CHILDHOOD TRAUMA AND ADULT ILLNESS

By Ellen Taliaferro, MD, FACEP

    Have you thought about your childhood lately? If you find yourself struggling with a medical, social, or behavioral disorder that seems to defy standard treatment, you might benefit from examining your childhood.

    We now have good evidence to support the link between adverse childhood experiences and later negative health effects in adulthood. The connection between those childhood experiences and later negative health effects are underscored by the decades-long, ongoing adverse childhood experiences (ACE) study, a collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente.

    This collaborative study began in the mid-1980s. Dr. Vincent Felitti and his colleagues working in an obesity program in Kaiser Permanente's Department of Preventive Medicine in San Diego noted that their patients who were most successful at losing weight were the ones most likely to drop out of the program. Examination of this unexpected observation revealed that the patients had been reaping sexual, physical, and emotional protective benefits from overeating and their subsequent obesity.

    This realization lead to another realization: From the patient's standpoint, obesity was not a problem but a solution. A solution to what? The ACE study soon began to supply answers by finding common adverse childhood experiences in the patients participating in the study.

    To date, ten adverse experiences consisting of abuse, neglect, and household dysfunction have been identified, falling into these categories of experiences during the first 18 years of life:

• Abuse:

1. Emotional
2. Physical
3. Sexual (by contact)

• Neglect

1. Emotional
2. Physical

• Household dysfunction:

1. Watching mother being battered
2. Parental separation, divorce, or loss in childhood
3. Mental illness in household
4. Incarcerated household member
5. Presence of alcohol and/or substance abuse

   As the ACE study progressed, the researchers noted that patients who had one adverse childhood experience in their lives were at risk for having additional adverse childhood experiences. For instance, growing up in a household where the mother was battered increased the patients' risk of having one or more adverse childhood experiences in the form of:

• Emotional abuse
• Physical abuse
• Sexual abuse
• Emotional neglect
• Physical neglect
• Parental separation or divorce
• Substance abuse
• Mental illness

    Thanks to this study, we now know that approximately two-thirds of our population has an ACE score of 1 or higher. The higher the score, the more likely a person will be to:

• Smoke or abuse alcohol or drugs
• Experience unintended pregnancy, teen pregnancy, miscarriage, and stillbirth
• Be promiscuous, have sex before the age of 14, and have sexually transmitted diseases
• Have poor work performance
• Attempt suicide
• Experience depression and have a poor health-related quality of life
• Have liver disease, ischemic heart disease, diabetes, obesity, and experience other leading causes of death in the United States.
• Experience a high level of perceived stress
• Have difficulty in controlling anger
• Have an increased risk of becoming a perpetrator of relationship abuse or domestic violence

    The researchers conducting the ACE study note that their findings likely reflect the accumulative neurobiological effects of early trauma and stress in a person's life. Such accumulation of stress and trauma can result in long-term changes in brain function and structures. In turn, these changes can impact adult emotional and physical responses to stress and contribute to substance abuse, sexuality and memory disturbances as well as aggression.

    Adult response to childhood trauma in the form of disease and behavioral disorders can appear late in life, masking the relationship between the distant trauma and current life problems. To compound matters, such adult disease and behavioral disorders are often complex and resistant to standard biologic treatment.

    The ACE Study researchers recommend an approach that addresses the early childhood trauma as well as the adult disease and distress. When treating patients with past adverse childhood events, these physicians augment standard pharmacological treatment with the use of medical interviews and autobiographical writing to explore how their patients perceive that the earlier childhood events have shaped their adult life and well-being.

Ellen Taliaferro, MD, FACEP

www.healthaftertrauma.com

www.savingcindy.com

www.ellentaliaferro.com

ellent@mac.com

Ellen H. Taliaferro, MD, FACEP, is the Project Director of the Health After Trauma project of Creekside Communications. She is an author, speaker and expert witness in the area of the medical response to intimate partner violence. In 1998, she founded the Parkland Hospital Violence Intervention and Prevention (VIP) Center in Dallas, TX, and served as its Medical Director until returning home to California in 2001. She was the co-founder and former Executive Director of Physicians for a Violence-free Society (PVS).

Dr. Taliaferro co-authored the Physicians Guide to Domestic Violence. She is the editor of the Journal of Emergency Medicine Section on Violence: Recognition, Management, and Prevention, which published a series of articles on manual strangulation in October of 2001. For that series of articles, she wrote the lead article, “Walking and Talking Victims of Strangulation. Is There a New Epidemic?”