peace, or whole, as an adult: “I was afraid I could be blindsided by any small medical crisis that could morph and change my entire life.

The traumatic stress field has adopted the term “Complex Trauma” to describe the experience of multiple and/or chronic and prolonged, developmentally adverse traumatic events, most often of an interpersonal nature (e.g., sexual or physical abuse, war, community violence) and early-life onset. These exposures often occur within the child’s caregiving system and include physical, emotional, and educational neglect and child maltreatment beginning in early childhood - Developmental Trauma Disorder

Psychologists call the everyday occurrences of my and Lindsay’s life “adverse childhood experiences,” or ACEs. ACEs are traumatic childhood events, and their consequences reach far into adulthood. The trauma need not be physical. The following events or feelings are some of the most common ACEs: • being sworn at, insulted, or humiliated by parents • being pushed, grabbed, or having something thrown at you

And just like two siblings with the same parents might have different eye colors, they also might have different lengths of telomeres, which can lead to different outcomes even if they experience similar doses of adversity.

Shame reduces complex circumstances to simple solutions like “It’s all my fault” and “I must deserve this.

adverse childhood experiences,” or ACEs. ACEs are traumatic childhood events, and their consequences reach far into adulthood. The trauma need not be physical.

Those of us who have overcome so many adversities from a very young age, are privileged to be able to communicate profound insights and advice to others, speaking from a place of genuine confidence and knowing.

and I learned that behavior I considered commonplace was the subject of pretty intense academic study. Psychologists call the everyday occurrences of my and Lindsay’s life “adverse childhood experiences,” or ACEs.

The body of research sparked by the ACE Study makes it clear that adverse childhood experiences in and of themselves are a risk factor for many of the most common and serious diseases in the United States (and worldwide), regardless of income or race or access to care.

Severe early childhood trauma creates a child with equally intense coping mechanisms—these children are often seen as “mature for their age” and “old souls.” While maybe true, it often negates the fact that their innocence was taken away at an early age and they are in survival mode. —Azia Archer

Ultimately, when you embrace the process of healing despite your Adverse Childhood Experiences, you don’t just become who you might have been if you hadn’t encountered so much childhood suffering in the first place. You gain something better: the hard-earned gift of life wisdom, which you bring forward into every arena of your life.

Pretty straightforwardly, the more categories of adversities a child suffers, the dimmer his or her chances of happy, functional adulthood.

Learn to differentiate between the sound of your intuition guiding you and your traumas misleading you.

Toxic stress response can occur when a child experiences strong, frequent, and/or prolonged adversity—such as physical or emotional abuse, neglect, caregiver substance abuse or mental illness, exposure to violence, and/or the accumulated burdens of family economic hardship—without adequate adult support. This kind of prolonged activation of the stress-response systems can disrupt the development of brain architecture and other organ systems, and increase the risk for stress-related disease and cognitive impairment, well into the adult years.

One would think that the adverse effects of, say, low socioeconomic status in childhood would occur as a result of brain development being delayed. Instead, the problem is that the early-life stress accelerates maturation of the brain, meaning that the window for brain construction being sculpted by experience closes earlier: U. Tooley, D. Bassett, and P. Mackay, “Environmental Influences on the Pace of Brain Development,” Nature Reviews Neuroscience 22 (2021): 372.

Greater ability to trust and connect with other people. Others and the world are viewed as safe and predictable, consistent with early experiences with the primary caregiver(s) (Snyder and Lopez 2007). A greater likelihood of viewing God as loving (Granqvist et al. 2007).

Childhood adversity increases depression risk via "second hit" scenarios - lowering thresholds so that adult stressors that people typically manage instead trigger depressive episodes. This vulnerability makes sense. Depression is fundamentally a pathological sense of loss of control (explaining the classic description of depression as "learned helplessness"). If a child experiences severe, uncontrollable adversity, the most fortunate conclusion in adulthood is "Those were terrible circumstances over which I had no control." But when childhood traumas produce depression, there is cognitively distorted overgeneralizations: "And life will always be uncontrollably awful.

CONSENSUS PROPOSED CRITERIA FOR DEVELOPMENTAL TRAUMA DISORDER A. Exposure. The child or adolescent has experienced or witnessed multiple or prolonged adverse events over a period of at least one year beginning in childhood or early adolescence, including: A. 1. Direct experience or witnessing of repeated and severe episodes of interpersonal violence; and A. 2. Significant disruptions of protective caregiving as the result of repeated changes in primary caregiver; repeated separation from the primary caregiver; or exposure to severe and persistent emotional abuse B. Affective and Physiological Dysregulation. The child exhibits impaired normative developmental competencies related to arousal regulation, including at least two of the following: B. 1. Inability to modulate, tolerate, or recover from extreme affect states (e.g., fear, anger, shame), including prolonged and extreme tantrums, or immobilization B. 2. Disturbances in regulation in bodily functions (e.g. persistent disturbances in sleeping, eating, and elimination; over-reactivity or under-reactivity to touch and sounds; disorganization during routine transitions) B. 3. Diminished awareness/dissociation of sensations, emotions and bodily states B. 4. Impaired capacity to describe emotions or bodily states C. Attentional and Behavioral Dysregulation: The child exhibits impaired normative developmental competencies related to sustained attention, learning, or coping with stress, including at least three of the following: C. 1. Preoccupation with threat, or impaired capacity to perceive threat, including misreading of safety and danger cues C. 2. Impaired capacity for self-protection, including extreme risk-taking or thrill-seeking C. 3. Maladaptive attempts at self-soothing (e.g., rocking and other rhythmical movements, compulsive masturbation) C. 4. Habitual (intentional or automatic) or reactive self-harm C. 5. Inability to initiate or sustain goal-directed behavior D. Self and Relational Dysregulation. The child exhibits impaired normative developmental competencies in their sense of personal identity and involvement in relationships, including at least three of the following: D. 1. Intense preoccupation with safety of the caregiver or other loved ones (including precocious caregiving) or difficulty tolerating reunion with them after separation D. 2. Persistent negative sense of self, including self-loathing, helplessness, worthlessness, ineffectiveness, or defectiveness D. 3. Extreme and persistent distrust, defiance or lack of reciprocal behavior in close relationships with adults or peers D. 4. Reactive physical or verbal aggression toward peers, caregivers, or other adults D. 5. Inappropriate (excessive or promiscuous) attempts to get intimate contact (including but not limited to sexual or physical intimacy) or excessive reliance on peers or adults for safety and reassurance D. 6. Impaired capacity to regulate empathic arousal as evidenced by lack of empathy for, or intolerance of, expressions of distress of others, or excessive responsiveness to the distress of others E. Posttraumatic Spectrum Symptoms. The child exhibits at least one symptom in at least two of the three PTSD symptom clusters B, C, & D. F. Duration of disturbance (symptoms in DTD Criteria B, C, D, and E) at least 6 months. G. Functional Impairment. The disturbance causes clinically significant distress or impairment in at least two of the following areas of functioning: Scholastic Familial Peer Group Legal Health Vocational (for youth involved in, seeking or referred for employment, volunteer work or job training)

Things changed after that between me and Mark. I stopped being mortified that people might mistake me for one of his acolytes. I was his Boswell, don’t you know. I interviewed him about his childhood—his father was a psychiarist in Beverly Hills. I cataloged the contents of his van. I followed him around at work, sitting in while he examined patients. He had been a bit of a prodigy when we were in college. After his father developed a tumor, Mark, who was pre-med, started studying cancer with an intensity that convinced many of his friends that his goal was to find a cure in time to save his father. As it turned out, his father didn’t have cancer. But Mark kept on with his cancer studies. His interest was not in fact in oncology—in finding a cure—but in cancer education and prevention. By the time he entered medical school, he had created, with another student, a series of college courses on cancer and coauthored The Biology of Cancer Sourcebook, the text for a course that was eventually offered to tens of thousands of students. He cowrote a second book, Understanding Cancer, that became a bestselling university text, and he continued to lecture throughout the United States on cancer research, education, and prevention. “The funny thing is, I’m not really interested in cancer,” Mark told me. “I’m interested in people’s response to it. A lot of cancer patients and suvivors report that they never really lived till they got cancer, that it forced them to face things, to experience life more intensely. What you see in family practice is that families just can’t afford to be superficial with each other anymore once someone has cancer. Corny as it sounds, what I’m really interested in is the human spirit—in how people react to stress and adversity. I’m fascinated by the way people fight back, by how they keep fighting their way to the surface.” Mark clawed at the air with his arms. What he was miming was the struggle to reach the surface through the turbulence of a large wave.

i like to believe that once our society truly focuses on the needs of children, all form of social support for families - a policy that remains so controversial in this country - will gradually come to seem not only desirable but also doable. ... if we feel abandoned, worthless, or invisible, nothing seems to matter. Fear destroys curiosity and playfulness. In order to have a healthy society, we must raise children who can safely play and learn. Currently, more than 50 percent of children served by Head Start have had three or more adverse childhood experience like those included in the ACR study: incarcerated family members, depression, violence, abuse, or drug use in the home and periods of homelessness... Trauma is now our most urgent public health issue, and we have the knowledge necessary to respond effectively. The choice is ours to act on what we know.

According to Jay Belsky, a leading proponent of this view and a psychology professor and child care expert at the University of London, the reactivity of these kids’ nervous systems makes them quickly overwhelmed by childhood adversity, but also able to benefit from a nurturing environment more than other children do. In other words, orchid children are more strongly affected by all experience, both positive and negative. Scientists have known for a while that high-reactive temperaments come with risk factors. These kids are especially vulnerable to challenges like marital tension, a parent’s death, or abuse. They’re more likely than their peers to react to these events with depression, anxiety, and shyness. Indeed, about a quarter of Kagan’s high-reactive kids suffer from some degree of the condition known as “social anxiety disorder,” a chronic and disabling form of shyness.

Between 1995 and 1997 the California-based healthcare network Kaiser Permanente gave more than 17,000 patients a questionnaire to assess the level of trauma in their childhoods. Questions included whether the patients' parents had been mentally or physically abusive or neglectful and whether their parents were divorced or had abused substances. This was called the Adverse Childhood Experiences (ACE) study. After taking the questionnaire, patients were given an ACE score on a scale of 0 to 10. The higher the score, the more trauma a person experienced in childhood. The results of the study were astoundingly clear: The more childhood trauma someone had suffered, the worse their health outcomes were in adulthood. And their risk for contracting diseases didn't go up just a few percentage points. People with high ACE scores were about three times as likely to develop liver disease, twice as likely to develop cancer or heart disease, four times as likely to develop emphysema. They were seven and a half times more likely to become alcoholics, four and a half times more likely to suffer from depression, and a whopping twelve times more likely to attempt suicide. Scientists have learned that stress is literally toxic. Stress chemicals surging through our bodies like cortisol and adrenaline are healthy in moderation—you wouldn't be able to get up in the morning without a good dose of cortisol. But in overwhelming quantities, they become toxic and can change the structure of our brains. Stress and depression wear our bodies out. And childhood trauma affects our telomeres. Telomeres are like little caps on the ends of our strands of DNA that keep them from unraveling. As we get older, those telomeres get shorter and shorter. When they've finally disappeared, our DNA itself begins to unravel, increasing our chances of getting cancer and making us especially susceptible to disease. Because of this, telomeres are linked to human lifespan. And studies have shown that people who have suffered from childhood trauma have significantly shortened telomeres. In the end, these studies claimed that having an ACE score of 6 or higher takes twenty years off your life expectancy. The average life expectancy for someone with 6 or more ACEs is sixty years old.

Primary narcissism is a normal state for a child and is different from what we refer to as adult narcissism. Primary narcissism simply means that a child cannot experience themself as anything but the center of their own universe. When a child experiences neglect, abuse, or chronic misattunement, they experience it as their fault. The failure is always personal. Simply put, a child cannot experience themself as a good person in a bad situation. By definition, when the environment fails a child, the child believes that they have failed. This brings us to the concept of splitting.

tried to go to a counselor, but it was just too weird. Talking to some stranger about my feelings made me want to vomit. I did go to the library, and I learned that behavior I considered commonplace was the subject of pretty intense academic study. Psychologists call the everyday occurrences of my and Lindsay’s life “adverse childhood experiences,” or ACEs. ACEs are traumatic childhood events, and their consequences reach far into adulthood. The trauma need not be physical. The following events or feelings are some of the most common ACEs: •​being sworn at, insulted, or humiliated by parents •​being pushed, grabbed, or having something thrown at you •​feeling that your family didn’t support each other •​having parents who were separated or divorced •​living with an alcoholic or a drug user •​living with someone who was depressed or attempted suicide •​watching a loved one be physically abused. ACEs happen everywhere, in every community. But studies have shown that ACEs are far more common in my corner of the demographic world. A report by the Wisconsin Children’s Trust Fund showed that among those with a college degree or more (the non–working class), fewer than half had experienced an ACE. Among the working class, well over half had at least one ACE, while about 40 percent had multiple ACEs. This is really striking—four in every ten working-class people had faced multiple instances of childhood trauma. For the non–working class, that number was 29 percent. I gave a quiz to Aunt Wee, Uncle Dan, Lindsay, and Usha that psychologists use to measure the number of ACEs a person has faced. Aunt Wee scored a seven—higher even than Lindsay and me, who each scored a six. Dan and Usha—the two people whose families seemed nice to the point of oddity—each scored a zero. The weird people were the ones who hadn’t faced any childhood trauma. Children with multiple ACEs are more likely to struggle with anxiety and depression, to suffer from heart disease and obesity, and to contract certain types of cancers. They’re also more likely to underperform in school and suffer from relationship instability as adults. Even excessive shouting can damage a kid’s sense of security and contribute to mental health and behavioral issues down the road. Harvard pediatricians have studied the effect that childhood trauma has on the mind. In addition to later negative

When in child consciousness, an adult relates to themself and the world through helplessness, lack of agency, and feeling dependent on others for them to be OK. They experience their lives narrowly and without many options, leading to a limited sense of capacity and resiliency. They feel the regressive need to protect themselves from the threat of relational loss through a variety of strategies of disconnection (which traditionally have been referred to as defense mechanisms). Any sense of “growing up” or forward progress may feel like threat to the loyalty to these old survival style patterns.

Secure attachment reflects the deep emotional bond that forms in the first months of life between an infant and the primary caregiver when the child feels consistently loved and cared for. The caregiver conveys in many ways that the child is safe, protected, and valued: by holding, skin-to-skin touching, kissing, and hugging; by loving gazes and facial expressions; by safe, rhythmic gestures and vocal sounds; by timely attention to the infant’s needs; and by smiling, laughing, and having fun with the child. Through repeated encounters that are sensitive to the child’s needs, the child learns that the caregiver is available and responsive, and will not abandon her.

As mentioned, once implicit memories are formed, they may be triggered by present events. Because these memories are not managed by the logical mind, they resurface with the same emotions and sensations as when originally experienced. Thus, your boss’s criticism might feel just like being severely scolded as a child by a critical parent. Never mind that the adult being criticized is now “successful.” Because implicit memories are not settled and situated in the verbal and logical brain, they are only marginally affected by words or logic. Other approaches are called for, as we’ll soon see. These approaches do not target primarily the logical, verbal left brain, but the regions of the brain that regulate emotions, images, and bodily sensations.

Many children are not raised in such environments; their caregivers focus instead on the child’s behaviors, performance, goals, and results, which can lead to a child feeling fundamentally unseen. It is a form of objectification when adults focus solely on correcting a child’s behavior. This lack of empathy gives the child a sense that no one has interest in who they are underneath the behaviors. There are two significant consequences to a child feeling such rejection. First is their hopelessness, despair, and pain from experiencing this level of misattunement. Second is how a child personalizes and internalizes this experience of misattunement. The environmental failure is experienced by the child as their personal failure. Tragically, a child then learns to treat themself in ways that they were treated. If a child’s openness and curiosity are minimized, unsupported, or attacked, they learn to do that to themself.

Hoover was deeply respected by both parties. In 1928, the Republicans nominated him for president. In his acceptance speech, delivered at the height of prosperity, Hoover proclaimed that Americans were “nearer to the final triumph over poverty than ever before in the history of any land.” His profound belief in individualism, voluntarism, and the fundamental strength of the American economy blinded him from realizing, until too late, that government had to exert a primary role in helping people through what was fast becoming the worst Depression the country had ever known. At the slightest uptick in the stock market, Hoover believed and summarily proclaimed that the worst was over. When the economy continued to flounder, he came under blistering assault. Still, he would not admit that voluntary activities had failed. He adopted a bunker mentality, refusing to countenance the worsening situation. By contrast, Roosevelt had adapted all his life to changing circumstances. The routine of his placid childhood had been disrupted forever by his father’s heart attack and eventual death. Told he would never walk again, he had experimented with one method after another to improve his mobility. So now, as Roosevelt campaigned for the presidency, he built on his own long encounter with adversity: “The country needs and, unless I mistake its temper, the country demands bold, persistent experimentation. It is common sense to take a method and try it: If it fails, admit it frankly and try another. But above all, try something.

posttraumatic growth. Many people who suffer shattering experiences are scarred for life, with little hope of recovery. But for others, shattering experiences prompt them to face their fears, transcend the horrors of the past, and become resilient. PTSD is not a life sentence. POSTTRAUMATIC GROWTH While PTSD grabs the headlines, news stories about posttraumatic growth are rare. Up to two thirds of those who experience traumatic events do not develop PTSD. This estimate is based on studies of the mental health of people who have undergone similar experiences. Studies of US veterans who served in Iraq and Afghanistan show this two-thirds to one-third split. What’s the difference between the two groups? Research reveals a correlation between negative childhood events and the development of adult PTSD. Yet some people emerge from miserable childhoods stronger and more resilient than their peers. Adversity can sometimes make us even stronger than we might have been had we not suffered it. Research shows that people who experience a traumatic event but are then able to process and integrate the experience are more resilient than those who don’t experience such an event. Such people are even better prepared for future adversity. When you’re exposed to a stressor and successfully regulate your brain’s fight-or-flight response, you increase the neural connections associated with handling trauma, as we saw in Chapter 6. Neural plasticity works in your favor. You increase the size of the signaling pathways in your nervous system that handle recovery from stress. These larger and improved signaling pathways equip you to handle future stress better, making you more resilient in the face of life’s upsets and problems.

I’m the kind of patriot whom people on the Acela corridor laugh at. I choke up when I hear Lee Greenwood’s cheesy anthem “Proud to Be an American.” When I was sixteen, I vowed that every time I met a veteran, I would go out of my way to shake his or her hand, even if I had to awkwardly interject to do so. To this day, I refuse to watch Saving Private Ryan around anyone but my closest friends, because I can’t stop from crying during the final scene. Mamaw and Papaw taught me that we live in the best and greatest country on earth. This fact gave meaning to my childhood. Whenever times were tough—when I felt overwhelmed by the drama and the tumult of my youth—I knew that better days were ahead because I lived in a country that allowed me to make the good choices that others hadn’t. When I think today about my life and how genuinely incredible it is—a gorgeous, kind, brilliant life partner; the financial security that I dreamed about as a child; great friends and exciting new experiences—I feel overwhelming appreciation for these United States. I know it’s corny, but it’s the way I feel. If Mamaw’s second God was the United States of America, then many people in my community were losing something akin to a religion. The tie that bound them to their neighbors, that inspired them in the way my patriotism had always inspired me, had seemingly vanished. The symptoms are all around us. Significant percentages of white conservative voters—about one-third—believe that Barack Obama is a Muslim. In one poll, 32 percent of conservatives said that they believed Obama was foreign-born and another 19 percent said they were unsure—which means that a majority of white conservatives aren’t certain that Obama is even an American. I regularly hear from acquaintances or distant family members that Obama has ties to Islamic extremists, or is a traitor, or was born in some far-flung corner of the world. Many of my new friends blame racism for this perception of the president. But the president feels like an alien to many Middletonians for reasons that have nothing to do with skin color. Recall that not a single one of my high school classmates attended an Ivy League school. Barack Obama attended two of them and excelled at both. He is brilliant, wealthy, and speaks like a constitutional law professor—which, of course, he is. Nothing about him bears any resemblance to the people I admired growing up: His accent—clean, perfect, neutral—is foreign; his credentials are so impressive that they’re frightening; he made his life in Chicago, a dense metropolis; and he conducts himself with a confidence that comes from knowing that the modern American meritocracy was built for him. Of course, Obama overcame adversity in his own right—adversity familiar to many of us—but that was long before any of us knew him. President Obama came on the scene right as so many people in my community began to believe that the modern American meritocracy was not built for them. We know we’re not doing well. We see it every day: in the obituaries for teenage kids that conspicuously omit the cause of death (reading between the lines: overdose), in the deadbeats we watch our daughters waste their time with. Barack Obama strikes at the heart of our deepest insecurities. He is a good father while many of us aren’t. He wears suits to his job while we wear overalls, if we’re lucky enough to have a job at all. His wife tells us that we shouldn’t be feeding our children certain foods, and we hate her for it—not because we think she’s wrong but because we know she’s right.

Knowing each student and adult employee by name and need is a requisite for school systems in the 21st century.

Several studies have demonstrated an association between alexithymia and insecure attachments (e.g., Taylor et al., 2014; Troisi et al., 2001); and there is evidence that alexithymia or the difficulty identifying feelings facet are associated with retrospectively reported experiences of adverse experiences during childhood, especially emotional neglect (e.g., Goldsmith & Freyd, 2005; Paivio & McCulloch, 2004). Research studies exploring the relationships among trauma, attachment, and alexithymia are reviewed by Schimmenti and Caretti in Chapter 8.

Adaptive Survival Style Shame-Based Identification Connection Feel shame at existing, feeling, and connecting Attunement Feel shame when experiencing and communicating their needs Trust Feel shame when feeling dependent, vulnerable, or weak Autonomy Feel shame at their impulses toward self-determination, autonomy, and independence Love/Sexuality Feel shame about sharing their heart and relational intimacy

Many traumatized individuals are too hypervigilant to enjoy the ordinary pleasures that life has to offer, while others are too numb to absorb new experiences—or to be alert to signs of real danger. When the smoke detectors of the brain malfunction, people no longer run when they should be trying to escape or fight back when they should be defending themselves. The landmark ACE (Adverse Childhood Experiences) study, which I’ll discuss in more detail in chapter 9, showed that women who had an early history of abuse and neglect were seven times more likely to be raped in adulthood. Women who, as children, had witnessed their mothers being assaulted by their partners had a vastly increased chance to fall victim to domestic violence.

Take the Intergenerational ACES (Adverse Childhood Experiences) Questionnaire.

Causes of anxiety range from gut bacteria to adverse childhood experiences to existential angst.

Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: The Adverse Childhood Experiences Study,” Pediatrics, 2003, 111(3), 564–572.

The resolution of these core dilemmas is about learning to be authentic and at the same time be connected with others. The psychological concept of object constancy refers to the ability of an individual to feel both love and anger toward a person they are in an intimate relationship with. Holding that emotional complexity is an important capacity for healthy adulthood. For a child experiencing attachment and relational failure, it is simply too threatening to stay connected to themself while staying in connection to their caregivers. Yet for an adult, this relational capacity can feel liberating. New possibilities open up as one shifts from child consciousness into embodied adult consciousness, a process we refer to in NARM as disidentification

Connection: Reflect on a time you felt most connected—to yourself, to another person, to a pet, to nature, to God. Attunement: Reflect on a time you expressed your needs—and someone responded positively. Trust: Reflect on a time you depended on someone—and they came through for you. Autonomy: Reflect on a time you stood up for yourself in a relationship—and the other person did not reject you. Love-Sexuality: Reflect on a time you reached out with love—and it was reciprocated by another person.

For children experiencing chronic misattunement, staying connected to their own needs and feelings becomes intolerable and unsustainable. Children are unable to tolerate the distress that occurs in these painful situations. The only strategy they can use to survive is disconnecting from their authentic needs and feelings.

Embodied adult consciousness is a NARM term that refers to adults who experience themselves not just physically as adults but also psychologically and emotionally. They embody separation-individuation in the sense that they experience themselves as less dependent on others for their sense of self-worth. By so doing, they have greater capacity for authentic relationships. Their behaviors are not driven from adaptive survival strategies but emerge from connection to their authentic needs, feelings, and a sense of agency and self-activation. Being embodied in adult consciousness provides a secure platform to feel connected to Self and others without conflict between the two.

Transcendent human experiences that Einstein alluded to, like aliveness, spirituality, and love, are difficult to measure. They don’t fit well in modern psychological and scientific theory. There is a tendency to try to reduce complexity. We see curiosity as a pathway for supporting nuance within complexity. It allows us to exist, and delight in, the full spectrum of human experience. It frees us from having to figure anything out and instead supports us to have a direct, lived experience.

Using the framework of the adaptive survival styles, we can begin to understand some of the adaptive strategies for avoiding feelings: Connection: A client may use avoidant strategies such as dissociating, splitting, intellectualizing, and spiritualizing. They may generally narrow their lives by limiting emotional awareness and social engagement. Attunement: A client may avoid attuning to their own emotions or may feel that they do not deserve to have their own needs and feelings. They may focus on being there to meet others’ needs and feelings at the expense of connecting to their own needs and feelings. Trust: A client may work to limit situations where they are not in control, including any situation where they are asked to be vulnerable with their needs and feelings. They may set up situations where they can avoid sharing their emotions. Autonomy: A client may avoid self-referencing and direct expressions of their authentic Self. They may avoid situations where speaking directly about their authentic feelings would be appropriate and useful. Love-Sexuality: A client may avoid authentic emotions by focusing on achievement and performance. They may avoid intimacy and other relationships where they might be invited to share their heart.

The intention of acceptance is to allow for complexity. As humans, we are faced with managing an extremely complex world. Preconceived knowledge, beliefs, and agendas are often used to manage the complexity of the therapeutic process, but they can also get in our way of being present and open to the direct experience with our clients. To truly understand another’s internal world, we have to free ourselves from what we believe we know, to the best of our abilities, so as to be able to make real contact. Once we can say “I don’t know,” we can be open to new learning and greater complexity. As philosopher Jiddu Krishnamurti taught, “You can learn only if you do not know.”4 The reality is that we will never fully know our client’s internal experience, but we can continue to learn as we deepen into relationship with them.

Developmental trauma is about heartbreak. The resolution of developmental trauma is about heartfulness.

What we don’t use it for is to pathologize our clients. Levels of organization do not define who someone is, and we do not make judgments based on the scores.

Loneliness can be experienced as both frightening and liberating. When in child consciousness, adults may still experience the loneliness as terrifying. These clients often rely on adaptive survival strategies to manage and limit their lives. When in adult consciousness, adults may experience the loneliness as relief, expansion, and increasing freedom. These clients often report an increased sense of internal space and depth in which to meet the world. We track cycles of connection–disconnection in the service of disidentification. As identifications dissolve, people often experience increasing states of connection: expansion, freedom, hope, strength, and aliveness. One way we resource our clients is to reflect to them when they are able to stay in states of connection for longer periods of time. As people experience greater internal organization, they feel less compelled by old strategies of disconnection. Instead of relying on adaptive survival strategies to control their lives, they experience increasing agency and choice.

The experience of a secure sense of Self, grounded in healthy attachment and separation-individuation, leads to the ability to tolerate a wide range of internal states, including the sensations of distress that accompany environmental challenges. It also leads to the capacity to hold both frustrating and pleasurable aspects of life experiences simultaneously. This reflects increased psychobiological capacity, or what has traditionally been referred to as resiliency.

Complex trauma results from chronic, long-term exposure to relational and emotional trauma in which an individual has little or no control—in other words, experiences no self-agency—and from which there is little or no hope of escape—in other words, experiences helplessness. Relational and emotional trauma lead to profound changes in neurological development and functioning, which causes significant problems in a person’s life in such areas as family, relationships, education, and occupation.

Beginning in the contracting process (Pillar 1), and then moving into asking exploratory questions (Pillar 2), we are guided by curiosity in our client’s internal process. Specifically, we are interested in what’s getting in the way of what our clients say they most want for themselves. We begin organizing our understanding of our client’s internal obstacles, which in NARM we refer to as the working hypothesis.

Unmanaged empathy can look and feel like caring but may be driven from impulses that relate to the ways we avoid deep feelings, particularly the feelings of helplessness. We are vulnerable to our sense of helplessness when we empathize with but are not able to impact another’s suffering. For many of us who experienced early trauma, this leads us directly back to our own fear of helplessness. We might ask ourselves: How can I be with another person’s suffering? Am I able to stay present? Or do I try to compulsively effect change?

When these powerful energies of anger toward the caregivers emerge, it puts the child in a bind, because acting aggressively or even feeling strong aggression toward their caregivers threatens the attachment relationship. In order to protect the attachment relationship, children learn to disconnect from, split off, and redirect the anger toward themselves. This helps us recognize the survival value inherent in turning anger against oneself, seen from a child’s perspective—for example, the child who gets stomachaches or self-harms in various ways.

Connection Feel shame at existing, feeling, and connecting Attunement Feel shame when experiencing and communicating their needs Trust Feel shame when feeling dependent, vulnerable, or weak Autonomy Feel shame at their impulses toward self-determination, autonomy, and independence Love/Sexuality Feel shame about sharing their heart and relational intimacy

In NARM we do not view shame, self-rejection, and self-hatred as emotions but as psychobiological processes, or strategies, of disconnecting from one’s authentic Self. We do not work directly with these strategies but instead explore what unresolved emotions may be underneath them.

What message is the emotion attempting to convey? What is the underlying intention in this emotional response? What is the emotion trying to accomplish?

Connection survival style themes to show up in an atmosphere of safety and consent. The use of contracting emphasizes the therapist’s attention, interest, and concern about truly understanding the client. Contracting provides an opportunity to shift old relational patterns of feeling completely alone. This process of intersubjectivity supports a shift away from objectification toward subjectification. Clients are invited to be active collaborators with their therapist, which provides a sense of control over the therapeutic process. Attunement: The contracting process invites clients identified with Attunement survival style themes to check in with and express their needs and feelings. From the very beginning, this process provides an opportunity to shift old relational patterns of feeling that they cannot express their needs and feelings. Contracting helps clients feel seen and heard—by their therapist but also themselves. They are invited, welcomed, and encouraged to reflect on their authentic needs and wishes. Trust: The contracting process gives clients identified with Trust survival style themes the power to set their own course for therapy. The collaborative nature of contracting provides an opportunity to shift old relational patterns where they felt they had to control others in order to feel safe. They are welcomed to modulate their level of openness and vulnerability according to their own sense of comfort and trust. Autonomy: The contracting process encourages clients identified with Autonomy survival style themes to share their authentic Self in an environment of openness, understanding, and respect. Inviting the client to determine their intention and goals for therapy provides an opportunity to shift old relational patterns of having to control against other people’s agendas. Love-Sexuality: The contracting process supports clients identified with Love-Sexuality survival style themes with a sense of not having to be perfect to be accepted and loved. Contracting provides an opportunity to shift old relational patterns where they felt pressure of having to perform and achieve. Clients are welcomed to share from a more open-hearted and intimate place.

Two distinguishing features of C-PTSD are early attachment failure and ongoing interpersonal victimization. While these failures from caregivers and environment may have threatened a child’s life, they were more than simply one-time traumatic events.

This can be seen in the ways humans fear what they most want and use self-sabotaging strategies to inhibit separation-individuation, agency, self-activation, and possibilities for love. This conflict between staying connected in a relationship while staying connected to one’s authentic Self often shows up for people in their most intimate relationships—with their partners, children, and close friends—and demonstrates the enduring fear of relational loss.

A child’s survival depends on their developing a secure sense of Self, which is shaped by secure attachment, consistent attunement, and an environment of safety. Environmental failures thus impact the organization and security of the Self. In order to adapt to early environmental failure, children learn to disconnect from themselves, which leads to profound disorganization of the Self. As we will see in the next chapter, shame and self-hatred become survival-based mechanisms of disconnection, and they fuel disorganization. Children cannot recognize or tolerate that their environment is failing, because they depend on their environment for survival. Therefore, children are unable to see themselves as a good person in a bad situation. In order to protect against attachment loss and environmental failure, children internalize these failures as their own personal failures: “I must’ve done something,” or “I deserve this,” or “I am bad.” Children are left with an internal sense of badness. They identify with it. And it becomes part of their identity that they carry into adulthood. For example, many adult victims of abuse and violence blame themselves and are riddled with shame and self-hatred.

Future chapters will explain other factors that influence the working hypothesis, such as the client’s psychobiological capacity, the role of shame as an adaptive survival strategy, unresolved needs and emotions, and the therapist’s capacity for self-inquiry. Remember, the working hypothesis is cultivated through curiosity and openness to the client’s internal world—and not through interpretations, which can be distorted by the therapist’s unconscious biases and countertransference reactions. Therapists hold the working hypothesis in a way that does not simplify the client’s experience but encourages the therapist and client to be present with increasing complexity, nuance, and depth.

In a modern world beset by complex trauma and a legacy of suffering, conflict and disconnection, healing trauma can serve as a vehicle for personal and social transformation. NARM Training Manual The NeuroAffective Relational Model relies on organizing principles that help frame and guide our therapeutic approach.

When a young child faces a conflict between Self and attachment, the need for attachment always wins. When experiencing a threat to the attachment relationship, children are faced with an impossible situation: they need to stay connected to their caregivers, but they also need to stay connected to their authentic Self. This bind pits their relationship to caregivers against their relationship to Self, which reflects a conflict between attachment and separation-individuation.

PTSD focuses on experiences of safety, related to life-and-death threat, and the symptoms associated with physiological dysregulation. C-PTSD focuses on experiences of inner security, related to the threat of the Self, and the symptoms associated with psychobiological disorganization.

This process of exploration is in service of disidentification. As introduced in chapter 2, disidentification is the process of a person bringing a quality of mindfulness to their consciousness, taking their thoughts and reactions less seriously, not presuming that what they feel is truth, recognizing they aren’t defined by who they’ve taken themselves to be, and ultimately, dissolving their adaptive survival styles. As these old patterns of identity distortion and physiological dysregulation begin to quiet down, people begin seeing themselves less through the filters of their survival style identifications. This helps clients shift out of child consciousness into adult consciousness. Through inquiry, clients receive support and guidance to connect with what’s real for them in the here and now.

adverse childhood experiences,” or ACEs. ACEs are traumatic childhood events, and their consequences reach far into adulthood. The

The landmark ACE (Adverse Childhood Experiences) study, which I’ll discuss in more detail in chapter 9, showed that women who had an early history of abuse and neglect were seven times more likely to be raped in adulthood.

Childhood adversity increases depression risk via “second hit” scenarios—lowering thresholds so that adult stressors that people typically manage instead trigger depressive episodes. This vulnerability makes sense. Depression is fundamentally a pathological sense of loss of control (explaining the classic description of depression as “learned helplessness”). If a child experiences severe, uncontrollable adversity, the most fortunate conclusion in adulthood is “Those were terrible circumstances over which I had no control.” But when childhood traumas produce depression, there is cognitively distorted overgeneralization: “And life will always be uncontrollably awful.” Experience childhood poverty, and your future prospects are better if your family is stable and loving than broken and acrimonious

Not many people know how tumultuous and draining family life can be with a child who has had adverse early experiences.

The ethos when I went through Teach for America was that good teaching and good leadership could solve the problems of poverty,” said Dominique Lee. “That’s part of the pie, but that’s not all of the pie. Our most dynamic teachers were burning out—the need and anger in the children, the mental health issues, the absenteeism, the transience.” They were witnessing the effect of what researchers call adverse childhood experiences, multiple traumas that, studies have shown, significantly interfere with learning and focus in children in the most disadvantaged communities.

The R in NARM is about the therapeutic relationship, which includes both client and therapist. NARM is an approach based in intersubjectivity. This process invites the possibility of deepening connection to Self and others. As we teach in NARM—and will detail throughout this book—connection is both our deepest desire and greatest fear.

ACEs: Adverse Childhood Experiences The human brain is a social organ that is shaped by experience, and that is shaped in order to respond to the experience that you’re having. So particularly earlier in life, if you’re in a constant state of terror; your brain is shaped to be on alert for danger, and to try to make those terrible feelings go away. In a healthy developmental environment, your brain gets to feel a sense of pleasure, engagement, and exploration. Your brain opens up to learn, to see things, to accumulate information, to form friendships. But if … you’re not touched or seen, whole parts of your brain barely develop; and so you become an adult who is out of it, who cannot connect with other people, who cannot feel a sense of self, a sense of pleasure. If you run into nothing but danger and fear, your brain gets stuck on just protecting itself from danger and fear. Dr. Bessel van der Kolk, “Childhood Trauma Leads to Brains Wired for Fear” (interview), Side Effects Public Media

When a child experiences early trauma, their developing sense of Self becomes embedded in shame. Whether consciously or unconsciously, so many of our clients do not feel that they deserve good things.

Understanding the shame-based sense of Self that emerges out of early trauma may provide a new way of understanding the profound internal conflict that leads people to act against their best interests and damage their lives.

NARM Clinical Approach Is Not NARM Clinical Approach Is Primarily historically focused Primarily present-moment focused Focused on trauma stories (content-driven) Focused on the adaptations to trauma (process-driven) Regressive (child consciousness focused) Grounded in here and now (adult consciousness focused) Cathartic Containment oriented Pathologically oriented Resource oriented Goal driven Inquiry driven Strategically based Curiosity based Behaviorally focused Internal-state focused Focused on symptom reduction Focused on shifting underlying patterns that are driving the symptoms Practitioner driven, with client following their lead Client driven, with practitioner providing new opportunities for exploration

The work of “soul retrieval” is to bring these fragmented parts of the soul back together. By reconnecting fragmented inner states—physical sensations, emotions, impulses, behaviors, and thoughts—NARM reinforces a deepened experience of one’s subjectivity. When these aspects of the Self are invited back into awareness, they create something greater than the sum of its parts. In this way, NARM is not just about post-traumatic healing, but about transformation of the Self.

The spontaneous movement in all of us is toward connection, health, and aliveness. No matter how withdrawn and isolated we have become, or how serious the trauma we have experienced, on the deepest level, just as a plant spontaneously moves toward sunlight, there is in each of us an impulse moving toward connection and healing. This organismic impulse is the fuel of the NARM approach.

The NeuroAffective Relational Model (NARM) is one of the first therapeutic models that provides a framework and clinical guidelines specifically designed for the treatment of complex trauma, or as it is now officially referred to as Complex Post-Traumatic Stress Disorder (C-PTSD).3 While other therapeutic models are adapting their treatment protocols to address adverse childhood experiences and complex trauma, NARM was specifically designed to address the long-term impacts of ACEs and C-PTSD.

Relational trauma also emerges out of the oppression of communities, cultures, and nations. These relational systems of oppression and subjugation create and perpetuate complex trauma. We cannot separate a person’s developmental process from the society in which they are raised. There is a growing movement within mental health that speaks to these larger concerns and seeks to expand inclusion of more culturally informed perspectives and models. Within the trauma field, it is important to identify the historical legacy of brutality, oppression, and generations of complex trauma that has deeply impacted, and continues to impact, vulnerable individuals and cultures.

the trauma field is still early in the process of clearly differentiating between post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (C-PTSD). A distinguishing factor of C-PTSD is the focus on self-organization, which refers to a neurodevelopmental and psychobiological process of shaping one’s personality and life experience. C-PTSD focuses on three areas of disturbances in self-organization: emotional regulation, self-concept, and relationships.

children who go through at least six adverse childhood experiences could see their life expectancy reduced by more than twenty years. Physiological stress leads to hypertension, which results in higher rates of infant and maternal mortality, among other conditions. Research has even

In the recovery world, we often speak of outcomes: who succeeds in treatment; who relapses or disappears or dies. My ability to stay sober was more than explained by my ACE score, the metric for Adverse Childhood Experiences, which in my case was an almost unheard-of zero. Loving family; no incarceration, addictions, or domestic violence—all of which raised the question of why I’d turned to drugs in the first place. Was there some trauma I’d repressed? That was entirely possible; Own Your Unconscious has turned up all kinds of repressed brutalities, and thousands of abusers have been convicted based on the evidence of their victims’ externalized memories, viewed as film in courtrooms. But what I kept coming back to was my cousin Sasha.

I’ve held on to those memories for the longest; never letting them go because it takes time – sometimes years – to truly understand how a childhood adventure can impact you. When I look back, I marvel at how surreal that day had been. It was the kind of misadventure one had only seen in the movies and in all those stories the protagonists were adults, some of whom did not make it. But we were just children, and this was happening to us. And this was as real as it could get. For years after, numerous existential questions raced through my head: Was God testing us? Were we handpicked for it? Was it preordained? Th en the fog started to lift and I saw it for what it was: a day in the jungle. Also, a day when everything went wrong. I’d read somewhere that adversity does not build character, it reveals it. We were tested, we were pushed to the limits of our physical and emotional endurance. We made it out alive, and it is important that this experience be shared.

Felitti and Anda spent more than a year developing ten new questions14 covering carefully defined categories of adverse childhood experiences, including physical and sexual abuse, physical and emotional neglect, and family dysfunction, such as having had parents who were divorced, mentally ill, addicted, or in prison.

A recent study by the National Survey of Children’s Health found that almost 50 percent of the children in the United States have had at least one significant traumatic experience. Even more recently, a study from 2019 by the U.S. Centers for Disease Control and Prevention (CDC) found that 60 percent of American adults report having had at least one adverse childhood experience (ACE), and almost a quarter reported three or more ACEs. These numbers are even more sobering when you consider that the CDC researchers believe them to be an underestimate.

Having Experienced Multiple Adverse Childhood Experiences; I had to become resilient in the fight to overcome future traumas. However, trauma has left me with neurological scars.

Childhood Trauma is the leading cause to Adult Mental Health. Its Pivotal to access early prevention to treat Adverse Childhood Experiences; otherwise its an injustice on victims of abuse.

War and conflict destroy the lives of children across the world. Its time to provide children with a voice through advocacy. It would be an injustice if we continue to silence children whilst they are being silenced. The leaders of the world need to swiftly answer the calls of all children including Palestinian children that are subject to Adverse Childhood Experiences.

My experience dealing with both sides of the ACEs coin is in part what drives my work. I know that the long-term impacts of childhood adversity are not all suffering. In some people, adversity can foster perseverance, deepen empathy, strengthen the resolve to protect, and spark mini-superpowers, but in all people, it gets under our skin and into our DNA, and it becomes an important part of who we are. I don’t think people who grew up with ACEs have to “overcome” their childhoods. I don’t think forgetting about adversity or blaming it is useful. The first step is taking its measure and looking clearly at the impact and risk as neither a tragedy nor a fairy tale but a meaningful reality in between. Once you understand how your body and brain are primed to react in certain situations, you can start to be proactive about how you approach things. You can identify triggers and know how to support yourself and those you love.

Toxic shame begins as an adaptation to adverse childhood experiences. Shame is the mechanism of disconnecting from and attacking the Self. Shame becomes a survival strategy to protect against attachment loss and environmental failure, which are experienced as loss of love in the universe. When shame occurs early in a child’s development, their sense of Self becomes associated with shame.

When people experience relational trauma, they are generally not responding to a mortal threat. Instead, they are responding to a threat to the security of one’s sense of Self. This has profound impact on the neurodevelopment of children and self-organization. For young children, their sense of Self is dependent on their early environment. They are 100 percent dependent on their caregivers for their survival and well-being. A young child who experiences environmental failure has the lived experience that they themself won’t exist without connection and love.

JR Blosnich, et al. “Disparities in Adverse Childhood Experiences (ACE)

All these are among the criteria for childhood affliction in the well-known adverse childhood experiences (ACE) studies.

A 2016 study by Johns Hopkins University scientists Dr. Lawrence S. Mayer and Dr. Paul R. McHugh corroborates Heyer’s and Paglia’s claims. Its findings include: scientific evidence does not support the claim that sexual orientation is an innate, biologically fixed property (that people are “born that way”); some 80 percent of male adolescents who report same-sex attractions do not do so as adults; non-heterosexuals are two to three times more likely to have been sexually abused in childhood; gay people have an increased risk of adverse health and mental health outcomes; gay-identified people have a nearly two-and-a-half times greater risk of suicide; the notion that gender identity is fixed (that a man might be trapped in a woman’s body or a woman in a man’s body) is unsupported by scientific evidence; studies of brain structures show no evidence for a neurological basis for cross-gender identification; sex-reassigned people are five times more likely to attempt suicide and nineteen times more likely to die by suicide; the rate of lifetime suicide attempts by transgenders is 41 percent compared to 5 percent among the entire U.S. population; and only a minority of children who experience cross-gender identification continue to do so into adolescence or adulthood.

ACES they called them. Adverse Childhood Experiences. Iris has a pocket full of ACES.

As with most persistent patterns, self-defeating behavior usually has roots in childhood experience. When children confronted with traumas are given both loving support and patient, effective guidance, they tend to develop healthy coping mechanisms. As adults they tend to be resilient, confident and resourceful. Any self-defeating behaviors they have are relatively minor and easy to overcome. By contrast, children who are not loved, and are abused or neglected instead, feel unprotected and alone. Then there are children who do not lack affection and attention, but are not given adequate guidance. Although they might feel loved, they often grow up feeling incompetent and incapable, and therefore unsafe in the face of adversity. In either case, they reach for anything they can find to make their unbearable feelings bearable. The more anxious and alone or inadequate and incompetent they feel, the more tenaciously they hold to whatever thoughts, attitudes and behaviors bring relief. If they do not develop more effective coping mechanisms, the ones that bring relief solidify into self-defeating behaviors.

The landmark ACE (Adverse Childhood Experiences) study, which I’ll discuss in more detail in chapter 9, showed that women who had an early history of abuse and neglect were seven times more likely to be raped in adulthood. Women who, as children, had witnessed their mothers being assaulted by their partners had a vastly increased chance to fall victim to domestic violence.

The landmark ACE (Adverse Childhood Experiences) study, which I’ll discuss in more detail in chapter 9, showed that women who had an early history of abuse and neglect were seven times more likely to be raped in adulthood. Women who, as children, had witnessed their mothers being assaulted by their partners had a vastly increased chance to fall victim to domestic violence.15

Self-awareness, the basic sense of self, and implicit memory (discussed below). To a great degree, self-esteem is imprinted as a felt sense in the right brain by the first three years, and stored implicitly below conscious awareness (Wilkinson 2010). Such imprints are usually not responsive to logic or words.

Later on, we’ll address how imprints from the early years can be rewired, not through logic and words, but through strategies involving imagery, emotions, and body-based skills.