Adverse Childhood Experiences (ACE) and health status
In the 1980’s, Kaiser Permanente commissioned a study to investigate the treatment of obesity. A researcher, Dr. Vincent Felitti was asked to consider all possible approaches. Obesity is associated with many serious chronic health problems. If Dr. Felitti could find a solution to this health problem, a great deal of suffering could be avoided. He decided to try a simple approach--fasting under medical supervision. Not surprisingly, many adults lost vast amounts of weight quickly. But something happened that didn't make sense to him. Many of these patients, having shed, in some cases, hundreds of pounds, fell into a deep depression, panic, or rage for inexplicable reasons. These individuals left the program, gorged themselves, and gained back the weight they lost.
Instead of lecturing, he asked them--What happened when you lost the weight? He wanted to know how they felt. And then he took his inquiry a step further and asked the subjects when they started to gain weight in their earlier life and what had been going on at that time.
What he found shocked him. Many of these adults started gaining weight after a trauma, including sexual abuse. Women who had been raped or molested gained weight as a way of protecting themselves from unwanted male attention. Many of these stories had never been shared until these individuals were asked what was going on in their lives when they started putting on weight.
These insights were further validated in research called the Adverse Childhood Experiences (ACE) study of 17,000 people who were seeking healthcare. These adults completed a 10 item questionnaire that asked them about their childhoods—had they been abused, neglected, or experienced traumatic events as a child?
What they found was remarkable. If you had 6 categories of childhood trauma you were 5 times more likely to become depressed as an adult. If you had 7 categories of adverse events, you were 3,100% more likely to attempt suicide as an adult. Furthermore, these adults were more likely to develop serious health problems. Indeed, adults who had 6 or more of these events, died on average 20 years earlier than adults who had none of these experiences!
What were the questions?
- Did a parent or other adult in the household 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?
- Did a parent or other adult in the household often ... Push, grab, slap, or throw something at you? Or ever hit you so hard that you had marks or were injured?
- Did an adult or person at least 5 years older than you ever...Touch or fondle you or have you touch their body in a sexual way? Or Try to or actually have oral, anal, or vaginal sex with you?
- Did you often feel that ...No one in your 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?
- Did you 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?
- Were your parents ever separated or divorced?
- Was your mother or stepmother: Often pushed, grabbed, slapped, or had something thrown at her? Or sometimes or 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 gun or knife?
- Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?
- Was a household member depressed or mentally ill or did a household member attempt suicide?
- Did a household member go to prison? _
The good news—disclosing these experiences and getting counseling can help adults cope better and improve their health. In the original study, when patients disclosed these experiences to a health provider or to a therapist, they were 35-50% less likely to come back to see their health provider for health problems. Simply disclosing these experiences in a non-judgmental setting can be enormously healing.