The ACE Study: Finding a new fix

This month, we are exploring The Intersection between childhood trauma and adult adverse health outcomes. 

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Have you heard of the ACE study? It resulted in the largest public health discovery of our time and possibly of all time, but you likely have no idea what I’m talking about…yet.

It all began with interviews Dr. Vincent J. Felitti conducted with individuals who were obese and participating in a weight loss study:

Of the 286 people whom Felitti and his colleagues interviewed, most had been sexually abused as children. As startling as this was, it turned out to be less significant than another piece of the puzzle that dropped into place during an interview with a woman who had been raped when she was 23 years old. In the year after the attack, she told Felitti that she’d gained 105 pounds.

“As she was thanking me for asking the question,” says Felitti, “she looks down at the carpet, and mutters, ‘Overweight is overlooked, and that’s the way I need to be.’” [Source]

The first thing that shocked Felitti and his team of researchers was how common experiences of child sexual abuse were among their research subjects. Prior to this study, he had received only one disclosure of child sexual abuse in his career. Was it possible that child sexual abuse was much more common than previously thought? (Yes.)

Beyond this surprising data, another profound insight awaited:

During that encounter, a realization struck Felitti. It’s a significant detail that many physicians, psychologists, public health experts and policymakers haven’t yet grasped: The obese people that Felitti was interviewing were 100, 200, 300, 400 [pounds] overweight, but they didn’t see their weight as a problem. To them, eating was a fix, a solution. (There’s a reason an IV drug user calls a dose a “fix”.)

One way it was a solution is that it made them feel better. Eating soothed their anxiety, fear, anger or depression – it worked like alcohol or tobacco or methamphetamines. Not eating increased their anxiety, depression, and fear to levels that were intolerable.

The other way it helped was that, for many people, just being obese solved a problem. In the case of the woman who’d been raped, she felt as if she were invisible to men. In the case of a man who’d been beaten up when he was a skinny kid, being fat kept him safe, because when he gained a lot of weight, nobody bothered him. In the case of another woman — whose father told her while he was raping her when she was 7 years old that the only reason he wasn’t doing the same to her 9-year-old sister was because she was fat — being obese protected her. Losing weight increased their anxiety, depression, and fear to levels that were intolerable. [Source]

The realizations from the weight loss study led to the ACE Study, one of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being. What were the startling findings from this study?

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Image Credit: Des Moines University

  • ACEs are common: nearly two-thirds (64%) of adults have at least one.
  • They cause adult onset of chronic disease, such as cancer and heart disease, as well as mental illness, violence and being a victim of violence.
  • ACEs don’t occur alone. If you have one, there’s an 87% chance that you have two or more.
  • The more ACEs you have, the greater the risk you have for chronic disease, mental illness, committing violence and being a victim of violence.*
  • Childhood adversity contributes to most of our major chronic health, mental health, economic health and social health issues. ACEs are responsible for a big chunk of workplace absenteeism, and for costs in health care, emergency response, mental health and criminal justice.

What explains this connection between adverse childhood experiences and adult mental illness, physical illness, violence, and shortened life spans? Much of the answer lies in the neurobiology of trauma—i.e., how trauma impacts the brain and body:

Stress is the body’s normal response to challenging events or environments. Positive stress — the first day of school, a big exam, a sports challenge — is part of growing up, and parents or caregivers help children prepare for and learn how to handle positive stress, which is moderate and doesn’t last long. It increases heart rate and the amount of stress hormones in the body, but they return to normal levels quickly.

But when events or the environment are threatening or harmful – we stumble across a bear in the woods – our brains instantly zap into fight, flight or freeze mode and bypass our thinking brains, which can be way too analytical to save us (Is the bear really mean? Is it more interested in berries or killing me? Should I wait until I see it charge?). With help from caring adults, children also recover from this tolerable stress.

Too much stress – toxic stress – occurs when that raging bear comes home from the bar every night, says pediatrician Nadine Burke Harris. Then a child’s brain and body will produce an overload of stress hormones — such as cortisol and adrenaline — that harm the function and structure of the brain. This can be particularly devastating in children, whose brains are developing at a galloping pace from before they are born to age three. Toxic stress is the kind of stress that can come in response to living for months or years with a screaming alcoholic father, a severely depressed and neglectful mother or a parent who takes out life’s frustrations by whipping a belt across a child’s body. [Source]

Based on what he learned from this research, Dr. Felitti now warns that it is a profound error to mistake someone’s solution for their problem. To address unhealthy coping behaviors, we must identify and address the underlying trauma and associated toxic stress that are already fundamentally unhealthy for those living with it.

Understanding trauma helps us in many ways. It helps us understand what behaviors are traumatizing, including physical and non-physical abuse. It helps us understand how unresolved trauma can impact people severely and for a lifetime. It helps us understand why trauma survivors may act in “strange” or seemingly counter-intuitive ways that “don’t make sense.”

Finally, it helps us address, rather than dismiss, traumatizing violence. Eliminating toxic stress among children would have a profound impact on the health and well-being of individuals and entire populations.

You may not have heard of ACEs before now, but chances are you’ve lived them. And as you read this, children are currently enduring adverse childhood experiences that will put them at a higher risk for a multitude of mental, physical, and behavioral health issues.

How can you fix this?

  • First, you can find out your ACE score here and visit www.acestoohigh.com to get more informed.
  • Recognize the prevalence of ACEs and their connection to most community health challenges. Resist re-traumatizing those who have experienced ACEs.
  • Spread the word! Share this information with others.
  • Ask yourself:
    • “How can I be more trauma-informed? How can I work in a way that is more trauma-informed?”
    • “How can I act in my sphere of influence to ensure the children around me are protected from ACEs?”
    • “How can I act in my sphere of influence to increase social support and other protective factors for children who have already had adverse childhood experiences?”

You have a role to play in addressing community health challenges and creating opportunities for people to lead healthier lives. What’s your fix going to be?

 

*People with an ACE score of 4 are twice as likely to be smokers and seven times more likely to be alcoholic. Having an ACE score of 4 increases the risk of emphysema or chronic bronchitis by nearly 400 percent, and suicide by 1200 percent. People with high ACE scores are more likely to be violent, to have more marriages, more broken bones, more drug prescriptions, more depression, and more autoimmune diseases. People with an ACE score of 6 or higher are at risk of their lifespan being shortened by 20 years. [ACEs 101]

 

Additional Resources:

The Adverse Childhood Experiences Study — the largest, most important public health study you never heard of — began in an obesity clinic

TED Talk: How childhood trauma affects health across a lifetime

Toxic Stress, Behavioral Health, and the Next Major Era in Public Health

Interview with Dr. Rebecca Campbell on the Neurobiology of Sexual Assault

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