The Unexpected Health Consequences of Adverse Childhood Experiences
It is more widely accepted now that childhood experiences can have a lasting impact on your emotional and mental health
Dr Aneliya Gonsard explores the lesser known impact that adverse early experiences can have on your later physical health
We have psychotherapists who specialise in working with childhood difficulties – find them here
Most people would readily agree that genetic predisposition and lifestyle choices have much to do with whether a person is vulnerable to developing conditions such as heart disease, dementia, cancer, and lower respiratory diseases. These, according to the UK Office of National Statistics, are amongst the main causes of death between 2001 and 2018. It is still news to many, however, that early life adversity is a major risk factor for developing a chronic, life-threatening illness .
A seminal study, published by the American Journal of Preventative Medicine in 1998, linked adverse childhood experiences (ACEs) to the leading causes of death in adults . The study looked at experiences such as psychological, physical, or sexual abuse; violence against mother; and living with household members who were substance abusers, mentally ill or suicidal. The more ACEs a person had endured in childhood, the higher the risk of ill health and death in adulthood.
The question is: how can such early life events, which are external to the child, contribute to developing serious health conditions like cancer decades later? The answer is twofold.
The stress response
First, emotions such as fear linked to the experience of threat to our safety and wellbeing, trigger a complex physiological stress response. This response involves the nervous, endocrine, and immune systems . It is designed by evolution to be lifesaving: it prepares the body to fight the danger, run away from it, or, if neither is possible, to freeze in the hope that the threat will eventually disappear. The fight-flight-freeze response is indeed adaptive and useful when the source of stress is acute and time-limited.
When the source of stress is chronic and enduring, however, the same complex physiological response designed to preserve life, can create internal heath risk factors. This is because prolonged changes in the production of hormones such as cortisol and adrenaline (well-known to be key players in the body’s response to perceived threat), leads to the disruption of normal physiological functioning and to compromised immunity. The adverse childhood experiences described by Felitti et al. (1998) are examples of such chronic early life stressors.
The quality of our relationships
Second, learning how to respond to and manage stress is an important part of normal development. This typically happens through the relationships we have first with our caregivers, and then with the wider social network and environment. A key feature of a healthy parent-child relationship is the sense of security and attunement that the parent provides to the child. This manifests through being physically and emotionally present, responsive to the child’s needs, capable of offering protection from danger, and, perhaps most importantly, conveying to the child that they are loved unconditionally.
A child feels unconditionally loved when they are not punished or rejected when they express feelings such as anger and fear; and when they feel their parent can receive such emotional states without becoming overwhelmed by them. Feeling loved and held, physically and emotionally, has a direct and measurable impact on the functioning of a child’s nervous system, and through this - on other important markers such as hormonal production and balance, and immunity.
When a parent is preoccupied with their own problems with health, relationships, or finances, they become, inadvertently, limited in their availability to the child. This has direct consequences for the child’s developing capacity to respond to and cope with stress in an optimal way.
It is crucial to note that parents can be emotionally unavailable to their children even when they are physically present. In his book When the Body Says No: The Hidden Cost of Stress Dr Gabor Maté describes this type of absence as proximate separation. Later this is not consciously remembered as a loss by the child. It has nonetheless led to the nearly same physiological stress response as physical separation from the parent. Maté argues that this type of separation is becoming the norm in our modern hyper-stressed society. A child in such an environment learns not to communicate painful states to their parents; and to exclude them from their own awareness.
The problem is that emotions do not disappear when we are not consciously aware of them. Conscious awareness of an emotion (for example, feeling sad) is conceptualised as 'Emotion III' by the psychologist Ross Buck [iv].
'Emotion II' consists of all the non-verbal expressions of emotion that can be observed by those around us. We can experience and display an emotional state, without being aware of it ourselves.
'Emotion I' is the physiological expression of emotion – the automatic cascade of activity that takes place across the nervous, endocrine, and immune systems, without any conscious awareness or behavioural expression.
Dr Maté offers a detailed account of personal stories and scientific research that make the link between the chronic exclusion of emotions from awareness, on the one hand, and the risk of developing autoimmune illnesses, on the other hand. This, in my view, is important knowledge, which can be used on multiple levels.
First, on a societal level, we need to work towards a long-overdue paradigm shift in how we understand and take care of our health. We need a holistic approach, which does not fragment physical and mental health when preventing and treating any kind of illness.
Second, on an individual level people need to be supported to overcome feelings of shame when it comes to linking their emotional and relational experiences to their physical health. I can think of quite a few people I have consulted therapeutically, who have responded with shame at the suggestion that their feelings and their physical health might be connected. As if accepting this somehow makes the individual responsible for falling ill in the first place.
Shame is also triggered powerfully in people who are used to taking care of others’ emotional needs, at the expense of their own. It can be very uncomfortable, indeed, for such people, to allow themselves to be seen – with all their pain, anger, and fear.
One of the key functions of psychotherapy is to create a space where the therapist can notice such painful states, and the underlying and often unconscious assumptions the person might have about them (for example “I will only be loved if I please others, and show no anger, or make no demands”). A therapeutic relationship becomes transformative when the patient not only becomes aware of their emotions and beliefs, but when they can be experienced in real time, first in relation to the therapist, and then in relation to other significant others, without getting punished, rejected, or shamed in return. It is then that it becomes possible to feel genuinely connected to self and others in ways that promote resilience and health.
[i] Van der Kolk, B. (2014). The body keeps the score: Mind, brain and body in the transformation of trauma. penguin UK.; Maté, G. (2011). When the body says no: The cost of hidden stress. Vintage Canada.; Bauer, J. (2003). Das Gedächtnis des Körpers. Frankfurt: Eichborn.
[ii] Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American journal of preventive medicine, 14(4), 245-258.
[iii] Psychoneuroimmunoendocrynology as a discipline is dedicated to precisely studying these connections. It considers all these elements to be part of one “super system”, designed by nature to optimise our chances for survival.
[iv] Buck, R. (1993). Emotional communication, emotional competence, and physical illness: A developmental-interactionist view.