ACES (Adverse Childhood Experiences) and Trauma

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This link between health issues and trauma was discovered by accident in an obesity clinic in San Diego in 1985. Dr. Vincent Felitti was overseeing Kaiser Permanente’s department of preventative medicine. He noticed year after year, about half of the patients were dropping out after making progress. He accidentally asked a routine screening question about the age at which people became sexually active as ‘How much did you weigh when you had your first sexual experience? The answer was ‘40lbs’. It was discovered that this person had been sexually abused by their father at the age of 4. This question was asked to a sample of 286 people, and it turned out the majority had been sexually abused. There was a lot of disbelief about these findings when they were first presented. Felitti engaged in research from 1995-1997 with the help of Anda and interviewed a total of 17,421 patients. They were followed over the next 15 years. A direct correlation was found between childhood trauma, and adult onset of chronic disease, mental illness, prison time, work issues, and absenteeism. 2/3 had 1+ ACE. Around 12.5% had four or more ACES. The more ACES a person had, the greater their risk of these health issues. Scoring 4 or more on the ACES scale correlated to 240% greater risk of hepatitis, 390% greater chance of chronic obstructive pulmonary disease, 240% greater risk of a sexually transmitted disease, 2x more likely to be a smoker, 12x more likely to have attempted suicide, 7x more likely to be an alcoholic, and 10x more likely to use injectable street drugs.  This group experienced more violence, more marriages, more broken bones, more prescription drug use, more depression, auto-immune diseases, and work absences. This sample was average Americans with jobs and healthcare. It was comprised of 75% white, 11% Latino, 7.5% Asian, and 5% black. 40% had college degrees (Stevens, 2012).

Since that initial study, these results have been replicated globally in different countries. They have supported a link between suicidal behavior and ACES in South Africa, heavy drinking and ACES in the United Kingdom, illicit drug use in Brazil, and anxiety, depression and PTSD symptoms in South-East Asia. Meta-analyses have supported the significant negative effect that multiple ACES have on long-term physical and mental health outcomes, and self-harming behaviours (Thurston et al., 2023). This link is thought to be caused by hormonal, immunological and neurobiological impact of trauma on the developing child. These types of ongoing stresses can be toxic, increasing inflammation in the body and increasing allostatic load (Hardcastle et al., 2020).

To find your ACES score, there are ten questions on the questionnaire about your childhood experiences. Each is a potentially traumatic event or stressor, experienced from birth until 18 years old. This tool can be used to screen for dangerous levels of stress making a person more likely to smoke, have a SUD, develop heart disease or have chronic pain (Shulman & Maul, 2019). ACES are common in North America, with many people having at least one. It is estimated that 5.9-20% of people have 4 or more. Felitti et al. (1998) as cited in Bristow et al. (2021) classified child maltreatment in various forms and household dysfunction. The initial ACES included emotional, physical, and sexual abuse and emotional/physical neglect. Household challenges included exposure to Intimate partner violence between parents, household substance abuse, household mental illness, parental divorce or separation, and parental legal trouble/incarceration. Researchers Affifi et al. (2017) suggest spanking should be added as another ace, due to similar predictive correlations between that and negative adult health outcomes.

It is so important and validating to understand that our choices and coping mechanisms are shaped by our early experiences. This can help us let go of undue responsibility where we are blaming ourselves. Whether you are looking to address unresolved trauma or seeking support for addiction issues, Oceans Counselling has the expertise and resources to guide you on your healing journey. Don’t hesitate to reach out and take the first step towards a brighter, healthier future with their trauma counselling services.

References

Afifi, T. O., Ford, D., Gershoff, E. T., Merrick, M., Grogan-Kaylor, A., Ports, K. A., MacMillan, H. L., Holden, G. W., Taylor, C. A., Lee, S. J., & Bennett, R. P. (2017). Spanking and adult mental health impairment: The case for the designation of spanking as an adverse childhood experience. Child Abuse & Neglect, 71, 24-31. http://dx.doi.org/10.1016/j.chiabv.2017.01.014

Bristow, L. A., Afifi, T. O., Salmon, S., & Katzu, L. Y. (2021). Risky gambling behaviours: Associations with mental health and a history of adverse childhood experiences (ACES). Journal of Gambling Studies, 38, 699-716. https://doi.org/10.1007/s10899-021-10040-3

Hardcastle, K., Bellis, M. A., Sharp, C. A., & Hughes, K. (2020). Exploring the health and service utilization of general practice patients with a history of adverse childhood experiences (ACEs): An observational study using electronic health records. BMJ Open, 10(9). https:/doi.org/10.1136/bmjopen-2019-036239

Shulman, M., & Maul, A. (2019). Screening for adverse childhood experiences and trauma. Center for Health Care Strategies. https://www.traumainformedcare.chcs.org/screening-for-adverse-childhood-experiences-and-trauma/

Stevens, J. E. (2012, October 3). The Adverse Childhood Experiences Study- the largest, most important public health study you never heard of-began in an obesity clinic. Aces Too High LLC. https://acestoohigh.com/2012/10/03/the-adverse-childhood-experiences-study-the-largest-most-important-public-health-study-you-never-heard-of-began-in-an-obesity-clinic/

Thurston, C., Murray, A. L., Franchino-Olsen, H., & Meinck, F. (2023). Prospective longitudinal associations between adverse childhood experiences and adult mental health outcomes: A protocol for a systemic review and meta-analysis. Systemic Reviews, 12, 181. https://doi.org/10.1186/s13643-023-02330-1