When children witness a violent, dangerous, or frightening event that threatens their life or well-being, it can leave an indelible scar. The same is true if they witness that happening to someone else, whether they know them or not. Many events can cause childhood traumas. Accidents, natural disasters, wars, terrorist attacks, mass shootings, and the loss of a parent can all create overwhelming distress for children that affects them for years to come.

Everyone deals with stress in life and must learn to cope with it. That’s a normal part of healthy development. However, mounting evidence shows that experiencing repeated stressful situations, especially without loving stable support, can lead to serious problems. When Dr. Debra Houry, the director of the National Center for Injury Prevention and Control, spoke to the House Committee on Oversight and Reform in July 2019, she shared alarming facts about the damages of prolonged stress.

Houry described how trauma can affect the most basic functions of the body, altering the nervous, endocrine, and immune systems, as well as the brain. New research even suggests that traumatic stress can change people’s DNA, resulting in poor physical health, reduced attention, difficulty controlling emotions, and impulsive behavior.

Houry’s message was clear: This health issue demands thoughtful attention and meaningful investment. Many clinicians and care providers like psychiatric mental health nurse practitioners can play a meaningful role in addressing the problem. Those interested in helping to heal childhood trauma in adults need to develop the right skills.

Emotionally painful experiences that leave mental or physical scars can create childhood trauma. For example, some relationships damage a child’s sense of security. This is referred to as interpersonal trauma. It involves relationships in which the child experiences violence, abuse, or neglect in some way. Childhood trauma usually occurs in one of two ways:

• Something is done to a child:
  • A child witnesses abuse in the home or elsewhere.
  • A child experiences physical, sexual, or emotional abuse at home, school, or elsewhere.
  • A child experiences violence in the community, perhaps because of a war, famine, or another disaster.
• Something that should happen doesn’t:
  • A child’s emotional and physical needs aren’t met, perhaps because a parent is mentally ill or misuses substances.
  • A child can’t form important bonds with a parent because of abandonment or imprisonment.

While some children experience immediate symptoms from trauma, others have delayed responses. Additionally, the severity of responses can vary. For example, an abandoned child can experience serious depression and attempt suicide or, as an adult, experience intense anxiety and fear of abandonment in personal relationships.

The National Institute of Mental Health identifies several factors that make people more vulnerable to the effects of trauma, including:

• Direct involvement, i.e., child receives abuse
• Severe or ongoing exposure to a traumatic situation or event
• Multiple traumatic experiences
• A lack of caring support from family, friends, or professionals
• Ongoing stressful events, such as frequent moves or changes in schools

Childhood trauma can have lasting effects on individuals throughout their lives, making it a crucial mental health issue. Research on the prevalence of traumatic events in children’s lives presents alarming findings. A recent review of numerous studies found that around 45% of American children experience at least one traumatic event.

This number is particularly worrying considering the links between past traumas and future chronic health conditions. In addition, childhood trauma has a greater likelihood of affecting people as adults since it happens when the brain is particularly vulnerable.

According to research scientist Andrea Roberts, events that make people believe their lives or safety are in danger can trigger emotional and physical responses that increase susceptibility to several health conditions, including:

• Stroke
• Heart attack
• Diabetes
• Obesity
• Cancer

These health conditions may originate from two factors that traumatic events often provoke:

• Changes in behavior. People who experience trauma may get involved in behaviors like using drugs and alcohol, smoking, or binge eating to escape their pain. These activities all pose risks that can lead to health problems in the future.
• Physical effects from trauma. Experts have found that ongoing extreme stress keeps the body on high alert — the heart races and adrenaline surges, causing excessive wear on the body and aging all of its systems.

Childhood trauma can take many forms, including:

Early childhood trauma. Early childhood trauma, which refers to trauma experienced from infancy to age 6, can have devastating effects. Children at this age still can’t discern the difference between cause and effect, so they can easily believe their thoughts and fears can become real.

Loud noises, such as bombs exploding, and frightening images, such as seeing a bleeding or wounded person, can destroy a child’s sense of safety. Traumatic events can also plague children with nightmares and guilt, thinking they’re somehow responsible for what happened.The rapid development of children’s brains at this age leaves them particularly vulnerable. Researchers have found links between a small brain cortex — the area of the brain responsible for memory, language, thinking, and perceptual awareness — and early childhood trauma. A smaller cortex can affect IQ and a child’s ability to control emotions and fears.

Violence and physical abuse. Violence and physical abuse can refer to a parent or other individual causing injuries, such as welts, cuts, and broken bones, to a child. Physical abuse can lead to distrust of authority figures, low self-worth, and aggressive behavior toward others, among other reactions. Some children become numb and withdraw from other children and school, showing little interest in the world around them. Others develop severe anxiety

Bullying. Bullying can harm children emotionally and physically. It can take the form of physical assaults (hitting, kicking, tripping); verbal attacks (taunts, threats, sexual comments); and social attacks (purposefully isolating others, spreading rumors, shaming or embarrassing others publicly).

Bullying can affect a child’s ability to do well in school and interact with other children. It can also lead to severe anxiety and a low self-image. The article, “Childhood Bullying Can Cause Lifelong Psychological Damage – Here’s How to Spot the Signs and Move on” cites research which shows nearly 28% of boys and 40% of girls who experienced bullying had PTSD.

Sexual abuse. Sexual abuse involves interactions where an adult engages a child sexually. This may include touching or looking at a child’s naked body. Additionally, showing a child pornography or exposing body parts to a child for sexual pleasure also constitutes sexual abuse. Sexual abuse can lead to immediate and long-term consequences for children.

Many children show changes in emotions and behaviors, such as angry outbursts, depression, withdrawn behaviors, and anxiety. Other children may not show visible symptoms and keep the experience secret, but sexual abuse that isn’t dealt with can lead to serious emotional and physical problems, such as PTSD, acting out sexually, and suicidal behaviors like self-cutting.

Terrorism. Terrorism can refer to mass shootings, bombings, and other types of large-scale violence, such as 9/11. These traumatic events can result in physical injuries, but they can also lead to anxiety, depression, and other emotional reactions.

Disasters. Disasters such as earthquakes, hurricanes, and wildfires can all create dramatic challenges, including displacement, loss of a family home and community, and sometimes loss of life. These experiences can all traumatize children and cause anxiety, depression, persisting thoughts about the traumatic event, difficulty managing emotions, and pain in the body that doesn’t appear to have a clear cause. Figures from the National Child Traumatic Stress Initiative show that some form of disaster has hit more than half of American families.

Different types of childhood trauma affect varying numbers of people. However, it’s useful to understand how many people are impacted and by what. Of those impacted by these different traumatic events, who gets treatment? What are the long-lasting effects of childhood trauma? Learning some specific facts and childhood trauma statistics can help health professionals to create preventive initiatives and treatment plans that address the problem.

As noted earlier, research shows that nearly half of children experience at least one traumatic event by age 17. Data from the National Survey of Children’s Health shows the percentage of children who experience different kinds of traumatic events:

• 25% have a parent or guardian divorce
• 9% live with someone who misuses alcohol or drugs
• 8% have a parent or guardian who has spent time in jail
• 8% live with someone who has mental illness
• 6% witness adults in the home physically abuse others
• 4% experience physical abuse in their neighborhoods
• 4% experience unfair treatment because of their race, ethnicity, etc.
• 3% have a parent of guardian who has died

When people experience numerous traumatic events, they face greater risks of developing serious emotional problems, which can lead to suicidal thoughts and attempts.

The National Survey of Children’s Exposure to Violence reveals additional insight into violent traumatic events children experience. Some of its findings include the following:

• While 60% of children report being exposed to some form of violence in the past year, more than 10% report being exposed to violence five or more times.
• Around a quarter of children were robbed or witnessed violent acts, and almost half were assaulted one or more times in the past year.

The survey also reports research on how experiences with violence puts children at a greater risk for future violent experiences. In fact, children who’ve experienced violence or assault in the past year are five times more likely to experience sexual abuse.

While it’s hard to know the extent to which people receive treatment for childhood traumas, it’s clear that many people go untreated. However, institutions and health professionals can adopt trauma-informed care (TIC). TIC uses a system of principles and practices that help to recognize and treat the effects of trauma and empowers those who’ve experienced trauma to heal and feel safe.

The Substance Abuse and Mental Health Services Administration describes four important components of TIC:

1. Realizes the widespread impact of trauma and understands potential paths for recovery
2. Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system
3. Responds by fully integrating knowledge about trauma into policies, procedures, and practices
4. Resists re-traumatization

The Substance Abuse and Mental Health Services Administration reports that behind almost every substance abuse or behavioral health disorder stands some sort of trauma.

The impact of child traumatic stress can last well beyond childhood. In fact, research has shown that childhood trauma survivors may experience:

• Difficulty learning
• Less academic success
• Higher incidences of alcohol abuse
• More school disciplinary actions, such as suspensions and expulsions
• Greater need for health and mental health treatment
• Higher suicide rates
• More involvement with child welfare services and the criminal justice system
• Chronic health problems, such as diabetes and heart disease

Many who experience traumatic events as children exhibit symptoms throughout their adulthoods that make life much more challenging. Some common symptoms of childhood trauma in adults include:

• Passive-aggressive behavior
• Unresponsiveness
• Sleep disturbances
• Emotional outbursts
• Compulsive behavior

These symptoms and others may arise when people internalize traumas. Internalized traumas can leave a person feeling angry, anxious, and depressed. People can also externalize trauma, causing them to act out violently or have panic attacks.

Trauma often overwhelms people’s ability to cope or pushes them to adopt behaviors that don’t serve them well later in life. For example, children who grow up in abusive households may learn to hide negative emotions because any signs of them result in beatings. This prevents children from learning to express frustration in a healthy way, so as adults they may hide their emotions or express them in damaging ways that interfere with their ability to have loving relationships.

A lack of healthy coping mechanisms can easily result in anger, violence, panic attacks, and anxiety.

Anger is an emotion that all people experience, and it can serve an important purpose. However, people with traumatic histories may not know how to control their anger or express it appropriately because childhood trauma can disrupt their emotional and interpersonal development. This can turn anger into a destructive force.

As a result, people may respond to a situation with a disproportionate amount of anger. They may also repress their anger and redirect it inappropriately. For example, they may redirect it against a spouse, friend, or child, or against themselves in the form of self-loathing, shame, and guilt. In effect, they’re acting out unresolved anger about their childhood trauma.

A relationship between childhood trauma and violence also exists. The study “Association of Childhood Trauma Exposure With Adult Psychiatric Disorders and Functional Outcomes” found that those with traumatic histories were more likely to have violent relationships.

Additionally, in a study examining the relationships between the maltreatment of children and violence in adulthood, participants who experienced physical abuse were almost 40% more likely to be arrested for a violent crime in adulthood. Traumatic events, such as physical abuse, present clear risk factors for acting violently in adulthood. This violent behavior may express itself in criminal behavior or domestic violence.

Studies have shown links between childhood trauma and panic attacks. Panic attacks are sudden occurrences of intense fear accompanied by physical symptoms, such as a racing pulse, shortness of breath, and trembling, despite a lack of actual danger. Children who have experienced trauma may also experience panic attacks, and these panic attacks may continue into their adulthood.

Childhood trauma can trigger anxiety disorders, and studies have established links between childhood trauma and chronic anxiety. When a child experiences a trauma, the emotions and fears from it can continue to express themselves well into adulthood if they aren’t resolved. Traumatic events can put children on high alert.
When traumatic events persist, children become especially vulnerable to staying in a perpetual state of high alert into adulthood. As adults, they may carry this anxiety and fear of impending doom, and it can prove very disabling. Additionally, an event such as a war or natural disaster, which puts the lives of a child’s entire family in danger, can lead to serious anxiety in adulthood.

Childhood trauma can significantly affect a person’s ability to thrive as an adult because it can compromise people’s emotional, physical, and mental health. Some common effects of childhood trauma in adults include depression, PTSD, substance abuse, and poor physical health.

Depression can plague anyone. It involves persistent feelings of sadness, fatigue, hopelessness, lack of interest in activities that were once enjoyed, and repeated thoughts of suicide or death. Those with childhood trauma tend to experience depression more often.
Experts explain that childhood trauma can affect brain development and circuitry that manages a person’s moods and responses. The mere passage of time can’t make trauma go away. Accounting for these biological factors may require different methods of intervention.

PTSD can involve:

• Invasive memories of a traumatic event in the form of nightmares or flashbacks
• Feelings of hopelessness, isolation, and emotional numbness
• Unwillingness to talk about a traumatic event
• Aggressive behavior
• Difficulty sleeping and concentrating
• Problems maintaining relationships with friends and family

When these symptoms persist for months or years after a traumatic event, a person likely has PTSD.

Children who experience trauma, especially repeated trauma, can get stuck in a shock response, which prevents them from processing their feelings. This ongoing state of shock, also known as PTSD, can carry through to adulthood.

Substance abuse, or the use of illegal drugs, prescription medications, or alcohol in destructive ways, can become a problem for individuals for many reasons. However, because childhood experiences shape physical and emotional development, researchers have considered childhood trauma as a contributing factor to substance abuse in adults.

Some studies suggest that childhood trauma harms brain development, which then makes people more susceptible to substance abuse as adults. Another explanation for the link between the two considers how witnessing a parent or a loved one abuse substances can influence a child’s behavior as an adult. Whatever the reasons, those who experience childhood trauma have high rates of substance abuse issues.

Poor physical health in adults may originate from childhood trauma. Greater traumatic incidents in people’s lives are linked to eight of the top health problems that cause death, according to the Centers for Disease Control and Prevention (CDC). For example, people who experienced numerous childhood traumas have higher rates of suicide and drug overdose, two leading causes of death.

The landmark “CDC-Kaiser Adverse Childhood Experiences Study” found heart disease, liver disease, chronic obstructive pulmonary disease, and cancer to be more prevalent among adults with childhood trauma. Additionally, childhood trauma can result in what experts call “a heightened stress response,” which can affect a person’s immune system and the ability to sleep and regulate emotions.

Despite the long list of challenges childhood trauma presents, research also shows that people have an incredible capacity to adjust and recover from traumatic events. There are various treatment strategies for healing childhood trauma in adults.

Experts have developed evidence-based treatment methods that offer important support. These methods can help people to heal from traumatic events more quickly and go on to lead healthy, productive lives. Researchers have tested them in different settings and with varying types of trauma types and populations. Some include:

• Trauma-focused cognitive behavioral therapy. TF-CBT is an evidence-based approach for people experiencing chronic symptoms as the result of trauma. This method helps people cope with the memories of the event by giving them tools to tell their story of the trauma in a safe, supportive environment.
• Trauma Affect Regulation: Guide for Education and Therapy. TARGET helps to prevent and treat PTSD by helping people to use their strengths to understand the daily events that can trigger trauma-related reactions. The approach can empower individuals to become more mindful, enabling them to make healthy decisions and improve their relationships.

The presence of a supportive family and community can play an important role in healing childhood trauma in adults. Access to knowledgeable clinicians can provide valuable guidance to recovery as can support groups of others recovering from childhood trauma. Supportive spouses, family members, and friends can listen, encourage, and offer validation.

According to the study “Social Bonds and Posttraumatic Stress Disorder,” accumulating evidence shows that social support, which helps people to regulate their feelings under traumatic stress, can help to protect people from developing PTSD. Additionally, social support, along with other social factors, can serve as one of the most powerful tools for those recovering from PTSD. By soothing trauma-driven fears, loved ones can significantly affect a person’s healing.

Holistic therapies that consider the mind, body, and spirit can also aid in recovery. For example, exercise, yoga, and meditation can raise serotonin levels, improving a person’s mood and general health. In fact, more than one study has found that these activities reduce stress and anxiety and may also reduce depression.

Other useful treatments include massage, acupuncture, and art therapy. They can relieve stress, reduce pain, and serve as positive coping outlets for those dealing with emotional, physical, and mental pain.

Psychiatric mental health nurse practitioners can help to build resilience to childhood trauma in adults by focusing on treatment and prevention. By addressing the immediate needs of people experiencing traumatic stress symptoms, they offer much-needed relief. Psychiatric mental health nurse practitioners work with physicians and other medical staff to develop treatment solutions that help to alleviate the symptoms and effects of childhood trauma in adults and allow people to thrive in life.

Those inspired by the chance to reduce the long-term effects of trauma should consider a nursing career. The first step in this direction involves getting the right education. Regis College offers an online BSN to DNP program that prepares nurses to effectively help and treat those facing childhood trauma.