The ACE study and Toxic Stress

Two blog posts ago, I wrote about how we are experiencing a global, collective trauma. Because we are. I talked about how trauma is a response to an event, not necessarily the event itself.

Something that I’m deeply passionate about is helping people understand and perhaps even reframe the way they conceptualize and understand Trauma. What we are seeing right now is that trauma doesn’t just happen to them, but it happens to all of us. And we’re allowed to be mad about that. This was not the way the world was intended to be, and at our core, we pant for the restoration of all things, we pant for pain and sorrow to cease.

Over the past few years, I’ve dug into the research and the literature. I’ve educated myself about what trauma is and how, over the past two decades especially, our understanding of its effects on the body and the mind has grown extensively. My quest to know more about this really began when I was teaching in the inner-city. I knew that the behaviors I saw in my classroom, the irritability and difficulty focusing and aggression, was deeper and more complex than a DSM-5 diagnosis or a learning disability. Deep down, I knew that if my kids could control these seemingly irrational behaviors, they would. So, I began to read.

My desperate desire to understand what was going on inside of my kids’ minds and bodies led me to a study, and that study changed everything for me. It’s called the ACE study. I want to share it with you because I sincerely believe that this should be common knowledge for all of humanity. Trauma, and I’d argue childhood trauma, is the number one threat to public health, and it’s time we start to take that seriously.

Thanks to researchers Felitti and Anda, we know now with certainty that there is a biological link between childhood adversity and poor health. These two internal medical doctors set out to study how adverse childhood experiences (ACEs) effect health across the lifespan. They sampled over 17,000 people (which in researcher land, is a really significant sample size) and gathered information about ACEs and health.

So, what’s an ACE? There are many, but in Felitti and Anda’s groundbreaking study these are the ACEs they looked for: Emotional abuse; Physical abuse; Sexual abuse; Physical neglect; Emotional neglect; Substance abuse in the household (living with an alcoholic or a person with a substance-abuse problem); Mental illness in the household (living with someone who suffered from depression or mental illness or who had attempted suicide); Mother treated violently; Divorce or parental separation; Criminal behavior in the household.

What they discovered was that ACEs were incredibly common, in fact 67% of the sample had 1 ACE. They also found a dose-response relationship between ACEs and poor health outcomes. In other words, the higher the persons ACE score, the greater risk to his/her health. They found that a person with four or more ACEs was twice as likely to develop heart disease and cancer and three and a half times as likely to develop chronic obstructive pulmonary disease (COPD) as a person with zero ACEs. They found that a person with an ACE score of seven or more has TRIPLE THE LIFETIME ODDS of getting lung cancer and three and a half times the odds of having ischemic heart disease. They also found that having an ACE score of two or more doubles someone’s likelihood of developing an autoimmune disease. Interesting how autoimmune diseases seem to be on the rise these days…(*insert, slightly snarky but mostly curious face). Results from the study also indicated that people with a high ACE score are more likely to be violent, have more broken bones, do more prescription drugs, and be diagnosed with a depressive disorder.

In research world, it is very difficult to prove a causal relationship, to show that A causes B. It’s really hard to statistically and scientifically prove that A causes B because there are so many other variables that can also cause B that it’s really hard to say that it’s definitely A that is the culprit. But what Felitti and Anda proved (and what several other researchers later proved who replicated their research) was that ACEs are in and of themselves a risk factor for the most common and serious diseases in the United States.

So, you’re wondering why you hadn’t heard of this study before? I felt similarly when I discovered it. Before I explain why this may be new news, I need to tell you about Dr. Nadine Burke Harris.

Dr. Nadine Burke Harris, pediatrician and the current Surgeon General of California, has extended Felitti and Anda’s research. I already had a mad woman crush on her, and then a few weeks ago I started reading her book, The deepest well: Healing the long-term effects of childhood adversity, and my crush exponentially grew. It’s big, people. She is a pioneer in this field and has greatly expanded my knowledge of ACEs, toxic stress, and health across the lifespan.

In her book (*which I highly recommend you buy and read), she gives 3 reasons why this study isn’t common knowledge. First, she explains that it could be a misconception with the ACE study itself, and the popular belief that increased risks are only due to behavior. She says, “Popular thinking goes that if you live in poverty or have a rough childhood, you inevitably cope by drinking and smoking and doing other risky things that damage your health. But if you’re smart and strong, you rise above what you were born and raised with and leave the bad things behind. At first, this construct seemed to make sense, but remember, at one point it made perfect sense that the Earth was flat” (p. 40). She is fierce and feisty, and I love it.

Even if you don’t engage in any health damaging behaviors as a means to cope with trauma, a person is still more likely to develop heart and liver disease.

The second reason, she says, is because this is scary and emotional stuff. And she’s right, it is. It’s vulnerable stuff that takes courage to really face. She says, “It’s possible that we marginalize the impact of trauma on health because it does apply to us. It’s hard, after all, to accept that there might be biological implications that persist whether people are sinners or saints. Maybe it’s just easier to see it in other zip codes” (p. 41).

A third reason is because though this study proved that adversity is bad for your health, it didn’t tell us how, or the mechanisms by which this happens.

This study was published in the late 1990’s, and since that time and as technology has evolved, we have learned so much about the body’s stress-response system. Now, we know so much about the specifics, the biological, genetic, and neurophysiological means to the end. Thanks to Dr. Bessel Van Der Kolk, we know about how the brain and body store trauma and how they change in response to post-traumatic stress. We can literally see it in brain scans! Thanks to Dr. Dan Seigel, we know about Interpersonal Neurobiology and how attachment changes the brain and influences behavior. Thanks to Dr. Peter Levine, we have the Somatic Experiencing method to help people heal from trauma. Thanks to Dr. Stephen Porges, we know how the nervous system changes in response to trauma via the Polyvagal Theory, which has had vast implications for how we treat clients in therapy. Thanks to Dr. Bruce Perry, we know how maltreatment wires and shapes a child’s developing brain. 

We have come so far, and yet, we have so far to go.

We can no longer turn a blind eye to the reality of trauma and the true devastation that childhood trauma causes. We can no longer separate ourselves from this problem because while a global pandemic wasn’t one of the ACEs that these researchers tested, I am fairly confident that what our children are experiencing right now is inherently traumatic for them. Some might say that’s a dramatic even far-fetched claim. But knowing what I know about children’s bodies and brains, I don’t think it is. Yes, our children are resilient, but only if they have their basic needs met. Right now, children need healthy, self-regulated adults to help them understand what is going on in the world, to help soothe their nervous systems. They need their parents to attune to their emotions and validate their experiences. They need support and love and nurture because without it, they suffer.

This knowledge doesn’t need to breed fear or hopelessness. What it needs to breed is awareness and empowerment. We can do something about this. And we must. Also, thanks to neuroplasticity, our brains are malleable. They can change and our bodies can heal. But in order for healing to happen, we have to understand the reality and the gravity of the problem. We have to look at trauma and toxic-stress and acknowledge how damaging it truly is.

I hope you are all well and taking care of yourselves. It’s not just our kids that are feeling collective anxiety right now, us big kids are too. So, go easy on your mind and body. If you’re having a hard time, consider yourself normal (yay!) because all of us are undergoing a stress response right now, so for real…be gentle. These are triggering and challenging times for all.

With gratitude,

Rachel