What is Trauma? 

Trauma is a person’s response to a deeply distressing event. It overwhelms their ability to cope, causes feelings of helplessness, diminishes their sense of self and limits their ability to feel a full range of emotions. While everyone is familiar with PTSD, most are unfamiliar with Complex-PTSD (C-PTSD), a different type of trauma experience. Complex Trauma, also known as childhood trauma, is more than a single event. It is a series of events or one prolonged event perpetrated by a caregiver, or someone else in the child’s life who is supposed to protect them. These offenses include physical abuse, sexual abuse, emotional abuse or emotional neglect. It typically occurs in early life when a child is still developing and is most vulnerable. It leaves the child feeling alone in their trauma, and is complicated by the ongoing presence of the offender in the child’s life. 

Typically, we think of childhood as the most carefree period in life. The work of being a child includes running, playing, engaging in fantasy, and living a carefree existence. Those of us who have had a happy and healthy childhood often yearn to return to that state of bliss; a time without the burdens and pressures we face daily as adults. But not every child experiences childhood as blissful. For children who experience childhood trauma, childhood is lonely and isolating, hurtful and dangerous. 

Recovering from childhood trauma is hard. What makes recovering from childhood trauma so difficult? Here is an illustration of the difference between how an adult responds to trauma and how a child responds to trauma. For example, once an adult has recovered from a serious car accident, they can get behind the wheel again and revisit the scene of the accident (the traumatic event). The intention is to  regain control by facing their fears. Children are vulnerable, dependent, and have no agency over themselves. When they suffer at the hands of their caregiver they cannot simply leave and go elsewhere to get the type of care they need and deserve. They are repeatedly traumatized.

Another difference in the way adults and children process trauma is adults use traumatic life events as markers and use the words ‘before’ and ‘after’ when speaking about them. For example, an adult might say, “Before I was in my car accident, I never thought twice about driving through that intersection. After the accident, I’ve noticed that I am more cautious whenever I go through any intersection.” Childhood trauma is not a single, discrete event. There is no before and there is no after. It just is.

Emotional Neglect, the Invisible Trauma

When complex trauma takes the form of emotional neglect, it goes undetected. Unlike physical or sexual abuse, there is no mark on the body that can be pointed to or serve as evidence of the assault and betrayal. Emotional neglect, unlike emotional abuse (i.e.name calling, mocking, insulting, or scornful remarks), is a passive affront to the child’s well-being. Emotional neglect is the absence of emotional nurturing, empathy, and verbal or non-verbal expressions of love. 

When children grow up in a nurturing family, they form a secure attachment to their primary caregiver. This bond is the source of emotional health and it creates a lifelong template for their perceptions of the value and reliability of relationships. It lets the child know that there will always be someone there for them and this ‘knowing’ allows them to form meaningful relationships with others throughout their lifespan. Under these conditions, children are mentally and emotionally available to learn about life through their experiences. They learn that they are lovable, worthy, have innate value, and that they matter. .

However, a child develops an insecure attachment when the primary caregiver is emotionally unavailable, rejecting, and is inconsistent in meeting the child’s needs. This thwarts development of the child’s self-esteem, impairs their ability to form relationships, and makes it challenging for them to seek the help of others when they need it. Children are egocentric and when something bad happens to them, they conclude that is their fault because there is something wrong with them. Children who experience emotional neglect (and other forms of childhood trauma) are caught up in a maelstrom of confusing and noxious feelings. When they aren’t given a sense of belonging, affection, modeling of appropriate behavior, they are unable to decode who they are or what they feel. The adult who is supposed to guide them fails them. This makes it impossible for them to feel safe at home or in the world.

Normative childhood experiences like being tucked in, listening to a bedtime story, sitting on a parent’s lap, being soothed after a fall, feeling their hair stroked or getting a good-night kiss are vital modes of communication and contact that children need in order to thrive. When these vital emotional needs go unmet it leaves a huge void in the child’s life. 

They have no way of understanding or filling this void. 

Often, the child grows up feeling the void so acutely that they somaticize it, thinking that the void is contained in their body and they feel hollow or empty, a profoundly painful experience. 

Just as the offense is invisible, its effects on the child are unseeable as well. There are no marks on the child’s body, but the marks on the child’s psyche are immutable unless treated.

Coping Mechanisms

Coping mechanisms are strategies we use when faced with stress. Two common coping mechanisms used by victims of complex trauma are dissociation and substance abuse. 

Dissociation is the mental separation from an experience. Because children are powerless, are unable to physically escape from a harmful situation. Instead, they mentally detach from their bodies and observe themselves from another place in the room, often on the ceiling. This dissociative state allows them to feel like the event is happening to someone else. At this stage in life the coping mechanism can be considered adaptive because it protects them from mental harm and anguish. However, once the dissociative response is learned, it becomes the default setting and is automatically used whenever other stressful situations arise. This can have adverse effects on the child’s ability to learn in school and respond appropriately in social interactions. Dissociative states may look like the child is spacing out, daydreaming or just not paying attention. When these responses occur in these settings, they are considered maladaptive.

There is a high correlation between emotional neglect and self-medication. Later in life, after the child has acquired some autonomy they are still desperate to numb their pain and commonly turn to alcohol, marijuana or cocaine.  

The likelihood that the symptoms of trauma will be noticed by a person who can help is higher for those who act out by abusing drugs. Those who merely go through life in a dissociated state are less likely to draw the attention of someone in a position to help. 

Ethan was hanging out with his friends when Alex came running over. 

“Hey guys, did you hear what happened? Mr. Henderson was just arrested!”

Ethan and his friends were shocked to hear the news about the school’s soccer coach. As Alex filled them in on the details of Mr. Henderson’s arrest and the allegations made against him, they all began to insert their opinions of his guilt or innocence, their experiences with him, and what his arrest would mean to the school and its soccer team.

Ethan remained still. He sat there staring into space without saying a word. He hadn’t been on the soccer team at school and never had any contact with Mr. Henderson. Still, the news affected him in a deep way. The others were so involved in their discussion they took no notice of Ethan’s reaction.

Wen Ethan heard the news about the soccer coach,  he became overwhelmed. The disturbing information triggered him. His response to past traumas had been to dissociate and when he heard about the gym teacher, his default setting was activated. 

In Their Own Words

When adolescents and young adults in treatment for emotional neglect put their experiences into words it makes the listener cringe and wonder how these children survived the solitary confinement of emotional neglect. They explain that the people who were supposed to love and nurture them said terrible things to them at best, and ignored them at worst. They learned to hate themselves, felt like freaks, believed that they would never fit in and became depressed. Because they felt misunderstood and uncomfortable among others, they self-isolated.  Ironically, the emotional isolation they felt within the family unit - a deeply painful experience - expanded and became all encompassing.

One young man made a poignant observation. He said others looked at him derisively and often asked, “What’s wrong with you”.  The question he longed to hear was, “What happened to you?”. Another explained why he engaged in risky behaviors that endangered his life, “I did that so I could point to it and say ‘this is why I hurt’ versus really knowing what hurt me.”.

The Emotional Toll of Emotional Neglect 

The impact of childhood trauma can last well beyond childhood. The pain is real even if the offense is invisible and it follows the children into adulthood. Adults who were emotionally neglected do not link their symptoms with the neglect they experienced because the neglect is out of their awareness. It was not an event, it was just their life.

When someone experiences an event like an earthquake and then begins demonstrating symptoms, the connection between the event and the symptoms would be unmistakable. When symptoms are displayed without an antecedent, the person can only draw one conclusion, “I feel this way because there is something inherently wrong with me”. The cycle of self-blame and self-hate continues and the victim aches for relief.

Many who experience emotional neglect report that their life on the outside and their life on the inside do not match. What does this mean? Because emotional neglect is invisible. Others do not see it happen. Often, the family appears to be fully functional and in-tact. The child’s physical needs are met so there are no outward signs of neglect. However, the child’s inner life is very much affected by the absence of validation, expressions of love, and guidance in navigating interpersonal relationships. They feel hopelessness, despair, a lack of meaning to life, a pervasive and painful emptiness, a feeling of being unlovable and deep shame. They feel disconnected from others and of greater significance, they feel disconnected from themselves because they never learned what their feelings meant.

Treatment

Symptoms of neglect are chronic. Without treatment, recovery is improbable. Therapy offers the adult the opportunity to work through the pain of childhood experiences, understand how it affects their self-concept and their current relationships. The relationship between the therapist and patient can provide a model of what a close relationship is like. Therapy helps you recognize that it was not your fault and you will finally forgive yourself. It reduces your feelings of shame - a barrier that separates you from others. It helps you understand what you are feeling and accept those feelings as valid. You replace self-criticism with self-compassion. You allow yourself to come into contact with parts of yourself which you detached from. This happens first in the therapy room and later, it extends into the world beyond.

Therapy requires courage; you need to  manage the tension you experience while talking about the past and still live in the present. Courage pays off. It empowers you to prevent the transmission of trauma to your own children, a consideration which frequently prompts people to enter treatment in the first place.

Amanda knew that she was attached to her therapist. She looked forward to her weekly sessions; they were the highlight of her week. Amanda felt fully accepted and she could say anything in session without being judged. She learned that her feelings were valid which was a huge change for her. She used to discount them, thinking that she had no right to feel the way she felt. The first time her therapist demonstrated true outrage about the way she had been treated was an experience she will never forget. No one had ever stood up for her before. It took some time, but eventually Amanda noticed that there was a shift in the way she thought about things. Her inner-critic quieted down.  She has flare ups when she is under stress, but she’s learned how to manage them and soothe herself. Amanda began feeling more comfortable around other people and has stopped worrying what they think about her. She likes herself better and feels worthy.

Amanda has learned how to fill her life with things that matter to her and she rarely experiences that emptiness that used to plague her. When she does feel that way, she tries to understand what the feelings are telling her - what needs to change. Although no longer in treatment, Amanda knows that when she needs help, her therapist is just a phone call away. Her ability to reach out for help is a direct result of having a corrective emotional experience with her therapist. A relationship which taught her that she matters and that it’s okay to ask for help.