Childhood Trauma in Adults: How Early Experiences Can Show Up Later

You may sense that things from early in your life still shape how you feel, trust and cope. Or you may have come across an ACE score online and wondered what the number means.

This article covers what the research on adverse childhood experiences found, where its limits are, and what the term developmental trauma does and does not mean. It will not ask you to count or revisit anything. Nothing here can tell you what your own history means for you.

What are adverse childhood experiences, and what did the research find?

The Centers for Disease Control and Prevention (CDC) defines them this way: "Adverse childhood experiences, or ACEs, are potentially traumatic events that occur in childhood (0-17 years)." Its examples include experiencing violence, abuse or neglect, witnessing violence in the home or community, and growing up in a household with substance use problems or mental health problems. The CDC says its examples "are not a complete list of adverse experiences." The word "potentially" matters. An ACE is something a child was exposed to. It is not a diagnosis.

The first ACE paper, by Felitti, Anda and colleagues, appeared in 1998. A questionnaire was mailed to 13,494 adults who had completed a medical evaluation at a large health maintenance organization, and 9,508 responded. It covered seven categories of experience.

Two findings stood out. Such experiences were common: more than half of respondents reported at least one category, and one-fourth reported two or more. And the authors found "a strong graded relationship" between the number of categories and risk factors for several leading causes of death in adults. People who reported four or more categories, compared with people who reported none, had 4- to 12-fold increased health risks for alcoholism, drug abuse, depression and suicide attempt.

Newer CDC data show a similar spread. In surveys from 2011 to 2020 covering all 50 states and the District of Columbia, 63.9% of U.S. adults reported at least one ACE and 17.3% reported four or more (Swedo and colleagues, 2023).

If you are thinking about harming yourself, call or text 988, or call 911 in an emergency.

What are the limits of that research?

There are several, and they change how the findings should be read.

• It reports a relationship. The 1998 paper describes a "graded relationship" between the number of categories and adult health risks. A questionnaire answered in adulthood and compared with a person's current health cannot show, on its own, that early experiences caused the later problems.
• It relies on recall. Adults were reporting on their own childhoods. CDC researchers writing about the newer surveys say recall and social desirability biases might reduce the accuracy of self-reported ACEs.
• It studied one population. The participants were members of one health maintenance organization who had completed a medical evaluation. The CDC identifies it as Kaiser Permanente in Southern California.
• The score is a count. It adds up categories, from zero to seven in the 1998 paper. The CDC researchers say their survey questions "do not reflect the full range, severity, or frequency of ACEs," and a 2021 study notes that the ACE measures in current use do not capture the timing or duration of what happened.

The newer CDC figures are also self-reported by adults in surveys.

Does an ACE score predict your health?

Not for an individual. A 2021 study by Baldwin and colleagues in JAMA Pediatrics tested this in two groups followed from birth, one in the United Kingdom (2,232 people followed to age 18) and one in New Zealand (1,037 followed to age 45). In the first group, children with higher ACE scores had a greater risk of later health problems. For individuals the result was different. The authors concluded: "although ACE scores can forecast mean group differences in health, they have poor accuracy in predicting an individual's risk of later health problems."

The numbers show how poor. On a measure where 0.50 is chance, the score reached 0.58 for any mental health problem and 0.60 for any physical health problem in that first group, and the authors report that findings were consistent in the second. They add that results from these two countries may not generalize to other populations.

So a high score is not a forecast. A score describes populations. It does not describe you, and it cannot say what your health will be.

How can early experiences show up in adult life?

In different ways, and not in any fixed pattern. The VA's National Center for PTSD, writing about traumas that were long-lasting, happened during childhood and involved harm from another person, says people "may find changes in their personality, their ability to have meaningful relationships, and their ability to manage strong emotions."

That description belongs to the idea of complex PTSD, which is a diagnosis in the international ICD-11 system and not a separate diagnosis in the American manual, DSM-5-TR. The VA adds that such traumas are more likely to lead to complex PTSD, but "this is not always the case."

No checklist works backward from adult difficulties to a childhood cause. The American Psychological Association has said "there is no single set of symptoms which automatically indicates that a person was a victim of childhood abuse." That statement dates from 1995 and sits on an archived page.

What does "developmental trauma" mean?

It is a descriptive term that clinicians use. It is not a formal diagnosis in DSM-5-TR.

A diagnosis called developmental trauma disorder was proposed for DSM-5 by van der Kolk and colleagues in 2009. A 2014 commentary by Bremness and Polzin records the result: "As is now known, it was not accepted."

So when a therapist or a website uses the phrase, as Dr. Rabin's own trauma page does, it describes a kind of history. It does not name a condition someone has been found to have.

What is known about memories of childhood abuse?

The main statement behind this guide is a question-and-answer page from the American Psychological Association dated August 1995. It is archived and no longer regularly updated, so read it as a statement of its time. It makes three points.

• Most people remember. It reports a consensus "that most people who were sexually abused as children remember all or part of what happened to them although they may not fully understand or disclose it."
• A forgotten memory can return, rarely, and false ones can form. It says most leaders in the field agree that "although it is a rare occurrence, a memory of early childhood abuse that has been forgotten can be remembered later," and also that "it is possible to construct convincing pseudomemories for events that never occurred."
• The two cannot be told apart without other evidence. In its words, "it is impossible, without other corroborative evidence, to distinguish a true memory from a false one."

On therapy, the same page says a competent psychotherapist "will attempt to stick to the facts as you report them" and will not steer you toward a particular conclusion.

Where can you turn for support?

If you are worried about a child now, the Childhelp National Child Abuse Hotline can be reached at (800) 422-4453, or by text or live chat through its site, at any hour and in over 170 languages. Its site says: "It is not a reporting line and is not connected to 911 or emergency services." If a child is in immediate danger, call 911.

If you have been sexually assaulted or abused, or someone you love has, RAINN's National Sexual Assault Hotline is free, confidential and open 24/7. Call 800.656.HOPE, text HOPE to 64673, or chat online.

For yourself, therapy is one option. For PTSD, U.S. guidelines most strongly recommend specific trauma-focused psychotherapies. The 2023 VA/DoD guideline names cognitive processing therapy, EMDR and prolonged exposure. The American Psychological Association's 2025 guideline names cognitive processing therapy, prolonged exposure and trauma-focused cognitive behavioral therapy. Both found insufficient evidence to recommend for or against psychodynamic therapy, which has been studied much less for PTSD. Types of trauma therapy covers the research, and do I need trauma therapy? may help you decide.

Dr. Rabin's trauma therapy page speaks of developmental trauma and complex trauma, and of trouble trusting, shame and a harsh inner critic, in college students and adults. Her approach is psychodynamic, attachment-based, trauma-informed and mindfulness-based. The work moves at the client's pace, and the client decides what is discussed and when. You can request a free consultation of about 15 minutes through the contact page and ask whether she offers a particular treatment or would refer you. She sees clients in Brookline and by telehealth across Massachusetts.

Keep reading

• Do I Need Trauma Therapy?
• Types of Trauma Therapy and What the Research Says
• How to Choose a Trauma Therapist
• All trauma guides

Sources

• Centers for Disease Control and Prevention, About Adverse Childhood Experiences (reviewed March 2, 2026)
• Felitti VJ, Anda RF, Nordenberg D et al., Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med (1998)
• Baldwin JR, Caspi A, Meehan AJ et al., Population vs Individual Prediction of Poor Health From Results of Adverse Childhood Experiences Screening, full text. JAMA Pediatr (2021)
• VA National Center for PTSD, Complex PTSD (last updated September 29, 2026)
• Bremness A, Polzin W, Commentary: Developmental Trauma Disorder: A Missed Opportunity in DSM V. Journal of the Canadian Academy of Child and Adolescent Psychiatry (2014)
• American Psychological Association, Questions and answers about memories of childhood abuse (1995, archived page)
• Childhelp, Childhelp National Child Abuse Hotline (accessed 2026)
• Childhelp, National Child Abuse Hotline (accessed 2026)
• U.S. Department of Veterans Affairs and Department of Defense, VA/DoD Clinical Practice Guideline for Management of Posttraumatic Stress Disorder and Acute Stress Disorder (June 2023)
• Swedo EA, Aslam MV, Dahlberg LL et al., Prevalence of Adverse Childhood Experiences Among U.S. Adults - Behavioral Risk Factor Surveillance System, 2011-2020, full text. MMWR Morb Mortal Wkly Rep (2023)
• Centers for Disease Control and Prevention, About the CDC-Kaiser ACE Study (last reviewed April 6, 2021)
• American Psychological Association, APA Dictionary of Psychology: recovered memory (updated 2018)
• RAINN, National Sexual Assault Hotline (accessed 2026)
• American Psychological Association, Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults (2025)

Last reviewed October 2026. This guide is general information, not medical advice or a diagnosis. If you are in crisis or thinking about harming yourself, call or text 988, or call 911 in an emergency.