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How Do Adverse Childhood Experiences Affect Our Adult Life?
Adverse Childhood Experiences (ACE) and Trauma:
1. What are Adverse Childhood Experiences (ACEs) and what are some examples?
ACEs are traumatic events occurring in childhood (typically before the age of 18) that have significant, lasting impacts on health and well-being. The ACE study primarily focused on 10 categories of adverse experiences: physical abuse, sexual abuse, emotional abuse, physical neglect, emotional neglect, loss of a parent due to divorce or separation, witnessing violent treatment of the mother, having a household member with mental illness, having a household member who was incarcerated, and having a household member with substance abuse issues. Other types of trauma, like accidents or living in an unsafe neighborhood, also increase risk.
2. How prevalent are ACEs, and how are they measured?
ACEs are surprisingly common. For example, physical abuse affects about 1 in 3.5 Americans, while sexual abuse impacts about 1 in 5. The ACE score is calculated by assigning one point for each category of ACE experienced. The higher the score, the greater the risk of negative health and social outcomes. Over half (52.1%) of people in one study reported exposure to at least one ACE category.
3. What are the potential long-term health consequences associated with high ACE scores?
Higher ACE scores are linked to a multitude of negative health outcomes, including increased risk of autoimmune diseases (a 20% increased risk with each additional point in ACE score), addictions (regardless of drug availability or public opinion), depression, suicide attempts, risky sexual behavior (including a higher number of sexual partners and sexually transmitted diseases), obesity, stroke, chronic bronchitis/emphysema, diabetes, skeletal fractures, hepatitis/jaundice, and fair/poor self-rated health. Multigenerational maternal ACEs increase a child's risk of physical and emotional health conditions.
4. How does trauma impact the brain, and what are some of the neurobiological effects?
Trauma, especially prolonged trauma, can cause permanent brain damage by keeping the brain bathed in a constant flow of stress hormones. Some neurobiological effects include an underdeveloped pre-frontal cortex (impacting decision-making), a smaller hippocampus (affecting long-term memory and spatial navigation), an enlarged amygdala (leading to a "hair trigger" threat response), and impaired thalamus functioning (affecting sensory processing and autonomic nervous system arousal). The alteration is so significant that it can be difficult to tell the brain of someone with a traumatic brain injury from someone who has undergone prolonged trauma.
5. What is the importance of empathy in healing from trauma, and how can it be applied?
Empathy, the ability to understand and share the feelings of another, plays a critical role in healing. According to Carl Rogers, the empathic therapist affirms the intrinsic worth of the client's perceptions, suspending any critical evaluation. Heinz Kohut defined empathy as "the capacity to think and feel oneself into the inner life of another person." Empathy validates the client's experience, removes blame, and allows for the development of new coping tools. It is important to note, however, that empathy should be used appropriately; misapplied empathy can lead to "incorrect results," as when Nazi bomber pilots used empathy to instill fear in their enemies.
6. What is Internal Family Systems (IFS) therapy, and how can it help individuals heal from trauma?
IFS is a therapeutic approach that recognizes that each individual has different "parts" or internal systems working together. These parts ideally help us survive and thrive, and they all have valuable qualities. Richard Schwartz, the founder of IFS, found that clients often spoke of these parts as if they had autonomy. IFS aims to help individuals understand and accept these parts, even those that seem negative or destructive, such as a "critic" part or a part that engages in self-destructive behaviors. By understanding the "secret histories" of these parts and learning how they have been forced to do extreme things to survive the past, individuals can begin to heal and integrate these parts into a more cohesive whole, led by the "Self," which embodies qualities like curiosity, calm, confidence, compassion, and clarity. Mapping parts can also be helpful when applying the IFS model.
7. What are some strategies individuals can use to regulate their nervous system after experiencing trauma?
Several strategies can help regulate the nervous system after trauma. These include titration (dosing small amounts of traumatic experience at a time), focusing on the present moment and surroundings, and using the breath to calm the vagus nerve (e.g., exhaling slowly, breathing deeply with the abdomen). Being a compassionate witness to others (without offering advice or judgment), practicing self-regulation, and finding ways to see others in pain without taking on their pain can also be helpful. It is also important to know that a negative life event occurring in a state of relative helplessness can produce the same neurophysiological changes in the brain as do traditionally-defined traumas.
Adverse Childhood Experiences (ACEs) & Trauma:
Definition and Prevalence: ACEs are a set of potentially traumatic experiences occurring in childhood, encompassing abuse, neglect, and household dysfunction. The excerpts from "ACE Scoring and research.pdf" and "CDC Study of ACE Trauma - July 2019.pdf" define the categories and present prevalence statistics:
Physical Abuse: 1 in 3.5 Americans
Sexual Abuse: 1 in 5 Americans
Emotional Abuse: 1 in 9 Americans
Household substance abuse: 1 in 4
Household member with mental illness: 1 in 5
Violent treatment of mother: 1 in 10
Household member jailed: 1 in 30
Impact on Health and Well-being: The original ACEs study ("ACE Study - original - Filetti et al.pdf") demonstrates a strong correlation between the number of ACEs and increased risk of various negative health outcomes.
This includes:
Mental health issues: depression, suicide attempts
Substance abuse: alcoholism, drug use, injected drug use
Risky behaviors: multiple sexual partners, sexually transmitted diseases
Chronic diseases: stroke, bronchitis, diabetes
Autoimmune diseases: "Autoimmune disease 20% increased risk with each additional point in ACE score"
Neurobiological Effects of Trauma: "Biological_Aftereffects_of_Trauma_F21.pdf" highlights the permanent brain damage caused by prolonged trauma.
"As a result of chronic exposure to these chemicals the way we process information is permanently altered. The alteration is so significant that it can be difficult to tell the brain of someone with a traumatic brain injury from someone who has undergone prolonged trauma. This is significant! It tells us that trauma causes brain damage. Permanent brain damage."
Underdeveloped pre-frontal cortex
Smaller hippocampus
Enlarged amygdala
Impaired thalamus function
Multigenerational Impact: "Multigenerational Maternal ACE increase child’s risk physical & emotional health conditions"
The Impact of Trauma Extends Beyond ACEs: According to Dr. Robert Scaer, “any negative life event occurring in a state of relative helplessness--a car accident, the sudden death of a loved one, a frightening medical procedure, a significant experience of rejection--can produce the same neurophysiological changes in the brain as abuse".
The number of Adverse Childhood Experiences (ACEs) a person has is strongly correlated with negative health outcomes, demonstrating a dose-response relationship where the risk of various health problems increases with the number of ACEs [1-4]. Here’s how the sources describe this correlation:
Increased Risk of Mortality and Chronic Illness:
Life expectancy is significantly reduced for individuals with higher ACE scores; for example, life expectancy is 20 years shorter for those with an ACE score of 6 or more [1, 4].
Individuals with an ACE score of 4 or more have a two-fold higher risk of premature death [1, 4].
The risk of developing various chronic illnesses, including heart disease, cancer, and autoimmune disorders, increases with a higher ACE score [5-7]. For example, the risk of autoimmune disease increases by 20% with each additional point in the ACE score [8, 9].
Hospitalizations for autoimmune diseases are 70% higher for those with an ACE score of 2 or more, compared to those with an ACE score of 0 [8, 9].
There is a graded relationship between the number of ACEs and adult diseases such as ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease [2, 10].
Mental Health and Behavioral Problems:
The risk of mental health conditions such as depression, anxiety, and PTSD significantly increases with the number of ACEs [5, 6, 11].
The severity of depression in adolescents increases with higher ACE scores, up to a score of 3 [1, 4].
Individuals with four or more ACEs have a 4- to 12-fold increased risk for alcoholism, drug abuse, depression, and suicide attempts [2].
The risk of suicide attempts increases dramatically, with a 12-fold increase for individuals with four or more ACEs compared to those with none [6, 12].
There is an increased risk of substance abuse, including a 7 times greater risk of alcohol abuse and a 10 times greater risk of illicit drug use with ACEs [6, 12].
ACEs are also linked to higher rates of self-harm, low life satisfaction, and poor academic achievement [6, 13].
There is also a correlation between higher ACE scores and increased risk of ADHD and behavior problems in children [6, 12].
Risky Behaviors:
Higher ACE scores correlate with a greater likelihood of engaging in risky behaviors [6, 12].
This includes increased risk of smoking, physical inactivity, promiscuity, and obesity [6].
There is also an increased risk of unintended pregnancy and paternity, intimate partner violence, and an increased number of marriages with ACEs [6, 13].
Risky behaviors such as drug abuse and unsafe sexual practices have been linked with a higher number of ACEs [2, 14].
The number of sexual partners also increases with ACE scores, as does the risk of sexually transmitted diseases [2, 14].
Other Negative Outcomes:
Individuals with higher ACE scores have an increased risk of injuries, both intentional and unintentional, such as motor vehicle accidents, shootings, and stabbings [6, 13].
There is a correlation between ACEs and an increased risk of criminality [6, 13].
Maternal ACEs increase the child’s risk of both physical and emotional health conditions [1, 9].
Dose-Response Relationship:
The risk of negative health outcomes generally increases with each additional ACE, further underscoring the graded nature of this relationship [1, 3, 4].
The more categories of childhood exposure to abuse or household dysfunction, the higher the likelihood of multiple health risk factors later in life [2, 15, 16].
The age of symptom onset decreases with more ACEs [1, 4].
Important Considerations:
While a dose-response relationship is evident, it's important to note that ACE scores are not deterministic. Not everyone with a high ACE score will experience negative health outcomes, and some individuals with lower scores may still face significant challenges [17].
The impact of ACEs can be influenced by various factors, such as the availability of social support, coping skills, and access to resources [18-20].
The effects of childhood trauma are not just psychological; trauma alters brain development, function and structure; autonomic nervous system regulation; physiology, stress responses, and gene function [21, 22].
These changes can be so significant that the brain of someone who has experienced prolonged trauma can be difficult to distinguish from someone who has experienced a traumatic brain injury, meaning trauma causes permanent brain damage [23].
In summary, a higher number of ACEs is strongly associated with a wide range of negative health outcomes, including increased risks for chronic diseases, mental health disorders, risky behaviors, and premature mortality. The dose-response relationship suggests that each additional ACE increases the likelihood of these adverse effects.
You can find out your ACE (Adverse Childhood Experiences) score by completing a 10-question questionnaire. The questionnaire asks about abuse, neglect, and other childhood adversities.
How do I take the ACE questionnaire?
Answer each question with a yes or no
Add up all your yes answers to get your ACE score
What does my ACE score mean?
A higher ACE score indicates a higher risk of health problems
An ACE score of 4 or higher is associated with an increased risk of depression, drug abuse, and alcoholism
An ACE score of 7 or higher is associated with an increased risk of dissociation
Even the lowest score can be associated with anxiety, difficulty in connecting in relationships, and repeated harmful patterns in adult life
Examples of ACEs:
Physical abuse
Sexual abuse
Emotional abuse
Exposure to domestic violence
Living with someone who has a serious mental illness
Living with someone who abuses drugs or alcohol
The ACE questionnaire can help you understand your childhood and your potential health risks.
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