Child Abuse is Bad for Your Health: The Adverse Childhood Experiences Study
By Deacon Anthony Rizzuto, PhD.
Consultant to the VIRTUS® Programs
“A torn jacket is soon mended; but hard words bruise the heart of a child.”
—Henry Wadsworth Longfellow (1807-1882).
In 1998, in a collaboration between the Centers for Disease Control and Prevention and the Kaiser Permanente Health Appraisal Clinic in San Diego, a team of doctors and researchers published the results of a two-year study entitled “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study.”[i] This landmark research is one of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being.
More than 17,000 Health Maintenance Organization (HMO) members undergoing a comprehensive physical examination chose to answer a questionnaire that asked them to provide information about experiences of abuse, neglect, and family dysfunction while they were growing up, as well as the details of their current health status and behaviors. To date, more than 50 scientific articles have been published and more than100 conference and workshop presentations have been made about its results. The ACE Study findings suggest that certain childhood experiences are major risk factors for the leading causes of illness and death as well as poor quality of life in the United States. Progress in preventing and recovering from some of the nation's worst health and social problems is likely to benefit from understanding that many of these problems arise as a consequence of early childhood trauma.
The ACE study questionnaire asked respondents to indicate whether they had experienced any of three categories of childhood abuse: recurrent psychological (emotional) or physical abuse or contact sexual abuse. Questions about exposure to four categories of household dysfunction during childhood included: exposure to substance abuse (by a household member); mental illness (someone who was chronically depressed, institutionalized, or suicidal); violent treatment of a mother or stepmother; and criminal behavior in the household. Respondents were defined as exposed to a category if they responded “yes” to 1 or more of the questions in that category. Thus the possible number of exposures ranged from 0 (unexposed) to 7 (exposed to all categories).
The researchers then conducted statistical analyses of the relationship between the self-reported level of exposure to childhood abuse and family dysfunction (0-7) and the health issues that the physical examinations revealed in the respondents. The results showed a strong and consistent relationship between the level of exposure to childhood trauma and numerous organic diseases. For example, a person with an ACEs score of four or higher is 260 percent more likely to have chronic obstructive pulmonary disease (COPD) than a person with an ACEs score of 0. Similarly, persons with ACEs scores higher than four were found to be 240 percent more likely to have hepatitis, 250 percent more likely to have a sexually transmitted disease, and 460 percent more likely to suffer from depression than persons with no exposure to childhood trauma. Persons reporting a high ACEs score of seven were found to be up to 360 percent more likely to suffer from ischemic heart disease (reduced blood supply to the heart due to coronary artery disease) than those reporting low or no exposure to childhood abuse or family dysfunction.
The results indicate that child abuse and neglect—either by themselves or in combination with other elements of family dysfunction—are related to multiple risk factors for several of the leading causes of death in adults in the United States, and that the impact of these experiences on adult health status is strong and cumulative. In a heartbreaking sequence of events, exposure to these traumatic childhood experiences leads to social, emotional, and cognitive impairment in children, which leads to the adoption of health risk behaviors in adolescents and adults, which leads to disease, disability and social dysfunction, and—ultimately—to early death.
Further research[ii] spun off from the ACEs study has found similar relationships between childhood trauma and normal neurological and hormonal function. In other words, these childhood traumas can actually cause long term changes in brain chemistry and function, as well as in the body’s hormonal balance. These, in turn, have been linked to appetite, the way the body ultimately distributes abdominal fat, the regulation of blood pressure, immune function, inflammatory responses, the regulation of sleep/wake cycles, and the formation of memory.
It is clear from these studies that child abuse is bad for your health in a number of ways. Beyond the psychological and emotional effects that we have come to understand as the consequence of childhood abuse and neglect, we are now learning that its effects are lifelong and life threatening in ways that were unimaginable only a few years ago. Yet the authors themselves, in the closing remarks of the study, point to a number of societal and community strategies as essential in combating the problem of adverse childhood experiences—the very first being strategies that include the prevention of their occurrence.
Sound familiar? As VIRTUS® facilitators, administrators, and participants, that is precisely what we are attempting to do in our parishes and schools. By building a Church community that strives to prevent child abuse and neglect before it occurs, or to recognize and respond to it at the earliest possible time; by training adults in positions of trust with children to spot the symptoms of child abuse and neglect and know how to respond and report their suspicions; and by training children about safe and unsafe touch boundaries, and how to respond if those boundaries are crossed; we help to create communities better equipped to prevent the abuse and neglect that constitute at least part of the adverse childhood experiences represented in the research above. And by doing so, we hope to prevent those “harsh words” and actions that can literally “bruise the heart of a child” for the rest of his or her life.
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[i] American Journal of Preventive Medicine - May 1998 (Vol. 14, Issue 4, Pages 245-258)
[ii] “The Relationship of Adverse Childhood Experiences to Adult Health: Turning gold into lead” Felitti, VJ
“Insights Into Causal Pathways for Ischemic Heart Disease: Adverse Childhood Experiences Study” Dong et al, Circulation. 2004;110:1761-1776
“Adverse Childhood Experiences and Chronic Obstructive Pulmonary Disease in Adults” Anda et al, Am J Prev Med. 2008 May; 34(5):396-403
“Stress Predicts Brain Changes in Children: A Pilot Longitudinal Study on Youth Stress, Posttraumatic Stress Disorder, and the Hippocampus” Carrion et al, Pediatrics 2007;119:509-516
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