Developmental Trauma & ACEs. Trauma Therapy online.
The Adverse Childhood Experiences (ACEs)
Developmental trauma refers to exposure to chronic adverse experiences during childhood — especially within caregiving relationships — that disrupt attachment, safety, and normal development. It differs from single-event trauma in that it occurs during sensitive developmental windows and shapes the trajectory of emotional, social, and neurobiological growth.
The Adverse Childhood Experiences (ACEs) framework, first studied in the late 1990s, provides large-scale epidemiological evidence linking childhood adversity to long-term mental and physical health problems.
The ACE Study (Felitti et al., 1998):
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Surveyed over 17,000 adults in the U.S.
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Identified 10 categories of childhood adversity in three groups:
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Abuse: physical, emotional, sexual.
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Neglect: physical, emotional.
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Household dysfunction: parental mental illness, substance abuse, incarceration, domestic violence, separation/divorce.
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Findings:
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ACEs are common: ~2/3 of participants reported at least one ACE.
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A higher ACE score strongly correlates with:
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Mental health problems (depression, PTSD, substance use).
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Physical illnesses (heart disease, diabetes, autoimmune disorders).
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Risk behaviors (smoking, early sexual activity, self-harm).
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Dose-response effect: the more ACEs, the greater the risk.
Clinical Relevance
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Screening: ACE questionnaires are widely used but should be applied with caution (not a diagnostic tool; risk of re-traumatization).
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Assessment: Developmental trauma may not fit neatly into DSM categories but aligns with ICD-11 Complex PTSD.
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Intervention:
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Early prevention: supportive parenting, stable environments, trauma-informed schools.
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Therapeutic approaches: EMDR, TF-CBT, attachment-based therapies, somatic and relational methods.
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Public health implications: ACEs research shifted trauma from an individual issue to a population health problem.
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Evidence-Based Therapeutic Interventions for ACEs
1. Eye Movement Desensitization and Reprocessing (EMDR)
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Mechanism: EMDR uses bilateral stimulation (eye movements, tapping, auditory tones) to facilitate reprocessing of traumatic memories. This reduces the intensity of distress while promoting adaptive integration of experience.
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Evidence: Multiple randomized controlled trials (RCTs) support EMDR for both single-incident trauma and complex, developmental trauma.
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Advantages:
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Effective when verbal recall is limited.
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Often produces faster symptom relief compared to traditional talk therapies.
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Adapted protocols for children and adolescents with ACEs are showing promising results.
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Clinical Use: Recommended by WHO and APA guidelines as a first-line therapy for trauma. Increasingly used with survivors of childhood abuse, neglect, and attachment disruptions.
2. Cognitive-Behavioral Approaches
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Trauma-Focused CBT (TF-CBT): Designed for children/adolescents with abuse or neglect. Involves cognitive restructuring, gradual exposure, relaxation training, and strong caregiver involvement.
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Cognitive Processing Therapy (CPT): Focuses on challenging maladaptive trauma beliefs (e.g., guilt, shame, “I’m worthless”). Strong evidence in adolescents and adults with ACE-related PTSD.
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Prolonged Exposure (PE): Structured exposure to trauma reminders (imaginal + in vivo). Effective for adults, though caution needed with dissociative clients.
Guideline Status: CBT-based therapies are considered first-line interventions in APA, NICE, and WHO recommendations.
3. Skills Training & Phase-Oriented Models
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STAIR (Skills Training in Affect and Interpersonal Regulation): Combines skills for emotional regulation and relational functioning with trauma processing modules. Effective for childhood abuse survivors.
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Phase-Oriented Treatment Models (e.g., Cloitre’s three-phase model):
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Phase 1: Stabilization and safety (skills, grounding).
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Phase 2: Trauma processing (CPT, EMDR, PE).
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Phase 3: Integration (identity, relationships, meaning).
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Particularly suited for survivors of chronic ACEs with dissociation or affect dysregulation.
CONTACT ME
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Fees: 70 USD per hour for the first three sessions (new clients only)
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