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Episode 30 · 39 min · Sep 29, 2026

She Was Hospitalized at 10, and Doctors Still Missed Her Diagnosis | Anna Lacey, LCSW

with Anna Lacey, LCSW

Anna Lacey was ten years old when she was placed in an adult psychiatric ward for anorexia. In Nebraska in 1990, eating disorders were poorly understood, and the clinical system had no framework to explain what she was experiencing. She was simply treated and discharged. What came next, a revolving door of therapists, years of addiction, corrosive shame, and relationships built on distrust, would go unnamed for more than two decades. It was not until Lacey sat in a classroom at UC Berkeley in 2012 that she heard the phrase complex PTSD, and everything clicked into place.

Lacey, now a licensed clinical social worker based in California and the founder of Let the Light In Therapy, built her clinical practice around the very thing no one diagnosed in her: complex post-traumatic stress disorder. Unlike standard PTSD, she explains, complex PTSD is not defined by a single catastrophic event. It is defined by identity and shame. It is the result of chronic, repetitive invalidation in childhood, the kind that erodes a child's sense of self worth until the distorted beliefs instilled by neglect and criticism feel like fact. As Lacey puts it, by the time those children become adults, they walk around looking for proof that the terrible things they believe about themselves are true.

The framework Lacey brings to her clients draws from two distinct modalities: dialectical behavioral therapy's prolonged exposure and Internal Family Systems. At the center of her DBT-PE practice is a tool called the Wheel of Traumatic Invalidation, developed by researcher Melanie Harned and almost entirely unknown outside the narrow subset of therapists who specialize in DBT-PE. The wheel maps nine categories of childhood harm, including controlling, ignoring, blaming, and rejecting, to the specific flavors of shame each leaves behind. A child who was chronically ignored internalizes the belief that their needs do not matter. A child who was criticized internalizes unworthiness. Lacey introduces this wheel to nearly every client she suspects may carry a layer of complex PTSD, and she describes the look on their faces when they see it as one of the most meaningful moments in therapy.

Understanding the origin of shame is only half the work. Internal Family Systems, developed by Richard Schwartz, gives Lacey and her clients a way to interact with the parts of themselves that still carry it. In IFS, different protective strategies, people-pleasing, isolation, substance use, exist to keep the exiled parts, the wounded inner children who hold the shame, out of conscious awareness. Once a client can identify which invalidation categories shaped their shame and at what age those wounds formed, Lacey guides them to re-parent those younger versions of themselves. This is not metaphorical: she describes waking at three in the morning after a nightmare rooted in her college years, feeling the old shame surge, and consciously entering the scene in her mind's eye, sitting with her younger self in that college housing, and telling her what she needed to hear then. She went back to sleep. The next morning, the emotion had shifted from shame to sadness, which is far easier to live with.

Lacey reserves particular care for two realities her clients often resist. The first is intergenerational trauma: she helps clients hold both love for their parents and recognition of the harm they caused, without collapsing into either defense or blame. The second is grief. People with complex PTSD carry the weight of years spent suffering, misunderstood, and ashamed of experiences that deserved compassion. Reclaiming those years requires naming what was lost.

She also lost her sister Sarah to anorexia at thirty-three. Lacey lived with that grief largely in silence, self-editing because she could see how uncomfortable others found it. Finding ACA, Adult Children of Alcoholics and Dysfunctional Families, gave her a community that could handle the full truth without flinching. That freedom, to speak plainly and completely, turned out to be a form of healing in itself.

The work Anna Lacey does is not theoretical. It is something she practiced at three in the morning and built out of her own survival. That may be why, when her clients see the Wheel of Traumatic Invalidation for the first time, they recognize themselves in it so completely. The shame was never who they were. It was what someone taught them to believe.

In this episode, you will learn:

  • Understand why complex PTSD is defined by shame and identity, not by the number or severity of individual traumatic events.
  • Use the Wheel of Traumatic Invalidation to trace how specific categories of childhood harm created distinct flavors of shame.
  • Recognize how Internal Family Systems helps you identify the parts of yourself that are protecting against buried shame.
  • Practice re-parenting your inner child in real time, including during nighttime distress, by entering past scenes in your mind's eye.
  • Learn to hold both love for parents and honest acknowledgment of the harm they caused without falling into black-and-white thinking.
  • Discover why radical acceptance does not mean agreeing with what happened, but accepting full reality so healing can begin.
  • Find community through ACA where complex PTSD experiences can be spoken aloud without self-editing or apologizing in advance.
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