In the mid 90s a team of researchers from a private healthcare company in America made a startling discovery.  They asked over 17,000 people about their experiences of abuse and trauma in childhood, and followed them over 15 years.  They called what they were measuring Adverse Childhood Experiences (or ACEs) and included trauma directly affecting a child, like abuse or neglect, as well as trauma affecting the environment, like witnessing domestic violence.

The people they studied were not from disadvantaged communities; they had jobs, college degrees and good healthcare.  What they found changed our understanding of the impact of trauma.

For one thing, ACEs were much more common than anyone had imagined.  More than two thirds of people had at least one ACE and over 10% had four or more.

Having a history of ACEs was strongly linked to the 10 leading causes of death in the US.  For example, a person with four or more ACEs had two and half times the risk of getting a respiratory disease like COPD, were four times more likely to get depression and seven times more likely to be an alcoholic compared to a person with no ACEs.  A person with seven or more ACEs had triple the risk of lung cancer and three and half times the risk of ischemic heart disease.

A person with six ACEs was likely to die twenty years earlier than someone with no ACEs.

The more ACEs you experienced as a child, the more likely you are to take risks with your health: smoke, drink and take illegal substances. But even when you control for lifestyle choices, the risks are still much higher the more ACEs you’ve experienced.

Scientists believe that the relationship between ACEs and health problems later in life is linked to our automatic response to danger.  When you’re exposed to a threat your body prepares itself to deal with danger; known as the fight, flight or freeze response, your heart rate increases, your pupils dilate and your body is flooded with adrenalin and cortisol.  After the danger has passed, your body and all the stress hormones return to their normal state.  Scientists believe that repeated triggering of this threat response in childhood causes tissue damage, inflammation and wear and tear on the body.  It changes immune system functioning and even determines the way the brain develops so that parts associated with decision making and problem solving are underdeveloped whilst those parts responsible for emotional regulation are overactive.

You can score your own ACEs here: Take the ACE quiz.

If you have a high score it shouldn’t feel hopeless. We’re beginning to understand more about the things that make someone resilient and there are things you can do to help.

Learn to meditate.  The brain has plasticity, which means the more you use certain parts, the more they develop. Regular meditation practice can help you respond to stress without automatically triggering the fight or flight mechanisms. 

Seek support to help you cope with the trauma.  Confiding in a trusted friend or family member can help.  Visit the NAPAC and the NSPCC for more advice and support.

Inform yourself. Watch this excellent TED talk from Nadine Burke Harris and this informative short animation from Public Health Wales. I’ve written about the link between ACEs and psoriasis on my blog


Dr Catherine OLeary

Catherine is a Consultant Clinical Psychologist who trained at the Institute of Psychiatry in London. She specialises in working with people with long term health conditions. She has had psoriasis for over thirty years.

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