Childhood Trauma and Addiction: Research Findings

Psychotherapists have long been aware of the devastating impact of childhood trauma on causing addiction. However, even though there is an increasing body of evidence that childhood trauma increases the likelihood of addiction, both in childhood and later in life, there are still those that consider addiction as a product of a ‘chemical imbalance’ in the brain.

While the relationship between childhood trauma and addiction has been obvious to therapists, and while research supports this, what still needs further study is the nature of this connection. Namely, despite all the available research, the internal psychological mechanisms that tie the two together are still not entirely clear.

I will here look at some of the research findings that link addiction to childhood trauma.

Addiction Through the Eyes of Attachment Theory

Research suggests that addiction is strongly associated with insecure attachment styles (Fuchshuber & Unterrainer, 2020; Kpelly et al., 2022; Schindler, 2019; Unterrainer et al., 2017). Kpelly et al. (2022), for instance, found a link between substance use addiction and insecure avoidant attachment as well as disorganised attachment.

Hiebler-Ragger & Unterrainer (2019), interestingly, point out an important aspect of boredom in substance use. Namely, boredom is often associated with the internal experience of emptiness, which is the result of disruptions in early attachment and the subsequent lack of identity integration.

While this is not surprising given that childhood trauma causes the development of insecure attachment patterns, it does not provide much insight into the underlying psychological processes. Additionally, the development of insecure attachment patterns itself does not predict that a person will also develop an addiction.

The research evidence, however, seems to point towards what we have been observing in clinical settings: early life adverse experiences, especially traumatic events in the caregiver-child relationship, have a long-lasting effect on the child's sense of self and perception of others. Often, an experience of emptiness or fragmentation is created, which may lead one to addiction as a means of mediating it—either in the form of substance use or an experience.

Childhood Trauma and Substance Use

There is generally high prevalence of childhood trauma amongst those presenting with substance use (Zhang et al., 2020) with an abundance of research confirming the relationship. As such, I will here name just a few.

Lotzin et al. (2019) found that the women presenting with substance use disorder (SUD) who had relatively more severe childhood trauma initiated substance use earlier in there lives. Similarly, Garami et al. (2019) found a positive correlation between childhood trauma and opioid addiction. Khoury et al. (2010) found a strong correlation between substance use and childhood physical, sexual, and emotional abuse, as well as symptoms of PTSD.

Even though there is an abundance of research linking childhood trauma and addiction, the research evidence is predominantly focusing on substance use, rather than addiction as a broader term—one that would include also non-substance or behavioural forms of addiction. Furthermore, the predominance of evidence focuses on attempting to link childhood trauma specifically with substance use disorders (SUD), which is a specific disorder and much narrower than one would refer to when referring to addiction.

Childhood Trauma and Behavioural Addiction

Addiction can take many forms. It can be in the form of substance use, alcohol use, or a so-called behavioural addiction, such as sports or exercise addiction, gambling, compulsive shopping, sex addiction, porn addiction, 'relationship addiction', 'food addiction' or eating disorders. Let's look at some research linking childhood trauma to the most common forms of behavioural addiction. While this is not an exhaustive list, it highlights the importance and prevalence of early-life adverse experiences as foundations for addiction.

Sex Addiction

One of behavioural addictions that have been strongly linked to childhood trauma, especially sexual abuse, is sex addiction (Giordano et al., 2024; Katehakis, 2009; Slain et al., 2020). Chatzittofis et al. (2016) found that sexual addiction was related to childhood trauma in the form of emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect.

Sex addiction has been linked to developmental adverse experiences of the lack of empathic connection between the parent and the child and the subsequent psychological immaturity of the person. Again, similar to other forms of addiction, insecure attachment styles, originating from the caregiver’s lack of attention, the capacity to soothe the child’s affect, the lack of affection and validation, along with potential neglect, have been associated with the development of sex addiction (Hall, 2011). Hall (2011) further argues that sexual addiction is a means of affect regulation.

In clinical setting we can often observe that, when a person is presenting with sex addiction, similar to other types of addiction, symptoms often exacerbate in response to interpersonal stressors, such as issues in romantic relationships or other close relationships, or at the prospect of experiencing rejection or abandonment. Compulsive sexual behaviour is often a form of stimuli that acts as a form of internal recognition, similar to self-harming behaviour.

Eating Disorders

Whilst eating disorders do not constitute an addiction, their underlying psychological foundations are often the same and some eating patterns may have a similar psychological underpinning to that of substance use or other forms of addiction. For instance, similar to how substance use can have a soothing as well as punitive psychological effect, the use or control of food can serve a similar purpose. Similarly, binge eating can serve the purpose of facilitating dissociation for one to get away from the uncomfortable and painful aftermath of trauma.

Studies confirmed the link between childhood trauma and eating disorders (Groth et al., 2019; Pignatelli et al., 2017; Vidaña et al., 2020). In fact, Vidaña et al. (2020) also found a link between adult trauma and eating disorders. Pignatelli et al. (2017) examined the impact of childhood trauma in the forms of physical and emotional neglect and their relationship with eating disorders. They found that both physical and emotional neglect were highly present with individuals present with eating disorder issues, whilst the presence of emotional neglect was even more prevalent.

McShane & Zirkel (2008) report a correlation between dissociation and binge-purge episodes in patients with bulimia nervosa and also found that sexual abuse was associated with both the increased levels of dissociation as well as more severe symptoms.

Compulsive Buying

Compulsive buying is an important type of behavioural addiction. It is underpinned by impulsivity and may be used to facilitate dissociation. Whilst the research on this type of addiction is still scarce, studies point towards a relationship between childhood trauma and compulsive buying (ElBarazi, 2023; Sansone et al., 2013). Sansone et al. (2013) found that particularly witnessing violence and emotional abuse played a significant role in development of compulsive buying later in life. It is worth pointing out that one of the symptoms of impulsivity with borderline personality disorder (BPD)—BPD is found to be largely predetermined by childhood trauma—is also impulsive spending.

Studies have also found a link between compulsive buying and dissociation. Young-Mi et al. (2020) examined the link between problematic internet shopping and dissociative experiences and found that dissociation was associated with higher levels of problematic internet shopping. It is worth, however, considering this in the context of the role that dissociation plays in trauma. Similar to what we know in relation to eating disorders—so, that dissociation may be facilitated by binge eating (Petrucelli, 2016)—compulsive shopping may also be a form of unconsciously initiating dissociation rather than the result of it.

Gambling Addiction

Similar to other forms of addiction, persistent maladaptive gambling has also been associated with childhood trauma (Hodgins et al., 2010; Kausch et al., 2006; Roberts et al., 2017; Sharma & Sacco, 2015). Furthermore, Roberts et al. (2017) report a link between childhood trauma, as well as adulthood trauma and gambling, while Afifi et al. (2010), even though not linking gambling with childhood trauma, found a link between gambling addiction and dating violence, marital violence, and severe child abuse.

If we consider gambling as a means of a person’s escapism from intolerable affects and problems (Rosenthal, 2008), we can appreciate gambling serving a similar purpose as other forms of addiction in terms of its mediation of the issues stemming from childhood trauma. There is, however, a distinct ingredient of unconscious self-defeat and self-punishment that a person may be chasing with gambling.

Ales Zivkovic, MSc (TA Psych), CTA(P), PTSTA(P), Psychotherapist

Ales Zivkovic is an MSc in Transactional Analysis Psychotherapy, a Provisional Teaching and Supervising Transactional Analyst (PTSTA-P), and a Certified Transactional Analyst in the field of Psychotherapy (CTA-P). He is a member of the United Kingdom Council for Psychotherapy (UKCP). Ales previously worked with individuals and groups in the UK National Health Service (NHS) and is currently a psychotherapist, counsellor, and supervisor in his private clinical practice in Central London, UK. He works with individuals, couples, and groups. In clinical setting, he specialises in the treatment of issues pertaining to childhood trauma, personality disorders, and relationship issues. He also specialises in online psychotherapy. Ales developed a distinct psychotherapeutic approach called interpretive dynamic transactional analysis psychotherapy (IDTAP). More about Ales, as well as how to reach him, can be found here.

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