Childhood Stress and Trauma Sets the Stage for Health Throughout Our Lifetime

As a pediatrician working in one of San Francisco's poorest and most underserved neighborhoods, Dr Nadine Burke Harris became aware of the significant impact that childhood trauma has on the health of children.  Here she talks about the research showing that not only was she right, the problem is much bigger than that- it turns out that significant trauma in childhood is the single most accurate predictor of a person's health throughout their lifetime.  In this TED talk she discusses that research and why these traumas have the effect that they do:

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.

More on this topic:

How Stress Effects Your Brain (a TED talk/lesson, gives the basics)

The type of PTSD that arises from chronic stress, abuse, or neglect in childhood is bow being called Complex PTSD (or C-PTSD for short).  This is a distinct form of PTSD and not just PTSD that arises from complex factors.  The difference is explained well in this video
C-PTSD vs PTSD - How are they Different?

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

This article is a really good discussion about how stress affects our mental and physical health, and our immune system specifically, and the ways in which they are connected.  It gives some history about how the emotions and physical health were seen as interconnected in many societies in the past, but in the west Descartes' rationalism separated mind from body.  It then discusses the work of Dr Esther Sternberg whose groundbreaking work looking at the interconnection between the central nervous system and immune system has brought the interconnection between the mind and body back into western thought.  It goes on to talk about how memories play a role in how we respond to stress, how acute stress and chronic stress differ biochemically, and how destructive chronic stress is to our bodies.  Lastly, there is mention of how social relationships can help shield us from the effects of stress.  For more on the protective effects of social networks read this page about recent research into the strong degree to which strong social support reduces our health risks.

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:

Childhood maltreatment is associated with reduced volume in the hippocampal subfields CA3, dentate gyrus, and subiculum

Chronic stress and anxiety can damage the brain, increase the risk of major psychiatric disorders

Stress lies at the heart of disease, addiction

"...we must move beyond the individual model of illness to embrace what he terms a “biopsychosocial” explanation, in which the mind, body and society are seen as an interacting continuum. Cancer, for instance, is usually caused by a number of factors, which may include toxins in our environment, chronic stress, and social isolation. Genes, he added, “can pre-dispose, but not pre-determine” who will get sick.

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

"Children exposed to adverse psychosocial experiences show elevated disease risk in adulthood. It is therefore important to characterize the biological mechanisms through which children may acquire such lasting vulnerability to disease, namely, the mechanisms of biological embedding."

Early Mortality and Primary Causes of Death in Mothers of Children with Intellectual Disability or Autism Spectrum Disorder: A Retrospective Cohort Study

"During the study period, mothers of children with intellectual disability or ASD had more than twice the risk of death. Mothers of children with intellectual disability were 40% more likely to die of cancer; 150% more likely to die of cardiovascular disease and nearly 200% more likely to die from misadventure than other mothers. Due to small numbers, only hazard ratios for cancer were calculated for mothers of children with ASD. These mothers were about 50% more likely to die from cancer than other mothers. Possible causes and implications of our results are discussed."

This post on the blog Questioning Answers talks about the above study.

"A few other details are also recorded in the Fairthorne study. "Mothers with both a psychiatric disorder and a child with intellectual disability or ASD had about six and a half times the risk of death" was an important finding reported by the authors. When it came to the cause of death, various factors were over-reported in case group mums including cancers, cardiovascular disease and death by misadventure (death due to an unintentional accident, homicide or suicide according to the authors' criteria)."

How Stress Is Making You Lose Your Mind

"The stress hormone cortisol can kill, shrink, and stop the generation of new neurons in a portion of the brain called the hippocampus.  The hippocampus is critical for learning, memory and emotional regulation, as well as shutting off the stress response after a stressful event is over: all much-needed processes in both our professional and personal lives.

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."

This article also talks about the effectiveness of exercise in reversing these effects.

Adverse childhood events appear to increase the risk of being a hypertensive adult

"Children who experience multiple traumatic events, from emotional and sexual abuse to neglect, have higher blood pressures as young adults than their peers, researchers report. The difference of 10 points in the systolic pressure -- the top number denoting pressure while the heart is contracting -- by early adulthood puts these young people at higher risk for hypertension and coronary artery disease by middle and/or old age, said Dr. Shaoyong Su, genetic epidemiologist at the Medical College of Georgia at Georgia Regents University."

Not yet listened to -


Van der kolk - Childhood adversity and attachment disruptions: Restoration by establishing synchrony