Back in 1998, medical doctors Vincent Felitti and Robert Anda, found that ten adverse childhood experiences (ACEs) independently predicted a wide range of psychological and medical disorders in adulthood in a stepwise fashion. That is, the more ACEs people experienced prior to age eighteen, the more likely they were to experience poor health outcomes in adulthood. As the head of preventive medicine at Kaiser-Permanente in San Diego, Felitti had access to the records of more than 17,000 middle-class, well-educated adults with good jobs and health insurance. The ten ACEs included: emotional, physical, or sexual abuse; emotional or physical neglect; or living in a home with an absent parent from divorce or separation, domestic violence, someone who was mentally ill or suicidal, someone who was addicted to alcohol, or other drugs, or someone who was incarcerated. The researchers found that about 2/3 of this population had experienced at least one ACE and that ACEs did not usually occur in isolation. For example, one who lived with an alcoholic adult might also have been abused by that perso.
Since the original study was published, many other studies have confirmed the link between ACEs and health outcomes. ACEs have been found to predict:
- Psychological conditions, such as adult depression, anxiety (including panic disorder), borderline personality disorder, drug abuse, ADHD, PTSD, suicidality, and low self-esteem
- Medical conditions, such as obesity, autoimmune disorders (including rheumatoid arthritis, type 1 diabetes, multiple sclerosis, psoriasis, inflammatory bowel disease), fibromyalgia, chronic fatigue, nearly all sleep disorders (such as sleep apnea, insomnia, and nightmares), ulcers, Alzheimer’s disease and other forms of dementia, fractures, shortened life span, cardiovascular disease (such as heart disease and stroke), cancer, type 2 diabetes, and chronic pain
- Risky behaviors and impaired functioning, including misusing prescription drugs (taking too much or too often, using them without a prescription, using higher numbers of prescriptions), smoking, precocious sexual activity (having multiple sex partners; teen paternity and maternity; unintended pregnancy), perpetrating and being victimized by intimate partner violence, criminality, financial or occupational challenges, memory disturbance, learning and developmental problems, more marriages, and lower educational attainment
For people who experience at least four ACEs, the risk for many health problems increases two to five times, although for drug dependency, Alzheimer’s disease, and suicide attempts, the risks are much higher. For those who experience six or more ACEs, nearly twenty years of life are lost on average.
In many high-risk populations, such as poor, urban, minority, military, and prison groups, the prevalence of ACEs often exceeds two-thirds. Felitti observed that time typically does not heal the hidden wounds from childhood and that we err to treat the smoke (that is, the stress-related conditions mentioned) without treating the fire (the unhealed hidden wounds resulting from ACEs). If the pain resulting from ACEs is not resolved, adults typically continue to suffer and fall back into harmful behaviors.
For example, Felitti found that Kaiser-Permanente had spectacular success in helping morbidly obese people lose weight. However, many of these successful weight losers rapidly regained the weight they’d lost. He found that weight served a protective purpose related to childhood wounds. For example, one might feel that extra weight made them unattractive to sexual predators. Others might find that having extra weight to throw around might protect them from bullying. Addictions—whether they relate to alcohol, drugs, shopping, screens, anger, gambling, sex, or perfectionism—often are fueled by the need for respite from intense, unresolved inner pain. Again, without healing the inner wounds from childhood—and associated worldviews, such as “I’m in danger” and “I’m damaged goods”) that continue to “run their show,” individuals will continue to suffer in adulthood.
Considering the costs associated with not treating the hidden wounds of childhood, ACEs might rightly be called the number one unaddressed public health problem in America. As we’ll see in later blogs, ACEs imprint and change our brain, biology, and sense of self in ways that often affect adults throughout life, if not addressed. In addition to the toll of human suffering, ACEs cost the Nation billions in terms of healthcare, welfare, criminal justice, and special education costs; as well as lost economic productivity and fatalities.
In addition to the ten original ACEs, which were those most commonly reported, there are many other ACEs that can potentially impair adult health, such as
- Loss of a parent, guardian, or other close family member due to any cause (such as deportation, murder, or other causes of death)
- Serious illness of a loved one
- Troubled marriage of caregivers
- Prenatal or perinatal stress of the mother or primary caregiver that prevents proper bonding to the child (such as unresolved grief, unwanted pregnancy, marital strife, worries over a cheating or abusive partner)
- Prenatal or birth trauma
- Separation from primary caregiver (for example, adoption, the child's removal from home because of maltreatment, or the mother is hospitalized following birth)
- Serious illness, injury, or medical procedures
- Discrimination or bullying
- Living in a war zone or violent community
- Witnessing gruesome injury, death, or genocide
- Child trafficking
As this blog hopefully makes plain, many adults suffer greatly—often for decades—because the inner wounds from childhood caused by ACEs are neither recognized nor properly healed. We need to resolve the root cause of suffering arising from ACEs, Fortunately, there are many new healing strategies which lessen this needless suffering.
In future blogs we’ll explore the mechanisms linking ACEs to adverse health outcomes, as well as some of the exciting healing strategies and treatment options.
Note: This article originally appeared in the Psychology Today blog, September 21, 2021.
About the Author
Glenn R. Schiraldi, PhD, has served on the stress management faculties at The Pentagon, the International Critical Incident Stress Foundation, and the University of Maryland, where he received the Outstanding Teacher Award in addition to other teaching/service awards. His fourteen books on stress-related topics have been translated into seventeen languages, and include The Adverse Childhood Experiences Recovery Workbook, The Resilience Workbook, The Post-Traumatic Stress Disorder Sourcebook, and The Self-Esteem Workbook. The founder of Resilience Training International (www.ResilienceFirst.com), he has trained laypersons, emergency responders, and clinicians around the world on various aspects of stress, trauma, and resilience.
Comments (1)