This month we are exploring childhood maltreatment and the connection to chronic pain and disease. One of the main points in the research (that is true, but bothersome) is that at least part of the increased risk is due to behavioral choices.

The fact of the matter is survivors are more likely to smoke, use substances and engage in high risk behaviors. (1) These are all risk factors for developing physical problems.

The trouble with coping

Survivors engage in these behaviors as coping mechanisms for trauma. Unfortunately, it is a catch 22. Due to survivors’ experiences of developmental trauma, they are more likely to have overactive nervous systems. Due to this over-activation, they are more likely to use substances to manage this reactivity. Further, because their caretakers were violent, they are less likely to have learned healthy coping mechanisms that would manage the reactivity in a healthy way. (2)

 However, even though the behaviors make sense and in many ways is not the ‘fault’ of the victim- it does not change the cost they incur.

Thus, we must consider ways to manage our particular challenges without resorting to mechanisms that can promote illness and pain.

Step 1: Awareness & Choosing Differently

Often, we act unconsciously. We drink when we are stressed. We zone out in facebook or on Netflix. We eat when we aren’t hungry. Why?

If I were to ask you, ‘why are you having a drink?’ You might respond, ‘because I had a long day’ or ‘because I always have a drink with dinner’. That response however isn’t considered. We need the deeper why.

Why do you drink when you’ve had a long day? Why do you always have a drink with dinner?

You do these actions for a reason. Is it a good one?


Put a sticky note on your particular coping mechanism- wine bottle, or in your candy cabinet. Write ‘why am I doing this?’ It’s not about judgment. We’ve identified above that using these mechanisms is normal for survivors of trauma. However, I want you to consider your own unique relationship to this item, and whether it is one that you want to continue.

When I started paying attention to my actions, I realized I was just drinking all the time. I drank when I was up, down, happy, sad, lonely, bored, hungry, watching tv, going out, eating, not eating. I hadn’t noticed how heavily I relied on alcohol.

When I started to get curious about why I was drinking so much, I realized that in observing my father’s substances use as a kid, I had developed this belief that alcohol is a tool to ‘make things better’. In pain? Alcohol will make it better. Had a hard day? Alcohol will make it better. Except, when I thought about it, alcohol actually didn’t make anything better. It was just a beverage. It had no power to fix my pain. Further, it had destroyed my family in many ways. It had made my life worse.  After that, instead of using alcohol, I would just ask myself, ‘how can I make this situation better?’

Step 2: Accepting discomfort

A huge piece of why we go to harmful coping is to get away from discomfort and pain.

Again, we can go back to the catch 22 mentioned above. As survivors, biologically we are more likely to experience pain and discomfort due to our trauma.  Further, the social aspect again comes into play. With violent caregivers, we were not taught how to manage discomfort and pain. Rather, we were often taught to shut down our feelings using substances or self-destructive behaviors.

Another piece is identity. We are taught we are fundamentally worthless and incompetent. These horrible beliefs lead survivors to believe that they have no power to change their situation, and that they are fundamentally damned or broken. No wonder we struggle with emotional pain!


Once we understand that these pieces are at play, we can stop each piece in time.

  • We can identify that we are in fight or flight by noticing symptoms like sweating, anxiety, fear and shallow breathing.
  • We can understand our desire to go to alcohol, sex, self harm or food as normal and simply a learned behavior from our childhood. Moreover, we can see these cravings as the body trying to regulate our nervous system using mechanisms that have worked in the past.
  • Further, we can anticipate thoughts that we are worthless, unlovable or incapable of handling the problem in front of us. We know these thoughts are not true, and are simply echoes of the violent person.

Once in this place, we can simply sit with the discomfort and the thoughts without getting hooked by them. We can see that all of these things are happening, but that we don’t need to react to them.

Next steps

Start to learn practical skills to help you choose healthier behaviors! Start with this meditation on sitting with discomfort as a practical tool to deal with difficult experiences and thoughts.