“When the mind becomes flooded with emotion, a circuit breaker is thrown that allows us to survive the experience fairly intact, that is, without becoming psychotic or frying out one of the brain centers.
“The cost of this blown circuit is emotion frozen within the body. In other words, we often unconsciously stop feeling our trauma partway into it, like a movie that is still going after the sound is turned off.
“We cannot heal until we move fully through the trauma, including all the feelings of the event.
Susan Pease Banitt, author of The Trauma Tool Kit: Healing PTSD from the Inside Out.
Trauma, defined as threats so severe or pervasive that they literally change our physiology, comes in all shapes and sizes. Many individuals who have done little or no research on the subject will immediately think of combat veterans or genocide when they hear the word trauma. And while these are definitely strong examples of trauma, many other adversities also constitute trauma: sexual abuse, rape, or incest; being beaten by a parent, being abandoned or neglected by a parent, or being involved in domestic violence are also traumatic to those victims involved.
For many decades, health providers saw such cases as either a social problem or a mental health issue and would refer their clients to what they believed were the best agencies to deal with such cases. And then, an enormous trauma study took place which was about to shed a new light on the effects of trauma.
In 1985, a medical doctor, by the name of Vincent Felitti, was running an obesity clinic in San Diego. Dr. Felitti was chief of the Department of Preventive Medicine at Kaiser Permanente, an integrated managed care organization in San Diego. A nurse’s aide, weighing over 400 pounds was accepted into the program. Following Dr. Felitti’s weight loss regime, her weight plummeted from 408 pounds to 132 pounds in eleven short months. Dr. Felitti saw the same woman a few months later and she had gained back more weight in that short amount of time than he had thought humanly possible.
What had happened? After her drastic weight loss, her slender body was now attractive to a male co-worker. He flirted with her and proposed that they have sex. Dr. Felitti probed deeper into her history and the nurse’s aide revealed a lengthy history of incest with her grandfather.
Dr Felitti and his team began inquiring of other obese patients and discovered that most of his 286 obese patients had been sexually abused as children.
Another doctor, Dr. Robert Anda, who was an epidemiologist from the Center for Disease Control (CDC), upon hearing Dr. Felitti’s statistics, encouraged Dr. Felitti to do a much larger study which drew on the general population. And so, in 1995, was born the Adverse Childhood Experiences Study (ACE), a gigantic investigation that eventually included over 17,500 patients. The study was headed by Dr. Felitti and Dr. Anda, the co-principal investigators.
Participants were given physical exams and completed gender specific confidential surveys regarding their childhood experiences, current health status, and current behavior.
The two doctors spent over a year developing a questionnaire which included ten questions that covered three categories of adverse childhood experiences: physical and sexual abuse, physical and emotional neglect, and family dysfunction. It should be noted here that the ten ACE questions included the childhood trauma most commonly mentioned by members of the group who took part; however, other types of childhood trauma such as bullying, losing a caregiver, losing a grandparent, homelessness, racism and others are also considered toxic stress and could potentially increase an individual’s risk of health consequences. (see footnote 1)
The following are the 10 questions:
Prior to your 18th birthday:
- Did a parent or other adult in your household often or very often ….. Swear at you, insult you, put you down, or humiliate you? Or Act in a way that made you afraid that you might be physically hurt?
NO_______ If Yes, enter 1________
- 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?
NO_______ If yes, enter 1 _________
- Did an adult person at least five years older than you ever….. Touch or fondle you or have you touch their body in a sexual way? Or Attempt or actually have oral, anal, or vaginal intercourse with you?
NO______ If yes, enter 1 __________
- Did you often or very often feel that…….. No one in the family loved you or thought you were important or special? Or Your family didn’t look out for each other, feel close to each other, or support each other?
NO______ If yes, enter 1 __________
- 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? Or your parents were too drunk or high to take care of you or take you to the doctor if you needed it?
NO ______If yes, enter 1 __________
- Were your parents separated or divorced?
NO _______ If yes, enter 1 _________
- Was your mother or stepmother:
Often or very often pushed, grabbed, slapped, or had something thrown at her? Or Sometimes, often or very often kicked, bitten, hit with a fist, or hit with something hard? Or ever repeatedly hit over at least a few minutes or threatened with a knife or a gun?
NO________ If yes, enter 1 _________
- Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?
NO ________ If yes, enter 1 _________
- Was a household member depressed or mentally ill, or did a household member attempt suicide?
NO ________ If yes, enter 1 _________
- Did a household member go to prison?
NO ________ If yes, enter 1 _________
(see footnote 2)
The Adverse Childhood Experience Study revealed that trauma in childhood was more common than originally thought. Respondents to the study were middle class, mostly Caucasian, educated, and financially solid enough to afford good medical insurance. Yet only one third of the 17,500 participants reported having no adverse childhood experiences.
ACE scores can range from zero to ten. Sixty-seven percent of the study’s participants reported yes to at least one ACE question. To the question regarding sexual abuse, twenty-eight percent of women and sixteen percent of men responded positively. Twelve percent of the participants reported having witnessed domestic violence. One in eight of the participants had scored four or more on the ten-questionnaire.
A high ACE score is likely to lead to high risk behavior for teens: smoking, drinking, obesity, unintended pregnancies, sexually transmitted diseases, fighting, and petty crimes. In the past, most of these issues would have been considered social problems. However, the Adverse Childhood Experiences Study correlated ACE scores with health outcomes. The higher your ACE score, the worse your health outcome. A person with an ACE score of four or more has two and a half times the risk of developing Chronic Obstructive Pulmonary Disease or hepatitis than someone with an ACE score of zero. A person with an ACE score of four or more has four and a half times the likelihood of developing depression. For suicidality, it was twelve times the likelihood. A person with an ACE score of seven or more has triple the lifetime risk of lung cancer and three and a half times the risk of developing ischemic heart disease – the number one killer in the United States.
Dr. Felitti and his team found that these adverse experiences were interrelated. If there is frequent verbal abuse in a household, there is usually some other dysfunctional problem as well, such as an alcoholic father, or a mentally ill mother. Typically, children don’t grow up in an environment where one parent is in prison but everything else is fine. The higher the ACE score, the greater the toll in damages later in life.
The ACE study discovered that of the ten leading causes of death in the United States, seven out of ten were dramatically increased by a high ACE score. In high doses, Adverse Childhood Experiences affect brain development, hormonal systems, and even the way our DNA is read and transcribed. Individuals exposed in very high doses have triple the risk of heart disease and lung cancer and a twenty- year difference in life expectancy.
The work of Dr. Felitti and Dr. Anda was eventually recognized by an aspiring, upcoming professional, a pediatrician by name of Dr. Nadine Burke Harris. In 2007, she became the founding physician of the Bayview Child Health Center, a poor neighborhood in San Francisco. She noticed that a large percentage of children were being referred for Attention Deficit Hyperactivity Disorder (ADHD). But in Dr. Burke-Harris’s professional opinion, these children did not fit the criteria for ADHD. After doing a thorough history and physical, she realized that most of these children had experienced severe trauma.
One day in 2008, a colleague handed her a copy of the Adverse Childhood Experience Study, information that gave her a whole new direction in her career. By 2012, she had opened the Center for Youth Wellness, created as a clinical model that recognized the impact of adverse experiences on health. The center strives to treat toxic stress in children. The center includes a multi-disciplinary team that concentrates on averting and undoing the chemical, physiological, and neurodevelopmental results of ACE’s.
Dr. Burke-Harris and her team do routine screening of ACE scores as a part of every physical. The team educates parents about the impact of ACE’s and toxic stress. Their hope is that parents will begin to search for pediatricians who are cognizant of the effects of toxic stress on children and who are routinely using the ACE screening strategies and follow-up care in their medicinal practices.
Dr. Burke-Harris explains that in an MRI scan, significant differences can be found in the amygdala, the brain’s fear response center. She explained that in a stressful situation, the amygdala engages the hypothalamic-pituitary-adrenal axis, the brain and body stress response system that governs our flight or fight response. If an individual encounters a bear in the forest, his body’s response system would produce cortisol and adrenaline, his pupils would dilate, his heart would pound, his airways would open up – preparing the individual to run. This is a life-sawing response when our life is threatened.
This response becomes a problem when an individual is under chronic stress and this system is activated over and over. It is no longer life-saving, but health damaging. Children are very sensitive to this chronic stress activation because their brains and bodies are still developing.
In the words of Dr. Burke-Harris,
“We now understand more than ever before how exposure to adversity affects the developing brains and bodies of children. It affects areas of the brain such as the nucleus accumbens, the pleasure and reward center of the brain that is implemented in substance dependence. It inhibits the prefrontal cortex, which is necessary for impulse control and executive function, a critical area of learning.” (see footnote 3)
Why is it important to know this information? Individuals raised decades ago may believe that living with an alcoholic and experiencing an occasional trip to the woodshed with Dad and his belt was just part of life. But at the same time, they may be battling high blood pressure, alcoholism, or other serious health issues.
For all of us seeking healing, it could benefit us to seriously consider the ten ACE questions and then look at any health care challenges we might be facing. Ask yourself, “Could there be a correlation?” We do this, not to condemn our parents or other caregivers, but to love ourselves enough to confront the split off parts of ourselves that might be causing depression, anxiety, or suicidal thoughts, or contributing to health problems. The Body Code is one avenue that can give us greater peace, less anxiety, and a body that is more energetically balanced. If you relate to this information, contact me! Together we can explore how we can bring more serenity to your life! God’s Blessings to You!
- Bessel Van Der Kolk, The Body Keeps The Score: Brain, Mind, and Body in the Healing of Trauma (New York: Penguin Books, 2014).
National Counsel of Juvenile and Family Court Judges, (NCJFCJ) NCJFCJ.org
Dr. Nadine Burke-Harris, TED Talk. Youtube.