Health & health care, Mental health, Trauma and PTSD

What we can learn about trauma from the ACEs study

adverse childhood experiences pyramid
Centers for Disease Control

The Adverse Childhood Experiences (ACEs) study was a landmark research trial conducted by Kaiser Permanente and the U.S. Center for Disease Control.  The study examined the correlation between adverse experiences in childhood and health outcomes in adulthood, and it clearly showed just how profound that connection is.

The ACEs study participants were asked to report whether they had experienced physical/sexual/emotional abuse, physical/emotional neglect, exposure to domestic violence, household substance abuse, household mental illness, parental separation/divorce, and incarcerated household members.  Two-thirds of participants reported at least one ACE, and more than 1 in 5 reported ≥3 ACEs.

The results of the ACEs study showed a dose-response curve between the number of ACEs and the risk of adult health problems (i.e. a higher number of ACEs was associated with a higher number of health complications).  ACEs were associated with the following negative outcomes and high-risk activities associated with negative health outcomes:

  • Alcoholism and alcohol abuse
  • Chronic obstructive pulmonary disease
  • Depression
  • Fetal death
  • Health-related quality of life
  • Illicit drug use
  • Ischemic heart disease
  • Liver disease
  • Poor work performance
  • Financial stress
  • Risk for intimate partner violence
  • Multiple sexual partners
  • Sexually transmitted diseases
  • Smoking
  • Suicide attempts
  • Unintended pregnancies
  • Early initiation of smoking
  • Early initiation of sexual activity
  • Adolescent pregnancy
  • Risk for sexual violence
  • Poor academic achievement

Not only are there a large number of negative effects, but also the magnitude of these effects is extremely disturbing.  An ACEs score above six was associated with a 3000% increase in suicide and a life expectancy 20 years less than the population average.  I think that one of the particularly important findings of the study was that the negative outcomes were not a simple cause-and-effect relationship with high-risk behaviours.  The wide-ranging negative outcomes still occur with or without high-risk behaviours.

ACEs are thought to affect the structural development of neural networks in the brain as well as biochemistry, including chemical messengers like cortisol and adrenaline.  The related stress can also cause epigenetic changes that alter how genes are expressed, and these changes can also be passed to fetuses.

I first heard about this study way back when I was in nursing school, and I remember wondering at the time why I hadn’t heard of something that important before then.  I still think it’s something that more people need to be aware of, because it sheds so much light on the experiences of those who have lived through childhood trauma.

The damaging effects of adverse childhood experiences, including the ACEs pyramid from the CDC

You can find more details on the CDC’s Adverse Childhood Experiences study page.

There’s a list of more posts on trauma in the Blog Index.

cover of PTSD Treatment Options: An Overview from Mental Health @ Home

The MH@H Store has a mini e-book on PTSD Treatment Options: An Overview that covers a number of evidence-based therapies for PTSD.  It’s also available as part of the Therapy Mini-Ebook Collection.

The blog index includes s list of posts related to trauma.

9 thoughts on “What we can learn about trauma from the ACEs study”

  1. Learning about the ACE study is such an “aha!” moment for so many people! It’s such an important study, and its findings continue to be relevant for a wide range of services. Thank you for introducing your readers to this important piece of research.

  2. I wish there was more attention paid to these studies and help for people who have suffered an extraordinary amount of ACEs. I myself have a ton of them when I have gone through their list and counted. There should be more help for people who go through such things.

  3. Great summary. My boys are adopted and many of their difficulties are because of traumatic life experiences. One thing that stuck with me in adoption training was an image of a typical brain compared to a trauma brain, the trauma brain had huge gaps in it. Early life trauma can affect so much developmentally.

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