Emotional, psychological and physical abuse during childhood lay the groundwork for the onset of mental illness, addiction and self-destructive behavior in later life. A long-range study carried out by the Centers for Disease Control and Prevention, in conjunction with Kaiser Permanente’s Health Appraisal Clinic in San Diego, has provided a wealth of data to back up this assertion. Researchers associated with the Adverse Childhood Experiences (ACE) Study initially collected data on 17,000 volunteers from 1995 through 1997. Follow-ups were performed repeatedly in subsequent years to track the life changes participants experienced. Common sense and decades of clinical practice had already made the link between youth-based trauma and adulthood dysfunction. But until the ACE Study, no one really knew how direct the relationship was. Now recognized as a landmark in its field, this project is one of the most scrutinized, dissected and widely cited epidemiological studies ever sponsored. So much valuable information was gathered that it is still being analyzed and written about even today.
Toxic Stress: The ‘Gift’ That Never Stops Giving
Mental health professionals use the term toxic stress to describe the intense emotional states young people experience when they are subjected to one or more adverse childhood experiences. Young people are reduced to helpless bystanders when stress-inducing events take place, uncertain of the outcome and unable to protect themselves from the frightening or dangerous behavior of adults. Their emotional equilibrium is destabilized, hampering neurological development and short-circuiting the areas of the brain designed to help them manage stress. These changes appear to endure as stressed children grow, putting them at grave risk for future problems. Toxic stress can be felt in response to a single incident of emotional trauma or from exposure to ongoing patterns of dysfunction and abuse. Researchers designed the questionnaire used in the ACE Study to detect and identify any and all stressors participants may have experienced. Ten categories of adverse childhood experiences were measured in the ACE Study, and they are listed below (with the percentage of participants reporting them in parentheses):
- Emotional abuse (10.6)
- Physical abuse (28.3)
- Sexual abuse (20.7)
- Emotional neglect (14.8)
- Physical neglect (9.9)
Household exposure to:
- Mental illness (19.4)
- Domestic abuse (12.7)
- Substance abuse (26.9)
- Divorce (or death) (23.3)
- Incarceration (4.7)
Approximately 64 percent of study subjects had suffered at least one type of adverse experience as children. The 36 percent who reported no adverse experiences was slightly surpassed by the 38 percent who survived two or more of these known sources of toxic stress. One out of eight study volunteers reported four or more adverse experiences. Not surprisingly, the people in this category had the highest incidence of mental health troubles, encounters with addiction and involvement in risky behaviors. Women reported approximately 20 percent more adverse childhood experiences than men, and in particular were far more likely to have undergone emotional or sexual abuse. In general—and to the shock of no one—the more “yes” answers recorded for the above categories, the more likely a person was to have a history of mental health or behavioral problems. Among other troubling conditions, diverse childhood history elevated the risk for:
- Alcohol abuse
- Illicit drug use and addiction
- Depression
- Anxiety disorders
- Sexual addiction
- Exposure to violence at the hands of an intimate partner
- Nicotine addiction
- Heart and/or lung disease (associated with some of the above problems)
- Suicide
When moving from zero exposure to toxic stressors to just one exposure, the risk of suicide doubled. The percentage of risk doubled again for those with two adverse childhood experiences. For those with five, six and seven exposures, the lifetime risk for a suicide attempt was 13.8 percent, 21.8 percent and 35.2 percent respectively—and naturally these statistics don’t reflect successful suicide attempts. To put this in perspective, only 1.1 percent of those with no adverse childhood exposures had ever attempted suicide.
Finding Strength on the Other Side of Adversity
The Adverse Childhood Exposure Study provided physicians, educators, social workers, therapists, prison psychologists, nonprofit managers, legislators and public health officials at the national and state levels with a treasure trove of scientific data. Over the past decade or so, trauma-informed approaches to intervention have been introduced in a number of settings where dysfunctional behavior and mental health troubles are suspected or known to be running rampant. In this style of engagement, full disclosure of past experience is encouraged, and frank and honest discussion about childhood suffering and trauma is considered a prerequisite for healing and improved life choices. The ACE Study has functioned as a conscious-raiser and a wakeup call for those assigned to work with troubled youth and adults. The information obtained has given them the crucial insights they need to make positive, lasting impacts in the lives of people touched by physical and emotional pain, heartache and tragedy.