ACoA Trauma Syndrome: How Childhood Trauma Impacts Adult Relationships

ACoAs can and often do suffer from some features of post-traumatic stress syndrome that are the direct result of living with the traumatizing effects of addiction. But we oftentimes don’t know it. Years after we leave our alcoholic homes behind, we carry the effects of them with us, we import past, unresolved pain into present day relationships–but again, without a lot of awareness as to how or why.

Studies on trauma and more recently neurobiology and attachment, have more or less proven what we have long observed clinically, that the shocking, humiliating and debilitating experiences that accompany living with addiction do, in fact, literally shape our neural networks. And that the personality complications caused by this early pain and stress can and often do emerge years and years after the fact. This is what being an ACoA is all about–a post-traumatic stress reaction. Long after CoAs leave their alcoholic homes, they remain ensnared in repeating relationship patterns that are the direct result of having been traumatized in childhood. Old pain keeps remerging in new relationships. The names change, but the pain and relationship dynamics remain the same. Growing up with addiction asks family members to live in two different yet overlapping worlds, a sober world and a using world. This is part of what makes living with addiction both traumatizing and contagious. The myriad of small losses involved in having the parent you love and need repeatedly moving in and out of themselves, their relationship with the family and their own inner core is deeply disturbing and can engender what I call relationship trauma, trauma that occurs in the context of relationships. The addict isn’t the only person who changes or whose thinking becomes confused or who suffers a loss of trust in relationships. Family members, too, experience the distorted world of the addict and internalize it as their own.

Picture the child in the alcoholic home. There is a power imbalance, the child is small, the parent is big. The parent is the one who “owns” the home, who is, or is supposed to be, in charge. And everyone knows this. The parent has the power. If a parent is yelling at a child, telling the child that he or she is the problem, that if he or she would only change everything would be better, the child tends to believe it. Children are disempowered by the very nature of their youth and dependency. The child learns to stand there in the situation that ensnares them, but on the inside they flee, they dissociate. The child is trapped in a world that is run and paid for by the parent; and the CoA has limited access to other sources of outside support and sustenance. Their ability to understand, process and manage this situation is dictated by their dependency and their limited intellectual equipment at any given point of development. The combination of these factors can contribute to PTSD, the symptoms of which may lie dormant in the unconscious for years.

When as adults, unresolved childhood pain gets triggered, the ACoA may stand there, looking like a grown-up, but feeling, on the inside, like that helpless, frightened, trapped kid. Naming and defining the ACoA syndrome gives us a way to finally understand ourselves, to feel our way out of our frozenness, so that we can finally grow up on the inside.

Cultivation of a False Self  

As children living with parental addiction, CoAs often learn not to tell the truth about what they see going on around them. For the family that is in denial about the progressive illness of addiction in its midst, telling the truth can be ostracizing. Family members can quickly turn against the one who tries to make the growing problems of dysfunction and addiction evident. The idea of “looking good” becomes a critical survival strategy and keeps the family from having to endure the pain slipping ever further into dis-ease. Because of her need to “look good” to herself and her family, the CoA may take refuge in creating a persona that is workable and acceptable within the family as it exists, at the expense of her own authentic self. It may feel easier to the CoA to adopt this false self and feel like a clever solution to a pressing identity problem, although in the long run it can cost a great deal in terms of self-honesty, genuineness and clarity of mind and heart. We all, to some extent, cultivate a false self (Horney, 1950) for protection, but the CoA may become her false self and lose touch with who she really is on the inside. Beneath the false self lies the fear of exposure, which can make the CoA, once they have grown up and become an ACoA, want to cling to it at all costs. This can complicate recovery as it feel dangerous to expose the confusion and pain that the false self was designed to keep in place.

Some of the factors that sear trauma in place and make it more likely that a CoA will develop post-traumatic trauma syndrome are:

When the Parent Is Causing the Stress  

When the same people who children would normally go to for comfort and to put their fear into perspective are the ones actually hurting them, it’s a double whammy for the children. Not only are they being hurt, but their access to the comforting side of their parents is interfered with because of parental dysfunction.

Lack of Access to Outside Sources of Support  

Oftentimes, the more dysfunctional a family becomes, the more isolated it becomes from other families. Having somewhere to go that feels safe and offers a different model of how to live can have a lasting, positive impact on a child that counters the effects of growing up with trauma. ACoAs often talk about grandparents’ houses, spending time at the neighbor’s, the house of a friend or relative, or a job where they could regain their balance and recognize that the world is full of options. These experiences restore a sense of hope and direction for the CoA.

Developmental Level of the CoA  

Children create an understanding of their environment with the psychological equipment they have at any particular stage of development. Small children may come up with fantastical, magical solutions that are the product of their immature minds. They may learn to bend the truth, for example, to make it less frightening, creating “reasons” for their parent’s erratic behavior that are less threatening than the truth. For example, they may think, Daddy yells at me more because I am his favorite. As adolescents, they have a greater ability to perceive reality but are still in the throes of their own individuation. Adolescents may have trouble figuring out how to separate from a situation and hold onto a sense of self when the circumstances of the family already feel fundamentally abandoning and confusing. Young adults can also struggle with families who “fall apart.” Once separation occurs, their home base disappears and is not there to return to.

Basic Power Imbalance  

Children are very dependent upon their parents who hold the keys to their world. If children fight back, they risk getting grounded, getting hit or having their allowance taken away. Older siblings can also trap younger siblings in this power imbalance that can become part of a trauma bond. Being at the disempowered end of a trauma bond can mean that children are stuck going along, stuck saying yes even when they want to say no.

Perceived or Real Helplessness  

Living with the mood swings, abuse, neglect, or emotional and physical violence that can accompany addiction is terrifying for children, and they can feel helpless to protect themselves or those close to them in the face of it. Learned helplessness can be part of the ACoA trauma syndrome. In disaster situations, the smallest form of involvement can allow victims to be less symptomatic. Even cleaning up branches and debris after a hurricane can allow those affected to restore a sense that they can do something to improve their situation, which counters the PTSD symptom of learned helplessness. Children can counter their own sense of helplessness by doing positive things for themselves, whether writing in a personal journal, helping to restore order in the house, engaging in fun or meaningful school activities that build their sense of having their own life or getting a job to earn their own spending money.

Organic Makeup of the CoA  

Basic intelligence is a factor in resilience along with the child’s own organic structure. Some children seem better equipped by nature to cope with adverse circumstances in spite of their gender or position in the family. Though it is virtually impossible to separate the combined effects of nature and nurture, there can be organic reasons that can influence a child’s ability to cope with adversity effectively.

Sensory Nature of the Stressor  

The more senses that are involved and attached to an experience, the more the brain and limbic system absorb and remember it. First responders at Ground Zero on 9/11 were more likely to become symptomatic because of the amount of sensory input they experienced; they saw, smelled, heard, touched and tasted the scene and experienced powerful emotions of horror, disgust, fear and compassion. Home is a highly sensorial environment full of smells, sounds, touch, tastes and imagery. What happens in the home is absorbed deeply into the brain and body.

Length of Time the CoA Spends in a Dissociated State  

While dissociation may represent our best, albeit unconscious, attempt at managing the unmanageable when we were small and trapped, it can become a liability and is considered to be maladaptive if it becomes a pattern that we fall into without awareness.

Length and Severity of the Stressor  

The cumulative effect of childhood toxic stress is part of what gives the ACoA trauma syndrome teeth. And although toxic stressors are common throughout society, some are more devastating than others. When CoAs move into adulthood with a history of childhood trauma, they are more vulnerable to being traumatized as adults (Krystal, 1968).

How Trauma Becomes Intergenerational  

Understanding how human beings process fear and trauma in their brain and body illuminates why emotions associated with frightening, disempowering experiences can remain unconscious. One reason triggered unconscious pain can be so confusing for the ACoA to decode is that the brain cortex (which is where we do much of our critical thinking and meaning making, where we think about what we’re feeling and make sense of it) shuts down when we’re in a state of terror or high stress. When we’re really scared our limbic system takes over and we go into fight/flight. Nature doesn’t want us thinking about running for safety when confronted with a charging, wild boar, it wants us simply to run. When someone perceives impending trauma, he or she is prone to an extreme startle (Simons, 1996) or “deer in the headlights” reaction. Following that is the attempt to fight or flee. If escape is possible, the experience of the near-trauma will be temporarily stressful, but the person is unlikely to develop full-blown post-traumatic stress disorder (PTSD). If, however, the intention to flee is thwarted, the result is a “freeze” response (Gant, 2003). The freeze response, akin to dissociation, creates an inability to process what is happening and increases PTSD symptoms. 

Because our ability to think is temporarily frozen or “out of order” when we’re in a fear state, we need to make sense of frightening or traumatic moments after the fact. We need to elevate our feelings about what happened and our sensorial impressions and responses to a conscious level and think about them after we feel the threat is over and we feel safe again. When this doesn’t happen, the memories and the feelings that surround us can remain locked within our unconscious, limbic (read: body) memory waiting to be triggered and jettisoned to the surface. But when they do surface they often get projected onto the situation that triggered the reaction with little or no awareness of their deeper origins. Needless to say, this can make adult intimacy feel confusing and unmanageable because the past becomes mixed up with the present and these feelings are difficult to separate, so problems become bigger and more complicated than necessary.

When ACoAs grow up and create families and relationships in adulthood, they may overreact to the vicissitudes of negotiating relationships. Parenthood and intimacy act as triggers and the feelings of dependency and vulnerability can consciously or unconsciously put the ACoA into a state of fear in which they see chaos, out-of-control behavior and abuse looming around the corner, because this was their early childhood experience. They may unconsciously be so convinced that distress is at hand that they may experience mistrust and suspicion when problems are solved too smoothly. They may even push a situation in a convoluted attempt at self-protection trying to ferret out potential danger until, through their relentless efforts to avoid it, they actually create it. And so the pattern of strong feelings leading to chaos, rage and tears is once again reinforced and passed along. People who have been traumatized tend to live in emotionally black and white worlds. Our thinking, feeling and behavior swing from zero to ten, with no speed bumps in between. We lose our ability to regulate our powerful emotions. We need to learn to think, feel and act in balance. Some of the long-term issues associated with the ACoA trauma syndrome are:

Relationship Issues  

Throughout this list we are describing issues that can result from relationship trauma. Because relationship trauma occurs within the context of primary relationships the issues that result from relationship trauma tend to resurface and get played out in subsequent relationships. Those who have experienced relationship trauma may recreate dysfunctional patterns relating to their present-day relationships that mirror unresolved issues from their past relationships. This “recreating” can occur through psychological dynamics such as projection: projecting our pain onto someone or a situation outside the self; transference: transferring old pain into new relationships; reenactment patterns: continually recreating dysfunctional patterns of relating whether or not they prove successful or healthy.

Problems with Self-Regulation  

The limbic system can become deregulated as a result of repeated toxic stressors. Because the limbic system has jurisdiction over our mood, appetite, sleep cycles and libido, deregulation in the limbic system can translate into a lack of ability to regulate our feelings, appetite, sleep or sex drive. Broad swings between states of emotional intensity and numbing are part of the natural trauma response. For example, we become overwhelmed with intense anxiety and fear and we shut down to protect ourselves from going on emotional and psychological “tilt.” Over time ACoAs may become used to living in emotional extremes and can be uncomfortable living in a more regulated, middle range of thinking, feeling and behavior.

Hypervigilance, Anxiety, Hyper-reactive  

When we’re hypervigilant, we tend to scan our environment and relationships for signs of potential danger or repeated relationship insults and ruptures (van der kolk, 1987). We constantly try to read the faces of those around us so that we can protect ourselves against perceived pain or humiliation. We “wait for the other shoe to drop” as we say in the rooms. Unfortunately, this reactivity can create problems that either aren’t there or that might be overlooked or easily managed were we not projecting our own past pain onto situations and relationships in the present.

Emotional Constriction  

Homes that do not encourage the expression of genuine emotion or that make us want to hide or shut down what we are experiencing on the inside may result in family members having a restricted range of emotions that they are comfortable feeling and sharing.

Unresolved Grief  

ACoA’s have suffered profound losses. There has been the childhood loss of family members to addiction and the disruption of family rhythms and rituals. There is the daily loss of a comfortable and reliable family unit to grow up in and often the anxiety of wondering if parents are in the position to parent the child and meet the child’s changing needs. ACoAs often need to mourn not only what happened in their childhoods, but also what never got a chance to happen.

Denial and Distorted Reasoning  

Watching someone we love slowly become someone we cannot make sense of can shake us to the core. It can be disturbing, humiliating and frightening. Family members may twist or distort their own reasoning to make this destabilizing experience easier to manage or less “real,” by essentially denying reality. Also as children, we make sense of situations with the developmental equipment we have at any given age; when we’re young we either borrow the reasoning of the adults around us or make our own childlike meaning. This “child think” may be saturated with what psychologists call magical thinking or interpretations that are laced with immature or even fantastical conclusions. It may also be influenced by the natural egocentricity of the child who feels that the world circulates around and because of them. This kind of reasoning can be immature and distorted and can be carried into and played out in adult relationships.  

Traumatic Bonding  

Because it is so deeply disruptive to our sense of normalcy, trauma in relationships can impel people both to withdraw from a close connection and to seek it desperately. Traumatic bonds are unhealthy bonding styles that tend to become created in families where there is significant fear. Children who are lost and frightened may “rescue” each other, or carry a sense of “surviving together” that can create a feeling that loyalty should be maintained at all costs, even if “close” bonds become problematic or dysfunctional. Traumatic bonds have a tendency to repeat themselves: that is, we tend to repeat this type of bonding style in relationships throughout our lives, often without our awareness.

Loss of Ability to Accept Care and Support from Others  

The numbing response along with the emotional constriction that is a natural part of the trauma response may influence our ability to accept care and support from others. We may develop fear, mistrust and a degree of emotional frozenness. Our willingness to let love and support feel good may lessen because we we fear that letting our guard down will only set ourselves up for more loss or pain. So we protect ourselves, imagining that by avoiding meaningful connection we will also avoid hurt (van der Kolk, 1987).

Loss of Trust and Faith  

When our personal world and the relationships within it become very unpredictable or unreliable, we may experience a loss of trust and faith in both relationships and in life’s ability to repair and renew itself. This is why the restoration of hope is so important in recovery. It is also why having a spiritual belief system can be so helpful in personal healing because hope and a sense of a larger more perfect order tend to be part of such systems.

Learned Helplessness  

When we feel that nothing we can do will affect or change the situation we’re in, we may develop learned helplessness. We may lose some of our ability to take actions to affect, change or move a situation forward; we may give up and collapse on the inside or adopt a permanent position of victimhood (van der Kolk, 1987).

Tendency to Isolate  

People who have felt traumatized may alternate between anxious clinging and taking refuge in avoiding connections with other people. They reason that by avoiding honest and authentic connections they will avoid being hurt–and so they isolate. Isolation is also a feature of depression. Unfortunately social connectedness, though natural to our species, still needs to be learned and practiced. The more we isolate, the more out of practice we become at making connections with people, which can further isolate us.

Survivor’s Guilt  

The person who “gets out” of an unhealthy family system while others remain mired within it may experience what is referred to as survivor’s guilt. Survivor’s guilt can lead to self-sabotage in recovery or prompt the AcoA to become overly preoccupied with fixing one’s family. The recovering person may seesaw between wanting to cut off from his or her family because being close to them makes the ACoA feel as if he or she is sliding backwards and wishing to “return to the womb” of the family to avoid having to tolerate the painful and uncomfortable feelings of separateness and differentness. Over time the recovering person needs to learn what every child needs to learn: to be in the presence of another person while still hanging onto his or her own autonomous sense of self and trusting what he or she feels and sees. Family members who are still “in their disease” can complicate survivor’s guilt for the recovering ACoA by blaming them or feeling threatened by the ACoA who is “blowing the whistle” by finding recovery.

Shame  

For the person growing up in an addicted environment, shame becomes not so much a feeling that is experienced in relation to an incident or situation, as is the case with guilt, but rather a basic attitude toward and about the self. “I am bad” as opposed to “I did something bad.” Shame can be experienced as a lack of energy for life, an inability to accept love and caring on a consistent basis or a hesitancy to move into self-affirming roles. It may play out as impulsive decision-making, or an inability to make decisions at all.

Development of Rigid Psychological Defenses  

People who are consistently being wounded emotionally and are not able to address or process these feelings openly and honestly may develop rigid psychological defenses to manage or ward off pain. Dissociation (remaining physically present but inwardly absent), denial (rewriting reality to be more palatable), splitting (seeing life and people as alternately all good or all bad), repression (pushing feelings down out of consciousness), minimization (minimizing the impact of situations or behavior), intellectualization (using thinking to rationalize and analyze to avoid feeling), and projection (disowning one’s own pain by projecting it outwardly) are some examples of these defenses.

Depression with Feelings of Despair  

Research on humans and other animals shows that stress or trauma early in life can sensitize neurons and receptors throughout the central nervous system so that they perpetually overrespond to stress throughout life (van der Kolk, 1987). The limbic system, which is part of the nervous system, regulates emotion. If a child’s limbic system becomes deregulated through living with the stress of addiction, it can lead to trouble regulating emotional states throughout life, which may contribute to depression.

Somatic Disturbances  

Our bodies are neurologically wired to process our emotions and our feelings by making us want to take action. For instance, we get scared so we run or freeze in place; we feel love so we reach out and touch or hug the object of our love. When we block experiencing or acting on powerful emotions, we may experience back pain, chronic headaches, muscle tightness or stiffness, stomach problems, heart pounding or headaches. This is why the catharsis of a “good cry” or getting angry, can release our bodies as well as our emotions (van der Kolk, 1987).

High-Risk Behaviors  

Adrenaline is highly addictive to the brain and may act as a powerful mood enhancer. Speeding, sexual acting out, spending money, fighting, drugging, working too hard or other behaviors done in a way that puts one at risk are some examples of high-risk behaviors (van der Kolk, 1987).

Desire to Self-Medicate  

All of the characteristics we have discussed that can result from relationship trauma can create emotional, psychological and somatic disturbance and dis-equilibration. Self-medicating can seem to be a solution, a way to temporarily calm an inner storm–as it can make pain, anxiety and body symptoms temporarily abate–but in the long run, it creates many more problems than it solves. ACoAs all too often become addicts themselves, engaged in a compulsive relationship with alcohol, drugs, food, sex, work or money as a form of mood management. Part of getting and staying sober involves facing childhood pain so that it doesn’t remain unresolved and inwardly active, which could trigger relapse (van der Kolk, 1987).

Implications for Treatment  

Because the types of trauma that occur in homes often constitute ruptures in relationships and often are at the hands of primary caretakers upon whom a child depends for nurturance and survival, the implications for treatment are complicated. That is, the very vehicle that will lead them eventually back to health (that is, connection with others, relationships in therapeutic situations such as one-to-one or group therapy, or 12-step programs) are the same situations that have become fraught with pain and anxiety. Entering an intimate relationship of one-to-one or group therapy can seem like a “really bad idea” to the ACoA who has learned that people cannot necessarily be trusted. Also, fears of disloyalty to the family or of becoming ostracized from the family for “telling the truth” can keep ACOAs from not only telling a lie to the outside world but living a lie within themselves well into adulthood. Treatment threatens to expose that lie.

An ACoA’s feeling of mistrust that can manifest as resistance is the truly unconscious nature of traumatic memory. Because the cortex was not fully involved in the storage of traumatic memories, the ACoA may have never processed the experiences nor put them into a logical context and sequence. Consequently, the traumatic memories can be difficult to access through reflective talking alone (Sykes Wylie, , 2004). This can be interpreted by the therapist as what may appear to be resistance but in reality is related to a loss of access not only to repressed feeling, but also to any understanding of what actually may have occurred. When asked to tell their story in therapy, a client may draw a complete blank. For this reason I find psychodrama, which allows memory to emerge through action and role play, is an ideal form of therapy–if done properly–for trauma resolution. Repressed limbic memory can rise naturally to the surface in a “safe enough” container so that the cortex, rather than shut down when re-experiencing fear, can remain alert enough to “self-observe” and make sense of the emotion that is emerging. Van der Kolk feels that “if clinicians can help people not become so aroused that they shut down physiologically, they’ll be able to process the trauma themselves” (Sykes Wylie, 2004).

According to Bessel van der Kolk, seminal researcher in trauma, “Fundamentally, words can’t integrate the disorganized sensations and action patterns that form the core imprint of the trauma.  The imprint of trauma doesn’t ‘sit’ in the verbal, understanding part of the brain, but in much deeper regions–amygdala, hippocampus, hypothalamus, brain stem–which are only marginally affected by thinking and cognition” (Sykes Wylie, 2004). J. L. Moreno, the father of psychodrama, understood that “the body remembers what the mind forgets,” recognizing far before his time that there is such a thing as somatic memory and that the body as well as the mind needs to participate in therapy for full and comfortable healing to occur.

At times, when we do psychodramas, clients freeze when confronted with even a surrogate of someone who has frightened them in the past. This response needs to be recognized as the way they may have coped early in their lives when something frightened them. Simply accepting it and allowing clients to slowly allow feelings to return and to be translated into their own words is important. At moments like these, clients are vulnerable to being told by therapists or group members how to feel.

Twelve-step programs can be a wonderful adjunct or even initial intervention to therapy. They allow for a slow warm-up in which there is no pressure to share and someone can simply “sit in the rooms,” identify with what they hear and slowly learn to tolerate their inner emotions and eventually share their feelings as they choose. Twelve-step meetings provide a safe and constantly available container in which ACoAs can feel both held and less alone in their pain. There are a variety of 12-step programs that address common issues that ACoAs, who are seven times more likely to self-medicate than the average, also face. In addition, one-to-one therapy can offer the kind of personal attention and tracking that will help the ACoA to slowly form new, trusting bonds.

Many who embrace recovery come to experience the journey of self-discovery, one of expansion into a new sense of self, self in relationships and meaning and purpose in life. Many find that the promises of 12-step programs do come true; and they do not regret nor wish to close the door on the past, because through processing it, they have come to a deeper sense of aliveness and self-confidence.

Who are ACoAs?  

An ACoA is an adult child of an alcoholic or addict. Because living with addiction is often traumatizing, ACoAs may be left with a post traumatic stress syndrome in which painful feelings and relationship dynamics from their childhood become relived and recreated in their adult relationships.

What is a CoA?  

A CoA is a child of addiction, still living in the home.
 
Statistics about Adult Children of Alcoholics

• 1 out of four children is a CoA
• 50% of ACoAs marry alcoholics.
• 70% of ACoAs develop patterns of compulsive behavior as adults. These may include abusive patterns with alcohol, drugs, food, sex, work, gambling or spending.
• ACoAs are four times more likely to become alcoholics than the general population.

Statistics about Families Coping with Alcoholism

• 55% of all family violence occurs in alcoholic homes.
• Incest is twice as likely among daughters and sons of alcoholics.
• Alcohol is a factor in 90% of all child abuse cases.

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