The Link Between Childhood Trauma and Lifelong Health Outcomes
Photo by Guillaume de Germain on Unsplash
In today’s blog post, I want to consider the link between childhood trauma and lifelong health outcomes, with a particular focus on the Adverse Childhood Experiences (ACE) Study.
Last month, I discussed the impact of childhood trauma on the brain. It affects immunity, hormonal systems, and even the way our DNA is read and transcribed. It’s also incredibly common, with one in four adults in Australia — nearly five million people — estimated to have experienced significant childhood trauma. And still, doctors are not trained in routine screening or treatment.
So what is childhood trauma?
As pediatrician Dr. Nadine Burke Harris explains in a TEDTalks video, childhood trauma refers to “threats that are so severe or pervasive that they literally get under our skin and change our physiology — things like abuse, neglect, or growing up with a parent who struggles with mental illness or substance dependence.”
Many medical professionals view this issue in one of two ways: as a social problem with a referral to social services or as a mental health problem with a referral to mental health services. After her residency, Dr. Burke went on to open a pediatric clinic in Bayview, one of the poorest and underserved neighborhoods in San Francisco. To better understand the severity of the situation, it’s important to note that, prior to the clinic’s opening, there was one pediatrician to serve over 10,000 children.
The clinic intended to target typical health disparities, including access to care, immunization rates, and asthma hospitalization rates. Early on, the team hit all of the numbers and felt very proud of their work.
“But then I noticed a disturbing trend. A lot of kids were being referred to me for ADHD, or attention-deficit hyperactivity disorder, but when I actually did a thorough history and physical, what I found for most of my patients [didn’t make a diagnosis of ADHD],” Dr. Burke explains. “Most of the kids I was seeing had experienced such severe trauma that it felt like something else was going on. Somehow, I was missing something important.”
The answer lies in the results of the Adverse Childhood Experiences (ACE) Study, completed in 1998.
Led by Dr. Vince Felitti of Kaiser Permanente and Dr. Robert Anda of the U.S. Centers for Disease Control and Prevention (CDC), over 17,000 adults were asked about their history of exposure to adverse childhood experiences, which include physical, emotional, or sexual abuse, physical or emotional neglect, parental mental illness, substance dependence, incarceration, parental separation or divorce, or domestic violence.1 For every yes, participants received a point on their ACE score.
Then, they correlated the ACE scores against health outcomes. There are two major takeaways from these findings:
1. ACEs are incredibly common.
67 percent of the population had at least one ACE, and 12.6 percent — or one in eight people — had four or more ACEs.
2. There was a dose-response, or exposure-response, relationship between ACEs and health outcomes.
The higher your ACE score, the worse your health outcomes. For an individual with an ACE score of four or more, their risk of chronic obstructive pulmonary disease (COPD) was two-and-a-half times that of someone with an ACE score of zero. For hepatitis, it was also two-and-a-half times. For depression, the risk was four-and-a-half times higher. For suicidality, it was twelve times.
An individual with an ACE score of seven or more had triple the lifetime risk of lung cancer and three-and-a-half times the risk of ischemic heart disease, the number one killer in the United States.
Of course, some people reviewed these study results and determined it wasn’t science but simply bad behavior.
People with traumatic childhoods were more likely to smoke, drink, and make poor choices. Thus, their health was negatively impacted. Now though, we understand that it’s so much more than that. For instance, exposure to early adversity affects areas of the brain like:
the nucleus accumbens, the pleasure and reward center in the brain that is involved in substance dependence.
the prefrontal cortex, which is needed for impulse control and executive function.
the amygdala, the fear response center.
Based on these findings, there are neurologic reasons why people who experience childhood trauma are more likely to engage in high-risk behavior.
However, even if suffering individuals don’t engage in high-risk behavior, they are still more likely to develop heart disease or cancer. This correlation is because of the hypothalamic-pituitary-adrenal axis, the stress response system that is in charge of our fight-or-flight response.
Dr. Burke gives this example:
Imagine you’re walking in the forest and see a bear. Your hypothalamus sends a signal to your pituitary, which signals your adrenal gland to release stress hormones like adrenaline and cortisol. In response, your heart begins to pound, your pupils dilate, and your airways open up. You are ready to either fight that bear or run from that bear.
This response is perfectly normal and helpful if you’re in a forest and there’s a bear. The problem is what happens if that bear comes home every night, activating this system over and over again.
Based on the lasting impact of childhood trauma, it’s easy to understand that children are incredibly sensitive to this repeated activation. The system goes from being adaptive and life-saving to maladaptive and health-damaging.
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Reference:
1. Felitti, V.J. and Anda, R.F. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245-258. https://www.ajpmonline.org/article/S0749-3797(98)00017-8/fulltext