How ACEs Influence Future Physical Health

When looking into childhood abuse and its effects, you’ll likely stumble upon something known as ACEs – adverse childhood experiences. This term derived from the ACE Study back in the 90s, which provided very valuable and eye-opening information on the long-lasting effects of childhood trauma.

I first stumbled onto the topic of ACEs a few years ago while reading Childhood Disrupted. It helped me learn more about the severe and enduring biological impacts of childhood adversity. The ACE study demonstrated how childhood trauma can emerge as physical health problems years or even decades after the traumatic experiences.

So in this post, I will discuss what the ACE study was, what ACEs are, and how they influence the future health and well-being of people who have experienced them.

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The ACE Study

The ACE Study is one of the largest investigations of the link between childhood mistreatment and health and well-being in later life. It was conducted by the Centers for Disease Control (CDC) and Kaiser Permanente from 1995 to 1997.

Over 17,000 people participated in this study, providing information about their childhood experiences of abuse, neglect, and household dysfunction. And these experiences are known as adverse childhood experiences (ACEs).

You can learn more about the demographics and ACEs of the study’s participants here.

What are ACEs?

ACE is the acronym for adverse childhood experiences. They are any potential adverse or traumatic experiences that occurred in childhood.

According to the study, ACEs are categorized into three groups. And each group is further divided into multiple categories.

Abuse
- Emotional Abuse
- Physical Abuse
- Sexual Abuse
Neglect
- Emotional Neglect
- Physical Neglect
Household Dysfunction
- Domestic Violence (Witnessing Abuse of a Parent)
- Substance or Alcohol Abuse in the Household
- Mental Illness in the Household
- Parental Separation or Divorce
- Incarcerated Household Member

Each participant received an ACE score based on the total number of categories they have. The ACE score then determines the amount of stress they had in childhood.

ACE Research Findings

ACE research demonstrates that trauma and adverse experiences in childhood are MAJOR risk factors for the leading causes of illness, death, and poor quality of life in the U.S.

Research shows that 64% of adults faced one ACE in their childhood. And 20% experienced three or more ACEs. The short- and long-term outcomes of these experiences include a myriad of health AND social problems. Basically, as the number of ACEs increases, so does the risk for negative outcomes.

ACEs have been linked to the following issues:

Alcoholism
Obesity
Depression
Drug Use
Liver Diseases
Cancer
Heart Disease
Diabetes
Autoimmune Diseases
Migraines
STDs
Smoking
Suicide Attempts
Teen Pregnancy
Learning Disorders
Depression

Learn more about the long-lasting effects of childhood abuse

ACE Questionnaire

The following ACE questionnaire was developed based on the original ACE study. This questionnaire is often used to determine one’s ACE score.

Before you were 18 years old:

1. Did a parent or other adult in the household often or very 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?

2. Did a parent or other adult in the household often or very often push, grab, slap, or throw something at you? OR Ever hit you so hard that you had marks or were injured?

3. 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 Attempt or actually have oral, anal, or vaginal sex with you?

4. Did you often or very 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?

5. Did you often or very 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?

6. Were your parents ever separated or divorced?

7. Was your parent or stepparent often or very often pushed, grabbed, slapped, or had something thrown at them? OR Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? OR Ever repeatedly hit at least a few minutes or threatened with a gun or knife?

8. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?

9. Was a household member depressed or mentally ill, or did a household member attempt suicide?

10. Did a household member go to prison?

Add up all your "Yes" answers to determine your ACE score.

Disclaimer: I edited Question 7 to make it gender-neutral. Originally, the question states “mother or stepmother”. However, abuse (in the case of Q7 – physical abuse) happens to all sexes and genders. Witnessing abuse happening to anyone, regardless of sex or gender, can be traumatic.

The Issues with the ACE Questionnaire

Learning your ACE score can be validating for some people because it may explain the many issues that have been unexplainable till now. However, an ACE score can also be invalidating. So while the questionnaire is useful in data collection and has significantly helped in the area of ACE research, it might not be ideal to use on an individual basis.

If your ACE score is not as high as you expected, you may get the impression that your experiences aren’t as bad as someone with a higher ACE score. But please remember that the ACE Questionnaire is a very simplified way to measure “childhood trauma”. It gives an idea of an individual’s adverse childhood experiences without needing to go too in-depth. However, it lacks nuance.

Categories of abuse, neglect, and household dysfunction are all worth “1” while it can be argued that some ACEs are more severe or traumatizing than others. Also, the questionnaire only focuses on traumatic experiences happening in the home. It misses out on other potentially traumatic experiences that can also lead to future health issues, such as:

Getting bullied
Living in a violent community
Living in a war zone
Experiencing a natural disaster
Experiencing a life-threatening accident, injury, or illness
Losing someone important
Being kidnapped

Someone with an ACE score of 1 can be more traumatized by their ACE than someone who has an ACE score of 4. So please don’t let your score dictate how you think you should feel. Whether you have a score of 1 or 6 doesn’t mean you should or shouldn’t have issues in your current or later life. Besides, research claims that it is a risk, not a definite.

Research indicates that the higher your ACE score, the higher your RISK of certain negative outcomes. Risk is the keyword here. A high ACE score does not mean you are doomed to have issues or that your current issues will never be resolved. Learning about your ACE score simply helps you learn a little more about how your trauma could’ve contributed to your present issues.

How ACEs Influence Future Physical Health

According to research, there is a strong relationship between stress and inflammation. Stress hormones promote inflammation. Thus, stress itself can trigger a horde of different health issues.

ACEs like abuse and neglect disrupt the child’s healthy brain architecture and cause a toxic stress reaction to occur. It ends up altering the gene expression that controls stress hormone output, thus triggering an overactive inflammatory stress response.

Over time, tissue damage happens gradually in response to chronic stress. And that eventually leads to symptoms and diseases. So something traumatic happening to a child predisposes them to future health issues and conditions. Like that one book title says, the body keeps the score.

Research claims that the higher one’s ACE score is, the higher the number of doctor visits they’d had in the past year, and the higher their number of unexplained physical symptoms. In other words, the more trauma a person experiences in their childhood, the more physical symptoms and ailments they encounter later in life.

For instance, I’ve struggled with various health problems and unexplained aches for years. Despite my attempts to be healthier – emotionally and physically – and the many doctors I’ve visited for solutions, the issues persist. And it’s hard to stay motivated and positive when trying your best doesn’t seem good enough. And unfortunately, this vicious cycle is something many people with ACEs struggle with.

How to Heal

Unfortunately, ACEs are common across all populations. And there is an overwhelming amount of evidence that it leads to health problems in later life. Even if not for all the research on the topic, you probably notice it within yourself.

Sure, many different possible factors could be causing you pain, discomfort, or illness. But when it boils down to it, your childhood likely played a very significant role. And if this is new information to you, take all the time you need to process that.

I know all of this information probably feels discouraging. Healing might not seem possible or may seem even more insurmountable than before. But as I always say, healing IS possible.

But first, let me emphasize that healing does not mean being “fixed”. It does not mean you will no longer have triggers or struggles or health problems. Not only is that unrealistic, but it’s impossible, not just for abuse survivors like us but for anybody.

Healing means doing better today than you were yesterday. It means making small improvements and trying to see value in yourself and your life. Life will still suck sometimes. Emotions will run strong. Things will continue to be tough. But you’re healing when you start taking care of yourself and your health and trying your best to make things work.

Maybe you won’t be in perfect health, but you CAN be in better health.

Interestingly, according to research, it isn’t a stressful experience that causes you harm. Rather, it is your reaction to the feeling that’s most harmful. So being able to reframe how you look at stress can help immensely. Try to see how the stress you might be feeling is helpful rather than hurtful. Listen to your feelings and learn how to healthily deal with them.

Please check out other posts at Hopeful Panda to begin your healing journey. If you don’t know where to start, you can start here.

ACE Resources

For more research and resources on adverse childhood experiences, see here.

As mentioned at the start of this post, the book Childhood Disrupted: How Your Biography Becomes Your Biology, and How You Can Heal by Donna Jackson Nakazawa taught me about ACEs. It’s also one of my favorite books on the topic of childhood trauma and its effects.

A lot of the information in this post is actually from this book. I recommend it as a way to learn more about how your childhood experiences contributed to your current struggles, particularly regarding physical health and illness. The author goes more in-depth about ACEs as well as discusses ways to heal, helpful types of therapy, and parenting tips.

You can sign up for a free trial of Kindle Unlimited to read this title for free or at a discount. If you prefer audiobooks, you can sign up for a free trial with Audible and claim this title for free. It would be yours to keep even when you cancel.