ACE Study & Score

A study shows there is a connection between "adverse childhood experiences" (such as abuse, neglect and family dysfunction) and health and mental health problems in adulthood.

Dr. Felitti from Kaiser Permanente in San Diego began a weight loss clinic for patients who were obese.

Unexpectedly, the weight program had a high dropout rate, mostly by patients successfully losing weight!

Exploring the reasons so many patients inexplicably fled their own success in the program led the researchers to recognize that:

• weight loss is often sexually or physically threatening and 
• that certain of the more intractable public health problems such as obesity were also unconscious, or occasionally conscious, compensatory behaviors that were put in place as solutions to problems dating back to the earliest years, but hidden by time, by shame, by secrecy and by social taboos against exploring certain areas of life experience. 

Patients were asked 10 questions about abuse, neglect and family dysfunction experiences (for example, parental incarceration, mental illness, drug use or loss) from ages 0 to 18 years.   Their ACE score is the total number of experiences reported when each experience equals one point.

It turns out that the higher the ACE score, the greater likelihood of:

• self-reported chronic depression
• self-acknowledged smoking and IV drug use
• sexual activity
• liver disease
• chronic obstructive pulmonary disease
• autoimmune disease

Many of our most intractable public health problems are the result of compensatory behaviors like smoking, overeating, and alcohol and drug use which provide immediate partial relief from the emotional problems caused by traumatic childhood experiences.

That is, the very things that harm our health also help us to survive the pain of what happened.

Adverse childhood experiences are lost in time and concealed by shame, secrecy, and social taboo against the exploration of certain topics of human experience.

The findings of the Adverse Childhood Experiences (ACE) Study provide a credible basis for a new paradigm of medical, public health, and social service practice that would start with comprehensive biopsychosocial evaluation of all patients at the outset of ongoing medical care.

Chapter 8  The relationship of adverse childhood experiences to adult medical disease, psychiatric disorders and sexual behavior:  implications for healthcare
Vincent J. Felitti and Robert F. Anda