A guest post from Rivia Mind, featuring Dr. Shaheen Ali, MD.
Many of us live out behavioral patterns we can’t quite explain. The tendency to pull away from relationships when things get serious. The relentless pressure we put on ourselves, where even minor failures feel outsized. The impostor syndrome that follows us into work.
We might assume that’s just how we’re wired. But most of the time, patterns like these aren’t personality. They’re history.
Shaheen Ali, MD, is a psychiatrist at Rivia Mind who works with adults navigating the
long-term effects of childhood experiences — and believes the mind and body are far more connected than most people realize.
Here, she breaks down childhood trauma: what it is, how we store it, and why it so often shows up in adulthood years after we thought we’d left it behind.
Trauma Can Be a Single Moment — or a Thousand Small Ones
Trauma is a triple threat: a past wound that resurfaces in the present and shapes how we move through the future. It’s deeply personal and contextual; the same experience may feel very different from one person to another.
There’s a difference between “big T” and “small t” trauma. Big T traumas are the ones most people recognize, like abuse, neglect, witnessing violence, or sudden loss. Small t traumas are subtler, but they accumulate.
The Adverse Childhood Experiences (ACE) questionnaire — a widely used research and clinical tool — includes questions that can surprise people. Not just “were you abused” or “did a parent go to prison,” but: “No one in your family loved you or thought you were special.” “Your family didn’t look out for each other.”
“Being misunderstood, being unrecognized, feeling invalidated… those are early childhood traumas that can get deep in the body and mind,” Dr. Ali says. “They can be stored within patterns of defense.”
An emotionally unavailable parent, even if they were providing. A household where achievement was celebrated but feelings weren’t discussed. A family culture where asking for
help was considered weak. None of these is abuse in the conventional sense. But these experiences shape the blueprint we carry into adulthood for how relationships work, what we can expect from other people, and what we believe about ourselves.
The Body and Mind Share the Load
Trauma isn’t simply a mental memory. It’s muscle memory, too.
“The mind and the body are not separate,” Dr. Ali says. “They’re one and the same.”
When a child experiences something threatening — a single acute event, or the slower grind of an unstable home — the brain’s stress response activates. Cortisol rises, and the nervous system shifts into fight, flight, freeze, or fawn. This is survival mode. It’s meant to protect.
The problem is that when this response is activated regularly, it starts to rewire things. Cortisol, while useful in the moment, causes lasting changes in cells throughout the body — particularly neurons — and directly affects the hippocampus and amygdala, the brain’s centers for memory and fear. Over time, this has real consequences.
Early childhood trauma is associated with higher rates of anxiety, depression, and ADHD, as well as cardiovascular disease, high blood pressure, obesity, diabetes, autoimmune disorders, and substance use.
Alongside those physiological changes, the mind develops its own protective strategies. “There’s dissociation and forgetting certain things,” Dr. Ali explains. “It didn’t serve me to speak up for myself in the past, so I’m going to quiet that. Or sometimes it’s more obvious: blocking out an entire period of childhood because accessing it was too distressing. It can be very confusing to a child’s understanding of self. They can be left with questions like ‘What was wrong with me? What did I do, or what should I have done?’ Trauma can bring on a lot of self-doubt and anxiety.”
The brain’s job is to protect us. When it learns that something hurts, it finds ways to avoid that hurt. Those strategies get encoded and tend to stick around long after the original threat is gone.
Why Trauma Can Take Decades to Surface
For many people, the realization doesn’t arrive as a memory but as quiet friction.
Part of what makes small t childhood trauma hard to recognize is that the patterns it creates don’t feel like responses to anything. They feel like your personality. From the very beginning of life, we’re learning whether the world is safe and if other people can be counted on. When those early experiences are reliable and loving, they build a strong foundation for other relationships. When they aren’t, survival strategies start taking shape — and because they formed before we knew anything else, trauma registers as standard experience.
Big T trauma can work the same way, particularly when it’s chronic. A child growing up with domestic violence, a parent struggling with addiction, or ongoing abuse doesn’t necessarily experience those things as extraordinary. It’s simply the environment they learned to survive in. More acute and overwhelming experiences may get filed away differently; the mind sometimes has no choice but to limit access to what’s too painful to think about.
It’s often not until those survival strategies start creating friction in relationships, careers, your sense of who you are, or even in the body itself, that the question of where they came from begins to form.
“That early attachment trauma can look like a lot of things as an adult,” Dr. Ali explains. “Broken relationships, fear of being vulnerable, being sensitive to rejection, or avoiding relationships.”
Understanding the Past Isn’t the Same As Living in It
Psychodynamic therapy — a framework Dr. Ali works within — is sometimes assumed to mean years of excavating old wounds. That’s not quite right.
“It’s really thinking about the journey of someone’s life,” she says. “The things that happened to us in the past affect our present patterns. Understanding that is very useful to helping someone appreciate and adjust those patterns to get to their goals.”
She’s also clear that this work isn’t about spiraling into blame. “It’s [about] the understanding of it: it makes sense that you learned how to deal with things in this way because of what you were handed. It worked.”
She uses the example of a child who grows up in a household where achievement is the priority — maybe parents who work long hours, are not always available, and have high expectations around school. If that child is also struggling with an attention deficit, keeping up takes real effort.
“They may develop a compensatory sense of conscientiousness. I’m going to check my homework three times, not just twice. I’m going to work two extra hours every night just to keep my grades up. That work ethic is actually quite useful. But even too much holy water can drown us. Overconscientious tendencies can become perfectionistic over time, leading to unrealistically rigid expectations. That can cause a lot of self-doubt, stress, and difficulty taking on new academic or professional tasks, because there can be impostor syndrome as well.”
The goal isn’t to live in the past, but to understand it well enough that it stops making decisions for you.
“You can’t really make a plan for where you want to go if you don’t know where you are right now,” Dr. Ali reflects. “And you can’t know where you are until you understand where you’ve been.”
What Therapy for Childhood Trauma Looks Like
Dr. Ali is direct: this isn’t fast work. “If you’re 25, you’ve had 25 years to live in those patterns. Psychotherapy is a slow burn. Where you are is where you are, and we’re going to take it from there.”
Her approach starts with humility. “I make no claims to be the expert on someone else’s life. I go in with the understanding that you know yourself best. I’m here to witness and to point out what I observe, with empathy and curiosity. I can never assume someone’s experience. I can only hear it and help them see how it might be impacting them.” The culture of the therapeutic space, she says, is one of empathy, understanding, and non-judgment — “informed by the knowledge that we do the things we do because they helped us survive.”
It’s also not about drawing a straight line from a childhood experience to a present-day symptom. “It’s not that based on what happened to you in childhood, I can predict what’s going to happen in your future. Or that if you have anxiety, it must be because of this.
Absolutely not. It’s more of a framework for understanding that we do the things we do for a reason. It served a purpose in the past, and it’ll be useful to look at that so we can see how useful it is today and whether it’s getting you toward the goals you have for yourself.”
When someone comes in with acute anxiety or depression affecting their daily life, the first priority is often helping them get through the day — building skills to manage what’s happening right now. “Thinking about psychotherapy as a soul workout,” Dr. Ali says, “when you’re working out those parts of the psyche, it can get sore. Having the appropriate skills to cope with that soreness, to tolerate that distress safely is a big part of it.” Digging into deeper roots happens alongside that, at the person’s pace.
The therapeutic relationship itself is part of the work, especially for people whose early experiences left them with good reasons not to trust. “When someone comes to a session every week and sees that this person is here, I can be myself with them. I can be vulnerable with them, and they’re still there for me. That in itself is useful,” Dr. Ali says.
Part of that work means humanizing experiences that can feel isolating or shameful — whether that shame comes from the experiences themselves or from cultural stigma around seeking help at all. “We’ve all felt shame, we’ve all felt sadness, we’ve all felt anxiety,” she says. “But when it goes deeper, to depression or an anxiety disorder, sometimes it can be quite useful to help someone have a name for it. Offering a diagnostic name can be beneficial for some people. But really it’s about listening to their full story, understanding their perspective, and validating that human experience.”
Getting Help for Childhood Trauma
Childhood trauma — whether it was visible or subtle, acute or chronic — does not have to be the last word on how you move through the world. The patterns it created made sense at the
time. They helped you survive, or at least get through. Understanding them now is what makes it possible to decide what comes next.
At the end of it all, Dr. Ali says, it’s really about getting to one question: “How can I live a meaningful and joyful life? It’s a question each person will have a different answer to. And helping someone understand what that is for themselves — it’s beautiful work.”
If you or someone you love is living with the effects of childhood trauma, a Resource Specialist at rtor.org can help you find the right support. We connect families and caregivers with quality mental health providers, including Rivia Mind.
About Dr. Ali and Rivia Mind: Shaheen Ali, MD., is a psychiatrist and psychotherapist at Rivia Mind with training in consultation-liaison psychiatry. She brings a trauma-informed, psychodynamic approach to her work with adults, grounded in science and attentive to the full complexity of each person’s life.
Rivia Mind is a psychiatrist-owned private mental health practice that believes in evidence-based, whole-person care. Learn more at riviamind.com.
Resources:
- U.S. Centers for Disease Control and Prevention. About Adverse Childhood Experiences.
Photo by MART PRODUCTION: https://www.pexels.com/photo/close-up-photo-of-a-pensive-woman-in-black-long-sleeve-shirt-7278789/
The opinions and views expressed in any guest blog post do not necessarily reflect those of www.rtor.org or its sponsor, Laurel House, Inc. The author and www.rtor.org have no affiliations with any products or services mentioned in the article or linked to therein. Guest Authors may have affiliations to products mentioned or linked to in their author bios.
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