As more data roll in, it becomes increasingly clear that health is more than a function of our recent diet and exercise. On the contrary, health is more like an amalgamation of our personal habits, the policies that open or close doors to us, the environments in which we live, and even the experiences we collect.
Some of those experiences, especially those that occur during childhood, can affect our health for entire lifetimes—for better or worse. Having loving role models who share healthy foods and demonstrate the importance of physical activity and strong relationships can set an example that spans generations. Having parents or caretakers who do the opposite—or having no parents or caretakers at all—can leave us with lasting physiological and mental damage that reduces the likelihood we’ll enjoy a healthful life.
Humans are hearty and resilient, but not invincible. Our childhood experiences leave lasting marks that affect how our bodies and minds develop as adults.
This concept is crucial in healthcare. Comprehensive, high-quality care depends on a thorough patient history, and knowing whether patients have endured Adverse Childhood Experiences (ACEs) is an important step toward piecing that history together and providing the care that every patient deserves.
What are ACEs?
ACEs are potentially traumatic events that occur during childhood, from birth through age 17, according to the CDC. Examples include abuse, neglect, or violence; witnessing violence in or around the home; and having a family member who attempts or dies by suicide.
But ACEs don’t end there. They also include, “aspects of the child’s environment that can undermine their sense of safety, stability, and bonding, such as growing up in a household with substance use problems, mental health problems, [and] instability due to parental separation or household members being in jail or prison,” the CDC explains.
What conditions can childhood trauma cause?
ACEs have been scientifically linked to serious health problems later in life, from relatively common and treatable mental disorders to terminal disease. While the mechanisms behind all these connections are not universally understood, evidence suggests ACEs can alter the way our bodies execute routine processes, like the way we produce proteins and hormones, and the way we cope with stress.
Here are some conditions that ACEs may cause.
Cancer. In a systematic review, researchers examined 12 studies and their conclusions suggested that there could be significant associations between ACEs and increased cancer risk during adulthood. Two studies identified links between psychological and sexual abuse and cancer, and three found links between physical abuse and increased cancer risk. More research is needed to fortify these links, as results varied between abuse and cancer type. For example, one study showed significant associations between childhood sexual abuse and cervical cancer, while another showed graded associations between ACEs scores and lung cancer.
Anxiety and depression. Sometimes the negative effects of ACEs manifest in childhood. A study published in Academic Pediatrics found that 4% of children who had had ACEs were experiencing depression and 9% were experiencing anxiety just a few years later, between the ages of 8 and 17.
Diabetes. Data suggest that ACEs may increase the risk of type 1 and type 2 diabetes. A Swedish survey of more than 10,000 families found that children who experienced an event like a divorce, illness, or death in the family were about three times more likely to develop type 1 diabetes. A study published in BMC Public Health found that ACEs predicted type 2 diabetes onset among women, and that being overweight—a possible pathway from ACEs to type 2 diabetes onset—was significantly more common among women with a history of ACEs.
Post-traumatic stress disorder. Childhood PTSD can have far-reaching effects in adulthood. According to Stanford Children’s Health, PTSD in children can become chronic and be accompanied by anxiety, depression, and substance abuse. PTSD driven by ACEs can lead to trouble sleeping, nervous and jittery emotions, a general lack of interest, trouble displaying or accepting affection, increased aggression, and problems in school and social life.
Heart disease and early death. A study published in the Journal of the American Heart Association found that children were 50% more likely to develop CVD later in life if they experienced verbal, emotional, or physical abuse, or lived with drug- or alcohol-abusers, compared with those who had little or no exposure to such ACEs. Even those who experienced moderate exposure were 60% more likely to die from any cause by middle age.
The bottom line
While we may not fully understand the mechanisms behind ACEs and their downstream deleterious effects on health, the connection is borne out by an impressive and still-growing body of research.
In the case of heart disease, “people who face severe adversity as children undergo a combination of behavioral and biological responses not yet fully understood. Previous research shows part of what happens is people are more likely to develop unhealthy coping mechanisms, such as smoking and poor eating habits, which contribute to traditional cardiovascular risk factors, such as high blood pressure, obesity, inflammation and diabetes,” American Heart Association News reported.
The good news is that it’s never too late to deal with childhood trauma. Be sure to remain aware of the warning signs and be prepared to engage your patients should the need arise.