Good question. If I understand, for me I'd say the first thing was working on regulation and handling my emotions. I'm still working on it, but my meltdowns are less severe (although I have to stop drinking). After sort of sifting through all the junk and working on so many things (self care, basic survival, all of it...), I do think I see one more major issue/theme...and that is my inability to trust others or connect with others. I just don't get close to anyone and have a really hard time believing they care.
And it's not new, but through therapy I've noticed that for much of my life relationships have been hard because if I feel any bit unsure, either I or the other person feels somewhat unreal...like we can't simultaneously be real. This happens with perfectly kind people.
So after learning how to eat, diminish panic attacks and wanting to set myself on fire (all the survival stuff) I have to figure out how to connect better with others. It's maybe like trying to climb a mountain but I don't even have legs.
This is all the ripple of early trauma...but that wasn't an isolated event. I was isolated from my caregivers for a while, but also neglected and abused by my primary caregiver. As far as ripples, this has been more devastating to my overall quality of life than probably sexual assault or later traumas (though those have negative effects for sure). I often like my independence but it also often feels like it doesn't matter at all that I am alive.