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The traumas that the ACE score focuses on were well studied in research literature. Five of these trauma types are personal–physical abuse, verbal abuse, sexual abuse, physical neglect, and emotional neglect. Five are related to other family members: a parent who is alcoholic, a mother who is a victim of domestic violences, a family member in jail, a family member diagnosed with a mental illness, and the disappearance of a parent through divorce, death or abandonment. Each type of trauma is counting as one; so a person who have been physically abuse, with one alcoholic parent, and a mother who was beaten has an ACE score of three.
There are 10 types of childhood trauma measured in the ACE study. But, there are, of course, other types of childhood trauma–watching a sibling being abused, losing a mother or father, grandfather, etc. So if you have experienced other types of toxic stress, then they would like also increase your risk for health consequences.
To make sense of your ACE score, please consider how knowing the ACE study results can be helpful:
If you have been diagnosed with a flurry of diagnoses, the ACE does (perhaps of the first time) provide a way of understanding the core issues. Once you know the roots of the problem, you can begin to seek treatment that goes beyond just managing the symptoms or medicating your distress. In fact medications can be a helpful adjunct, but they do not “cure” trauma. They dampen the expression and help control feelings and behaviors, but they also block chemical systems that regulate engagement, motivation, pain and pleasure.
If you have “done the talking cure”and been instructed in behavioral/cognitive methods and, if have not been able to make to hold to progress, the results can help you understand why it is not a sign that you are beyond hope or defective, but these treatments may be flawed solutions to the challenges you face. In the largest published study of CBT for PTSD, 1/3 dropped out and the rest had a number of adverse reactions.
If you have found yourself engaged in numerous compulsive or self-sabotaging behaviors the ACE reveals how many of your problems are actually attempts at a solution. You have not been crazy and self-destructive or genetically defective, but consciously, or likely unconsciously, you have been seeking to find some temporary relief and safety using vehicles (drugs, food, sex etc) that do not serve you in the long run. For many people knowing this helps alleviate much of the shame and guilt. You did not come into the world this way, and our compounding later problems become so difficult to overcome because they have provided some temporary relief. As Felitti writes, “What one sees, the presenting problem, is often only the marker for the real problem, which lies buried in time, concealed by patient shame, secrecy, and sometimes amnesia–and frequently clinician discomfort.”
The ACE results can also assure you that you are not alone. Trauma and childhood abuse is one of the unacknowledged forces in the lives of many, many people. It is a reality that our society seems to have great difficulty facing. But this study shows that traumatic life experiences during childhood and adolescence are far more common than expected or acknowledged, even in employed, white middle-class, college-educated people with great health insurance. Only one-third of the respondents reported no adverse childhood experiences.
The ACE study has also helped to spur on a revolution that is taking place in counseling the helping professions, so there are many more effective resources than ever before.
Some general conclusions of the ACE study.
Multiple traumas: People usually experience more than one type of trauma; rarely is it only physical abuse or only sexual abuse. Two thirds of the 17,000 people in the ACE Study had an ACE score of at least one. 87 percent of those had more than one. Eighteen states have done their own ACE surveys; their results are similar to the CDC’s ACE Study. depression 460 percent and suicide 1,220 percent.
Chronic Disease: The study found a stunning and direct link between childhood trauma and adult onset of chronic disease. With an ACE score of 4 or more, things start getting very serious, the likelihood of chronic pulmonary lung disease increases 390 percent, hepatitis 240 percent. Those with an ACE score of 6 or above had a 15 percent or greater chance of than those with an Ace score of 0 of currently suffering from any of the 10 leading causes of death in the US, including chronic obstructive pulmonary disease (COPD), ischemic heart disease, and liver disease. They were twice as likely to suffer from cancer and four times a likely to have emphysema. As Van der Kolk writes, “The ongoing stress on the body keeps taking its toll.”
Emotional suffering: As the Ace score rises, chronic depression in adulthood also rise dramatically. The likelihood of being on antidepressant medication also rises proportionally. For those with an ACE score of 4 or more, depression is 66 percent in women and 35 percent in men, compared with an overall rate of 12 percent for those with an ACE score of zero. As Vincent Felitti writes,”Ironically, research has shown that depressed patients without prior histories of abuse or neglect tend to respond much better to antidepressants that patients with those backgrounds.” From a score of zero to a score of 6, there is about a 5,000 percent increased likelihood of suicide attempt.
Some specific results:
One in 10 responded yes to the question, “Did a parent or other adult in the household often or very often swear at you, insult you or put you down?”
More than a quarter responded yes to the questions “Did one of your parents often or very often push, grab, slap, or throw something at you?” and “Did one of your parents often or very often hit you so hard that you had mark or were injured?” This means that these individuals have been repeatedly physically abused as a child.
28% of women and 16 percent of men responded yes to the questions “Did an adult or person at least 5 years older ever have you touch their body in a sexual way?” and “Did an adult or person at lease 5 years older ever attempt oral, anal, or vaginal intercourse with you?”
One in 8 responded yes to the questions, “As a child, did you witness your mother sometimes, often or very often pushed, gabbed, slapped or had something throw at her?’ “As a child, did you witness your mother sometimes, often or very often kicked, bitten, hit with a fist or hit with something hard?
In our resources section of the website we provide some graphs that come from “The relationship of adverse childhood experiences to adult health, well-being, social function and health care,” in The Hidden Epidemic: The Impact of Early Life Trauma on Health and Disease, by Dr. Vincent Felitti and Dr. Robert Anda, co-founder of the ACE study.