Chapter 10: Treating the Long-term Impact of ACEs Part I: Personality Traits

Many clinicians assume that the stressful personality traits listed in Chapter 3 are not subject to change. That has not been my experience. Change begins with recognition that these traits are learned in response to ACEs. Often they helped the child survive their ACEs. Understanding how you learned these traits (and who taught them) is fundamental to changing them.  Let’s look at them again, recognizing that many are inter-related and leaving out those that are addressed in other chapters.

“When a child is unable to earn praise from caregivers at home, they can’t learn to feel satisfied with themselves when they have done well.”

1.     Low self-esteem is often the most fundamental personality trait problem in PPD patients. When children are criticized excessively, not praised sufficiently, neglected, abused, or unable to solve family problems they believe they should solve then they will internalize the assumption they are less worthy than other human beings. This contributes to all the problems in this chapter and the next three chapters.

2.     Perfectionism or being highly detail oriented.

a.     When a child’s best effort is not rewarded, usually they will try harder. If this happens repeatedly, the child will internalize the assumption that nothing they do is ever good enough. That is the definition of perfectionism. This is also highly damaging to self-esteem.

3.     It is highly important to please others or be seen as good by them.

a.     When a child’s home has problems, often the child will try to solve them. If the problems are not solved, usually the child will keep trying. From this they will learn repeatedly that meeting the needs of others is one of their core life tasks. This, too, is harmful to self-esteem.

4.     Being much more critical of yourself than you are of others, or they are about you.

a.     This issue is linked to the same sources as perfectionism. In addition, when a child is unable to earn praise from caregivers at home, they can’t learn to feel satisfied with themselves when they have done well.

b.     If you have this trait, recall a recent episode where you fell short of your expectations. Was your criticism of yourself the same that you would express to a friend who had committed a similar error?

5.     Giving more to your close personal relationships than you receive in return.

a.     It is common among PPD patients to choose partners who have problems that they feel obligated to solve, or partners who need more support than they provide in return. This issue is linked to the same sources as #s 1-4 above.

b.     Supporting others to a level that is detrimental for you often also extends beyond a partner to friends, neighbors, and workplace colleagues.

6.     In the past or present, being in close personal relationships with people who are demanding, controlling, or threatening.

a.     When a child grows up amid people with these qualities it is not surprising that this is the type of person with whom they continue to form relationships.

b.     Low self-esteem can contribute to the belief that a patient is unworthy of a relationship in which they receive as much love and support as they give.

7.     Living a highly stressful life.

a.     All of the issues in this list can contribute to this.

8.     Not taking enough time for personal enjoyment.

a.     A child whose attention is diverted from themselves (where it belongs) to the problems in the family often will not learn to take time for their own joy. The ability to play is an essential human skill. Without it, sooner or later the body will protest in the form of pain, illness, or fatigue.

b.     Low self-esteem can contribute to the belief that a person is not worthy of taking time for their own enjoyment. For such a person, attempts to self-indulge can feel selfish when they amount to no more than putting yourself on the list of people for whom you care.

9.     A current or past addiction, eating disorder, self-injury or suicide attempt.

a.     Addictions are forms of self-treatment for emotional distress. They usually take the form of abusing drugs, alcohol or nicotine but also can be to food, sex, work, exercise, gambling or even shopping.

b.     Eating disorders (including binge eating, bulimia and anorexia nervosa) in PPD patients are also forms of coping with emotional distress. In my experience, success in overcoming eating disorders is greatest when the underlying distress is uncovered and treated.

c.     My PPD patients who cut or otherwise injured themselves often had repressed their emotions so thoroughly that they felt little or no emotion at all. The pain of the self-injury enabled them to feel something which provided a form of relief. See Chapter 11 for more about repressed emotions.

d.     A suicide attempt usually occurs in a person with severe depression, and these are both much more common in people who suffered ACEs.

Replacing these traits with more positive options is difficult and time-consuming but can be done. All the resources on this website can help in this work. Psychotherapy can be another useful form of treatment.