Some people with a chronic illness or with distressing physical symptoms may have experienced trauma in their lives, either as a direct result of their illness or at a previous point in their lives. Ongoing childhood abuse, for example, has been shown to be related to ill health in adulthood, where those who experienced a rough childhood are more likely to be diagnosed with a chronic illness later on in life. While the causality between childhood adversity and adult chronic illness has yet to be fully determined (and is likely to be complex), researchers have now enough knowledge about the way chronic stress impacts physical health to make some educated guesses about their potential link. For example, when we are threatened, our bodies have what is called a stress response, which prepares our bodies for fight or flight. When this response remains highly activated in a child for long periods of time, and without the calming influence of a supportive parent or adult figure, toxic stress occurs and can damage crucial neural connections in the developing brain, and also affect the developing immune and endocrine systems. Fight and flight go from being adaptive and life-saving, to being maladaptive and health damaging. According to Harvard’s Center on the Developing Child, the impacts of experiencing repeated incidents of toxic stress as a child "persist far into adulthood, and can lead to lifelong impairments in both physical and mental health."
The impact of Adverse Childhood Experiences (ACEs) on Adult Health
In 1998, Kaiser Permanente released the ACE study, a comprehensive investigation into Adverse Childhood Experiences and their effect on survivors' health in adulthood, demonstrating the connection between trauma and illness, particularly childhood trauma, and the onset of chronic physical illness in adult life. The study revealed that individuals with ACEs had a higher likelihood of developing chronic conditions like heart disease, lung disease, liver disease, and cancer compared to the general population. Another study published in the American Journal of Preventive Medicine revealed that individuals with high scores on the ACE questionnaire had an increased risk of autoimmune diseases, depression, anxiety, insomnia, and frequent headaches. They concluded that extended emotional stress, often encountered by trauma survivors, causes various physical changes in the body that result in illness and disease. Indeed, individuals with PTSD for example, are more prone than those without PTSD to experience serious illnesses, including cardiovascular and respiratory diseases, as well as other physical health conditions. Those who have experienced childhood trauma, especially abuse and neglect, may face a 'cumulative disadvantage'.
It remains somewhat unclear at present which conditions might be triggered by childhood trauma. Many conditions, particularly neurological and autoimmune disorders, do not have a single known cause, but increasing evidence suggests that ACEs significantly contribute to their development. Overall, chronic stress in childhood is associated with illnesses in adulthood such as cardiovascular disease (heart attack and stroke, high cholesterol), diabetes, cancer, lung disease (asthma, chronic bronchitis and emphysema), renal disease, chronic pain, increased suicide rates and higher levels of anxiety and depression. The Kaiser study from 1998 revealed that an increase in the number of ACEs in a child's life correlates with a higher probability of "multiple risk factors for several of the leading causes of death in adults." Nearly two-thirds of participants reported experiencing at least one childhood stressor, with over 20% reporting three or more. An increase in these stressors was associated with higher risks of various adult health issues. As the ACE Score rose, so did the risk for the following health problems: alcoholism and alcohol abuse, illicit drug use, early initiation of sexual activity, sexually transmitted diseases, adolescent pregnancy, unintended pregnancies, fetal death, risk for intimate partner violence, multiple sexual partners, smoking and early initiation of smoking, suicide attempts, chronic obstructive pulmonary disease (COPD), ischemic heart disease (IHD), liver disease, anxiety, depression, and poor health-related quality of life. In addition, people with adverse childhood experiences are more likely to develop Mind-Body Syndrome and I will write more about that in relation to chronic pain in a future article.
How are ACEs related to illness?
The hallmarks of a rough childhood can take the form of emotional, physical, and sexual abuse, neglect (physical and emotional), household dysfunction (parental divorce, substance abuse and mental illness within the family) and exposure to violence within the home. Over time, this can affect the child's brain development, nervous system, immune system, endocrine (hormone) system, and also how their DNA is read and transcribed. When the body is subjected to prolonged stress, it releases stress-related neurochemicals and hormones in excessive quantities. Although these chemicals are naturally occurring and play a crucial role in normal bodily functions, their prolonged release can be harmful to the brain and body.
Elevated stress hormones can indeed weaken the immune system, making children more susceptible to infections and illnesses. Stress-related chemicals lead to increased activation in the body. Over time, this heightened state can erode muscles and tissues, resulting in inflammation. Inflammation is strongly associated with disease development and can further disrupt the body's ability to regulate inflammation and pain. ACEs can also trigger changes in gene expression through epigenetic mechanisms (e.g. changes in gene expressions), potentially impacting health outcomes later in life. Overall, repeated stress from ACEs can program the body to react differently to stress throughout adulthood, increasing the risk of chronic health issues.
The body utilizes stress hormones to ready itself for action when confronted with a threat. We call this the fight and flight mechanism. In Post Traumatic Stress Disorder (PTSD), a common characteristic is a malfunctioning threat response system, where threats are perceived even in the absence of actual danger. Individuals with PTSD often experience hypervigilance, keeping their bodies frequently on high alert. This persistent state of alertness is mentally and physically draining for the individual and, if left untreated, can switch the body's stress response system into high gear for the rest of their life. This elevated stress response can lead to increased vulnerability to chronic illness and chronic pain. It can also affect the structure and function of brain regions associated with emotion regulation, memory, and decision-making, potentially leading to difficulties with learning, behaviour, and social interaction.
From a behavioural perspective, individuals who have undergone physical and psychological trauma, including children, teens, and adults, may be more prone to adopting unhealthy coping strategies such as smoking, substance abuse, overeating, and hypersexuality. Indeed, in an attempt to regulate stress and distress to calm a dysregulated nervous system, adults who have experienced ACEs often engage in health-damaging behaviors like smoking, drug use, or alcohol consumption, which can lead to future health issues. For instance, increased smoking or drinking raises the risk of cardiovascular or liver disease. However, for many individuals, such behaviours might be minimal or not present at all, suggesting the influence of factors caused by the various long-term effects of chronic stress on the developing brain, nervous, endocrine and immune systems, and through epigenetics, where genes may be triggered to activate or deactivate. Also, a hyperactive autonomic nervous system and low-grade inflammation may make people more vulnerable towards chronic pain.
It's important to mention that not everyone with ACEs develop chronic illnesses. Resilience factors like having strong social support can help mitigate the negative impacts of ACEs. Providing children with supportive environments and access to mental health services can help reduce the long-term consequences of ACEs. Early intervention is key. However, in the absence of that, and with the aim of improving health-related quality of life, we can still teach adults how to better regulate their nervous system, how to use better serving coping strategies, and how to become more resilient during times of difficulty.
How do we heal?
As we have seen, the close connection between childhood adversity and adult illness does not necessarily imply that physical diseases faced by adults with traumatic childhoods are related to various behaviours, or are psychosomatic complaints. Although behaviours can also elevate the risk of developing certain conditions, the direct effect of ACEs on chronic illness in adulthood is very much real and can be independent of these behavioural factors. Indeed, the biological effects of childhood adversity are both genuine but can also be challenging to improve or fully reverse. It may nevertheless be helpful for people to learn better ways to manage stress, trauma triggers, and how to minimize symptoms, with the aim of becoming more resilient during difficult times. However, it's important to note that, with some effort, biopsychosocial approaches can most certainty significantly improve, or even cure, chronic pain conditions and symptoms related to Mind-Body Syndrome.
In spite of the known impact of childhood stress on long term health, there are still children who succeed despite difficult circumstances. Indeed, resilience has been proposed to be a protective factor against the trauma of ACEs. Resilience can be defined as the ability to bounce back in the face of adversity, and the good news is, resilience can be learned! Factors such as a stable relationship with a caring adult, and beliefs in one’s capabilities (self-efficacy) have been found to promote higher levels of resilience. Increased resilience has been associated with lower rates of mental and physical health problems as well as lower rates of inflammatory markers. This means that higher resilience may be protective against the detrimental effects of ACEs. Also, managing stress and distress when diagnosed with illnesses such as cancer, lung, cardiovascular disease, diabetes etc., is vital to maintain an acceptable health related quality of life. So, how do we heal?
In brief, providing psycho-education around childhood abuse and trauma, and how it may show up in daily life, is vital. For example, teaching people that trauma may present as physical symptoms, and not actual memories of events, is important. Trauma informed therapy and all that it involves, can create a sense of safety within the nervous system through various mindfulness strategies. That means that the fight and flight mechanism in the brain becomes less responsive to imaginary threats and triggers. You are essentially learning to communicate safety to the fight and flight mechanism, and thereby calm the nervous system; to recognize and handle triggers in a more efficient way.
Learning new and better serving coping strategies is also important, where, for example, people may allow themselves to be present with their symptoms, rather than using avoidance and distraction tactics to cope; the latter may serve to maintain distress and some physical symptoms such as fatigue, dizziness, nausea and pain. Working on increasing self-efficacy (the belief that you can accomplish goals and succeed at tasks) to foster resilience, is also very importance, as is using self-compassionate practices. Indeed, survivors of abuse are often really hard on themselves. Self-compassion activates the parasympathetic nervous system, which lowers the stress hormone cortisol, and helps the body relax.
In terms of chronic pain, a biopsychosocial pain management approach such as Pain-Reprocessing Therapy can actually remove pain completely, and, if not, reduce it significantly. Grief work is also important as people with high ACEs often experience numerous losses in their lives that may have been pushed to the wayside. That can take the form of narrative therapy or expressive writing. Generating a sense of meaning and purpose in one's life may serve to buffer suicidal ideations. There may also be room for work around post-traumatic/stress-related growth (if it feels appropriate), where one's experiences can be viewed as something to learn and grow from, and perhaps channeled towards helping others who have gone through something similar.
If this is something you’ve been affected by, please leave a comment below. If there’s something important you’d like to add, please do so. I'd love to hear from you!
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Dr. Ingela Thuné-Boyle is a licenced Practitioner Health Psychologist specializing in stress and loss, especially in improving the quality of life of people struggling with long-term health problems, chronic pain and (medical) trauma. She runs a private, online, telehealth practice at www.ingelathuneboyle.com.
Please note: Information and advice given in this blog is not meant to take the place of therapy or any other professional advice. The opinions and views offered by the author is not intended to treat or diagnose, nor is it intended to replace the treatment and care that you may be receiving from a licensed physician or mental health provider. The author is not responsible for the outcome or results following their information and advice on this blog.
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