Triggers and Re-traumatization

Triggers and Trigger Warnings have become common terms in today's culture. Scrolling social media or online videos, we often see "trigger warnings" posted, especially for sensitive topics. The question is: how many people actually understand what triggers are and the role triggers play in re-traumatization.

According to a 2022 journal article in Counselling and Psychology, the initial definition of the word "triggered" related to the clinical phenomenon of post-traumatic stress disorder (PTSD). Today, the definition of the word in the common vernacular seems to have been expanded. The article states: "Trigger warnings were first developed among the online community as a way to warn people before showing a potentially disturbing image. [They] have since proliferated beyond these formats and are used relatively often in a variety of settings, as well as vernacularly within conversation." The concern with expansion of the use of the words trigger and trigger warning is that the words lose their meaning in what they were originally intended to define.

In its original definition, what is a trigger? A trigger generally interacts with the senses and the brain to bring back strong memories of the original trauma. The person who is triggered feels he/she is currently experiencing the trauma (i.e. experiencing a flashback).  When a person has PTSD, his/her brain is unable to process the trauma in the moment. It is stored as a current memory, ever present and lurking in the brain, rather than being filed as a past memory. The brain attaches details to that memory, which become triggers.

Triggers may include sights, sounds, smells, sensations, thoughts, tastes, situations, words, etc.. 

Some common examples are: 

-Seeing a person that reminds you of a trauma. The person is not necessarily connected with the original trauma. He/she may merely have some characteristics that remind you of the original trauma.

-Being in the place where the original trauma occurred or in a place that reminds you of the original trauma.

-Another person touching you in a way that evokes the original trauma.

In the resource link below (What are PTSD Triggers), you will find more detailed information.

Trauma survivors may be aware of their triggers or they may be completely unaware. Some triggers are obvious (the sound of an ambulance); others may be subtle (the scent of roses). Trauma survivors may be triggered and have no idea why, as they may be unaware that their brain is associating a trigger in the present day to past trauma.

Awareness is key to understanding triggers. Very often, in the moment, the trauma survivor's brain is reacting with the "fight, flight, freeze" response and he/she is unable to logically process. After the brain has calmed and is able to return to logic, it can be advantageous to try to decipher what may have been the trigger. Keep a journal of the occasions when you are triggered, logging what was happening at the time and what was in the environment. Over time, patterns will emerge and you will be more readily able to identify your specific triggers, although you may still not understand exactly how they connect to the original trauma.

Re-traumatization is when a person experiences a trigger and it causes them to "re-experience" the original trauma. The brain is triggered to the "flight, fight, freeze" response, which causes the process of logical thought to temporarily shut down.

An article in the Journal of Counseling & Professional Psychology focuses on helping school professionals in "Understanding Childhood Trauma" with tips for preventing re-traumatization. While the article focuses on preventing re-traumatization of children in the school setting, there are helpful tips, as follow, which can apply to any trauma survivor. 

-Recognize that events do not have to be extreme to be traumatic. The perception of the trauma survivor of the original trauma may be very different from how others witness or experience it. This topic discusses the difference between "single traumatic events (also called acute or Type I trauma) vs. complex trauma (Type II), which is a "more prolonged, chronic or repetitive experience and is more likely to involve severe stress reactions and difficulty with adjustment." A car accident would be an example of a Type I trauma and ongoing childhood abuse would be Type II. The tendency can be to minimize Type I traumas. Additionally, Type I and Type II traumas can intertwine (e.g. seeing the police at the car accident can trigger a childhood fear of authority based on abuse from an authority figure.) The bottom line is don't diminish or dismiss a person's inexplicable fears, especially in the case of children. Instead, be curious and help the person express the fears with the goal of gaining mutual understanding.

-Understand that crises often co-occur. The example given in this article is a child experiencing a divorce in the family and, consequently, being transitioned to a new school and community. The co-occurring traumas can compound.

-Provide safety. Safety is the first and main need of a trauma survivor. The article encourages that safety can be provided by establishing a routine, offering information and encouraging dialogue.

-Promote self-regulation. The article gives examples of how children can display dysregulation or "outward traumatic symptoms," such as "impulsive behaviors, excessive talking, withdrawal, inattention or even destructive behavior." Self-regulation includes learning to name and understand feelings and emotions and then learning techniques for regulating them. Mental health professionals can help with learning self-regulation techniques.

-Encourage autonomy. Trauma often steals a person's autonomy (the ability to make your own choices free from external control). Finding ways to restore autonomy is very beneficial to healing. Examples given in this article are involving and including children in doing tasks around school and helping them feel included.

-Emphasize the positive. Some methods expressed in the article include: offering encouragement and positive reinforcement. Trauma survivors often have "difficulty identifying growth, positive change or healthy choices following traumatic incidents." Positive reinforcement and feedback can be life-altering.

-Appreciate the human capacity for resilience. Interestingly, the article states that supporters of trauma survivors may "inadvertently" treat them as if they are victims or unable. (Note: in the case of this article, the authors refer to school children; however, this could apply to any trauma survivors.) If supporters "believe in the human capacity for resilience," then they will "actively choose to treat [survivors] as if [they have] the potential to move through suffering toward a more balanced state of being." Trauma survivors often need help to believe in their own strengths and capacity for healing.

-Offer support through time. Spending time and "sharing space" with a trauma survivor will nurture a positive relationship and help him/her feel "understood and connected to another."

-House helpful resources on site. Again, this article is referring to the school setting. However, it is valuable to gather as many resources and learn as much as the trauma survivor is able. This helps overcome the sense of worthlessness, helplessness and loss of autonomy that trauma leaves in its aftermath.

-Provide supportive relationships. And, again, the main theme of this blog is reiterated. Supportive relationships are the most valuable resource in the trauma healing journey. This article points out how helpful it is to offer "undivided attention ... attending to someone involves communicating nonverbally that the other person has your full and present attention. It means using your body, your face, your eyes ... to say 'Nothing exists right now for me except you. Every ounce of my energy and being is focused on you." Offering your full and present attention, the article states, can be the "gateway for promoting a supportive relationship."

Resources: Supporting Survivors of Trauma: How to Avoid Re-traumatization. https://www.onlinemswprograms.com/resources/how-to-be-mindful-re-traumatization/

What Are PTSD Triggers? https://www.webmd.com/mental-health/what-are-ptsd-triggers

Bonus Video Link: Your Past Trauma is Triggered & Ways To Heal (PTSD and CPTSD) - Psych2Go

Bonilla, S., Natarajan, M., Koven, J., White, L., & Lamb, S. (2022). The discourse of being "triggered": Uses and meanings among counselling students. Counselling and Psychotherapy Research. https://doi.org/10.1002/capr.12535

Keller-Dupree, E.A. (2013). Understanding Childhood Trauma: Ten Reminders for Preventing Retraumatization. Practitioner Scholar: Journal of Counseling & Professional Psychology.

What is EMDR?

If you've been seeking information about treatments for post-traumatic stress disorder (PTSD), it's likely you've heard about Eye Movement Desensitization and Reprocessing therapy (EMDR). EMDR is considered the most effective treatment for PTSD. According to a 2022 article in the Journal of EMDR Practice and Research, the World Health Organization (WHO) recommends EMDR as a "first-choice treatment for PTSD."

In this post, we'll present a brief overview of EMDR, its origins and effectiveness.

EMDR therapy was discovered and developed relatively recently and accidentally. In the late 1980s, an American psychologist, Francine Shapiro. was taking a walk outdoors. She observed that moving her eyes from side to side while walking seemed to reduce disturbing thoughts. After this discovery, Shapiro began her research into this phenomenon and conducted a study, utilizing this technique with trauma survivors. 

As cited in the Journal of EMDR Practice and Research, Shapiro developed the EMDR protocol consisting of eight phases. 

Phase 1 involves "probing a client's history and building a therapy plan."

During Preparation (Phase 2), the "theory and protocol of EMDR is explained and relaxation techniques are practiced."

Phase 3, called Assessment, the "client is asked to think about the distressing event that constitutes therapeutic focus and to recall different aspects of this event." The aspects include any related images, thoughts, emotions and bodily sensations. During this process, "negative cognitions are identified and positive alternative cognitions are selected." The client rates the cognitions according to "how true they feel."

Desensitization begins in Phase 4. The side-to-side eye movements are evoked while the person processes the thoughts and emotions.  Originally, the eye movements were stimulated by the clinician holding up fingers and asking the client to follow the finger movements from side to side with his/her eyes. According to an EMDR fact sheet from the Cleveland Clinic (linked below), there are now newer methods to activate the same process, which is essentially stimulating both hemispheres of the brain. Some of the newer techniques include using a moving light instead of fingers, sound with tones playing through speakers on either side of the body, touch by tapping on hands, arms or thighs or holding a device that pulses in your hands.

Phase 5 (Installation) strengthens the "previously identified positive cognitions."

In Phase 6 (Body Scan), the client is asked to scan the body for "maladaptive thoughts or physical reactions." 

Closure (Phase 7) closes out the session by discussing potential after-effects (as traumatic memories are accessed, there can be after-effects such as dissociation). The clinician also provides the client with self-calming techniques to be able to manage any lingering stress or trauma reactions.

In Phase 8, the clinician checks for progress and plans for the future while reinforcing "healthy coping strategies." (Re-evaluation with future template).

In a collaborative book by trauma survivors, entitled When We Speak: Chains Break, a childhood trauma survivor describes EMDR therapy: "I would describe the reprocessing of memories this way. Imagine an extremely messy filing cabinet. Files are misfiled, falling out of the drawers, lying all around on the floor. EMDR puts everything in order into the right files and then into the correct drawers. As the 'files were arranged' in the correct place, I felt peace and easing of anxiety."

The survivor further shares, "EMDR therapy reprocesses trauma and turns it into a memory that doesn't trigger. Some trauma I have had to reprocess over and over because it kept resurfacing in various avenues. Other times, I would reprocess something in a short time and it would not resurface. I could recall the memory but it no longer triggered a PTSD response." [Note: book is linked below.]

EMDR tends to work faster than other forms of therapy for trauma. However, a number of EMDR sessions may be necessary to process through all the trauma, especially if the trauma being reprocessed is from childhood.

A crucial component of EMDR therapy is the presence of a trained clinician who is watchful and assists the client in coping with the various strong emotions and trauma responses evoked by the therapy. Again, the theme of our blog ... support is vital in the trauma healing journey!

We will continue to explore EMDR and other treatment methods in future blog posts.

Resources: Cleveland Clinic EMDR Fact Sheet: https://my.clevelandclinic.org/health/treatments/22641-emdr-therapy

Bonus Video Link: From the Veterans Health Administration - EMDR for PTSD 

Vanderschoot, T., & Dessel, P.V. (2022). EMDR Therapy and PTSD: A Goal-Directed Predictive Processing Perspective. Journal of EMDR Practice and Research. EMDR-2022-0009. https://doi.org/10.1891/emdr-2022-0009

Stop Suffering in Silence. (2022). When We Speak: Chains Break. Stop Suffering in Silence. https://www.amazon.com/When-We-Speak-Chains-Break/dp/B0CMRWKRLR

What is Dissociation?

Dissociation is a common effect of trauma, particularly of childhood trauma. A basic definition of dissociation is "a process in which a person disconnects from their thoughts, feelings, memories, behaviors, physical sensations or sense of identity." A protective mechanism of the human brain, dissociation is how the brain copes with the stress overload created by traumatic events.

An article by Natalie Riccio in Issues in Psychoanalytic Psychology, presents an informative overview of dissociation. According to this article, dissociation results particularly when the traumatized person is unable to activate the brain's "fight or flight" response during the time the trauma is occurring. The "fight or flight" response occurs without forethought and is the body's automated protective system. Riccio states, "While fighting or fleeing enables the individual to discharge hormones or adrenalin (thus avoiding potentially toxic effects on the body), in dissociative states, this discharge does not occur and the individual remains frozen or stuck."

Trauma survivors who I have interviewed describe dissociation as a sensation of being within a glass box. They are able to observe the environment through the glass but are unable to interact within the environment. Their senses (sight, hearing, smell, taste and touch) may be dulled. Or their senses may feel heightened but they themselves feel paralyzed. Others describe it as seeing the world through gauze or haze. Sometimes dissociation can render people temporarily mute. They can hear others talking to them but are incapable of responding.

From an article in the Journal of Trauma Practice comes this definition of dissociation: "traumatic experiences and consequently altered self-perceptions contribute to the impairment of the mutuality between internal world and external reality. This is accompanied by a renewed perception of the self in the context of a different reality accompanied by altered vigilance, awareness, control and sense of concentration."

Symptoms of Dissociation

The following brief definitions and descriptions were garnered from a fact sheet published by the International Society for the Study of Trauma and Dissociation (ISST-D). The fact sheet is linked below in the citations so you can study the information in its entirety.

-Depersonalization: The feeling of being disconnected from yourself or your body. Depersonalization happens when people are distressed and is more common among people who were mistreated as children. Depersonalization helps a person cope by detaching.

-Derealization: A sense of the external world not being real or being changed in some way. The world may look "far away" or as if the person is "watching a movie." Derealization helps a person cope by making the trauma seem "less real" and creating a "mental distance" to help them survive.

-Dissociative Amnesia: Not being to remember information or events. This amnesia is different than forgetting and normal memory lapses that all people can experience. People experiencing dissociative amnesia may completely forget part of a day or a conversation. They may have a job interview and later not remember it. Dissociative amnesia "makes sense" for survival. If a person cannot escape ongoing trauma, this dissociation can help them go to work or do other tasks of life while keeping the trauma temporarily blocked from their active memory.

In her book, Open Blind Eyes, author Rachel Timothy describes how dissociation and dissociative amnesia helped her survive being sex trafficked in her childhood. (See link to her book in citations below.)

-Identity Confusion and Identity Alteration: Confusion is when a person feels confused about "who they really are." Alteration is a sense of having parts that "belong to someone else." People may feel they have "different parts" to them that are not integrated or accepted into a single "self."

-Dissociative Disturbance of Movement and Sensation: Physical symptoms which may seem to be caused by a physical disease or disorder. Examples include: unexplained loss of function (i.e. loss of senses, movement or skills) or unexplained intrusions in the body (i.e. involuntary movements, inexplicable pain or seizures).

Note: Dissociation is not the same as dissociative identity disorder (DID), a mental health condition where a person has two or more separate personalities that control his/her behavior at different times.

Hopefully, the rudimentary definition and descriptions of dissociation in this blog post can be helpful to readers, whether trauma survivors or those who are in a supporting role. In future posts, we'll explore more about dissociation and treatments that can be helpful.

In their article, published in Journal of Trauma Practice, the following quote from Sar and Ozturk reiterates a key theme of this blog: "[Trauma] recovery can take place only within the context of relationships; it cannot occur in isolation (Herman, 1992)." Whatever the reason for your interest in reading this blog and whatever your role (as a trauma survivor or supporter), we can all purpose to be present for people who are struggling with trauma and its after-effects.

Resources: ISST-D Trauma-Related Dissociation Fact Sheet: https://www.isst-d.org/public-resources-home/fact-sheet-iii-trauma-related-dissociation-an-introduction/

Bonus Video Link: Four Types of Dissociation ‌

Riccio, N.Z. (2017) Trauma and Dissociation. Issues in Psychoanalytic Psychology, 39.Sar, V., & Ozturk, E. (2006). What Is Trauma and Dissociation? Journal of Trauma Practice, 4(1-2), 7–20. https://doi.org/10.1300/j189v04n01_02

Sar, V., & Ozturk, E. (2006). What is Trauma and Dissociation? Journal of Trauma Practice, 4 (1-2), 7-20. https://doi.org/10.1300/j189v04n01_02

Timothy, R. (2020). Open Blind Eyes. Xlibris Corporation. https://www.amazon.com/Open-Blind-Eyes-Rachel-Timothy/dp/166414367X

The Connection Between ACEs and Prison

Would it surprise you to learn that the majority of people who are incarcerated have high scores in the Adverse Childhood Experiences (ACEs) Questionnaire and resulting post-traumatic stress disorder (PTSD)? 

(See previous blog post What Are ACEs? to review the ACEs questionnaire.)

Published in the Clinical Psychology and Psychotherapy journal in February 2021 is an article detailing research exploring the connection between high ACEs scores and subsequent imprisonment in adulthood. The article cites a recent study done of 598 incarcerated women and men. The statistics are overwhelming. As stated in the article, 64% reported emotional abuse, 71% had divorced parents, 40% witnessed domestic violence, 64% had alcohol/drug use in their home, 34% had mental illness in their home and 42% had an incarcerated parent. (Messina & Burdon, 2018; Messina & Calhoun, 2018).  

And, in a second study conducted with 315 incarcerated women and 427 men, the findings were that "greater exposure to ACEs increased the likelihood that respondents were experiencing current trauma" symptoms associated with PTSD. (Messina et al., 2007)

Unfortunately, despite the research that clearly demonstrates the pervasiveness of childhood trauma in incarcerated individuals, the article states: "there is great hesitancy to open the proverbial 'can of worms' and invite the discussion of trauma within the prison-based programs." Among the concerns cited by correction officials include lack of mental health personnel needed to address potential retraumatization* of those who may participate in treatment programs.  Retraumatization without adequate mental health support could lead to aggressive behaviors and safety issues among the incarcerated population.

[*Note: Retraumatization occurs when any situation, interaction or environmental factor replicates events or dynamics of prior traumas and evokes feelings and reactions associated with the original traumatic experiences. During retraumatization, a person with post-traumatic stress disorder (PTSD) re-experiences past trauma as if it is happening in the moment. More information about retraumatization can be found here: https://www.brightquest.com/post-traumatic-stress-disorder/retraumatization/)

Hopeful progress is reported by a non-profit organization called Compassion Prison Project (https://compassionprisonproject.org). Founded by Fritzi Horstman, who herself had a traumatic childhood, the organization's mission statement is: "We create trauma-informed prisons and communities. We do this through trauma awareness education and programming." Compassion Prison Project (CPP) presents trauma educational workshops and videos for both incarcerated individuals and correctional officers.

Ms. Horstman records this statement on the CPP website, "The moment [I] stepped into the maximum security prison in central California, [I] had the realization: 'This isn't a prison, this is a trauma center.'" According to the CPP website, 98% of the prison population has at least one ACE.

CPP's Compassion Trauma Circle is a powerful illustration of the incredible prevalence of childhood trauma within this population. In the poignant video, Step Inside the Circle, Ms. Horstman invites a large group of inmates to acknowledge their ACEs by publicly stepping into a circle. As they step into the circle, they are in closer proximity to each other, symbolic of the healing that happens when people come together and support one another. And by candidly sharing their trauma, the individuals can receive support from CPP staff, along with peer support from other inmates. 

In her inspirational message to the inmates, Ms. Horstman reiterates, "There is no shame," a message that is invaluable for healing childhood trauma, as often childhood trauma survivors carry a deep sense of unwarranted shame and guilt for the experiences of their childhood.

More on this topic in a future blog post.

Bonus Video Link: Step Inside the Circle 

Messina, N.P., & Schepps, M. (2021) Opening the proverbial "can of worms" on trauma-specific treatment in prison: The association of adverse childhood experiences to treatment outcomes. Clinical Psychology & Psychotherapy, 28(5). https://doi.org/10.1002/cpp.2568

An Overview of Trauma and PTSD

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To the reader of this blog … welcome!

You may be someone who has experienced trauma. You may be a family member or support person for someone who is grappling with the effects of trauma and PTSD. You may be a researcher or clinician. You may be learning about trauma-informed care in order to better serve in your occupation. However you have come across this blog ... or possibly just stumbled upon it ... welcome!

I am passionate about trauma healing, about learning and supporting others in trauma healing journeys. Healing is worth every effort. Whatever your trauma is or the effects it has had upon you, healing is possible. There is hope!

First, let's start with a brief overview of trauma and PTSD.

Trauma is defined as an event, series of events or set of circumstances that are experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional or spiritual well-being. A traumatic event produces a sense of fear, vulnerability and helplessness. An individual is traumatized when a traumatic event (or series of events) causes them to respond with intense fear, horror and helplessness. Trauma can lead to Post-Traumatic Stress Disorder (PTSD).

Post-traumatic stress disorder (PTSD) is a psychological disorder that develops in response to trauma. The body responds to trauma by releasing adrenaline, the stress hormone that triggers “fight, flight, freeze or fawn” mode in the brain. For more detailed information, the world-renowned Mayo Clinic offers the following medical overview of PTSD: https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967

For further details about PTSD, we consult an article in the Journal of Clinical Psychology, co-written by Bessel van der Kolk, a psychiatrist who is a pioneer in trauma research and considered to be the world’s leading expert in the treatment of trauma. In the article cited below, van der Kolk traces the origins of how PTSD was recognized and diagnosed. The average person with little knowledge of PTSD associates the diagnosis of PTSD with war and combat veterans. As van der Kolk cites in this article, this is indeed how the medical community began to recognize PTSD as a mental health diagnosis.

(In this post, we will not delve into details regarding the origins of and research into the PTSD diagnosis. Perhaps, in future posts, we can explore this topic.)

In this article, van der Kolk states that he and several colleagues were the first clinicians to observe that other groups of people (not only veterans) were experiencing similar symptoms of PTSD. These included people who had “major trauma histories, i.e. victims of incest, child abuse and domestic violence.” The researchers conducted a study of over 500 patients in five different sites, “comparing the symptoms of adults with acute trauma to those with histories of domestic violence and a group with histories of childhood abuse.” Van der Kolk states in the article that “those with childhood trauma … suffered much more than the other two groups from self-hatred, amnesia, confusion, somatization, dissociation, self-harm and behavioral reenactments.” [Note: We will explore and define some of these concepts in later blog posts.] Through this study, van der Kolk and his colleagues defined what is now known as C-PTSD (complex post-traumatic stress disorder). 

Van der Kolk later wrote the best-selling book, The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma. Statistics from the book state that one in five Americans has been molested; one in four grew up with alcoholics; one in three couples have engaged in physical violence. These experiences and other traumatic experiences “inevitably leave traces on the minds, emotions and even on biology.” 

If you are one of these people, you are not merely a statistic and you are not alone. As this blog develops and we undertake this journey together, we will explore the numerous available resources. We will expand our knowledge of trauma and promote healing. Let’s venture on this journey together!

“Trauma is not meant to be battled alone.” -Rachel Timothy, co-founder of Stop Suffering in Silence https://stopsuffering.org/

Interview: What is PTSD Really? Surprises, Twists of History, and the Politics of Diagnosis and Treatment. Journal of Clinical Psychology, 69(5), 516–522. https://doi.org/10.1002/jclp.21992

van der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin Books.

ACEs and Eating Disorders

The previous blog post (What Are ACEs?) gave an overview of adverse childhood experiences (ACEs) and how they affect people into adulthood, based on an article published in the Journal of Child and Adolescent Trauma. Now let's investigate how adverse childhood experiences contribute to eating disorders.

For this subject, we turn to an article published in 2022 in the Journal of Eating Disorders. This article summarizes a case study, conducted between Oct. 1, 2018 and April 30, 2020, of 1,061 adult patients who were diagnosed with an eating disorder, according to criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)* [*Note: The DSM-5 is the handbook used by healthcare providers as the authoritative guide to diagnose mental disorders. It includes descriptions, symptoms and assessment tools to advise professionals in the diagnosis process.]

The individuals participating in this study were being treated in two private eating disorder treatment facilities. Some individuals were inpatient at the facilities, others were receiving residential care and some were partially hospitalized.

The results of the study demonstrated a clear association between adverse childhood experiences and eating disorders. The individuals with eating disorders had "significantly higher ACEs scores."

It is interesting to note that, according to this study, specific ACEs seem to be more associated with specific eating disorders. For instance, the ACEs of sexual abuse and parental divorce / mental illness were more significant factors contributing to eating disorders. Further, individuals with binge eating disorder (BED) reported higher levels of ACEs than people with anorexia nervosa. And people with other specified feeding or eating disorder (OSFED)** were more likely to have experienced dysfunction in their households during childhood than those with anorexia nervosa. [**Note: OSFED is an umbrella term for eating disorders that don't fit into the strict diagnostic criteria for the more typical eating disorders.] Being aware of the relationship with specific ACEs and eating disorders can help healthcare professionals with preventative care and treatment.

The researchers recommended that childhood trauma be examined specifically in the treatment of and prevention of eating disorders, as opposed to adult trauma, as this study indicates that trauma in childhood causes people to be at greater risk for eating disorders. For example, one of the findings in the study was that children who were bullied or teased were significantly more likely to be prone to eating disorders. Again, as stated in the previous blog post, What Are ACEs?, there is opportunity for supportive adults to intervene with children who are being bullied or teased and potentially make a difference in their future.

Bonus Video Link: An Eating Disorder Specialist Explains How Trauma Creates Food Disorders:

Rienecke, R.D., Johnson, C., Le Grange, D., Manwaring, J., Mehler, P.S., Duffy, A., McClanahan, S., & Blalock, D.V. (2022). Correction: Adverse childhood experiences among adults with eating disorders: comparison to a nationally representative sample and identification of trauma profiles. Journal of Eating Disorders, 10(1). https://doi.org/10.1186/s40337-022-00639-1

What Are ACEs?

 Adverse childhood experiences (ACEs) are specific unfavorable circumstances that occur in a child's life prior to the age of 18 and that affect many aspects of the child's well-being into adulthood. Most of the questions in the Adverse Childhood Experiences evaluation seek to disclose physical or sexual abuse. Other questions focus on emotional and mental abuse or neglect, such as, "Did you often feel that no one in your family loved you or thought you were important or special?" or "Did you often feel that you didn't have enough to eat, had to wear dirty clothes and had no one to protect you?" General household dysfunction or addictions and mental health of the adults in the household are also indicative of adverse childhood experiences. 

The following link will give you an opportunity to review the ACEs Questionnaire: https://www.ncjfcj.org/wp-content/uploads/2006/10/Finding-Your-Ace-Score.pdf You may wish to use this test for yourself or someone you are supporting.

As reported in the Journal of Child and Adolescent Trauma, individuals with higher ACEs scores are "predisposed to health-risk behaviors, have physiological, cognitive and emotional alterations, are at an increased risk of self-injurious thoughts and behaviors and are more likely than those without ACEs to develop psychiatric disorders." Higher ACE scores are associated with anxiety, depression and suicidal ideation and attempts.

In an article published in December 2022, the Journal of Child and Adolescent Trauma reports on a study conducted with 296 participants of varying ages, ranging from ages 18 to 81. 243 of the participants in the study had current psychiatric diagnoses. 206 participants reported three or more ACEs, while 65 reported one to two ACEs. 170 of the participants reported suicidal ideation within the previous 12 months, 89 had attempted suicide at least once and 33 felt they would be likely to attempt suicide in the future. Higher ACEs were also associated with higher levels of depressive symptoms and anxiety.

When traumatic events are experienced, the child's sense of "safety of the world" is altered. The article also reports that childhood trauma "contributes to negative self-perceptions, unhelpful thought patterns, greater negative affect and poor interpersonal relations." Other effects include "feelings of worthlessness, helplessness, hopelessness, an impaired view of oneself and negative cognitive biases."

The journal article reports that this study is "one of the first to examine resilience, social support and subjective well-being as mediators in the relationship between ACEs and psychopathological symptoms in adulthood." Children who have social support or supportive relationships will often demonstrate less effects from ACEs during their adulthood. When the child feels alone without any supportive adults to help make sense of traumatic experiences, the effects of ACEs are heightened. This is why it is so valuable for teachers, childcare workers and other professionals who work with children to be trauma informed and aware of childhood ACEs. A single caring person can make a difference in a child's life and future.

The results of this study are cohesive with other studies that have been administered and demonstrate the importance of testing for and being aware of the effects of adverse childhood experiences, as we work together to help and heal people with childhood trauma.

Kobrinsky, V., & Siedlecki, K.L. (2022). Mediators of the Relationship Between Adverse Childhood Experiences (ACEs) and Symptoms of Anxiety, Depression, and Suicidality among Adults. Journal of Child & Adolescent Trauma. https://doi.org/10.1007/s40653-022-00510-0