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Adverse Childhood Experiences Increase Risk for Chronic Diseases - It's Not Psychological


If you have a chronic illness, research showing that adverse childhood experiences (ACEs) increase risk for chronic illness may help begin to make sense of your symptoms.

They explain why it's not your fault.

And why it's not in your head.

What Are Adverse Childhood Experiences (ACEs)?

ACEs refer specifically to 10 types of trauma examined in an initial 1998 study conducted by Dr. Vincent Felitti, an internist at Kaiser Permanent in San Diego, and Dr. Robert Anda, an epidmiologist with the CDC.

ACEs refer to events happening before the age of 18 years. They include physical, sexual and emotional abuse; physical or emotional neglect; losing a parent such as through divorce; being exposed to domestic violence between your parents; having a parent with a mental illness such as depression; or having a member of the household who abuses substances such as alcohol or drugs or has been in jail.

Risk has been assessed according to ACE scores, which add up each ACE a person has experienced for a total potential score of 10. This is where it's been helpful to have a study looking at only 10 kinds of trauma.

Other Types of Adversity Also Affect Risk

There is a large body of evidence, however, that builds on ACEs findings. It shows that all kinds of adversity affect risk for disease. Risk for disease is not limited to the 10 ACEs. Adverse experiences also include neglect or abuse from someone other than a parent, the death of a parent or sibling or grandparent, growing up with a parent or other household member with a serious physical illness, being in a car accident, being bullied, being born prematurely, as well as difficult relationships with your parents and other types of adversity we frequently dismiss because they are so common.

The initial and subsequent studies find that ACEs increase risk for autoimmune disease such as multiple sclerosis, type 1 diabetes, rheumatoid arthritis, lupus and more; type 2 diabetes, obesity, asthma, chronic obstructive lung disease, heart disease as well as cancer and other chronic physical and mental illnesses.

Risk for Chronic Illness is Affected by Our ACE Scores

The key point about disease is that the ACE studies show that childhood trauma is a critical and prominent factor affecting risk for chronic diseases of all kinds.

This is important to know not only because chronic disease is such a painful, challenging, costly and life-altering experience, but also because chronic illness accounts for 7 out of the top 10 causes of death in the US  according to the CDC.

Furthermore, half of the adults in the US have a chronic illness.

1 in 4 people have two or more chronic health conditions.

Nearly 1 child in 10 is limited by a chronic disease.

Risk for chronic illness is especially high when a person has experienced 4 or more ACEs.

With a score of 4 or more, risk for diabetes goes up 1.6 fold, doubles for cancer and heart disease, and quadruples for chronic lung disease.

But even an ACE score of 2 is significant.

Risk for Autoimmune Disease Increases with ACE Scores of 2

Risk for the 80 or more types of autoimmune diseases increases as ACE scores rise.

For every increase in the ACE score of 1 point, risk for developing an autoimmune disease such as type 1 diabetes, lupus, rheumatoid arthritis and many others goes up by 20%.

An ACE score of only 2 - which can happen if your parents divorced and one of your parents had to cope with a common mental illness such as anxiety or depression - increases the chances of being hospitalized for an autoimmune disease by 70 to 80%.

Dube and Felitti also found that childhood stressful events may increase autoimmune diseases independently as well as amplify the effect of other environmental factors, such as infections.

ACEs Increase Risk for Other Diseases such as Chronic Fatigue Syndrome and Fibromyalgia

While I've seen no mention of chronic fatigue and fibromyalgia specifically in an ACE study yet, other researchers have foundhigher rates of childhood physical, sexual and emotional abuse in this population as well as links to very early trauma in the field known as fetal origins of adult disease.

In these conditions, lowered cortisol is not due to any adrenal or pituitary insufficiency. It comes from a body caught in a state of survival.

Changes in cortisol reflect a plausible early-life adaptation to increase the persistence of active cortisol in liver (to maximize fuel output) and kidney (to increase salt retention) without elevation of circulating levels, thus avoiding their deleterious effects on brain and muscle.

Symptoms Are Not Psychological

As with cortisol, changes in blood sugar, insulin levels, blood pressure, heart rate and other physiological functions can get stuck in high or low patterns. This is part of how our body's states of survival can lead to symptoms and disease.

As mentioned earlier, it's not because chronic disease is psychological. It's not because trauma is all in your head or because you are weak or have a personality flaw.

Trauma affects both physical and emotional health because it alters the nervous system, the immune system, the cell danger response, gene function and beyond.

Understanding these mechanisms and the science of trauma offers hope for people living with chronic illness. This is because healing the effects of trauma is possible, even if the events happened far in the past. And because addressing the effects of trauma also helps heal symptoms of chronic disease.

Read more of this post and download free ACE fact sheets from her blog to inform your doctor.

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@Tammy Cover posted:

This is what I have suspected for a while, but have had trouble finding research. Thanks for bringing this to light. I am an LPC and want to focus my practice on  clients with chronic illness and autoimmune disease. I have already been specializing in treating trauma and want to narrow even further because so many times these people are treated like they are making it up (I have had clients say they were accused of that).

Hi Tammy,
Yes - this is still a very common an occurrence, and happens for people with all kinds of chronic illnesses including ones I never thought would have that experience such as people with rheumatoid arthritis etc.

There is a remarkable amount of research but it's all in silos - individual, separate, isolated bits of research here and there that most medical professionals have never heard of even though some of it has been around for decades. We need trauma-informed folks working specifically with folks with chronic illness so it's great to hear that this is your plan! I share the research on my blog where you can find a big picture about risk if you haven't seen it already. Thx for writing!

This is what I have suspected for a while, but have had trouble finding research. Thanks for bringing this to light. I am an LPC and want to focus my practice on  clients with chronic illness and autoimmune disease. I have already been specializing in treating trauma and want to narrow even further because so many times these people are treated like they are making it up (I have had clients say they were accused of that).

HI Carey,

As with so many when faced with new information, it takes time, doesn't it?!

Along with personal experience for each medical professional to test the waters and find a way to talk about this with their patients.

I know for myself, even as a doctor, I haven't shared it much. It's partly because my illness is already at suck risk of being labelled as psychological. I've also been a little shy to add info to their work load when I don't personally have an ACE score. I gave it to my Kaiser doc at the end of the appointment, however, - not only had he never heard of ACEs even working for Kaiser, but he never said a word about it. 

My family doc, on the other hand, is so interested we scheduled a time to talk about trauma outside of my medical appointment and she's invited me to speak to some of her (very open-minded) colleagues. 

I'm so glad it sounds as though some are at least receptive to getting the info in the first place! 

I wish you well with all these seeds you're planting!



Hi Dennis,
I don't know if a list exists but perhaps someone here in the ACEs community knows? Or you could post your question in the "Ask Community" header?

One source of helpful information might be Dr. Nadine Burke Harris' book about ACEs. She has a sense of humor, keeps it actually light for such an intense topic, and explains all the different ways in which understanding ACEs helps her in her practice. Maybe the fact that she's an MD would make it interesting to someone like your NP - or that it's now only $2.99 for the kindle version on amazon !!!

Another option might be to give her a very brief summary of ACEs. I've created a 1 page ACE fact sheet that summarizes the different diseases found to be increased by ACEs, the studies and stats, and more. It has an additional 1 page of references and 1 page with the survey.

I have two ACE FACT SHEETs - One that summarizes all effects of ACEs and another that summarizes chronic illness related research only.

All the best to you in spreading the word to your health care folks:

Thanks, Veronique, for another informative post! I’ve shared your fact sheets with physicians. Most are more receptive but few are willing to share info with patients for fear of β€œupsetting them.”

Some are starting to trust that it is okay to ask, patients won’t fall apart it they ask patients to take the survey(s), people like to connect the dots, connecting the dots may help prevent some next-gen trauma. 


Last edited by Carey Sipp
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