How Childhood Trauma Affects Health Across a Lifetime
Significant childhood traumas, here referred to as ACEs for Adverse Childhood Experiences, have been shown to:
-increase the risk for 7 out of 10 of the leading causes of death in the US.
-affect brain development, the immune system, the hormonal system, and even the way our DNA is read and transcribed.
-increase the risk of heart disease and lung cancer by a factor of 3.
-shorten life expectancy by 20 years..
She also has a MA degree in public health, and she says that one thing that she learned in that program is that if there is a well, and 98 of 100 kids who drink from it develop diarrhea, as a doctor you can either write prescription after prescription for antibiotics or you can try to figure out what is in the well. You can use the health outcomes as a clue to fix underlying problems and risks.
The Adverse Childhood Experiences study was done as a collaboration between doctors at Kaiser and the CDC. It defined ACEs as physical, emotional, or sexual abuse: physical or emotional neglect: parental mental illness, substance dependence, incarceration: parental separation or divorce, or domestic violence. The ACE score is a measure of how many of these events a person has experienced. They found a dose-related correlation with health problems throughout life.
Some of the risk correlations that they found for someone with an ACE score of 4 or more include:
2.5 times the risk for COPD and Hepatitis,
4.5 times for depression
12 times for suicide attempts
For someone with an ACE score of 7 or more, the risks are:
3 times the risk for lung cancer,
3.5 times the risk of ischemic heart disease (the number 1 killer in the US),
Some people tried to write this off as a correlation that results from people who had "rough childhoods" making "poor decisions" about their health, and/or engaging in more risky behavior. This turns out not to be the reason for the correlation. It is more direct. For example, this stress affects brain development, such as the the area called the nucleus accumbens that is involved in pleasure and reward and is implicated in substance abuse. It inhibits the prefrontal cortex which is responsible for executive function and impulse control and important for learning. Measurable differences can also be seen in the amygdala, the part of the brain that processes emotions and fear. All of this is to say that there are real biological reasons why people with higher ACE scores might engage in more risky behavior.
However, the risks from ACEs are still there regardless of whether someone engages in risky behavior or not. The reason for this has to do with the Hypothalamic-Pituitary-Adrenal system, the brain's stress-response system, and the part that controls the fight/flight response. If you perceive threat, your hypothalamus sends a signal to your pituitary, that then sends a signal to your adrenal glands to respond by releasing stress hormones such as adrenaline and cortisol. If this system is chronically activated it can go from being an adaptive response to one that is maladaptive and damaging to health, and children are especially sensitive to this. Because children's bodies are still growing and developing, these ACEs not only affect the brain but also the immune system, the hormonal system, and even our epigenetics- which is the way that our DNA is read and transcribed.
She says it is the job of doctors to use information such as this- information about the causes of disease and poor health outcomes- for treatment and prevention. In San Francisco she helped found the Center for Youth Wellness, to identify and support kids who need help recovering from ACEs. They provide home care, mental health services, nutritional services, medication, and other interventions to try to reduce the impact of the ACEs. Dr Robert Block, former president of the American Academy of Pediatrics, said "Adverse Childhood Experiences are the single greatest unaddressed public health threat facing our nation today". Why is this information not being addressed? Is it the perception that this is a problem for "other people"? The original ACEs study was done in a population that was 70% Caucasian and 70% college educated, so it's not an issue of "those people"- it affects everyone. Are we in denial? We need the courage to take this problem seriously.
You can take a quiz on the NPR site to find out your ACE score. This site has some basic info about what the score means and other factors that also influence health outcomes, such as resiliency. It also has links to the CDC site about the ACE study and other relevant research.
How Stress Effects Your Brain (a TED talk/lesson, gives the basics)
Childhood, disrupted: Adversity in childhood can create long-lasting scars, damaging our cells and our DNA, and making us sick as adults
"New findings in neuroscience, psychology and immunology tell us that the adversity we face during childhood has farther-reaching consequences than we might ever have imagined. Today, in labs across the country, neuroscientists are peering into the once-inscrutable brain-body connection, and breaking down, on a biochemical level, exactly how the stress we experience during childhood and adolescence catches up with us when we are adults, altering our bodies, our cells, and even our DNA."
"...when children or teens face adversity and especially unpredictable stressors, they are left with deeper, longer‑lasting scars. When the young brain is thrust into stressful situations over and over again without warning, and stress hormones are repeatedly ramped up, small chemical markers, known as methyl groups, adhere to specific genes that regulate the activity of stress‑hormone receptors in the brain. These epigenetic changes hamper the body’s ability to turn off the stress response. In ideal circumstances, a child learns to respond to stress, and recover from it, learning resilience. But kids who’ve faced chronic, unpredictable stress undergo biological changes that cause their inflammatory stress response to stay activated."
This article from Psychology Today gives a more detailed explanation of some of the biological mechanisms responsible for the effects of early stress on the brain.
It's been found that trauma in adulthood is also associated with increased inflammation and disease.
The Science of Stress and How Our Emotions Affect Our Susceptibility to Burnout and Disease
How Child Abuse Primes the Brain for Future Mental Illness
"Now, in the largest study yet to use brain scans to show the effects of child abuse, researchers have found specific changes in key regions in and around the hippocampus in the brains of young adults who were maltreated or neglected in childhood. These changes may leave victims more vulnerable to depression, addiction and post-traumatic stress disorder (PTSD), the study suggests.
...chronic maltreatment can set the stress system permanently on high alert. That may be useful in some cases — for example, for soldiers who must react quickly during combat or for children trying to avoid their abusers — but over the long term, the dysregulation increases risk for psychological problems like depression and PTSD."
This is the study discussed in this article:
Stress lies at the heart of disease, addiction
Mate mentioned a study of breast cancer in women, which found that those who were both over-stressed and lacked strong social connections had a cancer rate nine times higher than women who were stressed but had strong social bonds, as well as those who had weak connections but were not stressed.
Chronic stress — from overwork, poverty, abuse and so on — suppresses the normal function of a person’s immune system, increasing the risk of a host of illnesses."
Biological embedding of stress through inflammation processes in childhood
Chronic stress can also shrink the medial prefrontal cortex. This negatively affects decision making, working memory, and control of impulsive behavior. Stress also has the ability to affect stem cells, inhibiting access to the prefrontal cortex, where we plan complex cognitive behavior and moderate social interaction. The result is a brain that is less capable of learning and memory, and more prone to anxiety and depression.
To make matters worse, these same stress hormones can increase the size and activity of a portion of the brain called the amygdala. The amygdala is critical in the formation and storage of memories associated with highly emotional events. It pairs an event with a feeling, and this connection is stored away in our long-term memory so we can either avoid the event or seek it out in the future. The changes cortisol creates increase negative emotions such as fear, anxiety, and aggression."
Adverse childhood events appear to increase the risk of being a hypertensive adult