Transcript The Story of: A Childs Path to Mental Illness

The damaging consequences
of childhood trauma:
Research Findings
The following slides are from the presentation
“A Child’s 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
The Adverse Childhood
Experiences Study
(ACE)
Collaboration between Kaiser Permanente’s Department of
Preventive Medicine in San Diego and the Center for Disease
Control and Prevention (CDC)
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.
ACE Study Findings
Childhood experiences are powerful
determinants of who we become as adults

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.
Adverse Childhood Experiences*
Abuse of Child

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Recurrent Severe Emotional abuse
Recurrent Physical abuse
Contact Sexual abuse
Impact of Trauma and Health
Risk Behaviors to Ease the Pain
Neurobiologic Effects of Trauma
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Trauma in Child’s Household
Environment

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Substance abuse
Parental separation or divorce Chronically depressed, emotionally
disturbed or suicidal household
member
Mother treated violently
Imprisoned household member
Loss of parent – (best by death,
unless suicide, - worst by
abandonment)
Neglect of Child


Abandonment
Child’s basic physical and/or
emotional needs unmet
* Above types of ACEs are the “heavy
end” of abuse.

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Disrupted neuro-development
Difficulty controlling anger-rage
Hallucinations
Depression
Panic reactions
Anxiety
Multiple (6+) somatic problems
Sleep problems
Impaired memory
Flashbacks
Dissociation
Health Risk Behaviors

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Smoking
Severe obesity
Physical inactivity
Suicide attempts
Alcoholism
Drug abuse
50+ sex partners
Repetition of original trauma
Self Injury
Eating disorders
Perpetrate interpersonal violence
Long-Term Consequences of
Unaddressed Trauma (ACEs)
Disease and Disability

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Ischemic heart disease
Cancer
Chronic lung disease
Chronic emphysema
Asthma
Liver disease
Skeletal fractures
Poor self rated health
Sexually transmitted disease
HIV/AIDS
Social Problems

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Homelessness
Prostitution
Delinquency, violence, criminal
behavior
Inability to sustain employment
Re-victimization: rape, DV
compromised ability to parent
Intergenerational transmission of
abuse
Long-term use of health,
behavioral health, correctional,
and social services

ACE study views health risk behaviors
as attempts to cope with impacts and
ease pain of prior trauma,

NOT as symptoms, bad habits, selfdestructive behavior, or public health
problems.
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.
Adverse Childhood Experiences
(ACEs) are Common
Of 17,000 HMO members:

72% had attended college

77% were white

62% were 50 or older
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.
What is uncommon is
recognition
 acknowledgement
 action

The higher the ACE Score, the
greater the likelihood of :

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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.
Adverse Childhood Experiences
and Current Smoking
20
18
16
14
12
%
10
8
6
4
2
0
0
1
2
3
ACE Score
4-5
6 or more
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) .
Childhood Experiences and
Adult Alcoholism
18
16
4+
% Alcoholic
14
12
3
10
2
8
6
1
4
2
0
0
ACE Score
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
ACE Score and Intravenous
Drug Use
% Have Injected Drugs
3.5
3
2.5
2
1.5
1
0.5
0
0
1
2
3
4 or more
ACE Score
N = 8,022
p<0.001
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
Childhood Experiences Underlie
Rape
35
4+
% Reporting Rape
30
25
20
3
2
15
10
5
1
0
0
ACE Score
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.
ACE Score and Hallucinations
Ever Hallucinated* (%)
12
10
Abused
Alcohol
or Drugs
8
No
Yes
6
4
2
0
0
1
2
3
4
5
6
ACE Score
*Adjusted for age, sex, race, and education.
>=7
The making of madness…..

There is a significant and graded relationship
between a history of multiple childhood
traumas (ACE’s) 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

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
% With a Lifetime History of
Depression
Childhood Experiences
Underlie
Chronic Depression
80
70
60
50
40
30
20
Women
Men
10
0
0
1
2
ACE Score
3
>=4
Chronic Depression

Adults with an ACE score of 4 or
more were 460% more likely to be
suffering from depression .
Childhood Experiences
Underlie Suicide
25
4+
% Attempting Suicide
20
15
3
10
2
5
0
1
0
ACE Score
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.

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.
% with Job Problems
ACE Score and
Serious Job Problems
18
16
14
12
10
8
6
4
2
0
0
1
2
ACE Score
3
4 or more
Much of what causes time to
be lost from work is actually
predetermined decades earlier
by the adverse experiences
of childhood.
Adverse Childhood Experiences and
Likelihood of > 50 Sexual Partners
Adjusted Odds Ratio
4
3
2
1
0
0
1
2
ACE Score
3
4 or more
Adverse Childhood Experiences and
History of STD
Adjusted Odds Ratio
3
2.5
2
1.5
1
0.5
0
0
1
2
ACE Score
3
4 or more
Frequency of Being Pushed, Grabbed, Slapped, Shoved or Had
Something Thrown at Oneself or One’s Mother as a Girl and the
Likelihood of Ever Having a Teen Pregnancy
35
30
25
Pink =self
Yellow =mother
20
15
10
5
0
Never
Once,
Twice
Sometimes
Often
Very
often
Sexual Abuse of Male Children and Their
Likelihood of Impregnating a Teenage Girl
35
1.8x
30
1.3x
25
20
1.4x
1.0 ref
15
10
5
0
Not
abused
16-18yrs
11-15 yrs
<=10 yrs
Age when first abused
% have Unintended PG, or AB
ACE Score and Unintended
Pregnancy or Elective Abortion
80
Unintended Pregnancy
70
Elective Abortion
60
50
40
30
20
10
0
0
1
2
ACE Score
3
4 or more
Effect of ACEs on Mortality
Age Group
Percent in Age Group
60
19-34
35-49
50-64
>=65
50
40
30
20
10
0
0
2
4
ACE Score
0 ACE 60% live to 65
4 ACE less than 3% live to 65
Many chronic diseases
in adults are determined
decades earlier, in childhood.
Other Studies on Childhood
Sexual and/or Physical
Abuse
Sarah
Joe,
Anna
John
Mary

In my experience, early child sexual abuse (CSA)
especially impairs resiliency

My other children experienced multiple ACE’s. They coped.

Anna experienced early CSA and ACEs. She broke.

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.

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

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

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
Yet the Silence Continues
“They do not want
to hear what their
children suffer.
They’ve made the
telling of the
suffering itself
taboo”
From ACE Study Slides: Vincent Felitti
From Possessing the Secret of Joy,
Alice Walker
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

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
Lasting Alterations in
Self Perception
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
Sense of helplessness, paralysis, captivity,
inadequacy, powerlessness, danger, fear
Continues over the lifespan
Sense of Shame, Guilt, Self-Blame, Being Bad
Continues over the lifespan
Sense of defilement, contamination, spoiled,
degraded, debased, despicable, evil
Continues over the lifespan
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
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
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Isolation, Withdrawal
Disruption in Intimate Relationships
Repeated Search for Rescuer
Persistent Distrust
Repeated Failures of Self-Protection
So, what do our children ask of us?

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.