Every day we are exposed to things like pollution and ultraviolet light that increase our risk of disease. Many people take additional risks, for example, from tobacco smoke, fast food, or alcohol.
But there is a less recognized exposure that is even more common than smoking and increases the risk of heart disease, diabetes, Cancer, chronic lung diseases, sexually transmitted infections, chronic pain, Mental illness Y reduces one’s life by up to 20 years.
This public health hazard that hides in plain sight is childhood adversity—experiences such as physical abuse, sexual abuse, and neglect.
Childhood adversity is common
In Canada, one in three children is physically or sexually abused or witnesses adult violence in their home. Other adversities like emotional neglect, living in an unsafe neighborhood, or experiencing prejudice and bullying are even more common. Studies in the United States show about 60 percent of children and adolescents have these adverse childhood experiences.or ACE. The more severe the exposure, the greater the health risk.
The reason ACEs contribute to so many diseases is that they are associated with many things that trigger other causes of disease. Think of ACEs as a “cause of causes.”
Health risk behaviors and physiological changes
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As children who have had adverse experiences grow older, they are more likely to smoketo excesive drinking and to use over-the-counter medications. It is more likely that engaging in risky sexual activities and to become obese. Not all children with ACEs engage in risky activities, of course, but enough to contribute to the health consequences of ACEs.
Growing up in conditions that are constantly frightening or stressful affects the biology of developing bodies, especially the development of the systems that regulate our reactions to threats, from predators to viruses. ACEs are even associated with changes in our chromosomes that are linked to early mortality.
Interpersonal and psychological effects.
As adult psychiatrists experiencing a combination of physical and mental illnesses, our patients often tell us about the personal impact of ACEs. One man said that he “had not the slightest doubt that the loss of human connection is the most substantial negative impact” of these experiences. The health costs of human disconnection are profound. Of course, lack of interpersonal support can hasten mortality as much or more than smoking, heavy drinking, inactivity, obesity, or untreated high blood pressure.
The psychological effects of ACEs may be more obvious and may include fearful expectations, the conviction that one is not worthy of love or protection, unregulated anger or shame, and disconcerting memories of bad events.
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It greatly increases the risk of depression, anxiety disorders, post-traumatic stress disorder and addictions. The one in three adults who experienced physical or sexual abuse as a child or witnessed interpersonal violence in the home have at least twice the incidence of these disorders compared to others.
And then the dominoes fall: Mental illness greatly increases the likelihood, burden, and consequences of physical illness. To give just one example, in the months after having a heart attack, those who are depressed are several times more likely to die. So we see that ACEs don’t just lead to one kind of problem, but many.
The social determinants of health
Finally, the disease burden is not evenly distributed. Maintaining health is more challenging for those who are disadvantaged by poverty, lack of education, language barriers, discrimination, and living with ongoing systemic damage from colonization and multigenerational trauma.
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Childhood trauma has a complex relationship with these social determinants of health. On the one hand, ACEs are not exclusive to marginalized groups and can occur in all strata of society. On the other hand, the risk of experiencing ACEs may be higher in some groups, and the consequences of ACEs may multiply as social forces interact.
For example, childhood trauma is strongly associated with behaviors that increase the risk of sexually transmitted infections. About half of people living with HIV have experienced childhood abuse. HIV is also more common in groups facing discrimination, including men who have sex with men, people who inject drugs, indigenous peoples Y immigrants from countries where HIV is endemic.
The intersecting components of personal experience and identity attract stigma and discrimination, which in turn influences mental health, self-care, and the ability to navigate a health care system that has multiple barriers and gaps. It is a complex network and ACEs contribute to this complexity.
A cause of causes
Events that occur in childhood can contribute to a cascade of health risks throughout life. There are so many pathways to disease, interacting with each other over decades and compromising health in so many ways, that it should come as no surprise that Childhood adversity is a profound public health problem..
It is time for us as a society to recognize ACEs for the evil force that they are. Those affected must be treated with compassion and also with an awareness of the lasting effects of early adversity on health. Research that helps us understand the lifelong impact of ACEs could help guide the prevention of chronic disease and mental health problems in many people who experience adversity during childhood.
