I’m an adult now, why is this back? Sexual Trauma Part 1.
The greatest ache and helplessness I feel as a physician is when patients are brave enough to recount the feelings of sexual trauma when they were younger. In my work, the details of these times are secondary to the primary goal of exploring and discussing the feelings they had back then, in addition to the how their feelings have changed over time. The most common word I use to describe the effects of these resurfaced times is: destabilizing.
Typically as we begin to explore this painful past, these are examples of the most common phrases I hear:
“That was so long ago. I have never forgot about it, but I don’t understand why it’s bothering me now?”
“I have already worked through that, there isn’t anything else to say about it.”
“I’ve gotten over that, or I thought I did.”
As I then start to help them peel back the onion layers, in general it becomes quickly evident they have not “got over it.”
Why?
Frequently, individuals prior work “through that” was not complete, and what I mean by this is that recounting details of events as one would read from encyclopedia is a very human response to relaying information. However, this is much different than the feelings and impact back then, the interim and then now of those times—so much different. Reporting the facts of the case is not sufficient to heal the wounds. Even when wounds can fully heal, some wounds permanently alter the outcome of an individuals life, and this is just as true for many of the wounds of sexual trauma.
Sexual abuse in childhood or adolescence is one of the most profound violations of trust and safety a person can endure. The effects of this trauma often have long-lasting, destabilizing impacts on both emotional and physical health. By “destabilizing,” we refer to symptoms that disrupt day-to-day functioning, such as disturbed sleep, sudden shifts in mood, difficulties with relationships, and a general feeling of disconnection from oneself or the world around them. These disruptions can seem to “come out of nowhere” years or even decades after the abuse, particularly during key life events like becoming a parent. To understand why this happens, we need to delve into some key psychological principles.
Why Trauma Resurfaces in Adulthood
The trauma of childhood sexual abuse does not simply “go away” with time. It becomes embedded within the brain and body, influencing a person's development, behavior, and emotional regulation in ways that may not become fully apparent until later in life. Many survivors cope by blocking out or compartmentalizing their trauma, which is a survival mechanism that helps them function. However, as life progresses, events or stages that resemble or trigger the original trauma can cause this psychological compartment to open.
The Brain's Protective Mechanism: Dissociation and Repression
Children who experience sexual abuse often dissociate as a coping mechanism. Dissociation is the brain's way of protecting itself by mentally “escaping” the situation. This can lead to memory fragmentation, where parts of the traumatic experience are stored in separate, less accessible parts of the brain. The brain may push these memories into unconscious or repressed areas, making it seem as if they are “forgotten.” This can allow the survivor to move forward in life seemingly unaffected. However, these memories and the emotions associated with them can resurface when something triggers them.
For example, when a survivor becomes a parent, especially when their child reaches the age at which the abuse occurred, the parallel in life stages can trigger old, repressed memories or emotions. The sight of their child at that vulnerable age might stir feelings of fear, helplessness, or anger that were buried long ago. It's not that the person hasn’t worked through the trauma or that they’re weak; rather, the experience of seeing their child can evoke powerful associations with their own past that weren’t previously triggered.
Emotional Memory and the Body
Psychologist Bessel van der Kolk famously said, “the body keeps the score.” Even if the mind has successfully repressed traumatic memories, the body holds onto the emotional imprint of trauma. This is why survivors may experience physical symptoms like anxiety, tension, or insomnia when the trauma is retriggered in adulthood. These sensations are the body’s way of expressing distress that the mind may not fully acknowledge. When life events (like parenthood) stir unresolved trauma, the body may start to react as if the danger is present again, causing sleep disturbances, hypervigilance, or emotional numbness.
Why "Getting Over It" Isn't a Measure of Strength
Many survivors believe that if they’ve gone through therapy or have worked hard to “move on” from their abuse, they should no longer be affected by it. When old trauma resurfaces, it can feel like a personal failure, reinforcing the harmful myth that strength means being impervious to the past. This belief is damaging and untrue.
Trauma is not a test of strength. It is not about how "tough" you are. Trauma is embedded in the body and brain through mechanisms that have nothing to do with willpower.
We don’t intentionally or willfully choose to remember good things in our life at any age and it’s not without surprise we are able to remember and still feel things that were amazing in childhood like a family trip, a dear friend, relative or super “fun” times. They just become a part of us. So then it shouldn’t be difficult for them the brain to remember the converse or opposite experiences that were painful or incredibly hard.
Even if someone has worked through their trauma, healing is not linear. There are layers to emotional pain, and sometimes it takes years or certain life events to uncover new dimensions of healing that were not accessible earlier.
Evidence-Based Methods to Work Through Trauma
While it may feel overwhelming when past trauma resurfaces, there are many evidence-based therapies and techniques that have been shown to help people process and heal.
1. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
This approach is widely used for trauma survivors. It helps individuals recognize negative thought patterns related to their trauma and teaches them skills to reframe and manage these thoughts in healthier ways. By confronting and reinterpreting traumatic memories, survivors can gain a sense of control over them rather than feeling blindsided by the emotions they evoke
2. Eye Movement Desensitization and Reprocessing (EMDR)
EMDR is a psychotherapy that has shown effectiveness in treating trauma by helping the brain process disturbing memories in a way that removes their emotional charge. By using guided eye movements while revisiting traumatic memories, the brain is able to "reorganize" these memories, making them feel less overwhelming. EMDR has been particularly effective for people who feel that their trauma is still "stuck" in their body or emotions despite traditional talk therapy.
3. Mindfulness-Based Stress Reduction (MBSR)
Mindfulness practices help trauma survivors reconnect with their body in a safe and compassionate way. Often, trauma can lead people to disconnect from their physical sensations, but mindfulness teaches individuals how to observe their thoughts, feelings, and bodily sensations without judgment. This can reduce anxiety and help survivors better manage emotional triggers.
When Professional Help May Be Needed
It’s important to emphasize that the reemergence of trauma does not signify failure. It’s simply a sign that additional healing is needed. However, it can be difficult for someone to recognize when they might need professional help. Here are some indicators that it may be time to seek support:
Difficulty functioning: If sleep disturbances, emotional outbursts, or feelings of numbness interfere with daily life or relationships, it may be time to seek therapy.
Intrusive memories or flashbacks: If past memories begin to intrude on everyday thoughts, especially if they feel overwhelming, professional help can offer tools to process them.
Avoidance: If the person finds themselves avoiding certain situations, people, or places that remind them of the trauma, this avoidance can lead to further isolation and distress.
Increased substance use or unhealthy coping mechanisms: If someone turns to alcohol, drugs, or other behaviors to escape their emotions, this is a clear sign that they need more structured support.
Compassion Over Strength
Finally, it’s crucial to reassure patients and survivors that their experience of trauma resurfacing does not reflect on their strength. Healing from trauma is an ongoing process that requires patience, self-compassion, and support. The idea that strength means being unaffected by trauma is a myth that only adds to the emotional burden survivors carry. Instead, true strength is found in the vulnerability to acknowledge pain, to seek help, and to continue on the journey toward healing.
By breaking the stigma around trauma and strength, we can create a more compassionate environment where survivors feel supported in their healing, no matter when or how their trauma resurfaces. Healing is not a sign of weakness; it’s a testament to resilience.
