If you have seen the amazing TV show Fargo, based on the movie of the same title, you may associate the term “aces” with beloved/hated antagonist Lorne Malvo. If you have not seen the amazing TV show Fargo, you should check it out on Hulu as soon as possible, because it is a dramatic masterpiece.
Regardless, the term “ACEs” is not used to signal that something is “groovy” or “neat” from a public health standpoint like it is in the show. Instead, ACEs is an acronym for Adverse Childhood Experiences, the exact opposite of groovy. We will get more into the nuts and bolts of what ACEs are, their prevalence, and how they relate to the major themes of this site.
What are ACEs?
ACEs, or Adverse Childhood Experiences, are traumatic events or repeated occurrences that can affect children for the rest of their lives. Most kids have traumas, at least on some level, and it’s difficult to be objective about what is considered a traumatic event. The word “trauma” has been tossed around more and more to describe unpleasant, but not damaging, events like seeing your ex at Walgreens or watching Ken Jennings lose his winning streak on Jeopardy.
When it comes to trauma from an ACEs standpoint, we are talking about much more serious occurrences, like abuse or neglect. More specific examples include:
- Having a parent who suffers from mental health issues
- Living with someone who abuses drugs or alcohol
- Suffering from physical, emotional, or verbal abuse or neglect
- Witnessing violence in the home
- Losing parent or loved one through death, incarceration, or separation
- And much, much more
Again, most of us have endured traumatic things throughout our childhood. The effects ACEs have on us vary on all kinds of factors, like the availability of a support system and the frequency of these events. Additionally, an event that may be considered traumatic for one person may barely affect another. People react to events differently and in unpredictable ways at times, and they also devise different coping mechanisms that can provide solstice to varying degrees.
It’s kind of like how being poor doesn’t change your perception of yourself and your family so much unless you actually feel poor. You could be living in a poverty-stricken area, where electricity and indoor plumbing are a luxury. If your home is one of the only homes in the area that has indoor plumbing, you’ll feel pretty darn rich in comparison, even if your home is considered a shack in other provinces.
If, on the other hand, you live in a 4-bedroom house in a suburban neighborhood, but your best friend’s family has a 6-bedroom house with a pool, you may feel poor. Forget the fact that you always have enough to eat, multiple cars in the garage, and no shortage of clean water and temperature control. You feel poor, and that’s what matters. In fact, where people rank themselves in terms of status is a better indicator of their health than their education level or actual income.1
To learn more about the topic of comparative poverty, check out the book The Broken Ladder (affiliate). It’s an awesome read that dives deep into poverty, and how that affects people physically, mentally, and emotionally.
Anyway, feeling poor, or feeling traumatized, no matter how an outsider may view a given situation has very real effects on our body’s chemistry, and in turn, our physical and mental health. This isn’t an invitation to say, “Trauma? Big deal, we all have that. Back in my day we dealt with adversity by not complaining about it.”
Although it’s difficult to be objective about what is considered traumatic, some types of trauma are clearly more harmful than others. With that being said, keep in mind that the effects trauma have on us are generally dose-dependent.
If we experience something that we feel is slightly traumatic occasionally, most of us will be okay. If, on the other hand, we experience something highly traumatic, like violence, neglect, and other abuses, and/or we experience it repeatedly, we are much more likely to suffer long-term physical and mental consequences.
Let’s talk about these effects further.
What Affects do ACEs Have in the Long Term?
Intuitively, most people understand that those who undergo childhood traumas are more likely to also experience substance abuse issues, elevated anxiety, lasting depression, and other mental health issues. What is less intuitive, however, is the fact that childhood traumas often have physical manifestations too.
According to Nadine Burk-Harris’s TedTalk on ACEs and the CDC, those who suffer from high levels of trauma as kids:
- Are 3 times more likely to develop lung cancer and heart disease
- Have a 20-year reduction in life-expectancy
- Suffer from changes in their immune and hormonal systems
- Experience increased rates of depression and anxiety
- Undergo changes in how their DNA is expressed
- Have difficulty forging and maintaining meaningful relationships and support systems
- Are significantly more likely to die by suicide
Upon reading this list, many people say, “of course this makes sense. When people have endured abuse, or other traumas, they use drugs/alcohol or they don’t take care of themselves. Why wouldn’t they be more likely to develop heart disease or have a lower life expectancy?”
Interestingly, substance abuse and other lifestyle factors related to ACEs do play a factor in about half of cases. ACEs are surprising, however, in that the other half of people with high ACE scores still experience these adverse health outcomes even when they exercise regularly, eat a balanced diet, have close relationships, and do not abuse drugs or alcohol.2
When major stressful events occur repeatedly in childhood, a stage where the brain is developing, the brain’s wiring can change and to be hyper aware of stressful situations and respond to these stimuli. As Burke-Harris puts it in her TedTalk, a stress response is great when we occasionally see a bear out in the wild, but if the “bear” comes home every night violently drunk, this mechanism backfires on us.
When this is the case for a kid, their brain becomes wired to perceive threats all around them, leading them to be jumpy, anxious, and feel like they are constantly in danger. These mechanisms can be life-saving at the time by making them hyper-vigilant and incredibly aware of their surroundings; however, it can set people up to struggle emotionally in other aspects of their lives.
In The Body Keeps the Score (affiliate), Bessel van der Kolk compares a brain wired with trauma to having a faulty fire alarm that goes off constantly even when there is no fire. He calls this an overactive stress response, and this is also why child abuse can be passed down for generations. When a kid is abused, and they develop an overactive stress response, leading them to overreact and abuse their partners or their own kids at the first sign of frustration.
Anyone who has spent any amount of time around kids knows that they can be instantly frustrating. That’s no reason to hit them or neglect them, but if a person’s brain is wired to have an overactive stress response, and their own parents did it to them, that will be many people’s natural inclination.
When it comes to forming healthy relationships, this can be very difficult for people who have suffered childhood abuse. They may not feel able to trust others, especially people similar to their abuser. Strong support systems are important for many reasons, and a lack of a network of friends or family can have very real adverse mental and physical health outcomes. Having a brain that sounds the alarm and distrusts others automatically serves as a major barrier to creating healthy, trusting, and balanced relationships.
In fact, many people who have been abused seek out abusive partners or friends. We humans flock to what is familiar, and if chaos, emotional neglect, and violence are familiar, that’s where we go.3 This is also what contributes to the cycle of abuse often seen in generations of families.
Additionally, ACEs are associated with much higher rates of mental health issues, like bipolar disorder, schizophrenia, and more. During my dietetic internship, I worked at an in-patient mental health facility, and nearly every person in there had a history of sexual, or other types of physical, abuse. It was rare to see a chart that did not say “hx of sexual abuse/violence”.
Children depend on adults to take care of them and help them meet their physical, mental, and emotional needs. When children are neglected or abused, their brains are constantly tuned to survival mode.
Survival mode, once again, is critical for keeping us alive when physical danger is present. When it is constantly activated, our nervous, immune, and hormonal systems go haywire, potentially leading to increased rates of heart attacks and heart disease, lung cancer, and more.
How Prevalent are ACEs?
It is estimated that about 62% of Americans have at least 1 ACE, and about 1/3 have 3 or more. If you are curious about how many ACEs you may personally have, here is an ACE quiz from NPR. This quiz may bring some past traumas back into the light, so please only take it if you feel that you are in a good place mentally.
Keep in mind, that a high ACE score doesn’t mean you are doomed to a life of poor health outcomes and constant suffering. ACEs only count the bad things that can happen, not the good. If you have a few ACEs, but mountains of positive experiences that have helped you feel trust in others, safe, and loved, your ACEs may not affect you all that much.
Regardless, ACEs can, and do, play a major role in the general public’s health outcomes. Black and hispanic people are significantly more likely to have a higher number of ACES, as are people who have a household income of less than $15,000/year. Those who identify as gay or lesbian, are unemployed, or are unable to work are also significantly more likely to have a higher ACE score.4
When I first started delving into ACEs, I wondered what ACE was the most common. My first guess was the loss of a parent or other loved one, but I was wrong. The most common ACE, according to one study from JAMA, was emotional abuse, followed by parental separation, and substance abuse. Of the over 200,000 participants, about 34% had experienced emotional abuse, and about 28% had experienced parental separation or substance abuse in the house.4
Dr. Nadine Burke Harris points out in her TedTalk, and on her episode of Armchair Expert, that if there was a chemical or material that affected 2/3 of the population and was this highly correlated with negative health outcomes, it would be pulled of the shelves immediately.
It’s not that people are in favor of child abuse or giving kids sexual trauma, but combating ACEs is a bit more complicated than outlawing a chemical. We will talk about what we can do to help prevent ACEs and help those who have experienced them in a bit, but first I want to connect ACEs to disordered eating and eating disorders.
How do They Relate to Disordered Eating and Dieting?
Aside from being much more likely to develop heart disease, cancer, and other physical issues, people who experience childhood adversity are also much more likely to eat in a disordered fashion. Binge eating disorder is the disordered eating pattern most directly related to childhood trauma. It is theorized that people turn to food to soothe anger, sadness and other emotions when the trauma is never dealt with properly.
From the research I could find regarding ACEs and disordered eating, emotional abuse is the type of trauma most commonly associated with disordered eating. This seems to be dose-dependent, too, meaning that more instances of emotional abuse appears to translate to worse disordered eating symptoms.5
After further reflection, this made sense in my mind. Emotional abuse can manifest in all kinds of ways, like yelling, blaming, insulting, gaslighting, and more. Now that I have been writing on this blog for over 5 months, many people have reached out to tell me their stories. A tragic number of them consist of parents or other adults verbally abusing them about many things, but especially their weight or size in childhood or their appearance in general.
Additionally, many adults and kids who feel that they do not have control over their lives turn toward having total control about what they eat. I have heard time and time again that “it felt like food was the only thing I could control, and I took it too far.”
Kids who are abused or neglected may also grow up to feel that they are not worthy of love or affection. Unfortunately, according to diet culture that people see online, in magazines, and social media, one way to be seen as attractive or worthy of love is by having a perfect body.
It instills the idea that nobody will want to be around you if you “look like you don’t take care of yourself.” It’s painful even writing about that, but I truly believe that the reason we spend so much money, time, and effort into changing our bodies is because we think that will make other people love us, and maybe we will finally love ourselves.
If you identify with this segment of the post and you feel that adverse childhood experiences play a part in any disordered eating habits you may have, I highly encourage you to seek professional help. You don’t have to fight these issues alone. Truly, even if you don’t have disordered eating patterns, but you struggle with trauma or PTSD, please seek help too. Check out Aunt Bertha to find affordable mental health care in your area, or text your zip code to 989211 for help finding all kinds of local resources.
What Can be Done About These Issues?
Having a high ACE score does not doom a person to have horrible health outcomes, but it does make a person more likely to suffer throughout their life if no interventions take place. Childhood adversity’s affect on a person’s life is cumulative, and having many positive experiences and relationships can be protective against the poor health outcomes associated with ACEs.
Of course, the best thing to do is to try to prevent kids from experiencing adversity in the first place. In a perfect world, no kids would lose a parent or other loved one to death or incarceration, no child would suffer from abuse of any kind, and nobody would deal with crippling poverty. There are programs that can help reduce the number of ACEs a child accumulates, and other programs focus on giving kids more opportunities to have positive relationships that can outweigh the effects of ACEs.
What is so encouraging about what we know about ACEs, is that with proper interventions, we can start to break the cycle of abuse that has persisted in families for generations. The vast majority of parents, even abusive ones, want what is best for their kids.
If we can develop systems where kids who have high ACE scores, and their parents and families, can get help to mitigate the damage caused by those ACEs, we will likely see a major drop in so many of the problems we face in America today. I’m talking about things like high incarceration rates, drug and alcohol abuse, truancy and high school dropout rates, and more. ACEs are at the roots of so many of the problems we face today, and it could change life as we all know it if we can do more to help those with many ACEs.
Some expecting parents are lucky enough to have the support of their own parents, or other family members, as they make arrangements for their child’s arrival. Unfortunately, this may not be the case for many moms and dads to be. As much as we like to think that parenting is natural, our instincts are wired to rely on a village-like setting like we used to settle in during hunter/gatherer times.
As a result, many parents are, understandably, terrified about parenting, especially when they are short on funds or work multiple jobs, among hundreds of other possible anxieties that can arise.
When I was in my dietetic internship at a Native American health center, they had staff that conducted parenting classes and in-home visits to equip expecting parents with tools and knowledge on how to take care of their babies and/or infants. These classes taught parents how to form bonds with their baby and read their cues, as well as information about attachment styles and how to create a secure attachment with their child.
They also provided tons of support after the baby is born, as well as numerous numbers to call if they ever need any help or have any questions. In the absence of a familial support network, just knowing you have someone to turn to is like having a life jacket while you’re on a boat. It brings a very real peace of mind.
Programs of this nature may seem like they would be costly or unnecessary. After all, if the parents would just read books or articles online about parenting they’d know everything, right? That’s unlikely. In either case, a culmination of studies have shown that for every dollar invested in these types of programs, it saves $1.70-$5.70 in costs attributed to child protection services, education, ecriminal justice expenses, and more.
The same is true about WIC programs, also known as Women, Infants, and Children. This is a government program that gives expecting families and those with young children food assistance as well as other important resources that can help alleviate some of the stress that comes with raising a child with a low income. Every dollar invested into WIC saves about $2.50 in educational, medical, and other expenses down the line.6
If you want to get involved in programs like these, check out your local WIC chapter for job opportunities or volunteering experiences. Also search on your county’s website to see if they offer parenting classes or in-home visits. They may also have volunteer opportunities or accept donations.
Widespread ACE Screening
A few years ago, I noticed that every time I went to the doctor’s office, I was screened for anxiety and depression. I am very much in favor of answering these basic questions, as I can see how it would help a doctor understand the whole picture of a patient to provide better, more comprehensive care.
Thanks to Nadine Burke Harris (can you tell I admire her by the 1,000 times I have mentioned her?), the state of California has begun to implement ACEs screening as of early 2020. As the state’s first Surgeon General, she has sought to implement widespread ACEs screening to help healthcare professionals and teams identify high-risk kids and help connect their parents to resources that can reduce the effect ACEs may have.
I have high hopes that ACEs screening will become more and more prevalent across the United States, and we will hopefully see a major breakthrough in getting kids and families the help they need as soon as possible.
It will be interesting to see how our young people will have been affected by the COVID-19 pandemic moving forward, as my gut tells me this will have major lasting mental health effects on them for years to come. I certainly hope more people will be informed about and on board with ACEs screening and interventions as we progress through the pandemic and come out on the other side.
Having supportive, warm adults in a kid’s life can be a protective factor against the effects of ACEs. For some kids, that adult is one or both of their parents, but it can also be a teacher, coach, or a parent of one of their friends. Having a positive relationship with adults, even if that adult isn’t in their home, can make a huge difference in a kid’s life and set them up for success and mental/physical well-being.
Organizations like Big Brothers Big Sisters are designed to pair kids up with an older buddy who can serve as a mentor and friend. These programs are quite successful in helping young people through tough times, and they are always in need of more volunteers. Male volunteers are especially in need. You could also volunteer with a local school district to help tutor kids after school, or sign up to chaperone during school field trips.
Another great way to get involved is by volunteering to coach a kids’ sports league in your community. I admire anyone who can stick out an entire sports season with high-energy kids, but many adults find this experience incredibly rewarding. Sports can help kids build strong friendship networks, be more physically active, and gain substantial amounts of confidence when they are not too competitive and cutthroat.
Overall, kids are resilient little things. They can overcome unimaginable traumas when given the right tools and interventions, and honestly, they don’t need us to move mountains for them. They just need a bit of support and care, and that goes a long way.
This week’s topic is a heavy one, and it’s never a fun one to discuss. Fortunately, knowing more about ACEs gives us an incredible opportunity to step in and help kids get what they need to have healthy and fulfilled lives.
As Always, a Book Recommendation
Sometimes when I discuss a heavy topic, I like to suggest a light-hearted book to balance it out. That won’t be the case today. For this post, I am recommending The Body Keeps the Score (affiliate) by Bessel van der Kolk, which is all about how we store stress and trauma in the body.
This book could definitely be too overwhelming for people who have suffered trauma, especially sexual abuse, as that is covered in detail. However, if you can stick with it, I believe it has the potential to help a lot of people understand why they do some of the things they do. It is also excellent in that it provides accessible tools and strategies we can use to help us overcome our traumas.
Van der Kolk has years of experience working with war veterans with PTSD, sexual abuse survivors, and those that suffered emotional abuse or neglect. He walks the reader through some of the thoughts and strategies therapists may have while working with traumatized patients, and it proves to be quite enlightening.
If you’re looking for a light weekend read, this book isn’t it. If, on the other hand, you’re looking for a book that may challenge your beliefs about trauma and how people deal with it, check this one out.
You can also get the audiobook version of this bad boy for free by using my link for a free trial of Audible below!
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- The Psychology of Inequality – The New Yorker
- How Childhood Trauma Affects Health Across a Lifetime – Nadine Burke Harris TedTalk
- Trauma Survivors at Risk for Future Abusive Relationships
- Prevalence of Adverse Childhood Experiences From the 2011-2014 Behavioral Risk Factor Surveillance System in 23 States
- Associations Between Adverse Childhood Experiences and Clinical Characteristics of Eating Disorders
- Powerful WIC Outcomes! – National WIC Association