The ACOA Trauma Syndrome

by Tian Dayton, Ph. D.

  Parents instinctively rock, coo, cuddle, and sing to their children to help them to feel safe and calm. When children are distressed, being held and reassured allows them to internalize the felt sense of tolerating or “living through” overwhelming emotions until calm is restored. Over time, children internalize the ability to “hold” their own, powerful emotions; in other words, they develop the skills of emotional regulation.

  Nature Favors Connection Over Disconnection

  Touch is the language of childhood. Parents and children who are held in a mutual embrace each experience that magic sensation of body chemicals that calm and nourish. Touching our children is like watering a plant; touch releases ­oxytocin—nature’s “brain fertilizer”—into their bloodstreams and, as a bonus, into the parent’s bloodstream as well. Touch also floods the child’s and the parent’s body with serotonin, the body’s natural antidepressant that soothes and regulates moods. “Hugs and kisses during these critical periods make . . . neurons grow and connect properly with other neurons,” writes Dr. Arthur Janov in his book The Biology of Love (2000). These hugs and kisses not only nourish the body of the child so that he or she can grow properly but they simultaneously nourish the parent’s body. Both are calmed and soothed. It is physically and emotionally heart smart, good for the body, the emotions, the soul, and the soul of the relationship. Nature rewards caring and close connection with body chemicals that make us feel good and punishes disconnection by flooding our bodies with uncomfortable stress hormones that make us feel bad, like cortisol. Alan Schore has demonstrated that cortisol, which floods the brain during intense crying and other stressful events, actually destroys nerve connections in critical portions of an infant’s developing brain (1991). Evolution ensures, through the chemicals of connection, that parents and children maintain sufficiently powerful and close bonds so that children will make it safely to adulthood. And it uses chemicals of disconnection to seal the bargain. Abandonment hurts.

  Child researcher Megan Gunnar and her colleagues found that three-month-old infants who received consistent responsive care produced less cortisol than infants who had received less responsive care. When tested again at age two, children who were classified as insecurely attached continued to show elevated levels of cortisol, continued to fall into the less securely attached group, and appeared more fearful and inhibited than their more securely attached counterparts. Dr. Gunnar’s findings reveal that the level of stress experienced in infancy permanently shapes the stress responses in the brain, which then affect memory, attention, and emotion (Gunnar et al 1996; Gunnar 1998). Babies and toddlers may be better off with plenty of closeness and touching; like little puppies, they want to be on top of each other, and like all animals, they feel more secure and even learn valuable social skills through this interactive touching and play (Panksepp 2003).

  Effects of Childhood Stress

  Understanding the nature of these powerful attachment bonds helps us to wrap our minds around why the threat of rupture between parent and child, which is an ever-present concern of the CoA, causes such stress. Addicts abandon their children whether they love them or not; when they are in the throes of using, their substance comes first. Because parent/child bonds are survival bonds, threatening them through the trauma of neglect, mental illness, addiction, or divorce can cause us to experience that rupture as traumatic. Children want to stay close to their parents and may even join their parents in a compulsive habit (process addiction) such as overeating so they don’t feel on the “outside” of a behavior that disturbs, confuses, or abandons them.

  Rejection can actually hurt physically. We use words like “broken heart” or “heartache” to describe the physical pain of rejection. “Social rejection activates the very zones of the brain that generate, among other things, the sting of physical pain . . . our brain’s pain centers may have taken on a hypersensitivity to social banishment because exclusion was a death sentence in human prehistory” (Eisenberger, Lieberman, and Williams 2003).

  We are wired to want to imitate, model, and belong. When children of alcoholics/addicts fear abandonment by their primary caretakers, they can feel that their very lives are at stake.

  Long-Term Effects of Toxic Stress During Childhood

  The Adverse Childhood Experiences (ACE) study is one of the largest studies ever conducted on the relationship between maltreatment in childhood and long-term effects on health and well-being, and it tells us much about the CoA experience. The ACE study is a collaboration between the Centers for Disease Control Prevention and Kaiser Permanente, an integrated managed-care consortium based in San Diego, California. The ACE study found that the risk factors that constitute “toxic stress” and contribute to long-term physical, emotional, and psychological health were surprisingly common. The 2006 study, led by Robert F. Anda, MD, MS, and David W. Brown, DSc, MScPH, MSc, included more than 17,000 health maintenance organization (HMO) members who underwent a comprehensive physical examination that provided detailed information about their childhood experiences of abuse, neglect, and family dysfunction. This study quantifies the long-term effects of cumulative childhood toxic stress from growing up with addiction and/or other types of adverse experiences during childhood.

  The researchers were not looking toward family addiction as a unique risk factor in their study design. Rather, parental addiction and the dysfunctional behaviors that clustered around it kept emerging through the collection of data as one of the statistically most significant causes of mental, emotional, and physical health problems in adulthood. People with high ACE scores who experienced the cumulative effect of growing up with a cluster of adverse childhood experience tended to be those who fell into the healthcare and penal systems in adulthood because their childhood stress was more than their brain/body could process. And the people who might have helped them to ameliorate their stress were often the ones causing it, or they were too overwhelmed with their own stress to be helpful to their children.

  Why Childhood Stress Has a Long-Term Effect

  Dr. Anda describes why ongoing, traumatic experiences such as growing up with addiction, abuse, or neglect in the home can have such tenacious effects. “For an epidemic of influenza, a hurricane, earthquake, or tornado, the worst is quickly over; treatment and recovery efforts can begin. In contrast, the chronic disaster that results from ACEs is insidious and constantly rolling out from generation to generation.” If the effects of toxic stress are not understood so that children can receive some sort of understanding and support from home, school, and community, these children simply “vanish from view . . . and randomly reappear—as if they are new entities—in all of your service systems later in childhood, adolescence, and adulthood as clients with behavioral, learning, social, criminal, and chronic health problems” (Anda, Felitti, et al. 2006).

  ACEs Are Common

  Contrary to the myth that adverse childhood experiences do not happen as frequently in middle- or upper-middle-class homes, toxic ACEs occur regularly and throughout all social classes and races. Dr. Anda feels that society “has bought into a set of misconceptions.” Some of those myths are that “(1) ACEs are rare, (2) that they happen somewhere else, (3) that they are perpetrated by monsters, (4) that some, or maybe most, children can escape unscathed, or if not, (5) that they can be rescued and healed by emergency response systems” (ibid).

  In the ACE study, 94 percent of those studied had gone to college and lived in San Diego, a very nice and not inexpensive area to live in, and had access to excellent health care. But even in this population, adverse childhood experiences were common.

  The ten Adverse Childhood Experiences studied were:

  • Childhood abuse

  • Emotional/physical/sexual abuse

  • Emotional or physical neglect

  • Growing up in a seriously dysfunctional household as

  evidenced by witnessing:

  —
Domestic violence

  —Alcohol or other substance abuse in the home

  —Mentally ill or suicidal household members

  —Parental marital discord (as evidenced by separation

  or divorce)

  —Having a household member imprisoned (ibid)

  Adverse Childhood Experiences

  Don’t Occur in Isolation

  If a CoA grows up with addiction, that is probably not the only risk factor in the home. ACEs tend to cluster; once a home ­environment is disordered, the risk of witnessing or experiencing emotional, physical, or sexual abuse rises dramatically. Anda and his team learned that ACEs tend to occur several at a time. CoAs are statistically likely to also have several other co-occurring issues from the above list. For example, addiction is statistically likely to be accompanied by abuse, neglect, or emotional, physical, or sexual abuse.

  High Cost of Ignoring Family Pain

  In a recent edition of Addiction Report, researchers report that family members of alcohol and drug patients had higher average costs per member-month and average overall costs, including psychiatric and alcohol and drugs, AOD than control family members; they also had almost five times higher psychiatry/AOD costs and more than twice the ER cost. For both groups, more than 40 percent of total costs were attributable to in-patient stays” (Weisner, Parthasarathy, Moore, and Martens 2010).

  According to Lewis D. Eigen of the National Association of for Children of Alcoholic (NACoA), “This means that a family of four would have $40,000 in excess medical costs from illnesses and emergency room visits. These do not include other social service costs, social welfare costs, law enforcement, education, and the like. Also, the costs are in constant dollars, so if there is typical inflation, the numbers would be larger. Historically, with medical inflation, we are looking at about $80,000 over a twenty-year span. Sis Wenger, NACoA’s CEO reflects that “We cannot afford to ignore the problems of CoAs, either financially or morally.”

  Dealing with Toxic Stress

  Dr. Anda refers to “dose and effect”; the more numerous the toxic stress clusters, the more serious and long term the effect and the higher the chance of getting involved in alcohol or drug use. There is also a higher risk for other issues, ­including having risky sexual behavior; STDs; contracting HIV from injected drug use; suffering from pulmonary disease; smoking-related lung disease; autoimmune disease; poor adolescent health; teen pregnancy; and mental health issues. There is also a higher risk of revictimization, instability of relationships, and poor performance in the workforce.

  To deal with what constitutes a national health crisis, we need to reduce the toxic stress load on our developing children. It is very expensive to help people who fall into the healthcare system and the judicial system and improve their outlook once the effects of toxic stress have set in. Much simpler and less expensive is to change our parenting and educational practices and reduce the effects of toxic stress on the developing child. Rather than wait for diseases to develop and then address them one at a time in adulthood, Anda feels that we need to look at the child-rearing practices that create the kind of toxic stress that undermines long term health and resilience (Anda, Felleti, et al. 2006). The kind of toxic stress that pounds away at our autoimmune system in childhood and all too often results in fully developed disorders as adults.

  No situation need be inherently traumatic. How we experience the circumstances of our lives determines whether or not we find them traumatizing. The presence of caring adults who help children decode the ever-unfolding situations of their worlds is a great protective buffer for the child. Without this reassuring presence, the child has no way of knowing whether or not to be scared, or how scared to be.

  FIVE

  Living on Our Emotional Edges:

  The Mind/Body Impact

  of Trauma

  I became what I am today at the age of twelve, on a frigid overcast day in the winter of 1975. I remember the precise moment, crouching behind a crumbling mud wall, ­peeking into the alley near the frozen creek. That was a long time ago, but it’s wrong what they say about the past, I’ve learned, about how you can bury it. Because the past claws its way out. Looking back now, I realize I have been peeking into that deserted alley for the last twenty-six years.

  —Khaled Hosseini, The Kite Runner

  Imagine that you’re walking through the woods on a sunny, crisp, spring day. The pleasant songs of birds are floating through the morning air. Your head is filled with the intoxicating scents of spring and you feel bathed by warm, caressing breezes. You’re relaxed, at ease, and wandering through your day. Then around the bend, in the middle of the path, you ­suddenly come upon a coiled-up snake ready to strike at you. A deep chill of fear shoots through your body. Before you think a thought, your heart starts pumping rapidly, your palms sweat, and your muscles fill with the extra blood supply you need to sprint to safety. No thought goes through your mind; you become entirely part of the moment. For a split-second you freeze, then immediately see a path out, and you are ready to bolt.

  But just as you’re taking off, the sun comes out. Gradually, through the placid movement of clouds overhead, light replaces shadow, and blades of grass become clear and distinct. The path is there beside you again, all laid out just as before. Then it dawns on you that the snake you thought you were looking at was not a snake at all but simply an old piece of coiled-up rope. You stare, amazed and relieved at this now-altered apparition. You take a breath. Your thinking brain—your prefrontal cortex—that had shut down comes back online and tells your feeling/sensing brain and body—your limbic system—that the snake it thought it saw is not a snake after all, just an inanimate object.

  You can relax, breathe again, and let go of your tension. Your body can settle down. The thinking part of your brain helps you put the whole situation into perspective and moderates your fear through observation, understanding, and insight. Your body slowly returns to normal as you tell yourself that you have nothing to be scared of. You take more deep breaths, shake your arms and legs a bit, or jog a few yards to get rid of the excess adrenaline your body just built up, and your muscles start to regain their supple, natural state.

  Nature evolved this fear response so that if we sense danger or feel threatened, our feeling of fear will signal our fight/flight/freeze mechanisms to go into self-defense mode. This fight/flight/freeze response is part of our limbic system. Our limbic system operates hundreds of times faster than our thinking mind because nature does not want us to think about whether or not we should run from a saber-toothed tiger or an oncoming truck. She wants us just to run, stand and fight, or freeze in our tracks till peril, hopefully, passes us by.

  The Limbic System:

  Our Emotional Processing Center

  We process emotions like fear and love, key to our human and animal experience, through our limbic system. Scientists sometimes refer to the limbic brain/body system as the “reptilian” or “animal” brain or the “feeling/sensing” part of the brain, and the prefrontal cortex as the “thinking/reasoning brain.” The limbic system developed long before the prefrontal cortex ever made its appearance on the evolutionary stage. Feelings, so necessary to our survival, came first. Thinking came thousands of years later.

  The limbic system is the part of our brain and body that processes our emotions and the information picked up by our senses: what we see, hear, smell, taste, and touch. It “holds,” records, and categorizes our emotional memories and the sensory data that goes along with them. We’re not necessarily aware of the limbic system as it gathers, records, and indexes these sights, sounds, and smells, and the emotions we’re experiencing until our ­thinking mind elevates these imprints to a conscious level and makes sense of them. But these emotional and sensory “files” are there nonetheless.

  Mind/Body Connection

  The limbic system has a huge job: it has
to do something with all of the sights, sounds, tastes, smells, and touch sensations that it is constantly gathering from the world around us. And it also has to process the feelings that are attached to that sensory information. The various jobs of the limbic system are far-reaching and crucial. It governs and regulates our mood, appetite, libido, sleep cycles, motivation, and bonding, to name just a few of its wide-ranging functions. If our limbic system gets thrown out of balance, through, for example, repeated experiences of fear, abuse, or neglect, we can have difficulty regulating our basic emotions and our emotional connection with others. Lack of limbic regulation can manifest as depression, anxiety, or sleep disturbances. Limbic disregulation can also cause difficulty in regulating mood, appetite, sexual responses, bonding, and motivation. Those affected by trauma (and a disregulated limbic system) can thus have trouble living moderately. Instead, they vacillate between life’s emotional extremes.

  Trauma and Our Loss of Self Regulation

  We all have an “emotional set point,” a default setting that represents our personal “norm.” It’s a set point that we can continually return to as our point of emotional balance and equilibrium out of which our thinking, feeling, and behavior grows. Trauma disturbs that delicate balance. It upsets the equilibrium and can cause us to lose our ability to return easily to our emotional set point because it has been disrupted too deeply and too often. We have become overwhelmed too frequently with too much feeling and slammed our foot on the emotional brakes too often. Our emotional gearshift gets eroded. We have trouble finding neutral.