Nadia*, a patient of mine, is a clever, wry high school freshman.
She likes video games, graphic novels, and drawing. She is also the child of an abusive father and a mother who was addicted to drugs for many years. After her teachers reported abuse and neglect, Nadia was removed from her home and placed in foster care, where she bounced from home to home. The difficulties of her childhood put Nadia at risk for problems in her social, emotional, physical, and neurological development that would manifest and unfold over the course of years.
Emotionally painful and distressing experiences like Nadia’s, which overwhelm a person’s ability to cope and leave them powerless, are called traumas. A bad car accident or natural disaster could be traumatic, as could neglect, abuse, or domestic violence. Two-thirds of young people will experience at least one of ten types of trauma (physical, verbal, or sexual abuse, physical or emotional neglect, alcoholic or addicted parenting, domestic violence, incarceration of a family member, severe mental illness of a caregiver, or the disappearance of a parent) before their 18th birthday. One-third will experience two or more. The more traumatic events a person encounters, the more difficult it is for them to recover. Trauma is our nation’s unspoken public health crisis.
When a person undergoes trauma, their body receives an overload of stress hormones, which can impede brain development. Too much of these hormones can increase cholesterol and blood pressure, and put a person at risk for Type 2 diabetes, arthritis, and gastrointestinal disease, just to name a few. Additionally, traumatized people are at higher risk for depression, anxiety, PTSD, eating disorders, and substance abuse. Over 90% of adolescents hospitalized for psychiatric problems have a history of physical, sexual, or psychological trauma, and 70% of adolescents in substance abuse treatment programs have a history of trauma exposure.
In Nadia’s case, trauma led to both physical problems and mental health issues. She suffered from insomnia, worrying about her siblings all night instead of sleeping. In foster care, she was anxious, angry, and lonely. As a result of the neglect she experienced, she began to lie and steal — food, clothes, video games — both for attention and to meet her basic needs. The punishments just made her feel more isolated.
Millions of children like Nadia live in the United States, and it’s a significant problem for our country’s well-being. High blood pressure and cholesterol resulting from trauma can lead to heart disease, which is the leading killer of Americans and costs our country over $100 billion every year. Post-traumatic stress disorder, a condition that impacts not only veterans but traumatized children, teens, and adults, can influence memory, attention, and ability to focus. As a result, traumatized children tend to be less successful in school, losing out on the opportunity to pursue higher education and lucrative careers. Childhood trauma is also common in the history of adult substance abusers, and substance abuse costs our country $484 billion dollars each year in lost income, health care expenditures, and costs associated with crime.
In addition, anyone who has loved an alcoholic or substance abuser knows the effect that trauma can have on our communities, as substance abuse very often follows traumatization. Trauma can put a person at high risk for suicide, which is the tenth leading cause of death in this country, and it leaves behind scores of devastated loved ones. People who have experienced more childhood traumatic events have a greater tendency towards violence, go through more divorces, and suffer more broken bones. The behavior of traumatized children, and the lack of training given to teachers about the impact of PTSD on learning, certainly plays a role in our country’s school-to-prison pipeline and our extraordinarily high rates of incarceration.
Nadia, despite her trauma, is now doing well. The skilled therapy interventions at the Mount Sinai Adolescent Health Center allowed her to process her feelings of anger and anxiety, and communicate better with her mother and siblings. After feeling so abandoned in the foster care system, Nadia appreciated that our care allowed her to focus on what she needed. Together, she and I worked on exercises to calm anxiety, identify her feelings, and communicate her needs. Now, her interactions with her family are safe and loving.
But millions of teens like Nadia lack access to this kind of care. Even in Nadia’s case, it’s far too early to tell what other long-term impacts the traumas of her youth will have. If we care about our nation’s health, we need to get serious about trauma: both preventing it, and providing care for people who have been victims.
This article was originally published on Nov. 23, 2015 on our Medium channel.
The Mount Sinai Adolescent Health Center is located in New York City. It provides comprehensive, confidential, judgment free health care at no charge to over 10,000 young people every year. This column is not intended to provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual, only general information for education purposes only.
*Names have been changed to protect patient privacy.