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National Association of Adult Survivors of Child Abuse
National Association of Adult Survivors of Child Abuse
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NAASCA Highlights
EDITOR'S NOTE: Occasionally we bring you articles from local newspapers, web sites and other sources that constitute but a small percentage of the information available to those who are interested in the issues of child abuse and recovery from it.
We also present original articles we hope will inform the community ... |
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Broken Mind, Broken Matter
A landmark study on adverse childhood experiences should revolutionize medicine.
But it hasn't yet.
by
Nicole Jordan
EDITOR'S NOTE: The featured "poster child" for the ACE Study is Amy Crohn from New York, a member of the NAASCA family, author of the book "Dying to Live" and special guest on our "Stop Child Abuse Now" talk show, Episode 838. Here's the direct link to her appearance on the talk show: http://www.blogtalkradio.com/bill-murray/2014/05/22/stop-child-abuse-now-scan--838
~~~
Amy Susan Crohn just turned 53 and says she's emotionally and physically “shot.” She likens caring for her health to a full-time job, referring to herself as a “professional patient,” without a hint of sarcasm. Considering Crohn teetered on the brink of life and death throughout her 30s and was once declared dead, passing the half-century mark has been no small feat. The New York native welcomes each birthday with bewilderment at her ability to defy the odds, saying she wonders every day how it is that she's still alive. “I don't know why I survived,” she says. “But I did.”
The youngest in a blended family, with a mentally ill mother and a habitually absent father, Crohn recalls receiving the brunt of emotional abuse and neglect. Sharing quarters with armies of roaches and never knowing where her next meal would come from bred severe anxiety and an assortment of phobias in the soft-spoken little girl. Eventually the anxiety became a way of life, coursing through her body like poison, manifesting itself in the form of nausea, dizziness and chronic illness. Like an unwelcome visitor, the crippling anxiety refuses to leave her to this day. |
Once she reached adulthood, Crohn sought to escape her past by building a career and a family she could feel proud of. She distanced herself from her parents, stuffing the pain from her childhood deep down. Crohn's physical ailments were harder to ignore, however, and at 36, she was diagnosed with Lupus and stage IV Hodgkin's lymphoma – a typically terminal diagnosis. One year and 18 chemotherapy treatments later, Crohn would learn she was in tentative remission. Her body was fragile and spent, but true to form, she had survived.
Recognizing the rarity of her near-death experience and finally prepared to meet her childhood issues head on, Crohn decided to document her story in the form of a memoir. It was while doing research for her recently published book, Dying to Live , that Crohn had an “Aha! moment.” Feeling curious, she did an Internet search on the long-term repercussions of childhood trauma, and research from across the globe popped up. Ultimately, Crohn found the Adverse Childhood Experiences (ACE) study, a massive study published in the '90s in the American Journal of Preventive Medicine that revealed stunning correlations between early childhood trauma and negative outcomes, including poor physical health, in adulthood. The implications for Crohn's life left her floored and, at 49, she began to connect the dots in her own complicated history.
Are you an ACE?
According to the ACE study, individuals with an ACE score of 4 (out of 10) or higher are prone to negative psychological, physical and social outcomes as adults. When Crohn sat down to calculate her score by answering 10 questions based on her first 18 years of life, she found out she was a 6.
“Was a household member depressed or mentally ill, or did a household member attempt suicide?” Check.
“Did you often or very often feel that you didn't have enough to eat, had to wear dirty clothes, and had no one to protect you?” Check.
“Were your parents ever separated or divorced?” Check.
And so on …
Among other things, an ACE score of 6 put Crohn at an increased risk of developing depression, alcohol and drug dependencies, and various health issues such as cancer, heart disease and obesity. Possibly most shocking, those with an ACE score of 6 or more face an average life expectancy of 20 years fewer than those without ACEs. As a cancer survivor with a history of near-debilitating anxiety, depression and poor overall health, Crohn fit the bill. Her health problems reached a peak when she learned of a tumor wedged between her heart and lung and, following complications, was pronounced clinically dead before being revived. But her health had been problematic for a long time. Crohn was diagnosed with autoimmune disease at 16, an event that – in retrospect – almost seems willed into existence by her mother.
The Crohn family matriarch, Norma, was eccentric, charismatic … and deeply disturbed. In adulthood, Crohn learned that her mother had borderline personality disorder. She also exhibited signs of Munchausen syndrome by proxy, a phenomenon unheard of in '60s suburbia. The rare – and sometimes fatal – form of child abuse involves the perpetuation or fabrication of illnesses in one's children to garner sympathy and attention. “When the kids were sick,” Crohn says, “Mom was happy.”
Not long before Norma's death, the mother and daughter shared an exchange that left Crohn's skin crawling. “Mom, do you know what you are?” she asked. “Yes, I'm a black widow spider,” Norma replied. “I eat my young.”
As Crohn delved into research surrounding the ACE study, she began to view her life experiences much differently. She realized that no matter how deeply she hid the pain from her childhood, her body would never forget. “I thought I had dealt with it and filed it away,” she says. “But your body has a memory.” Crohn began to think that there was more to her story than an unlucky child who grew into an unhealthy adult, and it left her reeling with anger. “I don't think there's any accident the tumor was centered on my heart,” she says. “I truly believe I wouldn't have gotten cancer or Lupus if I hadn't had the childhood experiences I had.”
The study you've never heard of
To blame one's cancer diagnosis on a dysfunctional childhood may seem outrageous, and at a cursory glance, the ACE study might elicit a smidge of skepticism. While it's important to note that not everyone with a history of adverse childhood experiences will have poor health and not everyone with poor health was a victim of adverse childhood experiences, the conclusions drawn by the ACE study and similar research are compelling.
Most people wouldn't be shocked to learn that the homeless guy hanging out at the liquor store was a victim of child abuse, but what about the schoolteacher with heart disease or the father of four with cancer? Is it so far-fetched to think early childhood trauma is potent enough to reach into the more tangible aspects of our being? The director of the Center for Family Counseling at Southern Methodist University, Sarah Feuerbacher, Ph.D., says it isn't. “Without a doubt, childhood trauma affects every single aspect of a person throughout their life,” she says, “including physical, mental, emotional, social, financial and spiritual health.”
Huffington Post recently called the ACE study “the most important public health study you've never heard of” – and with good reason. Originating from an obesity clinic in San Diego, the groundbreaking work became the largest study ever completed to investigate the effects of emotional and physical trauma during childhood on physical and psychological health in adulthood.
In 1985, Dr. Vincent Felitti, chief of Kaiser Permanente's Department of Preventive Medicine in California, was astonished to observe more than half of participants in his obesity study successfully losing hundreds of pounds, only to drop out of the program and gain the weight back – plus some, in many cases. To get to the root of the problem, Felitti began questioning participants. When he misspoke during a routine interview by asking a woman, “How much did you weigh when you became sexually active?” instead of, “How old were you when you became sexually active?” she burst into tears and replied, “Forty pounds. It was when I was 4 years old, with my father.”
It was only the second case of incest the doctor had seen in 23 years of practice, and he was aghast.
Felitti and his colleagues proceeded to interview 286 people, finding that most had been sexually abused as children. It was a turning point for Felitti as he began to see connections that would ultimately shift his entire perspective on health care and serve as the catalyst for a 25-year journey, resulting in the ACE study. For these individuals, obesity wasn't the problem, it was the solution. Not only did they seek solace in food, using it to soothe their anxiety, depression and fear, but they were subconsciously de-sexing themselves by putting on a proverbial coat of armor. “It was the beginning of helping us see that there was this public health paradox,” Felitti says. “Things that we see as public health problems are – for the individual – unconsciously attempted solutions to problems that no one knows anything about.”
Believing he was on the brink of something big, Felitti began spreading word of his findings, eventually connecting with Dr. Robert Anda, a medical epidemiologist from the Centers for Disease Control and Prevention. The pair decided that Kaiser Permanente, with 50,000 members filing through yearly, would be the perfect place for the massive study. Initially, the pair met resistance. Felitti says many physicians weren't keen on asking personal questions of patients, because “We've all been taught as children that nice people don't talk about certain things and sure as hell don't ask about them.” But in 1995, surveys of the 17,421 members who agreed began.
To say that the doctors were shocked when the results began to file in two years later would be an understatement. Anda wept. Not only did the data show a strong correlation between childhood trauma and adult onset of chronic disease, mental illness, incarceration and work issues, but approximately two-thirds of participants had experienced one or more types of adverse childhood experiences. The sheer prevalence of childhood trauma was astounding. These people were victims of incest, physical abuse, parental neglect and nearly every other childhood ill imaginable, not what you'd expect from a population mostly made up of educated white middle-class suburbanites. In all likelihood, these people represented your neighbors, your church members, your schoolteachers and your friends. They represented you and me.
David Cross, Ph.D, associate director of the Institute of Child Development at Texas Christian University, is just recently coming to terms with the trauma he endured as a child. “I guess I'm an ACE,” he says. “People look at us from the outside and it looks like we've got it together, but on the inside it's not quite so neat.”
The cost of trauma
While the psychological and psychosocial repercussions of childhood trauma are widely accepted, the very real physical complications that can follow are just beginning to be grasped. Cross says children who grow up under adverse circumstances are, simply put, wired differently. “They have a different brain from children who grow up in a protective, nurturing environment,” he says. “It's a brain that makes it hard for you to function well given the normal stresses and strains of life.”
For those of us without an M.D. or Ph.D. tagged to our name, the scientific explanation behind this faulty wiring of the brain can be difficult to follow. But the general idea is this: Childhood trauma has cumulative neurobiological effects. Repeated stress and trauma can result in a chain reaction of long-term changes in brain function and structure, impacting emotional and physical responses to stress in adulthood. This kind of chronic, unrelieved stress may result in problematic behavior, which can lead to health problems (e.g. smoking puts you at risk for lung cancer), but it also has extensive effects on the rest of the body, especially the endocrine and immune systems. These effects can show up decades into a person's life, making it difficult to connect the symptom with the childhood trauma.
Genetics can also have a bearing. Epigenetics, a new buzzword, is a concept that looks at the relationship between environmental factors and genetics. The idea is that our genes have a sort of “on-off” switch. A person can have the gene for a particular kind of cancer, but that gene may remain dormant without the influence of certain environmental factors, such as diet and emotional health.
Cross was removed from his parents' care at 4 years old and put in a group home where he was abused. After being shuffled among family members, he landed in foster care. A self-described “stress puppy” with hypertension and a history of migraines, Cross tucked away the pain for most of his life. It wasn't until he was working on a project with at-risk youth that he saw himself mirrored in the faces of the children and said to himself, “David, you were abused.”
On a recent morning, he pauses over biscuits and gravy, realizing he's never shared his story in such detail before; it's made him emotional and introspective. “When you're violated, you can't erase it,” he says. “It's always going to be there, living in your emotional machinery. Even though you don't think about it, it's there.”
When asked if he believes his childhood abuse and neglect are behind the high blood pressure and acute stress he lives with, Cross hesitates for a minute before offering a meek “maybe.” Either way, he agrees that trauma has taken its toll.
Put a Band-Aid on it
While the cost of childhood trauma is highest for the victim, it can also be high for taxpayers who end up footing the bill for lifetime costs associated with adverse childhood experiences, such as adult criminality, loss of productivity, medical care and child welfare. According to a 2013 CDC study, one year of confirmed cases of child maltreatment will end up costing $124 billion over the lifetimes of traumatized children.
To help these adults heal, Felitti suggests physicians incorporate the ACE survey into the paperwork patients fill out and ask about any troubling responses. “I see your mother committed suicide,” your doctor might ask. “How has that affected you?”
In the years following publication of the ACE Study, Felitti instituted this practice in his own work and discovered that there's great power in asking and telling. Patients were grateful for the opportunity to share. Felitti keeps a notebook full of letters, one of his most memorable coming from an elderly woman who wrote, “Thank you for asking. I feared I would die and no one would know what had happened to me.” The positive feedback was gratifying, but more impressive were the statistics, which showed a 35 percent reduction in doctors' visits and an 11 percent reduction in emergency room visits by patients who were asked about childhood trauma. Patients who participated in a one-hour therapy session with a staff therapist saw a decline in doctors' visits by an astounding 51 percent.
The numbers send a powerful message, which begs the question: Why aren't all physicians using the ACE survey?
Amy Susan Crohn believes reluctance from those in the medical community to look at the relationship between emotional and physical health stands in the way. “It's treat the symptom, treat the body part,” she says.
Hippocrates once said, “It is far more important to know what person the disease has than what disease the person has.” In Sarah Feuerbacher's experience, most doctors cite a lack of time, training and resources for their unwillingness to get to know the person behind the disease. She likens the current state of health care to putting a Band-Aid on a gaping wound, saying, “If people's mental and emotional health was acknowledged, understood, validated and treated throughout their lifetime, it could literally and figuratively remove the Band-Aid we've been applying to major health issues and actually be preventive.”
Removing the proverbial Band-Aid won't be easy. It's been 15 years since the publication of the ACE study, which has been underpublicized and ignored by many in the medical community. But there is movement. The ACE study is ongoing, with data from participants still being analyzed. Since 2009, 21 states (not including Texas) have performed their own ACE studies, and Felitti and Anda speak worldwide and are still publishing articles related to the study. As for Amy Susan Crohn, she says she's doing OK. She frequents doctor's offices like many people frequent Starbucks, and manages her conditions with a cocktail of prescriptions. For emotional health, she remains in therapy.
David Cross is optimistic about the future for those with ACEs. Even as he works to sort through his own past, he's using his platform with the Institute of Child Development to create intervention programs, which he hopes will change the lives of future “stress puppies” like himself. “If folks have these experiences, then they're at risk for a variety of problems later on,” he says. “But the other side of the story is that we now know more about how we can heal these things. Even in adulthood, there's a lot of healing that can go on. That's a really hopeful message.”
For more information on the ACE Study and to find out how you can help spread the word, visit: acestudy.org or cdc.gov/ace ~~~~~~~~~~~~~~~~~~~~~
What's your ACE score?
While you were growing up, during your first 18 years of life:
1. Did a parent or other adult in the household often or very often ...
Swear at you, insult you, put you down, or humiliate you?
Or
Act in a way that made you afraid that you might be physically hurt?
Yes No If yes enter 1 ___
2. Did a parent or other adult in the household often or very often ...
Push, grab, slap, or throw something at you?
Or
Ever hit you so hard that you had marks or were injured?
Yes No If yes enter 1 ___
3. Did an adult or person at least 5 years older than you ever ...
Touch or fondle you or have you touch their body in a sexual way?
Or
Attempt or actually have oral, anal, or vaginal intercourse with you?
Yes No If yes enter 1 ___
4. Did you often or very often feel that ...
No one in your family loved you or thought you were important or special?
Or
Your family didn't look out for each other, feel close to each other, or support each other?
Yes No If yes enter 1 ___
5. Did you often or very often feel that ...
You didn't have enough to eat, had to wear dirty clothes, and had no one to protect you?
Or
Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?
Yes No If yes enter 1 ___
6. Were your parents ever separated or divorced?
Yes No If yes enter 1 ___
7. Was your mother or stepmother:
Often or very often pushed, grabbed, slapped, or had something thrown at her?
Or
Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard?
Or
Ever repeatedly hit at least a few minutes or threatened with a gun or knife?
Yes No If yes enter 1 ___
8. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?
Yes No If yes enter 1 ___
9. Was a household member depressed or mentally ill, or did a household member attempt suicide?
Yes No If yes enter 1 ___
10. Did a household member go to prison?
Yes No If yes enter 1 ___
Now add up your “Yes” answers: ___ This is your ACE Score. |
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