a. Problem Statement
Traumatic childhood experiences strongly provide basis for antisocial behaviors and poor physical health outcomes during adulthood. Childhood experiences of physical/sexual abuse, neglect, family dysfunction and other traumatic events are likely to cause depression, psychiatric illnesses, regressive and high –risk behaviors. Lastly, studies have found stronger association between the severity of trauma and poor outcomes in adulthood.
b. Overview
Different compelling evidences from variety of scholarly studies suggest that adverse childhood experiences (ACE) constitute the major risk factor in developing persistent psychiatric and nonpsychiatric medical conditions (e.g. anxiety disorders, depression, substance abuse, etc) (Narrow, 2007 p.89-90). By definition, “ACE includes childhood physical and sexual abuse, emotional abuse, neglect, witnessing domestic violence, parental mental illness, substance abuse or criminal activity” (Mannel, Martens and Walker, 2008 p.74). Based on the study of Arnow (2004), events of childhood maltreatment greatly impact the development of a person frequently manifesting during adulthood. Sadly, approximately 80% of all filed cases of child adversities are associated with family dysfunctions, events of parental abuse and cases related to family/home issues (Kirmayer, Lemelson and Barad, 2007 p.232). The following sections examine and review recent scholarly literatures pertaining to the effects of ACE among adults in an effort to prove the problem statement.
II. Discussion
a. Adverse Childhood Experiences
Various ACE studies from 1998’s Kaiser Permanente and the Centers for Disease Control up to recent scholarly journals provide consistent evidences of strict relationships between ACE and major psychiatric conditions during adulthood (Kirmayer, Lemelson and Barad, 2007 p.232). Arnow (2004) emphasizes the parallel relationship between ACE and adult psychiatric health outcomes. The more severe the trauma and childhood abuse, the stronger the association with poor psychiatric health outcomes during adulthood. Various studies (Spataro, Mullen and Burgess, 2004; Whitfield and Fellitti et al., 2004) have attempted to explain the definite mental/psychiatric causalities of disorders and antisocial behaviors caused by ACE.
Children may suffer various kinds of ACE (e.g. sexual abuse, physical maltreatment, emotional trauma, etc.) and may produce varying indefinite health alterations. Meinlschmidt (2005) provides five shared aspects of ACE providing long-term effects throughout adulthood: (1) restrictions of developing selective social relationships, (2) disruptions in security, (3) threat to relationship, (4) group influences of a maladaptive kind, and lastly, (5) the overall quality of adult-child interactions and communications (p.10). According to Kirmayer, Lemelson and Barad (2007), early investigations suggest that ACE tends to discretely regress the person’s conditioned thoughts, behaviors and biological responses creating mental picture of trauma resulted by ACE (p.233). Meanwhile, adversities during childhood may occur from indirect or direct events viewed unfavorable by a given social, familial or cultural norm (e.g. divorce of parents, excommunication from a religion, etc).
b. Theories of Development Associated with Traumatic Childhood
The impact of ACE among adult behaviors and mental alterations can be best explained by Freudian theory of trauma and psychosocial development of Erik Erikson. Before the death of the famous psychosexual theorist – Sigmund Freud, he was able to conceptualize Moses and Monotheism (1939) consisting of his theory on traumatic memory obtained from childhood but greatly affecting adult behaviors, which eventually became the sole foundation of the modern trauma theory (Kirmayer, Lemelson and Barad, 2007 p.341). Psychoanalytic explanation of trauma views ACE as premature damaging event capable of awakening a person’s sexuality, feelings of violence and fault self-perceptions.
In addition, trauma theory holds that ACE produces psychological trauma, which may be repressed or suppressed, capable of overwhelming human coping capacities throughout life (Seeley, 2008 p.17). Nonetheless, the biological and mental connections of trauma on an adult’s susceptibility to mental disorders have not yet been uncovered, which consequently restricts the framework proposed by trauma theory (Seeley, 2008 p.17).
On the other hand, Erikson’s psychosocial theory explains that the impacts of ACE manifesting during adulthood are due to the failure of the child to satisfy their developmental needs (e.g. mistrust vs. trust, etc.). According to Wilson (2006), ego, personal component of Erikson’s psychosocial theory, is confronted by an extension task of reinventing “an alternative self” in order to master psychological trauma experienced during the child’s development (p.82). Unfortunately, reinvention of one’s ego after incidences of ACE result in posttraumatic consequences producing untoward psychological and mental alterations manifested by anxiety, fear, depression, etc (Scannapieco and Connell-Carrick, 2005 p.69).
c. Impact of ACE in Adulthood
Studies on the associations of ACE and adult antisocial and psychiatric conditions keep on increasing, while at the same time producing strong and consistent findings concerning the subject. According to compiled evidences and implication studies of Larkin and Read (2008), literatures produced from 2005 up to present reveal consistent standpoints on ACE causing psychological and physical health problems during adulthood. Their study has concluded with a strongly supported assertion that “childhood trauma (or ACE) is a causal factor in positive psychotic phenomena… linked to numerous negative mental health, physical health and social outcomes in childhood and later life” (Larkin and Read, 2008 p.5).
Proven by a prospective cohort study of Spataro, Mullen and Burgess (2004) from various mental health affiliations, both male and females with ACE confront higher rates of psychiatric treatment varying from 12.4% to 3.6% with occurrence of various mental, personality, anxiety and major affective disorders. Meanwhile, a retrospective cohort study of Chapman, Whitfield and Fellitti et al. (2004) comprising 9,460 adults with documented ACE reveals a rate of 23% lifetime prevalence of depressive disorders, while varying incidences of abuse are likely to increase the risk for lifetime depressive disorders by 2.7% (95% confidence interval) among women and 2.5% (95% confidence interval) among men.
In addition, ACE reveals strong association with wide range of clinical and social deficits, such as lower ability to maintain intimacy, emotional instability, impaired flexibility skills and poorer participation in rehabilitative psychological therapies (Larkin and Read, 2008). Indeed, based on these scholarly literatures, ACE has its strong association with adult manifestations of social, emotional and psychological health deficits.
In order to prove the health outcomes caused by ACE, scholarly studies have tried to simulate stressing environment among animals to strengthen the health claims caused by ACE. Narrow (2007) cites the animal laboratory studies of Heim et al. (2004) and Sanchez et al. (2001) revealing direct evidences that ACE early in life may cause sensitization of endocrine, autonomic and behavioral stress responses. Meanwhile, results from animal-based studies have also been observed by the study of Carpenter, (2004) occurring among adult humans with history of childhood adversity. Survey results from samples (n=8,760) during National Survey of Family Growth have been analyzed revealing poor kinship care as the primary predictor of perceived ‘unhappiness in life’ and physical manifestations of prolonged anxiety. Finally, ACE has indeed strong associations with adult mental and psychiatric illnesses, which usually progress later in life. Indeed, the relationship between ACE and adult health outcomes suggest a significant role in resolving psychological and physical health alterations caused by traumatic childhood events.
III. Conclusion
In conclusion, ACE significantly influences behaviors, mental status, self -perceptions and physical well-being of a person, especially during adulthood. These events remain repressed or suppressed and can occur through indirect or direct means depending on the social norms established in the person’s society. Various scholarly studies and theoretical frameworks (Trauma theory and Psychosocial Theory) discussed in this paper support the strong association between the adult’s psychiatric and physical health outcomes, and marked events consisting ACEs. Documented studies consider ACE as a predisposing causative agent of adult depressive, anxiety and traumatic disorders.
IV. References
- Arnow, B. A. (2004, January). Relationships between childhood maltreatment, adult health and psychiatric outcomes, and medical utilization. Journal of Clinical Psychiatry, 65, 10-15.
- Carpenter, S. C., & Clyman, R. B. (2004, July). The long-term emotional and physical wellbeing of women who have lived in kinship care . Children and Youth Services Review, 26, 673-686 .
- Chapman, D., Whitfield, C., & Felitti et al., V. (2004, January). Adverse childhood experiences and the risk of depressive disorders in adulthood. Journal of Affective Disorders, 82, 217 – 225.
- Kirmayer, L. J., Lemelson, R., & Barad, M. (2007). Understanding Trauma: Integrating Biological, Clinical, and Cultural Perspectives. New York, London: Cambridge University Press.
- Larkin, W., & Read, J. (2008, October). Childhood trauma and psychosis: Evidence, pathways, and implications. Journal of Postgraduate Medicine, 54, 287-293.
- Mannel, R., Martens, P. J., & Walker, M. (2008). Core Curriculum for Lactation Consultant Practice. New York, U.S.A: Jones & Bartlett Publishers.
- Meinlschmidt, G. (2005). Long-term Psychobiological consequences of adverse Childhood experiences: Implications for Vulnerability and Resilience. New York, London: Cuvillier Verlag Publishers.
- Narrow, W. E. (2007). Age and Gender Considerations in Psychiatric Diagnosis: A Research Agenda for DSM-V. New York, U.S.A: American Psychiatric Publications.
- Scannapieco, M., & Connell-Carrick, K. (2005). Understanding Child Maltreatment: An Ecological and Developmental Perspective. New York, U.S.A: Oxford University Press US.
- Seeley, K. M. (2008). Therapy After Terror: 9/11, Psychotherapists, and Mental Health. New York, London: Cambridge University Press.
- Spataro, J., Mullen, P. E., & Burgess et al., P. M. (2004, January). Impact of child sexual abuse on mental health Prospective study in males and females . The British Journal of Psychiatry, 184, 416-421.
- Waldinger, R. J., Schulz, M. S., & Barsky et al., A. J. (2006, June). Mapping the Road From Childhood Trauma to Adult Somatization: The Role of Attachment . Psychosomatic Medicine, 68, 129-135.
- Wilson, J. P. (2006). The Posttraumatic Self: Restoring Meaning and Wholeness to Personality. New York, London: CRC Press.
