Understanding Trauma in Childhood – Exposure and risk; the ACE study.
The ACE-study itself.
Initially the ‘Adverse Childhood Experiences Study’ or ACE-study was conducted by Vincent Felitti. He wondered why so many people did drop out of his losing weight program despite successfully losing the weight. He discovered that a majority of 286 people he interviewed had experienced childhood sexual abuse. The interview findings suggested to Felitti that weight gain might be a coping mechanism for depression, anxiety, and fear.
Later Felitti and Robert Anda went on to survey childhood trauma experiences of over 17,000 Kaiser Permanente patient volunteers. The 17,337 participants were volunteers from approximately 26,000 consecutive Kaiser Permanente members. About half were female; 74.8% were white; the average age was 57; 75.2% had attended college; all had jobs and good health care, because they were members of the Kaiser health maintenance organization. Participants were asked about different types of childhood trauma that had been identified in earlier research literature.
What traumatic events were taken into account in the ACE-study?
Research found that our risk for mental and physical health problems from a past trauma goes up with the number of traumatic events you’ve experienced. For example, your risk for problems is much higher if you’ve had three or more negative experiences, called Adverse Childhood Experiences (ACEs). If you click the link, you can get a feeling what experiences are brought into account and you can calculate your score.
Adverse Childhood Experiences include physical abuse, sexual abuse, emotional abuse, physical neglect, emotional neglect, witnessing domestic violence, substance misuse within the household, mental illness within the household, parental separation or divorce and incarceration of a household member.
What were the findings of the ACE-study?
Adverse childhood experiences are common. 28% of study participants reported physical abuse and 21% reported sexual abuse. Many also reported experiencing a divorce or parental separation, or having a parent with a mental and/or substance use disorder.
Adverse childhood experiences often occur together. Almost 40% of the original sample reported two or more ACEs and 12.5% experienced four or more. They often occur in clusters.
As researchers followed participants over time, they discovered that a person’s cumulative ACEs score has a strong, graded relationship to numerous health, social, and behavioral problems throughout their lifespan, including substance use disorders. Furthermore, many problems related to ACEs tend to be comorbid, or co-occurring.
Why is this so important?
Early exposure to adversities affects the body and brains of children. It affects the pleasure and reward system of the brain, the nucleus accumbens. It inhibits the prefrontal cortex (impulse control and executive functions, learning ability) On MRI-scans we see differences in the amygdala, the region in the brain responsible for fear response.
Based on these findings we can conclude that people who experienced a high score on the ACE questionnaire are more likely to involve in high-risk behavior later in life. Even when you don’t engage in high risk behavior you are still more likely to develop heart disease or cancer. This has to do with the HPA-axis in your brain or what sets your fight or flight response in action. If you want to know more about the HPA-axis, you can read ‘What stress can do to your body’.
In short, when your HPA-axis works overtime because of high doses of stress, you stay in a more stressed state. There are consequences on your immune and hormonal system.
Now you have an understanding what trauma can be next week I’ll look into the health risks engaged with the occurrence of traumatic events in childhood.
References and resources.
TED talk from Nadine Burke Harris on YouTube.
Online article Harvard Health Publishing (2019). Past trauma may haunt your future health.
Website trauma dissociation where you can find the Adverse Childhood Experiences Questionnaire and other useful information related to trauma.
 Stevens, Jane Ellen (8 October 2012). “The Adverse Childhood Experiences Study — the Largest Public Health Study You Never Heard Of”. The Huffington Post.
Illustration credits click here.