Objectives ~ Explore the relationship between ACEs and trauma ~ Identify the impact of ACEs and traumatic injury on mental, physical and interpersonal health in adults ~ Explore risk factors for ACEs and subsequent prevention and intervention measures.
Overview of LTE of ACEs ~ Adverse childhood experiences (ACEs) are stressful or traumatic events that children experience before age 18 years. Studies have linked exposure to ACEs and negative health, and developmental and behavioral outcomes. ~ Traumatic Event: Direct or indirect exposure to an event that involved the possibility of death or serious injury ~ Traumatic Injury: Psychological consequences sometimes experienced after a trauma. ~ 61% of adults surveyed across 25 states reported that they had experienced at least one type of ACE, and nearly 1 in 6 reported they had experienced four or more types of ACEs. ~ Over 50% of adolescents have been exposed to ACEs which can have detrimental effects on learning and behavior and is associated with increased suicidal ideation in adolescents ~ 68.1% of people who reported homelessness in childhood also reported experiencing four or more ACEs. Only 16.3% of people were never homeless in childhood reported experiencing four or more ACEs ~ ACEs have a different impact on the brain based upon the age of exposure, individual factors and microsystem protective factors ~ Strongest impacts are found for younger children (ages 2-5) and those living in households with incomes below 200% of the federal poverty level ~ ACEs contribute to disturbances in cognitive and affective processing including ~ Heightened attention toward threatening stimuli ~ Increased experience of loneliness ~ Increased HPA-Axis dysregulation / reduced impulse control ~ Functional alterations in key stress–and emotion associated brain regions particularly the anterior cingulate cortex [ACC], amygdala and hippocampus (shrinkage) ~ Initial increase in amygdala volume after ACEs, followed by a decrease in volume due to persistent distress in later life ~ These brain regions are particularly susceptible to damage from trauma/HPA-Axis hyperactivation due to the high density of glucorticoid receptors ~ Exposure to specific types of ACEs selectively affect the sensory systems which were involved in perceiving the trauma ~ Mental disorders in individuals with ACE exposure tend to have more severe symptomatology, increased risk of comorbidity and are less likely to respond to standard treatments (why?) ~ In adults, ACE exposure is associated with ~ A wide range of physical disorders including obesity, dysregulation of the immune system, autoimmune disorders and abnormal pain perception with and without underlying causes ~ Stress itself can sensitize nociceptive neurons in the spinal cord which result in comparable changes in pain-perception and related behavior. ~ Increased levels of pro-inflammatory cytokines ~ Disruptions in intestinal microbiota and the mucosal immune system ~ 200-400% increased risk of heart disease, cancer, chronic lung disease, skeletal fractures, depression, diabetes and prediabetes, liver disease Summary ~ More than 60% of people have experienced ACEs ~ It is believed the rate of exposure to ACEs has increased significantly during COVID ~ Not everyone who experiences ACEs will develop traumatic injury ~ Injuries related to ACE trauma include: ~ Borderline and antisocial personality disorder ~ Mood disorders ~ PTSD ~ Addictions ~ Autoimmune issues including IBS, Chron’s, Diabetes ~ Heart disease, cancer, chronic lung disease, liver disease ~ Increased difficulty in interpersonal relationships due to above issues ~ Increased risk to become a perpetrator of ACEs