Shirley J. Davis (Morgan) · 2020

How the Study Began

In the 1980s, a physician named Vincent Felitti, who worked for Kaiser Permanente in San Diego, asked a patient who had lost a great deal of weight in a weight loss program why she had dropped out. The answer stunned Dr. Felitti.

That patient, and many others Dr. Felitti interviewed individually, said the weight loss made them feel too vulnerable. Many of those he questioned also disclosed experiencing childhood sexual abuse and said they believed, deep inside, that the excess weight protected them from attack.

Dr. Felitti’s findings were of interest to Dr. Robert Anda of the Centers for Disease Control and Prevention (CDC), and together they launched the CDC-Kaiser Adverse Childhood Experiences Study.

Between 1995 and 1997, the study surveyed about 17,000 participants to measure the number of adverse childhood experiences they had lived through. The researchers wanted to understand the relationship between ACEs and the health and life functioning of people who had experienced extremely negative events in childhood.

The study was the first and largest of its kind to examine the impact of childhood trauma on adult health.

What the Study Found

The study brought groundbreaking insights. First, childhood trauma is much more common than previously thought, and it is not limited by race, creed, or income.

This finding, that children of every demographic group experience abuse and neglect, was unconventional. The prevailing belief had been that children from low-income families and racial minorities were more often victims of family violence than white children.

That belief is understandable once you consider the prejudices of the time and the disproportionate number of families from lower-income and minority groups represented in the child welfare system.

The ACEs Study introduced a new narrative on child abuse: it cuts across all populations, regardless of income, religion, race, and education.

Through the ACEs study, researchers learned that almost 30% of participants had experienced physical abuse in childhood, and 15% had experienced emotional neglect. The results became even more breathtaking when a related paper by Dube and colleagues was published in 2005.

Of the 17,337 adults in that study, 16% (about 1 in 6) of men and 25% (1 in 4) of women reported sexual abuse before their 18th birthday.

The researchers also discovered that the ten categories of abuse, neglect, and household stressors rarely occurred as single events. Among adults in the study who reported sexual abuse, 80% also reported at least one other type of abuse during their childhood.

Another finding startled the researchers: some of the men in the study reported being abused by women. Women, long thought incapable of committing such acts against children, were recast in a new light as possible sexual predators.

The Effects of ACEs on the Health of Adults

The effects of an abusive or neglectful childhood on adult health are devastating. They include changes in both the mental and physical health of survivors.

The ACEs study reported another finding with consequences for millions around the world: the higher the number of ACEs a participant reported, the more negative health consequences they experienced.

This is called a graded dose-response relationship between the number of ACEs a person experienced and their health and well-being across their lifespan. All that means is that the more negative experiences a person had in childhood, the greater the negative health consequences they are likely to experience.

There are enormous consequences of ACEs for a child grown into adulthood. The list below is by no means all-inclusive:

• Alcoholism
• Chronic obstructive pulmonary disease (COPD)
• Depression
• Lowered quality of life due to health problems
• Ischemic heart disease
• Illicit drug use
• Liver disease
• Poor work performance leading to job loss
• Impaired relationships
• Difficulty managing finances responsibly
• An increased risk of intimate partner violence (as victim or perpetrator)
• Numerous sexual partners, leading to sexually transmitted diseases
• Smoking
• Suicide attempts or death by suicide
• Unintended pregnancies
• Eating disorders
• Borderline personality disorder, dissociative identity disorder, and other serious mental health conditions

The Economic Costs to the United States

Although child abuse is a global problem, the economic costs are most readily available for the United States.

The total lifetime economic cost of new cases of fatal and nonfatal child abuse and neglect in the U.S. in 2008 was estimated at $124 billion. This figure rivals the cost of other well-known health problems such as stroke and type 2 diabetes.

It gets even more real when one considers that the lifetime cost per survivor of nonfatal child abuse and neglect was estimated in 2008 to be $210,012. These costs include:

• Childhood health care costs
• Productivity losses
• Adult medical care costs
• Child welfare costs
• Special education costs
• Adult and child mental health care costs

For each child who died from abuse or neglect, the estimated lifetime cost was $1,272,900, including medical expenses and lost productivity.

While these figures are staggering, they are the costs for just one country.

The Personal Cost of Adverse Childhood Experiences

While it is essential to understand the huge financial costs of ACEs, we can never put a price tag on the enormous personal toll on survivors.

Being a survivor of severe neglect and abuse leaves a person feeling anxious, desperate, and forever searching for peace of mind. We are always on the lookout for someone in our adult relationships to fill the gaps left by uncaring or abusive parents.

Unfortunately, so many people are walking about wounded that it is inevitable two hurt adults will find one another and experience more trauma when they realize the other person is caught in a silent prison of their own.

Preventing the Impact of ACEs on Future Generations

I think we can all agree that an ounce of prevention is worth more than a pound of cure. If we are to end the tragedy of adults living shortened and altered lives, we must stop child abuse from happening in the first place.

To do this, an open and honest dialogue needs to take place, and the abuse of children by both men and women must be brought out of the shadows and into the sunlight. For, as we all know, evil loves the darkness, but light stops evil cold in its tracks. Darkness and light cannot coexist.

Once ordinary citizens of the world like you and me force child abuse into the open, political leaders will have to deal with it by putting more money toward helping children who are in danger and living in the hell of child abuse and neglect.

Learn More

• About Adverse Childhood Experiences (CDC)
• Shirley’s articles at the CPTSD Foundation

© Shirley J. Davis. Shared on Ivory Garden with the author’s permission.