Although experiencing childhood trauma is something that can leave us feeling isolated and different from our peers, 75 percent of children report experiencing at least one traumatic event. This means that most of us have faced at least one destabilising or terrifying situation and its emotional after effects. When we are children, we don’t have the kind of emotional awareness or contextual information that can help us process trauma.
For many years we thought that childhood trauma could impact life trajectory, especially in terms of predicting our future relationships but it wasn’t until 1998 that the Centre for Disease Control and Prevention (CDC) and Kaiser Permanente published their Adverse Childhood Experiences (ACEs) Study based on seventeen thousand adult patients and how their childhood trauma exposure affected their mental and physical health in later life. This ground breaking study proved the theory, there is a connection between ACEs and future health challenges, and that the more traumatic childhood experiences we had, the more health concerns we are likely to have in our adulthood.
The ten ACE that were investigated were; emotional, physical, and sexual abuse, physical or emotional neglect, domestic violence, parental mental illness, substance dependence, incarceration, and parental separation or divorce. The demographic information for those included in the study are that participants were almost 75 percent white, about half were sixty years of age or older, and 39 percent of them had completed college, almost 75 percent of those studied reported at least one ACE. One in eight reported four or more ACEs.
I’ve done the questionnaire, who doesn’t love a quiz?! With that in mind please find below an adapted version of part of an ACE Questionnaire for you to have a look at:
When you were growing up, during the first 18 years of your life . . .
Did you live with a household member who was a problem drinker or alcoholic, or misused street or prescription drugs?
Did you live with a household member who was depressed, mentally ill or suicidal?
Did you often see or hear a parent or household member in your home being yelled at, screamed at, sworn at, insulted or humiliated?
Did you often see or hear a parent or household member in your home being slapped, kicked, punched or beaten up?
Did you see or hear a parent or household member in your home being hit or cut with an object, such as a stick (or cane), bottle, club, knife, whip etc.?
Did a parent or other adult in the household often or very often push, grab, slap, or throw something at you? Or ever hit you so hard that you had marks or were injured?
Did an adult or person at least five years older than you ever touch you or have you touch their body in a sexual way? Or attempt or actually have oral, anal, or vaginal intercourse with you?
Did you often or very often feel that no one in your family loved you or thought you were important or special?
Did you often or very often feel that you didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you?
Was a biological parent ever lost to you through divorce, abandonment, or other reason?
For every yes, give yourself one point; the total number is your ACE score.
You may think well its common sense that people who were traumatised as children will be more likely to drink, or take drugs, or engage in other risky behaviours, but the results don’t only show behavioural consequences, they show physiological consequences.
The CDC and Kaiser Permanente took these ACE scores and compared them with people’s physical health outcomes. They found that people with an ACE score of 4 or more were four and a half times more likely to suffer from depression than someone with an ACE score of 0, and twelve times more likely to struggle with suicidality.
They also found those with an ACE score of 4 or more were two and a half times more likely to have hepatitis, chronic obstructive pulmonary disease (COPD), and many other health concerns.
The Neurophysiology of Stress
When we get scared or stressed, our body sends the signal to our brain to release stress hormones, such as adrenaline and cortisol, and we enter our fight/flight/freeze response. This makes our heart pump faster, our airways open so we can breathe better, our pupils dilate so we can see more clearly, we are ready for action. This stress response helps keep us alert and alive – we can run from danger or we can fight back against a predator, after the danger is gone, we move back in to homeostasis and emotional equilibrium is restored.
The Healthy Stress Response
The Unresolved Stress Response
If we grow up experiencing ongoing stress, the stress response is engaged for prolonged periods of time and the stress becomes what the ACEs Study refers to as “toxic stress” and this affects our brain development. It can decrease the efficacy of the nucleus accumbens, reward centre of our brain, which is responsible for sending a signal alerting our midbrain to release more dopamine, making us feel great. When this part of our brain isn’t as responsive as it should be we can experience anhedonia or become prone to depression. It has been hypothesized that this is what leaves those of us with a high ACE score vulnerable to addiction – using drugs or alcohol to get that rewarded feeling.
Elevated ACE scores can also impact the amygdala, the bit responsible for initiating our fear response. If the amygdala activated too frequently, it can become enlarged and lead to symptoms of hypervigilance, eventually leading us to chronic anxiety and an inability to trust our own perceptions of danger – because everything feels uncertain and frightening.
The prefrontal cortex is responsible for our ability to take in information and for making decisions based on that information. It helps us to make decisions based on both our emotions and thoughts. If this part of our brain is impaired we become impulsive, struggle to plan and work toward goals.
The ACE questionnaire continually mentions “often or very often” when asking us if something happened to us when we were young. The ACEs are examples of experiences that could cause us to have C-PTSD, so rather than there being trauma of the one big event type these are experiences that cause us to have Complex Post Traumatic Stress.