Michael Abrahams | How childhood trauma affects all aspects of our health

The long-term effects of childhood trauma have been thoroughly researched and well-documented. One of the first studies on the topic was the ACE (adverse childhood experience) study conducted in the US in the 1990s. The study examined exposure to severe and stressful adversities related to maltreatment and household dysfunction experienced before age 18.

Ten ACEs were examined under three headings: abuse, neglect and exposure to dysfunction in the home. In the category of abuse were physical, emotional and sexual abuse. Under the heading of neglect were physical and emotional neglect. Exposure to dysfunction in the home included exposure to domestic violence, drug abuse, mental illness, divorce or separation and incarceration of a family member. The study found a dose-response relationship between ACEs and health-related issues in adulthood. In other words, the higher a person’s ACE score, the more likely the person is to be mentally and physically unwell as an adult. For example, 10 per cent of persons with an ACE score of 3 are likely to attempt suicide. With an ACE score of 7, the likelihood increases to 20 per cent.

The study also found that the higher your ACE score, the lower your life expectancy. People with four or more ACEs have a life expectancy that is 20 years shorter than that of those with no ACEs

Since then, over 200 studies and over 700 articles on ACEs have been published in more than 300 academic journals. Some subsequent studies have looked at other ACEs, too, including poverty, homelessness, hunger, bullying, racism, losing a caregiver, surviving a major illness, accident or natural disaster, community violence and war. All studies have shown a correlation between ACEs and poor health in adulthood. The definition of “health” encompasses physical, mental and social well-being, and ACEs have the potential to affect all three.

SEVERAL MECHANISMS

Several mechanisms have been discovered by which ACES can contribute to morbidity and mortality. Firstly, there is chronic toxic stress. When children face this constantly or repeatedly, their bodies respond by producing stress hormones in a dysregulated manner. The body also reacts by producing substances such as cytokines, which cause inflammation. This dysfunctional state can affect the developing brains in these children, , which will influence how they process information. These biochemical changes also affect their immune and endocrine (hormone) systems.

The neurological disruption increases the risk of developing abnormal behaviour and mental disorders, including anger management issues, depression, anxiety, post-traumatic stress disorder (PTSD), borderline personality disorder (BPD), bipolar disorder and suicidal behaviour. It has been estimated that approximately 30 per cent of all psychiatric disorders and two-thirds of suicide attempts are linked to ACEs

The combination of neurological, immune and hormonal disruption affects various organ systems in our bodies leading to maladies and diseases such as obesity, heart disease, liver disease, kidney disease, bronchial asthma chronic obstructive pulmonary disease (COPD), diabetes, hypertension, autoimmune diseases such systemic lupus erythematosus (SLE) or “lupus”, endometriosis, fractures and cancer. Survivors of childhood trauma are also prone to exhibit somatisation, which refers to physical manifestations of psychological distress.

Another mechanism by which childhood trauma affects us is by influencing our behaviour and the choices we make. Many survivors turn to and abuse alcohol, tobacco, illicit substances and mind-altering pharmaceutical drugs for solace, and suffer the consequences. Some exhibit irresponsible sexual behaviour, placing them at risk of developing sexually transmitted infections (STIs) and some cancers.

NEGATIVELY AFFECT

The combination of the above-mentioned sequelae of childhood trauma can therefore negatively affect one’s social well-being. Survivors often end up having dysfunctional and abusive relationships with romantic partners and family members and are more likely to be perpetrators and victims of violence, including sexual assault. They are also more vulnerable to joining gangs and engaging in criminal activity, and prone to poor academic and work performance and work absenteeism, placing them at risk of unemployment and homelessness.

And there is another factor: stress can affect our DNA. A process called methylation takes place in our bodies, altering the structure of our DNA and affecting how our genes are expressed. These alterations may not only influence an individual’s response to future stressors, but methylation within the gene itself can cause mutations that can lead to cancer and premature ageing, with the latter contributing to an increased risk of age-related diseases. Also of importance is the fact that these abnormalities can also persist in the genes passed down to the abuse survivor’s offspring. The combination of being exposed to a dysfunctional environment enabled by abuse-surviving parents, in addition to inheriting these altered genes, are mechanisms by which childhood trauma can be cyclical and generational.

The issue of ACEs is very relevant because in Jamaica, we have normalised some of these adverse experiences. For instance, many of us beat our children harshly. Many Jamaicans grew up with people other than their parents, who neglected them. Our high violent crime and murder rates traumatise our children and have deprived many of their parents. Research has found that approximately 28 per cent of women in Jamaica have experienced intimate partner violence during their lifetime, and these acts are often witnessed by their offspring.

A study conducted by UNICEF in 2013 found that 82 per cent of Jamaican children, aged 10-17 years, reported experiencing at least one ACE in the three months before the study, and 71, 46 and 29 per cent of the sample reported experiences of emotional, physical, and sexual abuse respectively.

We live in a traumatised and unhealthy society. According to Statista, our murder rate last year (53.34 per 100,000) was the highest in the world. Our rates of overweight/obesity (54 per cent) and depression (14 per cent) are higher than the global averages of 16 per cent and five per cent respectively. Many of our societal ills are influenced by childhood trauma. Breaking these cycles is essential if our nation is to heal. Policies must be put in place to educate the public and provide the necessary interventions.

Michael Abrahams is an obstetrician and gynaecologist, social commentator, and human-rights advocate. Send feedback to columns@gleanerjm.com and michabe_1999@hotmail.com, or follow him on X , formerly Twitter, @mikeyabrahams