Adverse Childhood Experiences (ACEs): The Root Cause of Systemic Health Disorders
By Marc Albritton- PsyD.
There are approximately 8 billion human beings on the planet. Each have their own psychological and physiological make up, argumentatively based upon genetics and environment. However, until recently relatively little attention has been paid to the factors that figure into the genetic and environmental make up of our fellow human beings.
We often wonder why does he or she behave like they do, or why certain physical and or mental dysfunctions occur in some people. In the 1980’s Dr. Vincent Felitti, founder of Kaiser Permanente’s Department of Preventive Medicine and director of its obesity-treatment program, the largest medical-evaluation facility in the developed world, happened upon the likely answer to these problematic questions.
While conducting a research study on adult obesity he noticed that the some of the participants with the greatest success rates in the study represented the greatest rates of those dropping out of the study. Accordingly, he followed the path of any good researcher, he asked “why”? When questioning one participant she reluctantly revealed that she had been sexually abused as a child and entered into subsequently failed marriage with a jealous husband at age 15 who was only comfortable when she was overweight and had low self-esteem.
In the 1990’s Dr. Fellitti expanded his research that would become the landmark research study on adverse childhood experiences (ACEs). When the average person is asked if they experienced abuse as a child (under age 18) they tend to immediately focus on sexual abuse and if they were not exposed to sexual abuse they reply “no, never.” However, ACEs encompass a much wider focus than sexual abuse. ACEs cover physical abuse (beatings, spankings, corporeal punishment etc.), psychological abuse (being made to feel worthless, insulted, devalued, etc.), neglect (deprived of basic material, nutritional, emotional necessities) household dysfunction (spousal abuse, interpersonal violence, family breakup, alcoholism, drug addiction etc.) witness to community violence or destruction (violence, vandalism, poverty, war, etc.).
In short answer, the ACE study of 9,508 participants found a dose/frequency relationship between ACEs and adverse health outcomes in adults. The greater the number of ACEs the greater the number of adverse health outcomes. The potential trajectory throughout the life span of survivors of ACE presents as follows: ACEs result in trauma. Trauma, amongst other things, is the inability to make sense of or process a negative experience that short circuits the mind/body fight or flight response. Trauma leads to social, behavioral, cognitive, and developmental impairments from excessive triggering, and overloading of the hypothalamus, pituitary, adrenal axis (HPA), resulting in heightened blood/cortisol levels, and consequential emotional dysregulation. Trauma is followed by the adoptions of maladaptive, compensatory, and health-risk behaviors such as smoking, drinking, drug use, high risk sexual urges and compulsion, and violence. Maladaptive behaviors are subsequently followed by diseases of the body such as: diabetes, obesity, heart disease, pulmonary dysfunction, gastrointestinal problems, depression, and other systemic disorders found in many adults. Diseases ultimately lead to disability and in many cases; early death. However, this cycle of destruction does not stop at the individual. Research results have also indicated that ACEs can result in genetically transferred intergenerational trauma from mother to child; prenatal.
| Trauma | |
 Trauma can appear as: avoidance of discussing or facing the reality of the traumatic event, re-occurring intrusive thoughts or images from the event, or hypervigilance and constant state of elevated response. Trauma results in dysfunction in self organization such as: affect dysregulation, negative self-concept, and disturbances in relationships. There is a positive dose/frequency relationship between ACEs and trauma. Said another way; as ACE increase in frequency and dosage, there is a proportional increase in trauma symptoms. Furthermore, the constant triggering of the body’s stress response systems have be shown to lead to long term mental and physical disorder. |
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| Common ACE Related Behavioral Disorders | |
 In normal functioning, the pre-frontal cortex (PFC) area of the brain processes and orders logical, rational, thought and behavior in response to external stimuli. When a person encounters another person, place, or thing, the information is processed by the PFC, the PFC and the HPA initiate an appropriate emotional/behavioral response proportional to the event encountered. In a traumatic event the mind body provides an emergency shortcut to save vital time, bypassing the PFC and presenting an almost automated response of the HPA for a quick, heightened, elevated emotional, physical, or behavioral response to the traumatic event. In hindsight, post-event people will often remark: “I just froze, I did what came natural, I just reacted, I wasn’t thinking, I just lost it, etc.” This PFC/HPA short cut is the mind/body’s first line of self-defense or preservation. There is no time for thinking. There is only time for reaction. However, When children experience frequent or high intensity ACEs, the PFC can become permanently short-circuited resulting in dysregulated HPA and irrational, illogical; behavioral, emotional responses grossly disproportional to the encountered event or stimuli. |
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| Conduct Disorder | |
 According to the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-V) Conduct disorder is aggression to people and animals with bullying, fighting, stealing, use of a weapon to harm others; destruction of property, fire setting; deceitfulness or theft, breaking and entering, lying to obtain goods or favors, conning; serious rule violations in home, runs away, school truancy prior to age 13. These symptoms are marked by: lack of remorse or guilt, callous lack of empathy, unconcerned with performance, and flat or shallow affect. Furthermore, persons presenting with these symptoms, or history of disorders with disruptive behaviors may are at greater risk for intermittent explosive disorder. |
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| Intermittent Explosive Disorder | |
 The DSM-V states this criteria consists of: recurrent behavioral outbursts representing a failure to control aggressive impulses with: temper tantrums, tirades, verbal arguments, or fights; the magnitude of aggressiveness is grossly disproportionate to the provocation; the recurrent aggressive outbursts are not premeditated, but impulsive and or anger-based, and not initiated in the pursuit or interest of obtaining tangible objective such as money or power, but for the destruction of property; and are not better explained by another disorder. |
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| Bipolar Disorder | |
Here, the DSM-V describes a manic episode of inflated self-esteem, decreased sleep need, need to keep talking, racing thoughts and flight of ideas, easily distracted by irrelevant and unimportant stimuli, increase in goal directed activity, sprees of high risk behavior with disregard to likely adverse outcomes. This period is accompanied by a depressive episode of: depressive mood most of the day, diminished interest in pleasure, significant weight loss, insomnia, psycho-motor retardation, or agitation beyond mere feeling of being slowed down, feelings of worthlessness, or guilt, inability to think or concentrate, indecisiveness, fatalism. |
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| Coping Mechanism | |
 Coping or the ability to return to normalize and return to positive function after encountering adverse stressors will vary from person to person and from encounter to encounter. Likewise the components that factor in to conclude coping mechanisms process and strategies will also vary from person to person and incident to incident as well as the circumstances in which the adversity occurs. Subsequently, there will be no right or wrong process or strategy. There will only be adaptive or maladaptive outcomes. Lazarus (1966) as well as Lazarus & Folkman (1984) offered a conceptual framework of coping and stress proposing that stress is a three step process of the mind. First step is the primary appraisal where the threat is perceived and appraised. Secondary appraisal is the dialing up of potential responses to the threat. Then finally, coping is the execution of the response |
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Hays-Grudo et al. (2021) identified ten Protective and Compensatory Experiences (PACEs) that could mitigate the effects of ACEs and trauma under the broad categories of relationships and resources: unconditional love from a caregiver, having a best friend, being part of a social group, having a mentor and volunteering in the community, having a home that is safe and clean with enough food, good schooling and education, having a hobby, sports and good physical activity, and having family routines and consistent rules. Moreover, this study concurred with Hays-Grudo et al. (2021), concluding that children who perceive love as unconditional, authoritative parenting with high expectations, clear rules responsive and caring communication were also associated with secure attachment and positive outcomes.
These studies reflected an expanded consensus that strengthened self-regulation skills and attenuated, dysregulated stress responses in parents were most likely to interrupt the intergenerational cycle of ACEs (Hays-Grudo et al., 2021). Here, the attempt was to reduce sympathetic nervous system activation and activate the parasympathetic nervous system to return the body and mind to a state of calm, thereby reducing heart rate, blood pressure, respiration, and oxygen consumption (Hays-Grudo et al., 2021). Hay-Grudo also suggested that this could be assisted by “mindfulness-based mind-body” approaches (MBMB) such as Zen Yoga, Tai Chi, meditation, diaphragmic deep breathing, guided imagery, and biofeedback amongst others that promote mindfulness.
Within the space of mindfulness is coping. Coping is a response to a stressor or trauma that can result in either adaptive behavior (a response that leads to restoring positive function) or maladaptive behavior (a response that leads to adverse behavior and function). Coping mechanisms can be subdivided into three observed types: active coping, avoidance coping, and focused coping. Active coping is attacking the stressor at the root cause in a direct manner. This is actually a form of problem-focused coping, focusing directly on the problem without distraction or diversion. The putting aside or suppression of multiple avenues of pursuit of solutions to focus on a singular method of attack is an aspect of problem-focused, active coping. Active coping may also be followed by planning or taking a step approach to overcoming the problem, stressor, or trauma. However, exercising restraint can also be a tactic in the arsenal of problem-focused, active coping that can be weaponized against the stressor. The ability to suppress the temptation to react or response is a strategic form of mindfulness which can present as waiting for the right time to address the situation or operating pragmatically to find the right words to alleviate the situation at hand. Additionally, seeking out social support in the form of advice, counseling, coaching, mediation, or mentoring is a type of problem-focused active coping. But, seeking emotional support for sympathy, and understanding or wanting to be heard is an aspect of emotion-focused coping (reacting from emotion).
Avoidance coping runs counter to active coping. Avoidance coping is self-distraction, daydreaming, drifting off or zoning out from the source of the trouble, stressor, or problem. Denial is a coming response in the category of avoidance coping. Here, denial often operates as acting like the stressor is not real or that the problem doesn’t really exist. The use of religion can operate as avoidance or active coping depending on its usage or application to the problem event. However, religion is personal and subjective. Every respondent will form their own methodology here. Therefore, there is no right or wrong coping mechanism, there are only adaptive or maladaptive responses. Each respondent will have to employ their appropriate coping mechanism according to their abilities and the prevailing stressor.
References
Felitti, V. J. (2002). The Relation Between Adverse Childhood Experiences and Adult Health: Turning Gold into Lead. The Permanente journal, 6(1), 44–47. https://doi.org/10.7812/TPP/02.994
Hays-Grudo, J., Morris, A. S., Beasley, L., Ciciolla, L., Shreffler, K., & Croff, J. (2021). Integrating and synthesizing adversity and resilience knowledge and action: The ICARE model. American Psychologist, 76(2), 203–215. https://doi.org/10.1037/amp0000766