Adverse Childhood Events and Relationships (ACE's, ACREs) and Chronic Illness

In 1997, the Centers for Disease Control and Prevention (CDC) and Kaiser-Permanente released a study examining the prevalence of adverse childhood experiences (ACEs) and how they affect physical health, confirming what Burke Harris had expected: Experiences of early adversity were linked to poorer health outcomes among adults. The study sparked countless initiatives to help prevent ACEs before they happen and build resilience among children who are at risk for adverse experiences.

Prevention is a step toward addressing this issue; however, there are still adults with ACEs who are currently experiencing the repercussions of early trauma, including mental health issues and chronic disease. Environmental factors - which include diet, stress, infections, toxins and trauma, among others - are responsible for up to 70-90% of risk for chronic illness ((Rappaport, S. M. (2016).

How Do Adverse Childhood Experiences and Relationships Affect Health in Adults?

Adverse childhood experience (ACE), a term coined in that 1997 study, is now universally recognized in the public health sphere. It is used to describe all types of abuse, neglect, and other potentially traumatic experiences that occur to people under 18.

According to the CDC’s resource page for ACEs childhood trauma has been linked to risky health behaviors such as smoking and substance use, chronic health conditions ranging from cancer to diabetes, and early death. Individuals with ACEs are also more likely to have what the study refers to as “low life potential,” meaning they have lower high school graduation rates and academic achievement and experience more lost time from work as adults.The scientific reason why individuals with ACEs are at higher risk for these issues can in part be attributed to the way early experiences of adversity affect brain and body development.

“It affects areas like the nucleus accumbens, the pleasure and reward center of the brain that is implicated in substance dependence,” Burke Harris said. “It inhibits the prefrontal cortex, which is necessary for impulse control and executive function, a critical area for learning. And on MRI scans, we see measurable differences in the amygdala, the brain's fear response center.”

These changes in brain chemistry can make an individual more likely to engage in high-risk behaviors such as the use of tobacco and alcohol, which are associated with physical health risks like cancer and cardiovascular disease. But even when people with ACEs abstain from high-risk behavior, the effects ACEs have on brain development can still cause physiological changes that result in a decline in health.

One example is the toxic stress that comes with experiences of childhood trauma that in turn produce poor health outcomes. The constant presence of chemicals such as adrenaline and cortisol heightens blood pressure, weakening the heart and circulatory system. These hormones also raise glucose levels, which can lead to type 2 diabetes and increase cholesterol.

In a system stuck in the ‘danger’ response, the body’s cells, organs and systems prioritise survival and no longer function to support thriving. Mitochrondria, our cells energy creating powerhouses no longer produce ATP for energy whilst in a cell danger response. They instead function to signal danger, thus increasing the ability of the organism’s danger response, but taking down energy capacity.

Constant stress can cause the adrenal glands to give out, eventually producing immune system issues. As a result, individuals with ACEs are more likely to experience a host of chronic illnesses in adulthood. Remember this, too: ACE scores don't tally the positive experiences in early life that can help build resilience and protect a child from the effects of trauma. Having a grandparent who loves you, a teacher who understands and believes in you, or a trusted friend you can confide in may mitigate the long-term effects of early trauma.

Some people may have a low ACE score however still recognise adverse childhood relationship experiences. (ACREs) draw from the science that recognizes how these kinds of difficult relationships influence the nervous system, epigenetics and health.

ACREs refers to emotional neglect and abuse in childhood. Experiences such as not feeling seen, having had no one to turn to with difficult feelings when you were a child, having had little sense of connection with others in your family, having not felt safe or protected or loved even though there was no abuse or violence (or if there was violence or abuse), having been treated as though you were invisible or the problem or weak or stupid. And more. Adverse childhood relationship experiences increase risk for chronic illness, PTSD and complex PTSD. ACREs represent what are also known as attachment wounds, developmental trauma, complex trauma and otherwise difficult early events that children experience when their parents are unable to be nurturing, supportive, kind and gentle, and to repair the inevitable mistakes that happen.

The value of understanding ACEs and ACREs? When we recognize that early adversity is indeed a risk factor for our symptoms, it gives us the context to find new tools for healing. Because reversing symptoms, recovering, improving and even reversing the effects of trauma is possible. It may not be a quick fix, but the effects of trauma are more common than we’ve though – and  not as solid or permanent.

In addition, there are positive experiences that make us more resilient in childhood as well as in adulthood that we can learn no matter what stage of life we are in.

Even more good news? Being sick, having a chronic illness. living with mysterious or difficult-to-diagnose symptoms, having PTSD or complex PTSD – is not in your head. It is not your fault. It’s in our nervous systems and immune systems, in our cell danger responses and more.

What we’re learning is that ACREs are “invisible ACEs.” They are real in the brain and body, and they can fully resolve with support, space, time and compassion (often what was missing in childhood)

Health Conditions Associated with ACEs

Autoimmune disease: Among patients with lupus, 63 percent reported having one or more ACE, and nearly 20 percent had four or more ACEs.1

Cardiovascular disease: Research has shown a strong association between exposure to ACEs and cardiometabolic outcomes, including heart disease, hypertension, and obesity.2

Chronic obstructive pulmonary disease (COPD): In a study on ACEs among individuals with COPD, after controlling for smoking and other risk contributors, the risk for COPD increased as the number of ACEs increased, suggesting that ACEs were an independent risk factor.3

Diabetes: ACEs exposure increases the risk of type 2 diabetes by 32 percent compared to patients with no ACEs.4

Cancer: ACEs strongly predict behaviors that increase the risk of adult cancer.5

Depression: Having at least one ACE is associated with almost three times the odds of depressive symptoms among individuals reporting poor perceived social support.6

Substance use: According to a 2018 study, adults who experienced household abuse were 30 percent more likely to binge drink alcohol than the general population.7

Who Is Affected by Adverse Childhood Experiences?

No one is immune to ACEs. The original CDC and Kaiser-Permanente study examining the prevalence of ACEs and how they affect physical health showed participants across different backgrounds had experienced traumatic events in their youth.

However, a 2018 study on the prevalence of ACEs External link  found that certain minority groups were more likely to have them than the general population. Based on the data, race and socioeconomic status were among the factors in determining the likelihood of having at least one ACE. The average number of ACEs among black, Hispanic, and multiracial individuals were 1.69, 1.8, and 2.52 respectively, compared to an average ACE score of 1.52 among white participants. Individuals with a household income of less than $15,000 had an average of 2.16 ACEs, a number that steadily decreases as household income increases.