A couple of weeks ago, I saw my primary care physician for my annual wellness exam. As usual, I was handed a clipboard and instructed to answer page after page of questions. They included updates to my demographics, my insurance information, my family medical history, and a "health risk assessment" that included questions about lifestyle (exercise, diet, smoking, and alcohol/drug use), about my mood and stress levels, current and previous health conditions, dementia screening, recent falls, and my ability to perform daily activities such as feeding myself, dressing, and bathing. It may be annoying to fill out the same questionnaires year after year because it's time consuming and redundant...but it makes sense from a health maintenance perspective. This line of questioning helps the physician identify problems that predict poor health outcomes. It provides information he can use to institute preventive strategies, as well as timely interventions to correct or compensate for developing problems.
"A facility that asks you to fill out
a health screening form is a sign of one
that really cares about its members."
~Kathi Davis~
Back when I was in practice, we didn't use screening questionnaires like these very much, but now they're considered an important part of the patient's medical record...which makes me wonder why the ACE (Adverse Childhood Experiences) Survey is not included in the paper work we submit to our health care providers. This questionnaire addresses childhood trauma and its effect on the development of chronic disease in adulthood.
A growing body of evidence supports the link between childhood adversity and the development of physical disease and mental health disorders later in life. Childhood tauma includes physical, emotional, and sexual abuse, physical, verbal, and emotional neglect, living with a depressed, mentally ill, or addicted parent, witnessing domestic abuse, and losing a parent to separation or divorce...among others. Chronic adversities like these actually change the architecture of the child's brain, altering the expression of genes that control stress hormone output. This triggers an overactive inflammatory response that leads to adult disease states, notably autoimmune conditions like lupus and rheumatoid arthritis, heart disease, and PTSD-like anxiety and reactivity.
You can take the quiz here. Answer yes or no:
Before your 18th
birthday:
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 intercourse 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 that 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 that 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 mother or stepmother often or very
often pushed, grabbed, slapped, or had something thrown at her, or sometimes,
often, or very often kicked, bitten, hit with a fist, or hit with something
hard, or ever repeatedly hit over 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 your "yes" answers. This is your ACE score. If yours is greater than 0, you should be concerned.
The bad news is that the higher your ACE score, the more likely it is that your health and well-being are under assault. People with an ACE score of 4 are twice as likely to be diagnosed with cancer than someone with a score of 0. Each "yes" response increases the likelihood of hospitalization for an autoimmune disease by 20%. Someone with an ACE score of 4 is 460% more likely to face depression as an adult than someone with a score of 0. An ACE score of 6 or higher shortens an individual's life-span by almost twenty years. This is a big deal.
The good news is that these early changes in the brain, and their subsequent effect on inflammation and the immune system can be mitigated. Epigenetic changes are reversible. There is a path to healing.
Some of the practices that have been shown to promote epigenetic healing include:
- writing to heal
- drawing
- mindfulness and loving-kindness meditation
- tai chi, qigong, and yoga (moving meditation)
- dietary changes to promote a healthy microbiome in the gut
- guided imagery
- hypnosis
- neurofeedback
- EMDR
The problem is that childhood trauma is notoriously shrouded in secrecy, and very few healthcare providers are aware of these associations so they don't ask about them. Most physicians see several patients with high ACE scores every day, but all too often the underlying trauma that plays a role in the patient's illness goes unidentified. The opportunity to intervene therapeutically is, therefore, lost.
If you're interested in the relationship between adverse childhood experiences and their effect on health outcomes in adults, I would recommend you check out the book, "Childhood Disrupted" by Donna Jackson Nakazawa, or visit her blog online at www.donnajacksonnakazawa.com.
If you're curious about the role of epigenetics in illness and healing, check out "The Biology of Belief" by Bruce H. Lipton, PhD.
Next on my list is "The Body Keeps Score" by Bessel van der Kolk, M.D.
"As the ACE study has shown,
child abuse and neglect is the single most common
cause of drug and alcohol abuse,
and a significant contributor
to leading causes of death such as
diabetes, heart disease, cancer, stroke, and suicide."
~Bessel van der Kolk, M.D.~
It is a shame to withhold this vast body of knowledge from patients when it offers an effective pathway to healing that has, so far, been largely ignored.
jan
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