The damaging consequences of childhood trauma: Research Findings

1
The damaging consequences of childhood trauma
Research Findings
2

• The following slides are from the presentation
• A Childs Path to Mental Illness and Suicide,
• by Ann Jennings, PhD.
• www.TheAnnaInstitute.org
• ACE Study slides are from the CDC (Center for
  Disease Control and Prevention) and from the
  September 2003 Presentation at Snowbird
  Conference of the Child Trauma Treatment Network
  of the Intermountain West,
• by Vincent J. Felitti, MD

3
Collaboration between Kaiser Permanentes
Department of Preventive Medicine in San Diego
and the Center for Disease Control and Prevention
(CDC)

• The Adverse Childhood Experiences Study
• (ACE)

4
What is the Adverse Childhood Experiences (ACE)
Study?

• Decade long. 17,000 people involved.
• Largest epidemiological study ever done.
• Revealed health and social effects of adverse
  childhood experiences over the lifespan.

5
ACE Study Findings

• Childhood experiences are powerful determinants
  of who we become as adults

6
ACE Study Findings and the Centrality of Trauma

• Adverse Childhood Experiences are the most BASIC
  cause of most health risk behaviors, morbidity,
  disability, mortality, and health and behavioral
  health care costs.
• Which means trauma is a crucial public health
  issue at the ROOT of and CENTRAL to development
  of health and mental health problems and to
  recovery.

7
(No Transcript)
8

• ACE study views health risk behaviors as attempts
  to cope with impacts and ease pain of prior
  trauma,
• NOT as symptoms, bad habits, self-destructive
  behavior, or public health problems.

9
Existing Practice

• Existing practice commonly asks What is wrong
  with the person? vs what happened to the
  person?
• Existing practice develops diagnoses, and treats
  symptoms instead of underlying causes.

10
Adverse Childhood Experiences (ACEs) are Common

• Of 17,000 HMO members
• 72 had attended college
• 77 were white
• 62 were 50 or older

11
Adverse Childhood Experiences are Common

• Of the 17,000 HMO Members
• 1 in 4 exposed to 2 categories of ACEs
• 1 in 16 was exposed to 4 categories.
• 22 were sexually abused as children.
• 66 of the women experienced abuse, violence or
  family strife in childhood.

12
What is uncommon is

• recognition
• acknowledgement
• action

13

• The higher the ACE Score, the greater the
  likelihood of

• health risk behaviors
• adult diseases
• disabilities
• severe social problems
• severe mental health problems
• For example
• The following information and slides are from
  September 2003 Presentation at Snowbird
  Conference of the Child Trauma Treatment Network
  of the Intermountain West, by Vincent J.
  Felitti, MD.

14
Adverse Childhood Experiences and Current Smoking

15
Current Smoking

• A child with 6 or more categories of adverse
  childhood experiences is 250 more likely to
  become an adult smoker .
• A person with 4 categories of adverse childhood
  experiences is 260 more likely to have Chronic
  Obstructive Pulmonary Disease (COPD) .

16
Childhood Experiences and Adult Alcoholism
4
3
2
1
0
17
Adult Alcoholism

• A 500 increase in adult alcoholism is directly
  related to adverse childhood experiences.
• 2/3rds of all alcoholism can be attributed to
  adverse childhood experiences

18
ACE Score and Intravenous Drug Use
N 8,022 plt0.001
19
Intravenous Drug Use

• A male child with an ACE score of 6 has a 4,600
  increase in the likelihood that he will become an
  IV drug user later in life.
• 78 of drug injection by women can be attributed
  to ACEs

20
Childhood Experiences Underlie Rape
4
3
2
1
0
21
Rape

• Women with an ACE score of 4 are 500 more
  likely to become victims of domestic violence.
• They are almost 900 more likely to become
  victims of rape.

22
ACE Score and Hallucinations
Abused Alcohol or Drugs
Ever Hallucinated ()
ACE Score
Adjusted for age, sex, race, and education.
23
The making of madness..

• There is a significant and graded relationship
  between a history of multiple childhood traumas
  (ACEs) and hallucinations.
• Compared to persons with 0 ACEs, those with 7 or
  more ACEs had a five-fold increase in the risk of
  reporting hallucinations
• Whitfield et al 2005

24

• Abuse and trauma suffered in the early years of
  development resulted in a far greater likelihood
  of pre-psychotic and psychotic symptoms.
• Perry, B.D. (1994)
• In an adult inpatient sample, 77 of those
  reporting CSA or CPA had one or more of the
  characteristic symptoms of schizophrenia listed
  in the DSM-IV hallucinations (50) delusions
  (45) or thought disorder (27) Read and Argyle
  1999

25
Childhood Experiences Underlie Chronic
Depression
26
Chronic Depression

• Adults with an ACE score of 4 or more were 460
  more likely to be suffering from depression .

27
Childhood Experiences Underlie Suicide
4
3
2
1
0
28
Suicide

• The likelihood of adult suicide attempts
  increased 30-fold, or 3,000, with an ACE score
  of 7 or more.
• Childhood and adolescent suicide attempts
  increased 51-fold, or 5,100 with an ACE score of
  7 or more.

29

• Suicidality is not usually caused by mental
  illness, drugs, rejection by peer groups, school
  pressure, failures, etc.
• Rather, it is a coping device a way to manage
  or escape from the unbearable impacts of adverse
  childhood experiences and/or adult trauma.

30
ACE Score and Serious Job Problems
31
Much of what causes time tobe lost from work is
actuallypredetermined decades earlierby the
adverse experiencesof childhood.
32
Adverse Childhood Experiences andLikelihood of
gt 50 Sexual Partners
33
Adverse Childhood Experiences andHistory of STD
34
Frequency of Being Pushed, Grabbed, Slapped,
Shoved or Had Something Thrown at Oneself or
Ones Mother as a Girl and the Likelihood of Ever
Having a Teen Pregnancy
Pink self
Yellow mother
Percent who had a teen pregnancy
Never Once, Sometimes Often
Very Twice
often
35
Sexual Abuse of Male Children and Their
Likelihood of Impregnating a Teenage Girl
1.8x
1.4x
1.3x
Percent who impregnated a teenage girl
1.0 ref
Not 16-18yrs 11-15 yrs
lt10 yrs abused
Age when first abused
36
ACE Score and Unintended Pregnancy or Elective
Abortion
37
Effect of ACEs on Mortality
Age Group
0 ACE 60 live to 65 4 ACE less than 3 live
to 65
38
Many chronic diseasesin adults are
determineddecades earlier, in childhood.
39
(No Transcript)
40

• Other Studies on Childhood Sexual and/or Physical
  Abuse

41
Sarah Joe, Anna John Mary

• In my experience, early child sexual abuse
  (CSA)
• especially impairs resiliency
• My other children experienced multiple
  ACEs. They coped.
• Anna experienced early CSA and ACEs. She
  broke.

42

• A number of studies suggest that severe sexual
  and/or physical violation early in childhood
  appear to have the greatest impact and to be
  associated with the most serious disabilities
  later in life.

43

• 2/3rds of men and women in substance abuse
  treatment report childhood physical and/or sexual
  abuse.
• 75 of women in treatment programs for drug and
  alcohol abuse report having been sexually abused.
  SAMHSA/CSAT, 2000 SAMHSA, 1994

44

• 51 98 of public mental health clients with
  severe mental illness, including schizophrenia
  and bipolar disorder, have been exposed to severe
  childhood physical and sexual abuse.
• Most have multiple experiences of trauma.
• Goodman et al, 1999, Mueser et al,
  1998 Cusack et al, 2003

45

• There is a significant relationship between
  childhood sexual abuse and various forms of
  self-harm later in life, including suicide
  attempts, cutting, and self-starving.
• Van der Kolk et al, 1991
• One study found childhood sexual abuse to be the
  single strongest predictor of suicidality
  regardless of other factors.
• Read et al, 2001

46
Yet the Silence Continues
They do not want to hear what their children
suffer. Theyve made the telling of the
suffering itself taboo From Possessing
the Secret of Joy, Alice Walker
From ACE Study Slides Vincent Felitti
47
Prevalence of the Problem

• 1/4th to 1/3rd of all children and as many as 42
  of girls are sexually abused before age 18 with
  9 experiencing persistent, genital assault.
  Saunders et al, 1992
  Randall 1995 Epstein, 1998
• 93 of psychiatrically hospitalized adolescents
  had histories of physical and/or sexual and
  emotional trauma. 32 met criteria for
  PTSD. Lipschitz et al, 1999

48

• Teenagers with alcohol and drug problems are 6 to
  12 times more likely to have a history of being
  physically abused and
• They are 18 to 21 times more likely to have been
  sexually abused than those without alcohol and
  drug problems. Clark et al, 1997
• Among juvenile girls identified by the courts as
  delinquent, more than 75 have been sexually
  abused. Calhoun et al, 1993

49
The sexual and physical violation of children
results in alterations in self-perception which
are immediate, last throughout the life-span, and
contribute to suicidality as a way to cope.
Judith Herman, 1992
Lasting Alterations in Self Perception

50
Sense of helplessness, paralysis,
captivity,inadequacy, powerlessness, danger, fear
Continues over the lifespan
51
Sense of Shame, Guilt, Self-Blame, Being Bad
Continues over the lifespan
52
Sense of defilement, contamination, spoiled,
degraded, debased, despicable, evil
Continues over the lifespan
53
Sense of complete difference from others,
deviance, utter aloneness, isolation, non-human,
specialness, unseen, unheard, belief no other
person can ever understand
Continues over the lifespan
54
Lasting Alterations In Relations With Others

• The sexual and physical violation of children
  results in alterations in relations with others,
  which often last throughout the life-span.
  Judith Herman, 1992

55

• Isolation, Withdrawal
• Disruption in Intimate Relationships
• Repeated Search for Rescuer
• Persistent Distrust
• Repeated Failures of Self-Protection

56
So, what do our children ask of us?
57

• That we pay attention
• That we overcome lack of knowledge our own and
  others
• That we overcome our fear
• That we speak out and end silence about the role
  of adverse childhood experiences in serious
  health, mental health and social problems of all
  kinds.