Trauma Is More Than ACEs

The original Adverse Childhood Experiences (ACEs) research from Felitti, Anda and their colleagues (1998) was the first to offer clear evidence of the long lasting impact of childhood trauma into adulthood. These researchers categorized the experiences of neglect, abuse, and household dysfunction into ten experiences, from incarcerated family member and emotional neglect to divorce and physical abuse. The study also showed that as children experience more ACEs, they are exponentially more likely to face disrupted neuro- and social development that contributes to high-risk behaviors, such as substance abuse and smoking, diseases, such as those of the lungs and heart, and even early death.

Over the last decade, schools and agencies have made tremendous progress in becoming trauma-informed, and care and concern are focused on being senstive toward trauma-impacted students and on building resilience to mediate the impact of ACEs. Unfortunately, ACEs are but one type of trauma experienced by children, their families, and those who serve them. This article offers a brief introduction into some of the other types of trauma experienced that have at least as much impact as ACEs and concludes with urgent request for those who serve trauma-impacted families to be mindful of their vulnerability to the impact of vicarious trauma.

Beyond ACEs

While ACEs highlight the impact of trauma within one generation, two types of trauma, intergenerational trauma and historical trauma, highlight the power of the traumatic experience to be passed through generations. First, intergenerational trauma, first recorded in 1950s with Holocaust survivors, acknowledges that “exposure to extremely adverse events impacts individuals to such a great extent that their offspring find themselves grappling with their parents’ post-traumatic state” (Yehuda & Lehrner, 2018, p. 243). This trauma is not limited to the first generation, however. Intergenerational trauma may continue to make an impact across generations of the same family far beyond the generation of the parent who experiences the trauma. Children affected by their parents’ trauma become parents who then pass the impact of the traumatic experience to their own children, and so on.

The second type of trauma that is experienced generation to generation is historical trauma, first studied in the 1980s within Native American communities. Historical trauma is the “cumulative emotional and psychological wounding over the lifespan and across generations, emanating from immense group trauma” (Brave Heart, 1998). Historical trauma is especially impactful as every generation is re-experiencing the trauma from the past and experiencing trauma within their lifespan. Unresolved grief and survivor guilt are passed down and further confounds the already enormous impact of trauma.

Several types of traumatic experiences occur because of perpetual racism and inequity in the world, including racial trauma, refugee trauma, and community trauma. While African-Americans are more exposed to racial trauma than other groups in the United States, Latinx, Asian-American, and Indigenous people are also exposed to racial trauma. Race-based traumatic experiences include experiencing and/or witnessing racial harassment, ethnoviolence, microaggressions, constant threat of discrimination, and institutional racism. Williams (2019) notes that racial trauma is often overlooked because the symptoms and signs of racial trauma are so similar to PTSD.

Refugee trauma reflects complex and cumulative trauma (Perzichilli, 2018). To explain, refugees first experience trauma as a the loss of safety and community as they leave war and/or persecution. Resettlement stress occurs as refugees are faced with inadequate housing and family separation. As refugees experience cultural misunderstanding and social isolation, they are exposed to acculturation stress. Finally, as refugees experience bullying and harassment in the new nation, as well as loss of social status from their previous community, isolation stress occurs.

When communities are exposed to high frequencies of violence, the people of the community are exposed to community trauma. Pinderhughes, Davis, and Williams (2015) conceptualize community trauma as the constant reminders of inequity within the community that perpetuate the violence. These reminders are found in the social, economic, and physical structures of that community that prevent people from filling basic needs and erode the social supports essential to building resilience.

Institutional trauma occurs from the deliberate and/or negligent actions of institutions that betray those who come to these institutions for support, safety, and survival (Smidt & Freyd, 2018). Examples of this type of trauma include inappropriate response to reports of sexual assault, inhumane treatment of asylum seekers, and inadequate civil rights protections for workers.

Trauma-Informed Organizations

Organizations, intitutions, and agencies who serve trauma-impacted children and their families are at risk of organizational trauma, and their staff members are highly vulnerable to secondary traumatic stress and/or compassion fatigue. The susceptibility of organizations and their staff to these types of trauma stems from the nature of the work. Organizational trauma occurs as the details and observations of the trauma shared by clients, residents, and students become embedded within the organization, ecascerbated by little efforts to mediate the impact of this experience. Research from Vivian and Hormann (2015) on mission-driven non-profit organizations offer protective factors that will ensure the health of these organizations serving those most in need, including having strong core identities and building organizational self-efficacy.

People who work within these organizations, from frontline staff to central leadership, must be mindful that self-care is a priority in this ine of work. Secondary traumatic sress, also called vicarious trauma and shared trauma, is brought on acutely and often mirrors the signs and symptoms of PTSD. Compassion fatigue happens over time and occurs as staff are repeatedly faced with the details and the impact of traumatic experiences of those whom they serve. Symptoms of compassion fatigue include reduced feelings of empathy, increased irritability and anxiety, depersonalization of the clients, and more (Ligenza, 2018).

The most concerning result of compassion fatigue and secondary traumatic stress is the most compelling reason why being trauma-informed goes beyond understanding ACEs. When people experience burnout in these roles, job performance is not the only negative impact. As people become emotionally exhausted, they also begin to question the purpose behind the work. For many, service to vulnerable children and their families are a part of a life’s mission. They begin to feel more inadequate or hopeless about their ability to help. In severe form, compassion fatigue leads to the loss of purpose in life.

In sum, as we learn more about trauma and its impact, strong organizational health and the well-being of staff members must be the first priorities. By doing so, we ensure that healthy organizations and their staff continue to provide strength, support and safety to those most vulnerable.


Brave Heart, M.Y.H. (1998). The return to the sacred path: Healing the historical trauma and historical unresolved grief response among the Lakota through a psychoeducational group intervention. Smith College Studies in Social Work. 1998; 68:287–305.

Comas-Díaz, L., Hall, G. N., & Neville, H. A. (2019). Racial trauma: Theory, research, and healing: Introduction to the special issue. American Psychologist, 74(1), 1-5. http://dx.doi.org/10.1037/amp0000442

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D.F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S.  (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American Journal of Preventative Medicine, 14(4), 245-258.

Hartmann, W. E., Wendt, D. C., Burrage, R. L., Pomerville, A., & Gone, J. P. (2019). American Indian historical trauma: Anticolonial prescriptions for healing, resilience, and survivance. American Psychologist, 74(1), 6-19.

Ligenza, L. (2018). Compassion fatigue and self-care. Retrieved from https://integration.samhsa.gov/pbhci-learning-community/Compassion_Fatigue_Office_Hours.pdf.

Perzichilli, T. (2018, July 23). Broadening our understanding of trauma: why context matters https://www.goodtherapy.org/blog/broadening-our-understanding-of-trauma-why-context-matters-0723184

Pinderhughes H, Davis R, & Williams M. (2015). Adverse Community Experiences and Resilience: A Framework for Addressing and Preventing Community Trauma. Prevention Institute, Oakland CA.

Smidt, A.M., & Freyd, J.J. (2018). Government-mandated institutional betrayal. Journal of Trauma and Disassociation (19)5: 491-499. Retrieved from https://www.tandfonline.com/doi/full/10.1080/15299732.2018.1502029.

Vivian, P., & Hormann, S. (2016). Organizational trauma and healing. North Charleston, SC:


Williams, M.T. (2019). Uncovering the trauma of racism: new tools for clinicians. Retrieved from https://www.psychologytoday.com/us/blog/culturally-speaking/201901/uncovering-the-trauma-racism-new-tools-clinicians.

Yehuda, R., & Lehrner, A. (2018). Intergenerational transmission of trauma effects: putative role of epigenetic mechanisms. World Psychiatry 17: 243-257.

Julie E. McDaniel-Muldoon, PhD

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