ACE Study

Our childhood experiences have a strong influence on the health and well-being we experience as adults. The Adverse Childhood Experiences (ACE) study was a longitudinal study funded by the United States Center for Disease Control, and Kaiser Permanente. They examined the patterns of adverse childhood experiences and later life well-being. More than 17,000 people were recruited in the mid-nineties for the study and they have been followed ever since.

The study has proven that there is a significant link between adverse childhood experiences and health and social issues in adulthood.

ACE is a tool that assesses a person’s adverse childhood experiences by asking 10 questions. The person gets a score between 0 & 10. As the ACE score increases, so does the person’s risk for chronic disease. With a score of 4 or higher, a person’s risk for certain health issues increases–such as diabetes, heart problems, mental health issues, cancer, addiction, etc.

*It’s important to note that the ACE study involved mostly white, middle-class, college educated people who had health care coverage through Kaiser Permanente insurance.

The Nervous System and Trauma

It is important to know a little about the biology of trauma, as it can support us to understand how we can avoid retraumatizing people.

Trauma is stored both in our conscious and subconscious. The memory lives in the body and the brain. We have evolved to survive and learn from situations that hurt us, as a means of protection. However, the trauma response is extremely taxing on the body and overall health if it is engaged regularly.

We humans are complicated. The science of trauma, including why one person experiences Post Traumatic Stress Disorder (PTSD) following a traumatizing event and another person doesn’t, isn’t definitive. However, there are some well-accepted theories.

As we mentioned earlier in this module, a common theory is that a person is more likely to experience trauma after a traumatizing event if they feel threatened, helpless and alone in a way that overwhelms their ability to cope and affects their sense of self. Some experts say that the more support a person has during the time following a traumatizing event, the less likely they are to experience PTSD.

The American Psychological Association webpage Children and Trauma Update for Mental Health Professionals, says this:

On a positive note, individual, family, cultural, and community strengths can facilitate recovery and promote resilience. Social, community, and governmental support networks are critical for recovery, particularly when an entire community is affected, as when natural disasters occur. (2011)

There is no rule as to what constitutes a traumatizing event. The trauma might be directly caused by another person, a system, an accident, some kind of natural disaster, etc. For example, some people have managed fine throughout the COVID-19 pandemic, and depending on their circumstances, others may have experienced it as a traumatic event.

It’s important that we don’t judge other people’s trauma. It can be easy to make a judgement like, “that person is so messed up, but I know so many people who went through way worse, and they are ok.” We can’t possibly know or understand the entirety of someone’s situation. Part of being trauma-informed is learning to let go of our own judgments so we can focus on making people feel safe.

Bessel van der Kolk M.D., a trauma expert, says the following in his book The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma (2014):

The brain-disease model overlooks four fundamental truths: (1) our capacity to destroy one another is matched by our capacity to heal one another. Restoring relationships and community is central to restoring well-being; (2) language gives us the power to change ourselves and others by communicating our experiences, helping us to define what we know, and finding a common sense of meaning; (3) we have the ability to regulate our own physiology, including some of the so-called involuntary functions of the body and brain, through such basic activities as breathing, moving, and touching; and (4) we can change social conditions to create environments in which children and adults can feel safe and where they can thrive.

Have you experienced some difficult situations in your life? How did support from others affect your healing?

The Autonomic Nervous System

This system regulates all body processes that don’t require conscious awareness or effort. These processes include bodily functions such as digestion, heartbeat, breathing, and healing and restoration.

The 2 main components of the Autonomic Nervous System that are important aspects of trauma and healing from trauma are:

• Parasympathetic Nervous System conserves and restores, manages our “rest and digest” state
• Sympathetic Nervous System prepares the body for emergency situations by releasing adrenaline, norepinephrine, and cortisol

When one system is engaged, the other takes a more submissive role.

The Parasympathetic Nervous System

This system focuses on health and restoration. The job of this system is to create homeostasis–a stable internal state. It allows us to digest our food, regulate blood pressure, build strength, relax, and recover. Healing occurs when our parasympathetic nervous system is engaged.

This system functions best in a calm, relaxed state. Much of it happens at night. The more we are in this relaxed state, the healthier we are overall. Our health suffers when the parasympathetic nervous system is not able to do its job.

Conditions, in addition to trauma, that can cause the disruption of the parasympathetic nervous system are autoimmune disorders, cancer, diabetes, substance abuse, Parkinson’s disease etc.

The Sympathetic Nervous System

The purpose of this system is to prepare the body for an emergency. This system is all about protecting the body from external harm. The stress response (fight, flight, freeze, fawn) plays a very important role in our survival.

When a person senses physical or emotional danger, the sympathetic nervous system is engaged. The “stress” hormones (adrenaline, norepinephrine, and cortisol) are released. This causes the heart rate to increase, muscles get stronger, the airways widen, the body releases extra energy and the body goes into a fight or flight state. When the stress response is engaged, regular body processes of the parasympathetic nervous system that aren’t needed in an emergency are paused–such as digestion, the need to drink, or urinate. That’s why someone might throw up when they get bad news or see something traumatic. The stress response causes the digestion process to halt. If the sympathetic nervous system is constantly engaged, over time it will affect the digestive system, as well metabolism, and the endocrine system (manages hormones in the body).

The Fight, Flight, Freeze, Fawn Response

The fight, flight, freeze, fawn response is a function of the sympathetic nervous system, which, as discussed, is part of the autonomic nervous system. Understanding the effect of trauma on the brain and body and how re-traumatization occurs, first means understanding a little about the anatomy of the autonomic nervous system.

*Fawning is when people escape harm by pleasing the person who is threatening them. It can feel much less threatening to give up one’s personal boundaries, in exchange for then temporary relief of abuse or harm.

The purpose of trauma-informed practice is to prevent the activation of the sympathetic nervous system.

Effects of Chronic Engagement of the Stress Response

The stress response has been essential to our survival as a species. It gives us a burst of energy to be able to react quickly to the danger at hand. In the hunter/gatherer days, it was essential that there was a very quick reaction when one heard a wild animal rustling in the bushes. The fight, flight, or freeze response gave our ancestors a necessary edge to fight predators.

As the sympathetic nervous system protected our ancestors, it also protects us.

However, our bodies can’t differentiate between a life-or-death emergency (a wild animal ready to attack), and a non-physically threatening psychological emergency (this could be anything from conflict, a loud noise, self-deprecating thoughts, or emotional stress).

The sympathetic nervous system is involuntarily engaged in the same way regardless of the stressor. The system is intended to protect human beings from imminent danger. Our stress hormones are powerful, and this system supports us best when it is not constantly engaged. If it is activated too often, it is too much of a “good thing,” and has negative long-term effects on our health.  Remember that when the sympathetic nervous system is engaged, then the restorative parasympathetic nervous system takes a more submissive role.

Chronic secretion of cortisol, a stress hormone, can cause many health problems such as depression, anxiety, heart problems, insulin resistance, calcium loss from bones, hypertension, suppressed immunity, and reduced sleep quality.

The stress response is a normal and natural human response to perceived danger. However, retraumatization can happen when we experience a negative event that triggers those feelings of helplessness we had when we first experienced trauma. And the stress response in our body after an incident of retraumatization is just as powerful as it was after the original traumatic event.

For someone who is dealing with a major trauma in their past, a seemingly harmless experience can re-traumatize the brain. Though a person’s basic safety might not actually be in danger, the brain responds automatically to the possible threat by releasing the stress hormones.

Examples of Things that can Cause a Stress Response or Retraumatization in a Campus Setting

• Conflict, loud voices, angry tones, and arguing
• Not being believed by professors or administrators
• Failing a course
• Lack of choice
• Impersonal approach: feeling like a number in a system
• Rude and dismissive tones
• Curt and dismissive emails
• Coercive or oppressive behaviour
• Feeling invisible: not being heard or seen
• Violation of trust
• Not being in a safe space (being in a room without access to a door)
• Hearing details of someone else’s trauma
• Power dynamics
• Lapse in confidentiality
• Jokes that are sexual or racist
• Sexual harassment

What are some other behaviours that you think could be retraumatizing for someone with a trauma history?