Unhappy child, unhealthy adult

Childhood trauma influences every chronic health problem, and a new study reckons it could be driving the epidemic of gut issues such as IBS. Bryan Hubbard reports

As the Jesuits might have said had they been a medical order, what happens to the child determines what the adult becomes. A good start in life—breastfeeding, a nutritious diet and so on—is vital. But another element of childhood could be even more important: whether we were raised in a loving and happy home.

Abuse, both physical and psychological, is slowly being recognized as a major cause of chronic disease and even premature death. Childhood trauma and “adverse childhood experiences” (ACEs) have been cited as the fourth major cause of premature death, and they are also linked to heart disease and cancer.

People who had an especially traumatic childhood, registering more than six ACEs, died around 20 years earlier than those who registered none or just one. Less controversially, childhood trauma is driving the epidemic of opioid, alcohol and drug abuse.

Researchers from Kaiser Permanente and the CDC (US Centers for Disease Control and Prevention) came up with the idea of ACEs in 1997. They listed 18 examples, ranging from being shouted at by a parent to physical abuse, sexual abuse and incest, parental alcoholism, and divorce (see below).

Gut reactions

A new study has underlined the point and has linked ACEs to IBS (irritable bowel syndrome), which, in up to 60 percent of cases, has a mysterious origin and is often classified as idiopathic—doctor-speak for not knowing why it’s happening.

Although its origins are often mysterious, IBS is often associated with stress, which could be playing a part in 38–60 percent of all cases, and new research has discovered that it could be a special type of stress with its roots in childhood trauma. Early trauma can disrupt the gut-brain connection, which manifests as pain, constipation and IBS when you’re older, say researchers from New York University.¹

They investigated early-life stress using mouse models and compared the results to those of two large studies involving children. In the animal study, newborn mice were separated from their mothers for several hours each day to simulate early stress.

When examined months later, the mice showed increased anxiety-like behavior, gut pain and problems with gut movement. The type of motility issue differed by sex: females suffered from diarrhea and males from constipation.

Similar results have been seen in human studies. Some have linked infant constipation to maternal depression and noted trouble with bonding plays a role.² Others have found depression during pregnancy affects the infant microbiome³ and can lead to allergies and gastrointestinal problems.⁴ These effects aren’t limited to infanthood; they continue into childhood,⁵ suggesting exposure to maternal depression before birth could be a type of ACE.

Then, other ACEs further increase the likelihood of digestive issues through various mechanisms, such as by affecting the microbiome and the vagus nerve, the information superhighway between the gut and brain.⁶ These effects can also influence digestive function well into adulthood, increasing IBS risk by 40–200 percent and aggravating its symptoms.⁷

“When patients come in with gut problems, we shouldn’t just be asking them if they are stressed right now; what happened in your childhood is also a really important question and something we need to consider,” said Kara Margolis, one of the New York University researchers.

In the beginning

The idea that childhood trauma could influence our health—and even our longevity—was introduced nearly 30 years ago by a team of researchers from Kaiser Permanente and the CDC.

They surveyed around 9,500 people who had undergone medical examinations at a Kaiser Permanente clinic, and those who suffered four or more ACEs were up to 12 times more likely to have experienced depression, attempted suicide, or suffered from alcohol or drug abuse.⁸

They were also more likely to suffer from chronic health problems, such as heart disease and cancer. Those who registered six or more ACEs had a life expectancy 20 years shorter than those who suffered just one or no ACEs growing up.⁹

Despite its vital message, the study was dubbed “the most significant public health survey that no one has ever heard of.”

The Philadelphia story

A research team based in Philadelphia wanted to correct that and put ACEs at the front and center of health policy. But they also felt the CDC study may have been ignored because it was too white and middle-class, and so they broadened the range of ACEs to include those that people in their community might have experienced.

In addition to the CDC’s 18 ACEs, the Philadelphia team included questions about witnessing a shooting, being discriminated against because of color, being bullied or being in foster care. Of the 1,784 people who completed the survey, 35 percent reported physical abuse when they were children, and 33 percent suffered psychological abuse—a far higher prevalence than the Kaiser research saw.

Those who reported four or more ACEs were three times more likely to suffer from depression and far more likely to have attempted suicide, the researchers found.¹⁰

The Scottish Health Study, prepared by the country’s government, found something similar.  It reported that one in seven adults in the country had suffered four or more ACEs as children. As a result, 52 percent of this group suffered from a chronic health problem and 21 percent had heart disease.¹¹

Have a heart

Researchers from the Harvard T. H. Chan School of Public Health haven’t just seen a link between ACEs and heart disease; they’ve calculated the risk. In people born with a heart defect, ACEs are common, and every additional ACE increases the risk of a heart-related health event later in life—including heart failure, stroke or emergency care—by 24 percent. They surveyed 153 people with congenital heart disease, and 27 percent reported having had four or more ACEs as children.¹²

Other researchers have seen something similar. Those with the most ACEs are 1.5 times more likely to develop cardiovascular disease, a study by Shandong University in China found when they tracked the lifestyle and health of around 143,000 people in the UK for just over 12 years. The one bright spot was that a healthy lifestyle can lessen the worst effects of ACEs and reduce the risk by around 30 percent.¹³

Here comes everything

A traumatic childhood influences almost every chronic health problem. The tipping point seems to be around four or more ACEs, which raises the risk of respiratory problems, cancer and heart disease as well as mental health conditions such as alcoholism or drug abuse, violent tendencies, and depression, say researchers from Bangor University in Wales.¹⁴

Childhood trauma is also a big driver of cancer. A research team from Central South University in China reviewed 18 studies that had involved more than 406,000 people to see the impact of ACEs on cancer. Those who had suffered two or three ACEs were 35 percent more likely to develop cancer, but the risk more than doubled in those who reported four or more ACEs compared to those who hadn’t suffered any.¹⁵

ACEs also raise the risk of chronic kidney disease.¹⁶ And those who recorded four or more ACEs were three times more likely to suffer from chronic pain.¹⁷

Not surprisingly, people who end up in the hospital are likely to have suffered ACEs. In a survey of 2,392 patients, 36 percent had suffered at least one ACE as a child, and more than 6 percent reported at least four.¹⁸

It’s a gloomy picture, but only because we don’t recognize the impact of childhood trauma on our health and longevity. If we—and doctors—did, we could start undoing the damage that an unhappy childhood can do.

Unstitching the threads of an unhappy childhood

There’s plenty you can do if you’ve had an unhappy childhood. The first thing is to recognize its extent, and you can do that by going through the list of ACEs (see below) to see how many apply to you. If you score more than three, you should think seriously about doing something about it.

One mitigating factor is that the ACEs will have less impact if one of your parents was loving—in other words, if the ACEs were committed by only one parent. A healthy lifestyle can also weaken the influence of ACEs. Sadly, many people who suffer ACEs spiral into substance abuse, thus creating a vicious cycle.

Forgiveness can be a powerful ally, too. Researchers from Minnesota Medical School found it works best if parent and child work together to forgive themselves and each other, although it’s often the child who finds it harder to forgive their parents.¹

Bryan Hubbard developed Time-Light therapy, which can also address these issues. It recognizes the effect of trauma as an energy that influences our lives and health. See more at timelighttherapy.com.

The 18 ACEs

1. The parent swore at or insulted the child
2. The parent acted in a way that made the child fear physical harm
3. A parent often slapped, pushed or grabbed the child
4. A parent often hit a child so hard that there were marks or injuries
5. A parent fondled the child
6. A parent wanted the child to touch them in a sexual way
7. A parent attempted some form of sexual intercourse with the child
8. A parent succeeded in having sexual intercourse with the child
9. A parent had a drinking or substance abuse problem
10. A parent used street drugs
11. A parent was depressed or mentally ill
12. A parent attempted suicide
13. The mother was sometimes pushed or grabbed
14. The mother was kicked, bitten or hit with a fist
15. The mother was repeatedly hit
16. The mother was threatened with a knife or gun
17. A parent went to prison
18. Parents were separated or divorced

Some researchers have recommended expanding the list after studying youth crime. They suggest including experiences such as abuse by an older person other than a parent, the death of a parent, bullying, neighborhood violence, foster care and lack of stability due to multiple home moves.

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