On the other hand there can be an event, several events or a course of events in the past that continues to work through in the present.

Everyone carries pain from the past

That is part of the human condition. Such pain certainly does not always lead to post-traumatic stress disorder. That seems obvious, but in a psychiatrised society the threshold to the role of ‘patient’ can become dangerously low.

Your pain can be about your parents’ divorce, moments in childhood when you felt neglected, were in pain, fought with a brother or sister, lost a beloved grandparent, broke a leg, had to move away from familiar surroundings, were bullied, were approached by an adult in a way that crossed your boundaries, or worse.

Sometimes seemingly small things leave deep traces because they were very important to you at the time

• One person can suffer serious consequences for a long time from relatively mild pain.
• Another can (sometimes seemingly) leave terrible experiences behind without painful intrusions into consciousness or other after-effects.
• Others again have even grown from it, or inspire others in the capacity of wounded healer.

There are as many possibilities as there are people

Traumas are part of your history and give rise to painful memories that can show up in your consciousness more or less unexpectedly. Often as the result of an event that triggers the earlier experience.

Trauma can sometimes surface at unexpected moments

And with major consequences, especially when it concerns material that you no longer seemed to have conscious access to.

You may, for example, unexpectedly experience an image of yourself in your youth, in a painful situation, such as being intensely in love and being rejected in a humiliating way. This image may have been long forgotten but now forces itself on you unexpectedly, without a clear link to anything outside you.

You then face a challenge if the identity you have built up over the years does not really have room for such an intense image.

For example:

You may have come to experience yourself as distinctly attractive to the opposite sex, someone who would never, ever be rejected. The image of the old, painful and humiliating rejection can clash painfully with that, and may even force you to revise your life story and your identity.

Some people experience becoming aware of this as an attack on the ‘self’, and it can become a source of significant mental distress, as a signal that some adjustment of identity is needed.

Dealing with trauma and pain

Pain from the past tends to resurface at times when you are out of balance

When you get into a state of negative emotions, the pain from the past presents itself as the raw material of mental distress. So on the one hand, pain from the past can be a fairly neutral part of your experience in the background. On the other hand, the old pain is available to resurface in amplified form at moments when you are mentally vulnerable.

You could say that pain is our ‘fifth column’, waiting to step forward and make life miserable when your defences are low. This is why so-called insight-oriented therapies are useful. They enable you to know your pain better and to develop a perspective on it, so that you are not completely overwhelmed by it at times of mental dysregulation.

From pain to (complex) trauma

There is of course a spectrum of pain, conscious or not, that you can carry with you through life. And although we are all somewhere on that spectrum, some things have so much impact that a qualitative difference begins to arise.

About 10 to 15% of people go through things early in life that can be regarded as qualitatively different in impact and severity.

What are traumatic events?

Sometimes it concerns a single event, such as one instance of sexual abuse at a young age. More often it is a cluster of things that are going on at the same time for someone and/or their environment.

These are, for example, combinations of:

• Sexual abuse
• Emotional abuse
• Physical abuse
• Emotional neglect
• Physical neglect
• Poverty
• Bullying
• Discrimination
• Addiction
• Poor nutrition
• Conflict
• Medical problems
• Poor housing
• And many other things

Complex trauma

Chronic exposure to trauma

When there is chronic exposure to and/or an accumulation of (early childhood) adversity, especially experiences such as sexual abuse, people speak of ‘complex trauma’ or ‘complex post-traumatic stress disorder’.

In this context you can read the word ‘complex’ as: too complicated and too far-reaching to disappear with a simple EMDR treatment. See our page on treatment for trauma.

Early childhood trauma

Adversity and trauma in childhood tend to settle in you. This can then express itself at both a physical and a mental level. That settling is not a simple result of cause and effect.

It is a kind of effort to carry on with something that cannot possibly be integrated. It is a form of coping: being able to deal with, or being equal to, certain things or situations.

Trauma in childhood

The word ‘trauma’ is often too one-sided and too specific. Childhood adversity may be a better term.

Trauma, body and mind

Physical and mental impact

Trauma affects body and mind. Early childhood trauma and early adversity literally make us go in all directions, for as long as what happened has not been properly processed. Physically and mentally, in order to give the impossible a place after all.

It is a restless situation for which a price often has to be paid in the form of significant mental distress.

Your traumatised mind

If you have been exposed to early trauma, or to chronic severe trauma, this has deep consequences for how you experience the world and the people around you. It can be very hard for you to trust other people and to develop relationships with them.

You look at the world through very different glasses from someone who had a ‘rosy’ childhood. There is threat and danger everywhere, to which you can react strongly. You may have very negative feelings about yourself, or not be able to feel much at all. You may not be able to experience your own body well or be connected to it. Quite often there is an overall experience of not being allowed to exist, of being too much, of having to die.

Your traumatised body

Severe adversity and chronic stress can dysregulate the body from early in life, even before birth, and so contribute to both physical and mental ill health later in life.

Through trauma, all kinds of dysregulating mental and physical signals that represent a survival function can keep showing themselves, without you being aware of the link with that survival function. A possible underlying mechanism is that trauma and chronic stress affect the degree to which genes are expressed (that is, can be switched on and off).

The mechanism of epigenetics

As a result, trauma and stress can leave their traces in systems that are involved in your body’s hormonal, immune and metabolic response to the environment. This goes via epigenetics: changes in the way genes can be switched on and off by things such as trauma.

In this way, epigenetic consequences of your traumas can even be passed on to your children. The memory of the trauma becomes fixed in your epigenetics and is passed on to the next generation. But this does not have to happen, because epigenetic changes can also be reversed.

Body-oriented work

So the harmful consequences, also at the epigenetic level, can perhaps be processed and reversed through treatment. From that insight, body-oriented work is gaining ground as a way to treat trauma and chronic stress.

Mental distress in the context of early adversity and chronic stress therefore has a mental and also a physical context, both in how it arises and in how it may be treated.

Trauma is not only in the head, but also in the body

It is increasingly recognised that the consequences of trauma can also be understood and treated through body-oriented therapy. An added advantage is that ‘exposure’, which many people do not want or cannot cope with, is not needed.

Do you need help now?

PsychosisNet offers information. We do not offer a chat, a helpline or crisis support. If you or someone else is in immediate danger, call the emergency number in your country. If you are thinking about suicide, or you need to talk to someone now, see Need help now? for helplines by country.

Prof. dr. Jim van Os, Chair Division Neuroscience, Utrecht University Medical Centre. Jim works at the interface of ‘hard’ brain science, health services research, art and subjective experiences of people with ‘lived experience’ in mental healthcare. 

Jim has been appearing on the Thomson-Reuter Web of Science list of ‘most influential scientific minds of our time’ since 2014. In 2014 he published his book ‘Beyond DSM-5‘, and in 2016 the book ‘Good Mental Health Care’. In 2026 he published 'Wat psychisch lijden is'.

Want to read more?

Blogs by Jim van Os can be read here

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