How Adverse Childhood Experiences (ACEs) Impact Adult Anger

Recognizing the impact caretakers play in human development, the Centers for Disease Control and Prevention and Kaiser Permanente joined forces in 1995 to study “adverse childhood experiences,” or ACEs. They assessed more than 17,000 participants to determine the extent to which, prior to 18 years of age, they were exposed to any of the following experiences: Emotional, physical, or sexual abuse; emotional or physical neglect; or household dysfunction including intimate partner violence, substance abuse, mental illness, parental separation or divorce, or member of the household with a jail or prison history.

That study found that the trauma of ACEs was associated with a predisposition in adulthood to engage in high-risk behaviors such as smoking, alcohol and drug abuse, promiscuity, and severe obesity. It also identified a link between the number of ACEs and health problems such as heart disease, cancer, lung disease, stroke, diabetes, and a shortened lifespan. Additionally, it found a significant correlation between a high number of ACEs and mental health problems, such as depression, anxiety, behavioral disorders, and suicidality. Since then, the National Scientific Council on the Developing Child has expanded ACEs to include community and systemic causes, such as violence in the child’s community, racism, and chronic poverty.

Following the original research, hundreds of studies have been performed to determine other potential consequences associated with ACEs—including their impact on trait anger—a predisposition for anger arousal and hostility. This makes perfect sense when we consider that childhood treatment represents a threat to children.

Source: 123rf Stock Photo/ Richard Villalon

ACEs and the Enhanced Vulnerability to Experience Threat

Simply stated, when a child undergoes ACEs, he experiences a sense of threat that activates the “fight-flight-freeze” response. These experiences contribute to a lowered “set point” for experiencing a threat, a sensitivity to experience threat even when none exists. They appear to lay the groundwork for deficits in the ability of the rational brain (cerebral cortex) to override the emotional brain (limbic system). In doing so, they increase the likelihood of being reactionary.

In recent years, there is a growing perspective that our neurophysiology has developed to support three types of affect regulation systems–the threat and self-protection system, the incentive and resource seeking system, and the soothing and contentment system (Gilbert, 2010). Children who experience ACEs experience intense activation of the threat system with diminished satisfaction of the others.

The Relationship Between ACEs and Anger

Numerous studies have found a correlation between ACEs and anger. One reviewed the records of 22,575 delinquent youth and found that every additional adverse childhood experience that the child had increased the risk for their becoming a serious, violent, and chronic juvenile offender (Fox, et. al., 2015).

A more recent study concluded that greater childhood trauma was associated with trait anger expression as an adult (Win & Newman, 2021). Additionally, such anger expression was associated with adulthood major depressive, panic, and alcohol use disorders.

Recognizing the association between ACEs and trait anger, other studies have tried to determine those specific factors related to ACEs that might contribute to such anger. In one such study, researchers assessed the cumulative childhood mistreatment for 349 undergraduate students (Atkins, 2018).

It found that disconnection—a sense of detachment—was a significant mediator of the association between childhood maltreatment and verbal aggression, anger, and hostility and a marginally significant mediator regarding all forms of aggression. Trauma was associated with anger and hostility but not with overt aggression.

In another study, 973 undergraduate students responded to questionnaires regarding trauma, hostility, anger rumination, and aggression (Zhu, et. al., 2020). It concluded that hostile attribution (the tendency to ascribe harmful or adverse intent to the ambiguous behavior of others), and anger rumination mediated the link between child maltreatment and aggressive behaviors. And it also found that anger rumination had a stronger impact than hostile attribution.

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One study found not only that those who were abused were more angry and aggressive, but they also experienced higher levels of shame-proneness than non-abused participants (Keene & Epps, 2016). Further analysis showed that narcissistic vulnerability, but not shame-proneness, mediated between abuse and aggression. However, both appeared to be mediators between abuse and anger and hostility. In this study, 400 undergraduate students, 134 of whom had a history of physical abuse, responded to questionnaires assessing childhood physical abuse, shame-proneness, narcissistic vulnerability, and physical aggression.

Other studies have tried to determine how certain patterns in thinking and emotional management might contribute to a better understanding of the correlation between ACEs and anger. One, for example, found that the early physical abuse was associated with later processing patterns, including hostile attribution biases, accessing of aggressive responses, and positive evaluations of aggression. These then predicted later externalizing outcomes.

One of many studies explored possible deficits in cognitive functioning as leading to impaired emotional regulation (McLaughlin, Sheridan & Lambert, 2014). This study was an attempt to differentiate the impact of abuse from neglect. It concluded that thinner cortical regions were associated with a lack of social stimulation and cognitive enrichment that limited learning opportunities and activation of higher functions associated with the cortex.

The Neuropsychological Perspective on the Influence of ACEs on Anger

Exploring the neuropsychological impact of ACEs has been enhanced with our increased understanding of neuroscience. Toward this end, a meta-analysis was conducted that included a review of 38 articles reporting the use of magnetic resonance imaging studies of adults with a history of childhood trauma. Those who experienced such trauma showed smaller hippocampus and amygdala volumes, regions of the brain involved in our fight-flight-freeze response (Paquola, et. al. 2016).

Since then, more recent studies have identified a more complex picture of how the brain might be influenced by ACEs. One, for example, reported that maltreated individuals exhibited greater activation of the amygdala and salience processing regions and deactivation in multiple regions involved in cognitive control (Jenness et. al., 2020).

Most recently, a study performed by a group of researchers at Harvard found that early childhood spanking was associated with greater neural response in multiple regions of the prefrontal cortex (PFC), including regions that are part of the salience network (a collection of regions of the brain that select which stimuli are deserving of our attention) (Cuartas, et. al., 2021). These areas of the brain respond to cues in the environment that tend to be consequential, such as a threat, and may affect decision-making and processing of situations.

What is significant about their study is that they selected children who experienced spanking but no history of severe violence. The lead researcher emphasized that such studies cannot directly lead to conclusions about any individual child.

Clearly, adverse childhood experiences can change the brain in a variety of ways, altering neural connectivity in the amygdala, the alarm center of the brain; the hippocampus, the center for processing memories and emotion; and the pre-frontal cortex, the decision-making are of the brain.

How to Manage ACE-Driven Anger

Mistreatment does not have to be severe to have a lasting and severe impact. I’ve observed in my practice the tendency by many adults with anger issues to downplay such impact. Unfortunately, it is often the denial or minimization of such suffering that becomes the foundation for sensitivity for anger arousal.

It is a fact that ACEs can influence our vulnerability to develop trait anger. But while we cannot undo what has happened, we can undo the patterns in thinking and feeling that resulted from it. As such, any program for anger management needs to address not only ways of coping with and managing anger but also the recognition of some of its origins. Helping to heal the wounds of early mistreatment should be a major task of any such program. This is essential in order to move past early childhood experiences and embrace new and healthier coping skills.