Objectives: Pacopampa, a ceremonial complex in Peru's northern highlands, reveals early evidence of trauma in the Middle to Late Formative Period coinciding with the emergence of social stratification in the area. We examine the prevalence of trauma in human remains found at the site and present evidence of the circumstances surrounding the deaths of individuals who lived during the early stages of Andean civilization.Materials And Methods: The materials are the remains of 104 individuals (38 non-adult and 66 adult) from the Middle to Late Formative Periods. We explored trauma macroscopically and recorded patterns based on skeletons' locations, age at death, sex, social class, and chronology.Results: We detected trauma in remains over the Middle to Late Formative Periods. While the prevalence of trauma was minimal in the Middle Formative Period, skeletons from the subsequent era exhibit more severe disturbances. However, all the skeletons show signs of healing and affected individuals experienced a low degree of trauma.Discussion: Given the archaeological context (the remains were recovered from sites of ceremonial practices), as well as the equal distribution of trauma among both sexes and a lack of defensive architecture, it is plausible that rituals, rather than organized warfare or raids, caused most of the exhibited trauma. Pacopampa was home to a complex society founded on ritual activity in a ceremonial center: this is indicated by the presence of ritual violence in a society that built impressively large, ceremonial architecture and developed social stratification without any political control of surplus agricultural goods.