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The damaging consequences of childhood trauma: Research Findings

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Title: 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
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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
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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.
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