Adverse Childhood Experiences (ACEs)

Each of us has usually experienced three kinds of stress: good stress, tolerable stress, and toxic stress (McEwen 2017). Each can cause us to stretch and grow, but toxic stress presents unique challenges, espe¬cially in childhood. These kinds of stress exist on a continuum, meaning that the line between them is somewhat gradual, but they can generally be defined as follows.

Good stress challenges without overwhelming us. We are under control emotionally and tend to make good decisions. Think of a student who has prepared for an important exam or a prepared athlete performing well in a big game. The stress response—fight or flight—is brief, and levels of stress hormones are appropriate.

Tolerable stress might involve intense fight-or-flight physical changes, with greater elevations of stress hormones. However, the body eventually returns to normal, especially if trusted adults help the child buffer the stress. Recovery occurs before there is lasting physical or psychologi¬cal damage. For example, you might think of the death of a loved one from natural causes or a community coming together after a hurricane.

Toxic stress is so overwhelming, so severe or chronic, that a person is “shook up” and stressed for a long time. This kind of stress adversely affects the brain and biology in ways that impair adult health, work performance, relationships, judgment, impulse control, spirituality, and self-esteem—especially in the absence of a safe adult to buffer the stress. The effects of toxic stress can be passed down intergenerationally if unchecked.

This brings us to a fascinating line of research regarding toxic early life stress.

Felitti and Anda (2014), found that about two-thirds of adults had experienced at least one early life adversity. And Adverse Childhood Experiences didn’t usually occur in isolation: most who had experienced one ACE also had experienced at least one more. For example, an alcoholic father might also be abusive.

Dis-orders—departures from our usual order—often have multiple causes, such as infection, a toxic physical environment, lack of social support, unhealthy lifestyle, genes, and temperament. However, Felitti and Anda’s original study and scores of later studies have shown that ACEs independently predict many disorders, and do so in a stepwise fashion. That is, the higher one’s ACEs score, the greater the likelihood of developing a disorder. Here is a sampling of what ACEs predict.

Medical Conditions
Obesity (eating might self-medicate pain)
Type 2 diabetes
Cardiovascular disease (heart disease, stroke)

Autoimmune diseases (rheumatoid arthritis, type 1 diabetes, multiple sclerosis, lupus, pso¬riasis, celiac disease, inflammatory bowel disease, Graves’ disease, vitiligo, idiopathic pul¬monary fibrosis, primary biliary cirrhosis)
Chronic fatigue
Nearly all sleep disorders (sleep apnea, nightmares, insomnia, narcolepsy, sleepwalking, sleep eating)
Reproductive problems (sexually transmitted diseases, preterm birth)
Shorter life span (by nearly twenty years when ACE score is 6 or higher)
Poorer self-rated health

Mental Health Conditions
Low self-esteem
Depression (including bipolar disorder)
Anxiety (including panic disorder)
Post-traumatic stress disorder (PTSD) and complex PTSD
Borderline personality disorder
Attention deficit hyperactivity disorder (ADHD)

Risky Behaviors
Drug abuse or misuse (smoking, substance use disorder, injecting drugs intravenously, misusing prescription drugs—taking too much or too often or using them without a pre¬scription, using a higher number of prescriptions)
Suicide attempts
Precocious sexual activity (greater likelihood of intercourse by age fifteen, having multi¬ple sex partners, teen paternity and maternity, unintended pregnancy)
Intimate partner violence

Felitti, V., & R. F. Anda. (2014). “The Lifelong Effects of Adverse Childhood Experiences.” In Child Maltreatment: Sexual Abuse and Psychological Maltreatment, vol. 2, 4th ed., edited by D. L. Chadwick et al. St. Louis: STM Learning.
McEwen, B. S. (2017). “Neurobiological and Systemic Effects of Chronic Stress.” Chronic Stress (Thousand Oaks) 1