the gravest health crises of our time -- 2/9/23

Today's encore selection -- from The Body Keeps the Score by Bessel van der Kolk, M.D. Between 1995 and 1997, the CDC and Kaiser Permanente, with Rob­ert Anda, M.D., and Vincent Felitti, M.D., as co-principal investigators, conducted the Adverse Childhood Experiences study, or ACE. More than 50,000 patients responded to an evaluation on childhood trauma and were scored from 0-10. The results linked childhood trauma with health and social problems across an adult's life. The ACE study brought to light one of the gravest health crises of our time -- child abuse:

"In 1985 Felitti was chief of Kaiser Permanente's Department of Pre­ventive Medicine in San Diego, which at the time was the largest medical screening program in the world. He was also running an obesity clinic. ... One day a twenty-eight-year-old nurse's aide showed up in his office. Felitti accepted her claim that obesity was her principal problem and enrolled her in the program. Over the next fifty-one weeks her weight dropped from 408 pounds to 132 pounds.

"However, when Felitti next saw her a few months later, she had regained more weight than he thought was biologically possible in such a short time. ... It turned out that her newly svelte body had attracted a male coworker, who started to flirt with her and then suggested sex. She went home and began to eat. She stuffed herself during the day and ate while sleepwalking at night. When Felltti probed this extreme reaction, she revealed a lengthy incest history with her grandfather. ...

"[A]n epidemiologist from the Cen­ters for Disease Control and Prevention (CDC) encouraged Felitti to start a much larger study. ... The result was the monumen­tal investigation of Adverse Childhood Experiences (now know as the ACE study). ...

"Felitti and Anda spent more than a year developing ten new questions covering carefully defined categories of adverse childhood experiences, including physical and sexual abuse, physical and emotional neglect, and family dysfunction, such as hav­ing had parents who were divorced, mentally ill, addicted, or in prison. ...

"The ACE study revealed that traumatic life experiences during childhood and adolescence are far more common than expected. The study respondents were mostly white, middle class, middle aged, well educated, and financially secure enough to have good medical insurance, and yet only one-third of the respondents reported no adverse childhood experiences. ...

"Each yes answer was scored as one point, leading to a possible ACE score ranging from zero to ten. ... Of the two-thirds of respondents who reported an adverse experience, 87 percent scored two or more. One in six of all respondents had an ACE score of four or higher.

"In short, Felitti and his team had found that adverse experiences are interrelated, even though they're usually studied separately. ... Incidents of abuse are never stand-alone events. And for each additional adverse experience reported, the toll in later damage increases. ...

"When it came to personal suffering, the results were devastating. As the ACE score rises, chronic depression in adulthood also rises dramatically. For those with an ACE score of four or more, its prevalence is 66 percent in women and 35 percent in men, compared with an overall rate of 12 percent in those with an ACE score of zero. The likelihood of being on antidepressant medication or prescription painkillers also rose proportionally. ... (Ironically, research has shown that depressed patients without prior histories of abuse or neglect tend to respond much better to antidepressants than patients with those backgrounds.)

"As part of their initial medical evaluation, study participants were asked, 'Have you ever considered yourself to be an alcoholic?' People with an ACE score of four were seven times more likely to be alcoholic than adults with a score of zero. Injection drug use increased exponentially: For those with an ACE score of six or more, the likelihood of IV drug use was 4,600 percent greater than in those with a score of zero.

"Women in the study were asked about rape during adulthood. At an ACE score of zero, the prevalence of rape was 5 percent; at a score of four or more it was 33 percent. ... [N]umerous studies have shown that girls who witness domestic violence while growing up are at much higher risk of end­ing up in violent relationships themselves, while for boys who witness domes­tic violence, the risk that they will abuse their own partners rises sevenfold. More than 12 percent of study participants had seen their mothers being battered.

"The list of high-risk behaviors predicted by the ACE score included smoking, obesity, unintended pregnancies, multiple sexual partners, and sexually transmitted diseases. Finally, the toll of major health problems was striking: Those with an ACE score of six or above had a 15 percent or greater chance than those with an ACE score of zero of currently suffering from any of the ten leading causes of death in the United States, including chronic obstructive pulmonary disease (COPD), ischemic heart disease, and liver dis­ease. They were twice as likely to suffer from cancer and four times as likely to have emphysema. The ongoing stress on the body keeps taking its toll.

"Twelve years after he originally treated her, Felitti again saw the woman whose dramatic weight loss and gain had started him on his quest. She told him that she'd subsequently had bariatric surgery but that after she'd lost ninety-six pounds she'd become suicidal. It had taken five psychiatric hospi­talizations and three courses of electroshock to control her suicidality. Felitti points out that obesity, which is considered a major public health problem, may in fact be a personal solution for many. Consider the implications: If you mistake someone's solution for a problem to be eliminated, not only are they likely to fail treatment, as often happens in addiction programs, but other problems may emerge. ...

"The ACE study group concluded: 'Although widely understood to be harmful to health, each adaptation [such as smoking, drinking, drugs, obesity) is notably difficult to give up. Little consideration is given to the possibility that many long-term health risks might also be personally beneficial in the short term. We repeatedly hear from patients of the benefits of these "health risks." The idea of the problem being a solution, while understandably dis­turbing to many, is certainly in keeping with the fact that opposing forces routinely coexist in biological systems ....

"The first time I heard Robert Anda present the results of the ACE study, he could not hold back his tears. In his career at the CDC he had previously worked in several major risk areas, including tobacco research and cardio­vascular health. But when the ACE study data started to appear on his com­puter screen, he realized that they had stumbled upon the gravest and most costly public health issue in the United States: child abuse. He had calculated that its overall costs exceeded those of cancer or heart disease and that erad­icating child abuse in America would reduce the overall rate of depression by more than half, alcoholism by two-thirds, and suicide, IV drug use, and domestic violence by three-quarters. It would also have a dramatic effect on workplace performance and vastly decrease the need for incarceration."

Take The ACE Quiz



Bessel van der Kolk, M.D. 


The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma


Penguin Books


Copyright 2014 by Bessel van der Kolk


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