crying girl adverse childhood experiences

I grew up in a seriously dysfunctional household. My mother was battered by her partner. Both of them were alcoholics. Once, during a particularly bad fight, the police were called and, after they determined my mother did not own the house we lived in, my brother and I were hustled into my mother’s car for a pretty scary ride to a motel. In those, pre-MADD (Mothers Against Drunk Driving) days, drunk driving was not taken as seriously as it is now.

My brother and I were sure we were the only kids in our upper-middle-class community of Tiburon, California who lived like that. I didn’t even know anyone else who had a divorced mother. I didn’t know that domestic violence is common. In fact, I am not sure I even knew what domestic violence was. I never told any one of my classmates or their parents anything about my home life. I was too ashamed.

It wasn’t until long after I became a doctor that I started learning about domestic violence, now called intimate partner violence to acknowledge that it affects people in all kinds of relationships. I have been involved in working to increase awareness of the problem ever since. I co-founded Physicians for a Violence-free Society (now closed) and co-authored a book for health professionals on the topic, “The Physicians Guide to Intimate Partner Violence.”


The Adverse Childhood Experiences (ACE) Study

During the course of my advocacy work, I met Vince Felitti, MD, an internist at Kaiser Permanente’s Department of Preventive Medicine in San Diego, California. He told me about work he had been doing with Rob Anda, a doctor at the Centers for Disease Control and Prevention (CDC). This body of work has become known as the Adverse Childhood Experiences (ACE) Study.

Vince and Rob and their colleagues in the CDC ACE Study Group have analyzed data from more than 17,000 men and women who were seen in Kaiser’s Department of Preventive Medicine’s Health Appraisal Clinic. They used a carefully designed survey to learn about these people’s exposure to ten categories of stressful or traumatic childhood experiences. They then looked to see if these exposures were statistically correlated with a wide range of adult health problems, including obesity, heart disease, liver disease, diabetes, substance abuse, depression, and teen and unintended pregnancy.

The experiences they studied are as follows:


  • Emotional
  • Physical
  • Sexual


  • Emotional
  • Physical

Household dysfunction

  • Battered mother
  • Parental separation, divorce, or loss in childhood
  • Mental illness in household
  • Household alcoholism or drug abuse
  • Household member in jail


Adverse childhood experiences are common

The researchers learned that adverse childhood experiences are common—I wish I had known that as a kid. They also learned that they tend to occur in clusters. For example, 98% of children who experience emotional abuse also experience at least one other type of adverse childhood experience. A majority experience at least two other ACEs and between 30-60% experience 4 more.

Because it is so common to experience multiple ACE’s, the researchers developed what they call the ACE Score. Each of the ten exposures listed above counts as 1 point. My ACE score is 3 (battered mother, divorced parents, household alcoholism). My brother is 5 because he was also emotionally and physically abused by my mother’s abusive partner.

Vince and Rob’s research indicates that the ACE Score likely captures the cumulative biologic consequences of these exposures. Multiple, well-done analyses of the ACE data have been published in good medical journals. They demonstrate that the ACE score has a strong graded relationship to:

  • Obesity, diabetes, cardiovascular disease, liver disease, and other leading causes of death in the United States
  • Smoking, alcohol use and abuse, as well as illicit and IV drug use
  • Early initiation of sexual intercourse, promiscuity, and sexually transmitted disease (STDs)
  • Teen and unintended pregnancy, stillbirths, and spontaneous abortion
  • Suicide attempts, depression, and poor health-related quality of life

It is important to remember that these studies are not randomized controlled studies which are considered the gold standard when trying to determine if something causes a bad health outcome. These studies, instead, looked for statistical links between ACEs and adult health. What makes these studies so compelling, however, is the fact that they found a dose-related effect: As the number of exposures, or ACE Score, increases, so does the likelihood of having certain health problems as an adult.


If you have experienced ACE

So, what should you do if you are one of the many people in the world who has experienced one or more of these adverse childhood experiences? My friend Vince advocates autobiographical writing used in conjunction with an interested and hopefully experienced, health professional. It may be your family doctor or it may be someone in the field of behavioral health. He believes that acknowledging that you had these experiences and sharing your feelings about them with someone you trust has therapeutic value. Or you may find value in participating in support groups of people who have had the same experiences. Some folks with adverse childhood experiences may need medications for depression or anxiety. And some may benefit from formal psychotherapy.

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This post was reviewed and updated 05/13/2017.