The Lasting Impact of Childhood Trauma and How to Heal from ACEs

Hello, and I am your host, Dr. Valda Crowder, also known as Dr. V. I'm a board certified emergency room physician that is committed to empowering you with life-saving health information. Please make sure to subscribe to my channel, comment, and follow on all social media. Today's topic is childhood wounds that last a lifetime. Understanding adverse childhood experiences. So today's topic includes discussions of childhood trauma, abuse, neglect, and their long-term health effects. The content can be very sensitive for some listeners, and so I'm giving people a warning ahead of time before we actually get started. We are actually going to focus on how do you actually treat and and cure and cut get over these things. And we're also going to share our resources throughout the show. Alright, so today we're going to go back to where so many health problems begin, and that is not in the emergency department, not in your doctor's office, but in your childhood. There's been a lot of science on this, and I think a lot of people don't realize how much this field has actually been studied. And it's very, very clear that what happens between the time you're born and 18 years old really shapes your brain. In some cases, it actually shapes and changes your DNA and the expression of your DNA. It actually affects your health and it also impacts your overall life expectancy. It really, really has a profound impact on your entire life. So we are talking about adverse childhood events. In the medical field, we call these ACEs. Now, as a as a physician, I can tell you that there are experiences that lead to wounds that we carry from childhood and they show up in every area of our lives. So what I'm going to share with you today is what is that? How do we actually quantify it? And most importantly, what is the treatment that helps us heal from these experiences? So let's start at the very beginning. So an adverse childhood event or an ACE is actually a potentially traumatic event that occurs between birth and 18 years old. As I said, it stands for Adverse Childhood Experience. These were first formally identified in a landmark study that was done by the CDC and Kaiser Permanente in 1998. It was really one of the largest investigations of childhood abuse and neglect that was ever conducted. The original ACE study included 10 categories of childhood adversity across two domains. So I'll give you sort of an example of what this actually was in the original study. So in the original study, they talked about household dysfunction. So that included living with a parent with a mental illness, living with someone that abused alcohol or drugs, witnessing domestic violence against a parent or a caregiver, having a family member incarcerated is an adverse childhood experience. And also having a parent that is separated or divorced is an adverse childhood experience. And there was also a group of categories that actually specifically dealt with childhood abuse and neglect. So it left it talked about children's physical need uh being physically abused. It also talked about uh children and where their emotional needs met, sexual abuse, and then also physical neglect as far as children not being fed, not being clothed, um, and then also emotional neglect. So those were kind of the basic categories. Right? So modern research has really expanded this framework into a community-level ace or community-level adverse childhood events. And some of the community-level uh adverse experiences are poverty, racism, neighborhood violence, food insecurity. Um, a big one is involvement with the foster care system or juvenile justice system. So overall, it kind of really leads to sort of a robust sort of assessment of childhood stressors. So I want to really talk about, you know, what what how how is this actually measured? Because, you know, a lot of people will say that they they they had a tough childhood. Uh, for some people, um, you know, there were major things that were going on. Um, there's actually a measurement for this, a numeric measurement for this. Um, so the original ACE clinical tool uh was a scoring mechanism that was basically zero to ten. Zero was no identified adverse experiences. One to three was moderate risk. Outcomes depend heavily on protective factors, and we'll talk about what some of the protective factors are. The cutoff was really four. If you had on this clinical tool a score of four, that means you'd had a very high risk and a dramatically elevated risk for chronic disease, mental illness, violence, and most importantly, a shortened lifespan. And a score of four or more actually led to a lifespan that was shortened by 20 years. It was very, very significant. Um, so 64% of U.S. adults have at least one adverse childhood event, and 17% actually report 14 or more. So these are not these are not rare events. These are this is really a public health crisis that is really hiding in in plain sight. So ACEs are responsible. Adverse childhood events are responsible for because I want to I want to go over what this looks like later on in life. So adverse childhood events are responsible for two million cases of heart disease. They're responsible for 21 million cases of depression in the United States. Women and people of color also report a higher rate of adverse childhood experiences. Uh many people uh actually argue that systemic inequity and racism in the United States is in and of itself an adverse experience. Uh, children in low-income households are five times more likely to experience adverse childhood experiences than someone in a higher outcome. And in general, adverse childhood experiences cost the United States$748 billion annually in lost productivity, health care costs, and also criminal justice experiences. We have found that children in foster care have some of the highest highest scores of adverse uh childhood experiences of any population. I think that what's really important is what we see going on now with immigration. You can see how you know some of the experiences in immigration are also going to be uh causing significant issues for people later in life related to adverse childhood experiences as well. Alrighty, so let's talk about how adverse childhood experiences actually shape your body and brain. Your brain is not fully developed until you are about 26 years old, 25 to 26 years old. So when a child experiences repeated trauma, and especially without the buffer of a supportive adult, then the body's stress response becomes chronically activated. This is actually called toxic stress. So toxic stress is very, very different from typical stress. So what happens with toxic stress is it floods the brain with cortisol and adrenaline, and over extended periods of time, it literally reshapes your brain's development, it reshapes your immune system, it reshapes your nervous system, and it has also been found to have an impact on your genetic expression and your actual DNA. So, how does this actually occur? So there is a thing called the hypothalamic pituitary adrenal axis. So I want to kind of go over this a little bit. Your hypothalamus and your pituitary are all in your all in your brain area, and it actually connects with your adrenal system, which is actually in your body. And you get a hyperact hyperactivation of this particular system. And what happens is it structurally changes the fear center, the memory center, and the decision making. Yes. Did you call my name? What did you say? Yes, I did call your name.

You got me a hundred percent. That's why I couldn't believe it. That is able.

Technology, technology.

Yes, it is, it is. Thank you for taking my call, Dr. V. I I've been searching and I thank you for searching on this topic. It's so heartfelt. And I just wanted to ask, 'cause I want to be brief so that you can have other callers and save time. I have the youngest one out of three, and she's been struggling ever since, and she's had a rough upbringing because we got divorced military family members, and it's been just excruciating. So now she's having just about a lot of what you can imagine, and I don't know where to find the help she needs. So I am just trusting the Almighty that you could please if you can refer me to a place 'cause I just don't want to take her to any psychiatric place and then once they have control over her. I don't know what the methodology is in the treatment plan. So um can I leave my number might be or I don't know what to do. I'd like to see if I could get some guidance on how to how to help her.

Yeah, so I'll have you leave your number, but we'll do that offline. But a quick question for you. When you say that she's really struggling, tell me what that actually looks like.

A lot, a lot, a lot. She's solitary, doesn't have any friends, she talks to herself now. And it's breaking my heart. It really is. And I don't want to walk away from her because she needs help.

When you say she's talking to herself, she's actually talking to like talk literally having conversations with herself with no one else there or talking to people that are not there? Yes. Okay. Talking to herself constantly.

Okay.

All right. So is there any is there any talks of I don't want to live anymore or I don't want to be here or anything along that line?

No, that's why I try to be here. I've never heard that.

Okay. Okay, though. All right. What happens with adverse childhood events and experiences, and again, I don't want to go into what she experienced, but what happens is it can sometimes lead into more of a psychiatric breakdown, which which then sometimes does require medication to get someone out of the crisis situation along with some cognitive behavioral therapy. Right. So what what where where are you? Are you in uh Maryland or are you local? Where where are you? What state are you in? Okay, so you are in Maryland. Okay. Okay, all right, good. So University of Maryland has a great program. All right, so so a couple of things is a lot of if you're close to a university, a lot of them have uh outpatient uh mental health programs. And I would actually start there. If you know that she's had adverse childhood events, um, then you want to really make sure that you ask for someone who is trained in trauma-informed care. The other thing is that when when people have adverse childhood experiences, part of the therapy involves the parent and the child in therapy together. So the fact that you're there and the fact that you're supporting her actually is is really important. I wouldn't be as concerned about someone sort of taking control of her in the system because if you have the appropriate care, you would be involved the you would be integrally involved the entire time. I appreciate that.

Yes, absolutely.

Oh, thank you so much. And and you know, and and and also know that there are really things that can really make a difference with this. It sounds like she may be at a point where she may need to have some medication intervention. Um, but once once uh once young people begin to actually pull through this and actually get some coping skills and coping mechanism, they can go on to have a very normal life.

She's 37 and time is not playing, so I don't have forever either. Yes.

Oh, more even more important that you actually take her. Any dangerous you know, you think she's gonna harm herself or you think she's gonna harm others, take her straight to the emergency department.

I'd have to find the right one. I've taken her three different times. Oh, her vitals are stable and they send her back home. They don't seem to even have the urgency to help. That's why I was asking you to I have to know where I'm placing her is for her best interest.

For her best interest, yeah. No, I understand. Yes, yes, yes, no, I absolutely understand. All right, what I'm gonna have is I'm gonna have my board operator take your number, uh, take your name and your number. Uh, we don't want to do that while you're actually uh on the on the show live. And let me see if I can help guide you through the system, okay?

God bless you. Okay, bless you so much.

Thanks. You're welcome. You're welcome. All righty. So as you can see, this really is something that is real for people. And I want to kind of go over uh a couple of a couple of things and how adverse child experiences makes make a difference with um specifically with heart disease and stroke. You're two to four times more likely to have heart disease and stroke. It also increases the risk of diabetes, cancers, COPD, liver, obesity, autoimmune disease, and also chronic pain. All right, it looks like we've got another caller online too. Um, the most strong link that you actually see with adverse childhood experiences is depression and anxiety. Um we also have folks that uh have PTSD, substance use disorders, whether or not it's alcohol, opioids, or any other narcotics. And people that have at least five or more adverse childhood experiences are seven to fifteen times more likely to attempt suicide. So this is very, very, very serious. We also see psychosis and dis dissociative disorders. That was kind of what was described with the last caller. And we can find where people kind of isolate and they have problems with attaching, making friends, all of these sorts of things. Um we also see some social behavioral consequences, which is um early sexual activity, teen pregnancy, involvement in the criminal justice system, educational underachievement, employment instability, poverty, um, and repeated cycles of domestic abuse uh and violence. All right, we've got a caller on line two. Renee?

Yes, hi, Dr. Valda. Hi, how are you? Good morning. Good morning. Good morning. Um I was listening to your show, and I'd like to be able to get a sense of when we're talking about these um traumatic events. Um, how are we addressing um the traumatic event of COVID? Number one, because it it you know it's affecting everybody, in particular adolescents who and and young children. Right. Who no longer have the ability to socialize, who are confined to their homes. And and then the other question I have, because these seem to be like larger societal things, but they have individual impact. Right. And then the other area I had some concern about was the um ongoing violence, the societal violence, the war, the fear of ice. Um how how do we deal with, you know, our kids um and in particular like you know, the adolescents? How do we get how do we address that?

Yeah, so kind of trauma for our kids. Right. So the so the original study that was done was pre-COVID, pre-Iran war and pre-ICE, right? So so some of the um, so the scoring mechanism, some people are actually stating that the scoring mechanisms actually need to be changed and updated to actually include people's exposure to these things. Um COVID was a very interesting type of uh adverse uh experience. I know it was traumatic even for myself as an emergency medicine physician. You felt like you were going to work every day and the world was gonna end. I mean, it was really apocalyptic uh in the feeling of it. Um and so um I think that one of the things is that I think that people do have to really recognize that COVID has really made a very big difference on people's ability to socialize. We've also found that COVID had more, uh a higher concentration of the COVID infection was in the brain than in the lungs. So when we are now yes, and it has impacted the ability of certain vitamins and minerals to cross the blood-brain barrier. So we are seeing an impact um with mental illness post-COVID. Um, I think that ICE actually, you know, the the ICE and all the immigration stuff, I've I've been listening to the stories of some of the families that have been in ICE detention. Um and when we when we talk about the fact that, you know, the foster care system, which is people consider it to be a relatively, I mean a relatively safe system, um, obviously, you know, there are bad actors in any system, but the ICE immigration seems to be dysfunctional at all levels. Um the trauma of people that are actually being sent to other countries, um, being held for months and released, um, these are very, very, very severe um uh childhood uh experiences and also adult experiences. Um I think for one thing I would say one thing that is really, really important is for people to turn as far as the news and the war, um, is for people to really decrease their ingestion of video content and news on TV. You really have to create a protective environment. You can stay informed by reading the news or reading the headlines, but you really want to protect yourself from video content and the constant talking heads. It is really anxiety provoking. I've got another call. Greetings, Dr. B, is that me? Yes, this is you. Uh is your name Fahima?

Yes, it is. All right. Yeah, I um the the adverse child experience, because I'm also a clinician, is something that's close to my heart. And I wanted you if you could to talk about one epigenetics and ACEs and also the Philadelphia study, because as you know, the first study uh done with Kaiser and uh the CDC looked at middle class uh folks with insurance. And the ACEs transcends race, class, and social economics, they found the same corollary. So could you speak one about uh the uh ACEs and the Philadelphia study as well as epigenetics?

Okay, now when you say, yeah, well, wait, when you say the Philadelphia study, you have to actually there's uh I don't necessarily have right on the what what study are you referring to? Yeah.

Well initially initially the the first study was done, as you mentioned, uh with the CDC and Kaiser Permanente, and mainly it was uh actually middle class white folks with great insurance. And they found the same thing sometime later when they did a similar study with folks in the in the Philadelphia who may have been economically disadvantaged, and this just showed that adverse child experience pretty much transcended economic education, etc. So, you know, there's not a pathology in any particular community that it did not have a respective person. And then the other thing, if you could talk about epigenetics and ACEs.

Absolutely. I'll talk about epigenetics right now. So just real quickly. All right, thank you. So just real quickly, um, when we talk about epigenetics, I want to actually really tell people what that is. So basically, what that is, that is that is heritable changes in gene expression that occur without alterations to your underlying DNA sequence. So basically, what happens is your genes begin expressing, expressing their protein material, the expression that you actually see in your body is actually different. So someone could have one gene and it shows up one way, another person has the same exact gene and it shows up differently in their life. So that is what epigenetics is. So it's gene expression. How do you express your DNA? So specifically, adverse childhood experiences are specifically linked to lasting changes in gene expression. So it absolutely changes the way your DNA actually operates. It does it through many different ways. So the primary way that it does it is through a procedure called DNA methylization. There's also modifications of the histones, and there's also non-coding RNA regulation. So these are all very technical terms, but basically what it does is it actually changes and alters the DNA sequence itself and how it expresses yourself, it's how it expresses yourself in your life. What's really important about how adverse childhood experiences actually change your DNA and how your DNA experiences it means it can actually be transferred from generation to generation. So that is the most important part of the epigenetic impacts of DNA. And yes, adverse childhood experiences occur uh despite your socioeconomic category, although you are more prone to be exposed to it in an impoverished environment. But it does actually uh occur in all types of environments. It doesn't matter race, creed, color, socioeconomic impacts. All right, so we've talked a little bit about, um, and I want to make sure to get this in before the show is over. How do you heal? How do you actually heal? So one of the things that we actually talk about is positive childhood experiences. So positive childhood experiences actually help you heal. They're called PCEs, help you heal from ACEs or adverse childhood experiences. So what it is is a safe and supportive relationship, having at least one trusted adult that you can confide in, feeling your caregiver has your back, receiving affections and emotions from at least one adult. And I want to stress this: one adult in your life can make a difference. Having a sense of belonging, feeling accepted by peers and friends, feeling like you belong to a school or you belong to a community. This is really important. This is how come sometimes parents where there's a lot of bullying have to actually move to a new neighborhood. Experiencing positive school experiences, having teachers that actually care and encourage you. Feeling safe at school is very, very important. Feeling safe in your community is very, very important. Having an opportunity to learn, succeed, and be recognized. Opportunities for fun and growth, participating in play, participating in hobbies, participating in sports, having predictive routines that is really, really important. Children really need this. Um, a structure for mealtime, a structure for bedtimes, being able to safely explore your interests. Also living in a stable, nurturing environment, feeling safe at home, uh, experiencing constant caregiving and being protected from chaos, neglect, and violence. One of these things lowers your odds of mental illness by 24%. If people actually experience two to four of these things, it lowers the odds of mental health by 80% or more. This is really, really important. I'm really glad we had this conversation today. Um, again, there's a lot of uh support resources. There's a national domestic hotline, which is 1-800-799-7233. There is a suicide and crisis lifeline, uh, which you can reach 247 at 988. Please make sure to reach out to any of these, any of these services if you actually uh need them. Um if you enjoyed this topic, make sure to subscribe to my website, uh to my podcast, What the Health Is Happening. I want to thank you for joining me today. We are really committed to answering your most pressing healthcare questions. Make sure to email me at info at askdrv.us. That's info at ask drv.us.

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