We know that traumatic experiences can trigger both mental and physical health issues in adulthood. For example, a car accident or violent attack may lead to depression, anxiety, and post-traumatic stress disorder (PTSD) in addition to physical injuries.
But what about emotional trauma in childhood?
Research conducted over the last decade is shining a light on how adverse childhood events (ACEs) can affect a variety of illnesses later on in life.
A closer look at ACEs
ACEs are negative experiences that occur during the first 18 years of life. They can include various events like receiving or witnessing abuse, neglect, and various kinds of dysfunction within the home.
A Kaiser study published in 1998 found that, as the number of ACEs in a child’s life increases, so does the likelihood of “multiple risk factors for several of the leading causes of death in adults,” such as heart disease, cancer, chronic lung disease, and liver disease.
Another study examining trauma-informed care for survivors of childhood trauma found that those with higher ACE scores may also be at higher risk for autoimmune diseases such as rheumatoid arthritis, as well as frequent headaches, insomnia, depression, and anxiety, among others. There is also evidence that exposure to “traumatic toxic stress” can trigger changes in the immune system.
The theory is that extreme emotional stress is a catalyst for a number of physical changes within the body.
PTSD is a good example of this theory in action. Common causes for PTSD are often some of the same events recognized in the ACE questionnaire — abuse, neglect, accidents or other disasters, war, and more. Areas of the brain change, both in structure and function. Parts of the brain most affected in PTSD include the amygdala, the hippocampus, and the ventromedial prefrontal cortex. These areas manage memories, emotions, stress, and fear. When they malfunction, this increases the occurrence of flashbacks and hypervigilance, putting your brain on high alert to sense for danger.
For children, the stress of experiencing trauma causes very similar changes to those seen in PTSD. Trauma can switch the body’s stress response system into high gear for the rest of the child’s life.
In turn, the increased inflammation from the heightened stress responses may cause or trigger autoimmune diseases and other conditions.
From a behavioral standpoint, children, teens, and adults who have experienced physical and psychological trauma may also be more likely to adopt unhealthy coping mechanisms such as smoking, substance abuse, overeating, and hypersexuality. These behaviors, in addition to a heightened inflammatory response, can put them at a higher risk for developing certain conditions.
What the research says
Recent research outside of the CDC-Kaiser study has explored the effects of other kinds of trauma in early life, as well as what might lead to better outcomes for those exposed to trauma. While much research has focused on physical trauma and chronic health conditions, more and more studies are exploring the connecting between psychological stress as a predicting factor for chronic illness later in life.
For example, a study published in the journal Clinical and Experimental Rheumatology in 2010 examined the rates of fibromyalgia in Holocaust survivors, comparing how much more likely survivors were to have the condition against a control group of their peers. Holocaust survivors, defined in this study as people living in Europe during Nazi occupation, were over twice as likely to have fibromyalgia as their peers.
What conditions may be triggered by childhood trauma? That’s slightly unclear right now. Many conditions — especially neurological and autoimmune disorders — still have no single known cause, but more and more evidence is pointing to ACEs as playing an important role in their development.
For now, there are some definitive links to PTSD and fibromyalgia. Other conditions connected to ACEs may include heart disease, headaches and migraines, lung cancer, chronic obstructive pulmonary disease (COPD), liver disease, depression, anxiety, and even sleep disturbances.
Close to home
For me, this type of research is especially fascinating and fairly personal. As a survivor of abuse and neglect in childhood, I have a pretty high ACE score — 8 out of a possible 10. I also live with a variety of chronic health conditions, including fibromyalgia, systemic juvenile arthritis, and asthma, to name a few, which may or may not be related to the trauma I experienced growing up. I also live with PTSD as a result of the abuse, and it can be all encompassing.
Even as an adult, and many years after cutting off contact with my abuser (my mother), I often struggle with hypervigilance. I am overly alert to my surroundings, always making sure I know where exits are. I pick up on small details that others may not, like tattoos or scars.
Then there are flashbacks. Triggers can vary, and what might trigger me one time may not trigger me the next, so it can be hard to anticipate. The logical part of my brain takes a moment to evaluate the situation and recognizes that there’s not an imminent threat. The PTSD-affected parts of my brain take a lot longer to figure that out.
In the meantime, I vividly recall abuse scenarios, to the point of even being able to smell the scents from the room where the abuse occurred or feel the impact of a beating. My whole body remembers everything about how these scenes played out while my brain makes me relive them again and again. An attack can take days or hours to recover from.
Considering that total-body response to a psychological event, it’s not hard for me to understand how living through trauma might affect more than just your mental health.
Limitations of the ACE criteria
One critique of the ACE criteria is that the questionnaire is too narrow. For example, in a section about molestation and sexual assault, in order to answer yes, the abuser needs to be at least five years older than you and must have attempted to or made physical contact. The issue here is that many forms of child sexual abuse occur outside of these limitations.
There are also many kinds of negative experiences not currently counted by the ACE questionnaire, such as types of systemic oppression (for example, racism), poverty, and living with a chronic or debilitating illness as a child.
Beyond that, the ACE test doesn’t place negative childhood experiences in context with positive ones. Despite exposure to trauma, public health research has shown that access to supportive social relationships and communities can have a lasting positive impact on mental and physical health.
I consider myself well-adjusted, despite my difficult childhood. I grew up fairly isolated and didn’t really have a community outside of my family. What I did have, though, was a great grandmother who cared an awful lot about me. Katie Mae passed away when I was 11 from complications of multiple sclerosis. Up until that point, though, she was my person.
Long before I became ill with a variety of chronic health conditions, Katie Mae was always the one person in my family I looked forward to seeing. When I did get sick, it was like we both understood each other on a level that no one else could understand. She encouraged my growth, provided me with a relatively safe space, and fostered a lifelong passion for learning that continues to help me today.
In spite of the challenges I face, without my great grandmother I have no doubt that how I see and experience the world would be a lot different — and much more negative.
Confronting ACE in a clinical setting
While more research is needed to fully define the relationship between ACEs and chronic illness, there are steps that both physicians and individuals can take to better explore health histories in a more holistic way.
For starters, healthcare providers can start asking questions about past physical and emotional trauma during every well visit — or, even better, during any visit.
“Not enough attention is paid in-clinic to childhood events and how they influence health,” said Cyrena Gawuga, PhD, who co-authored a 2012 study about the relationship between early life stress and chronic pain syndromes.
“Basic scales like the ACE or even just asking could make critical differences — not to mention the potential for preventative work based on trauma history and symptoms.” Gawuga also said that there is still more research needed to study how socioeconomic status and demographics may bring up additional ACE categories.
However, this also means that providers need to become trauma-informed to better help those who disclose adverse childhood experiences.
For such people like me, this means being more open about the things we’ve been through as children and teens, which can be challenging.
As survivors, we often feel ashamed about the abuse we’ve experienced or even how we’ve reacted to trauma. I’m very open about my abuse within my community, but I have to admit that I haven’t really disclosed much of it with my healthcare providers outside of therapy. Talking about these experiences can open up the space for more questions, and those can be hard to handle.
For example, at a recent neurology appointment I was asked if there might be damage to my spine from any events. I truthfully answered yes, and then had to elaborate on that. Having to explain what happened took me to an emotional place that was difficult to be in, especially when I want to feel empowered in an exam room.
I found that mindfulness practices can help me manage difficult emotions. Meditation in particular is useful and has been shown to reduce stress and help you better regulate emotions. My favorite apps for this are Buddhify, Headspace, and Calm — each has great options for beginners or advanced users. Buddhify also has features for pain and chronic illness that I personally find incredibly helpful.
Despite gaps in the criteria used to measure ACEs, they represent a significant public health issue. The good news is that, by and large, ACEs are mostly preventable.
CDC recommends a variety of strategies that incorporate state and local violence prevention agencies, schools, and individuals to help address and prevent abuse and neglect in childhood.
Just as building safe and supportive environments for children is important for preventing ACEs, tackling issues of access for both physical and mental healthcare is crucial for addressing them.
The biggest change that needs to happen? Patients and providers must take traumatic experiences in childhood more seriously. Once we do that, we’ll be able to understand the link between illness and trauma better — and perhaps prevent health issues for our children in the future.