#1 in my news blog series; original post August 30, 2013
I’d heard of the Adverse Childhood Experiences (ACE) Study — but never asked why does their logo pyramid top with “Early Death“? [FN1] Then last week I stumbled onto a highly-informative website, ACEsConnection.com, social media site for the ACE Study, which has the story and then some. [FN2]
In the ACE Study, 17,337 middle class adults at an average San Diego HMO were asked during 1995-97 if they’d had bad childhood experiences, physical or emotional. Results were shocking. Two-thirds (64-67%) had one or more types of child trauma, and 38-42% had two or more types. In 2016, the same survey in inner city Nashville showed that 71% had four or more types and 51% had six or more. I believe a true national average would show some 50% of Americans suffer childhood trauma. [FN3]
The ACE Study then compared ACE scores to whether subjects developed serious bio-medical conditions as adults – and found a major correlation. As the ACE Pyramid shows, Adverse Childhood Experiences lead to impaired thinking, unhealthy behavior, disease, disability, and early death.
“Adverse childhood exposures showed a graded relationship to … adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease,” study co-directors Dr. Vincent Felitti MD and Dr. Robert Anda MD reported in 1998. [FN4]
They also showed a “proportionate relationship between ACE score and the likelihood of developing autoimmune diseases decades later in adult life.” Emotional disorders? They found “depression, suicidality, chronic anxiety, amnesia, and hallucinations were directly proportionate” to ACE trauma.
“It’s not about ‘them’ – it’s about us,” said Dr. Anda of these huge percentages and widespread lethal results. ACEs are “the leading determinant of what happens to the health of a nation’s population,” says Dr. Felitti.
The ACE Study began in 1995 at Kaiser Permanente, the largest HMO in California, jointly with the U.S. Centers for Disease Control (CDC). But this rigorous research hasn’t woken up medicine and psychiatry, despite the fact that Felitti, Anda et. al. have published over 75 medical articles on it. [FN5]
You’ve likely never heard of this, ‘tho we all should know about 20 years of official study on 17,337 citizens. I never heard of it even as a Kaiser Permanente client in 2010-11. So ACEsConnection is going to the grass roots, some states are doing ACE surveys, and social service agencies are training staff in “Trauma-Informed Care.”
Dr. Felitti never dreamed of any of this. He was an internist who fell into it all by accident. Kaiser had an obesity clinic, it was failing, and Dr. Felitti wanted to know why. Suddenly, by interviewing people who quit, this data jumped into his lap.
Now instead of retiring to the Bahamas after a long career, Dr. Felitti travels the world making speeches like “Why the Most Significant Factor Predicting Chronic Disease May Be Childhood Trauma” [FN6]
He insists that “contrary to conventional belief, time does not heal all wounds, since humans convert traumatic emotional experiences in childhood into organic disease later in life.” One does not “just get over” this, “not even 50 years later,” he says, without serious efforts and treatment. [FN7]
Baby Casey: the Attachment Disorder ACE
This is not an academic issue. Fifty percent of the American population has some degree of attachment disorder (see Blogs #1-4), and attachment disorder is a major component of many Adverse Childhood Experiences (ACE).
On ACEsConnection.com, created by journalist Jane Stevens, the first thing I saw was a video of a baby in a Polish orphanage that turned me inside out (click here & scroll down page). [FN8]
This is what the physical pain of attachment failure looks like. Left alone for months in the Warsaw facility, Baby Casey did not get the “face time,” physical holding, emotional attunement, or any of the interactions required for an infant’s brain to grow. Humans from birth require a constant stream of “emotional, spiritual, psychological, and physical inputs” from another loving human, says trauma specialist Mary Jo Barrett — just as we require air, food, and liquid.” [FN9]
A child left without this input stream learns that its own hard-wired biological needs are terrifying. “I learn that what I experienced internally and expressed externally with a cry, was met by a response that didn’t make any sense,” says neuroscientist Dr. Daniel Siegel. “I learned: it doesn’t matter what I’m feeling, because people don’t get what I need. Ultimately, I’ll become disconnected, not only from other people, but even from my own internal bodily self. ”[FN10]
Babies are also hard-wired to be flooded with stress chemicals when those needs are not met, Dr. Bruce Perry explains. And the flood can go on for decades. [FN11]
The emotional pain and terror are so intense that the child will do anything to distract itself from those needs. “In states of distress I can only comfort myself in ways that are maladaptive – I bite myself, rock myself perpetually, so I’m distracting myself from my needs,” Siegel says.
The fight-or-flight stress chemicals flood the bloodstream at a level which feels so terrifying, that the baby would rather pass out — or even die — than to feel it. “The baby thinks it’s going to die,” as Dr. Nancy Verrier puts it. [FN12] I saw this video and said, “That baby’s trying to knock herself out.”
Turning Gold into Lead
“The ACE Study findings suggest certain adverse childhood experiences are major risk factors for the leading causes of illness and death in the US,” the CDC reports. “As the number of ACE increase, risk for the following health problems increases in a strong and graded fashion:
Ischemic heart disease
Chronic lung disease
Alcoholism and alcohol abuse
Early initiation of smoking
Illicit drug use
Multiple sexual partners
Risk for intimate partner violence
Sexually transmitted diseases (STDs)
“The odds of having cancer before 50 among women increased twofold for those who had 2+ ACEs versus those with no ACEs,” confirmed a 2012 study of over 6,000 Britons born in 1958, “Childhood adversity as a risk for cancer: findings from the 1958 British birth cohort study,” published by the British Medical Council.
“This is the largest study of its type which has ever been done to examine the effect of ACE on physical health, over the course of a lifetime,” Dr. Felitti says. All 17,337 participants will be followed up for life.
“We’re asking, ‘How do you get from Here [slide above] to Here.’ From a newborn infant with total potential — to a man who is broken, bio-medically, psychologically and emotionally.
“We found that ACEs are remarkably common – what is uncommon is their recognition, or their acknowledgment. They are well-concealed by time, by shame, by secrecy, and by social taboo. They turn out to be strong predictors of what happens later in life in health risks, disease, and premature mortality. The combination of their high prevalence, and their great power, makes ACEs the leading determinant of what happens to the health of a nation’s population.” [FN13]
“In no way could you dismiss this as a marginalized population,” Dr. Felitti says of his 17,337 patients. Most of them are white middle class; 47% had attended college; they all had jobs and health insurance; they were at Kaiser.
“ACE are the risk factors which underlie the 10 most common causes of death in the U.S. With an ACE score of zero, you have a very medically uninteresting population – no internist has a chance of making a living with that group,” he notes.
“Swiss psychoanalyst Alice Miller says: ‘The truth about our childhood is stored up in our bodies, and lives in the depths of our souls. Our intellect can be deceived, our feelings can be numbed and manipulated, our perceptions can be shamed and confused, or our bodies tricked with medication. But our soul never forgets. And because we are one, one whole soul in one body, some day, our body will present its bill.’
“In this study, we are looking at it literally. The cost of this is truly enormous. Whoever would have thought that pediatrics is the breeding ground for internal medicine,” Dr. Felitti concludes.
Feel like you might have an ACE or two up your sleeve?
You can go to http://acestudy.org/faqs and take the ACE Survey, to see how many ACEs you might have. If you feel really awful, go to your family doctor, bring him this report, and tell him you want to see a specialist because you are a normal human responding to abnormal experiences. If you do not have health coverage, no matter what your age, you can contact the nearest children’s hospital or the National Children’s Advocacy Center’s local office and ask for help. At www.nationalcac.org/locator.html, I used my zip code and found four places right near my home, just so I could report to you that they probably have facilities to help near you.
To read more, join ACEsConnection.com, the community of practice “private Facebook” network designed to prevent ACEs & further trauma and to increase resilience. Just sign up, fill out your profile, and go to “My Page” to start adding information about what you’re doing or thinking about these issues. If you’re looking for others doing what you want to do, join a group, or start a group and invite people to join. I joined, and I formed a Southern California ACEs group; here’s my SoCal ACEs page: http://www.acesconnection.com/profile/399727599840151624
Excerpts from Kathy’s forthcoming book DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder – How I accidentally regressed myself back to infancy and healed it all are posted here most Fridays, unless current events beg an interruption. Watch for the continuing series of excerpts from the rest of her book, in which she explores her journey of recovery and shares the people and tools that have helped her along the way.
FN1 CDC ACE Study pyramid: http://www.cdc.gov/ace/pyramid.htm
FN2 Centers for Disease Control (CDC), “ACE Study DVD Pre-View movie,” 3-minute version: http://www.acesconnection.com/blog/ace-study-co-founders-tell-story-on-dvd-here-s-an-intro
FN3 Dr. Felitti reports 67% of participants had one or more types of ACEs, and 42% had two or more types of ACEs. The CDC website states that 64% had one or more types of ACEs, and 38% had two or more types of ACEs; http://www.cdc.gov/violenceprevention/acestudy/prevalence.html These percentages varied depending on when readings were taken as more subjects joined the study in the second “wave.”
Note: all these refer to “types” of ACEs. Thus, if 38-42% of the middle class Kaiser population had at two or more types of ACEs, each likely suffered multiple incidents of that type, be it abuse, neglect, or more.
In less privileged populations, far higher percentages suffer two or more types of ACEs as shown in Nashville, TN by The Family Center in 2016: http://www.familycentertn.org/our-impact
FN4 “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study,” by Vincent J Felitti MD, Robert F Anda MD, et al, American Journal of Preventative Medicine, May 1998, Vol 14, Issue 4, p 245–258
FN5 Felitti, Vincent, MD, “Adverse Childhood Experiences” www.youtube.com/watch?v=GQwJCWPG478
FN6 Felitti, Vincent, MD, official speaker biography at www.apbspeakers.com/speaker/vincent-felitti
FN7 Stevens, Jane, “The Adverse Childhood Experience Study” — the largest, most important public health study you never heard of — began in an obesity clinic” also published by Huffington Post at http://www.huffingtonpost.com/jane-ellen-stevens/the-adverse-childhood-exp_1_b_1943647.html
FN8 Brooks, John, “Video of Baby Casey in the Orphanage,” Warsaw, Poland, 1991, from Brooks, John, “The Girl Behind the Door: An Adoptive Father’s Lessons Learned About Attachment Disorder,” at http://parentingandattachment.com/the-girl-behind-the-door/. Baby Casey video at http://acestoohigh.com/2013/08/02/the-early-heartbreaking-rages-of-a-baby-with-attachment-disorder/. Original video at http://parentingandattachment.com/meet-my-casey/.
FN9 Barrett, Mary Jo, MSW, “How to Treat the Patient Without Further Trauma,” NICABM webinar June 29, 2011, NICABM.com. She is a professor at the University of Chicago; founder and director of the Center for Contextual Change; co-author of “Systemic Treatment of Incest;” and co-editor of “Treating Incest: A Multiple Systems Perspective.”
FN10 Siegel, Daniel J., MD, “Early childhood and the developing brain,” “All in the Mind,” ABC Radio National, Australia.
FN11 Perry, Bruce, MD, PhD, “Born for Love: The Effects of Empathy on the Developing Brain,” speech at conference “How People Change: Relationship & Neuroplasticity in Psychotherapy,” UCLA Extension, Los Angeles, March 8, 2013. See also “Overview of Neuro-sequential Model of Therapeutics (NMT),” www.childtrauma.org, 2010
FN12 Verrier, Nancy, PhD, “Coming Home to Self: The Adopted Child Grows Up,” self-published, Lafayette, CA, 1993
FN13 Op Cit Footnote 3, Felitti 13 minute video at http://www.youtube.com/watch?v=GQwJCWPG478
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