MARCH 06, 2020HEALTHrisks. The study also linked childhood trauma to a host of seeming-
ly unrelated physical problems, including ischemic heart disease,
cancer, chronic lung disease, skeletal fractures and liver disease.
What made the study so shocking was that the data suggested
that even those who didn’t drink, use drugs or act out in risky
ways still had a far higher rate of developing ischemic heart dis-
ease, cancer, chronic lung disease, skeletal fractures and liver
disease. Unexpectedly, the researchers had discovered that child-
hood adversity seemed to be an independent risk factor for some
of the leading causes of death decades later.
“We found a strong graded relationship between the breadth of
exposure to abuse or household dysfunction during childhood
and multiple risk factors for several of the leading causes of death
in adults,” the authors wrote.
The study dropped like a bomb in the world of public health.
But the scientific work was just beginning. In the years since,
scores of researchers have begun to dig into the biological mech-
anisms in play. And with emerging brain scanning technologies
and advances in molecular biology, an explanation for the ACE
study has begun to emerge. Some clinicians and scientists have
begun to turn these findings into concrete interventions and
treatments they hope can be used to reverse or at least attenuate
the impact.
Much of the research has focused on how ACEs affect the
functioning of the hypothalamic-pituitary-adrenal (HPA) axis, a
the critter to the ground and plunge a Bowie knife into its heart.
However, when the emergency goes on for a long time—per-
haps over an entire childhood of abuse—the resulting high levels
of cortisol take a big and lasting toll.
Almost as soon as the ACE study was published, dysregulat-
ed cortisol levels seemed a likely culprit to explain the study’s
startling implications. Was it possible that the chronic stressors
identified by Felitti and Anda led to elevated cortisol levels in
children? And could those elevated levels account for seemingly
unrelated diseases and the range of additional problems that re-
searchers were beginning to link to ACEs?
In the decade after the 1998 ACE study, researchers began
seeking out children in Romanian orphanages and measuringbiological system that plays a key role in the mind-body connec-
tion. The HPA axis controls our reactions to stress and is crucial
in regulating an array of important body processes including
immune function, energy storage and expenditure—even our
experience of emotions and mood. It does so by adjusting the
release of key hormones, most notably cortisol, the release of
which is increased by stress or low blood sugar levels.
Cortisol has many functions. On a daily basis, it regulates the
level of energy we have as the day progresses: we generally expe-
rience our highest levels of cortisol, and energy, upon waking up.
These levels gradually diminish throughout the day, reaching very
low levels just prior to bedtime.
Cortisol also serves a role in the body’s energy allocation
during times of crisis. When all is calm, the body builds muscle
or bone and socks away excess calories for future consumption as
fat, performs cellular regeneration and keeps its immune system
strong to fight infection. In the case of a child, the body fuels
normal mental and physical development.
In an emergency, however, all these processes get put on hold.
The HPA axis floods the bloodstream with adrenaline and cor-
tisol, which signals the body to kick into overdrive immediately.
Blood sugar levels spike and the heart pumps harder to provide
a fast boost in fuel. If an 11-foot-tall grizzly bear is lumbering
in your direction and licking his chops, the additional burst of
energy helps you run screaming through the woods or wrestleRegardless of whether adversity took the form of neglect
or abuse, the effects can have profound consequences later in life. Left: A
daughter of undocumented immigrants and the victim of sexual abuse now
suffers from depression. Right: A child draws during an art therapy session.Ơ“If you’re being regularly abused,
FROM LEFT: JEFF GRITCHENʔDIGITAL FIRST MEDIAʔORANGE COUNTY REGISTERʔ GETTY; HELEN H. RICHARDSONʔTHE DENVER POSTʔGETTY