Maintaining a Broad View of Adverse Childhood Experiences
ACEs help us understand ourselves, and let's keep the concept broad.
Posted Mar 23, 2020
During my training as a therapist, our class was subdivided into smaller breakout groups in order to explore deeper personal issues. I soon felt like an imposter. On the one hand, I was anxious and depressed and using food, alcohol, and SSRIs to get me through my week. On the other hand, everyone in my group had a story to tell which would fall under the category of an Adverse Childhood Experience (ACE), including:
- Physical abuse
- Emotional abuse
- Sexual abuse
- Physical neglect
- Emotional neglect
- Domestic violence
- Parental substance abuse
- Household mental Illness
- Crime or imprisoned family member
- Parental separation or divorce
- Parental suicide or death
ACEs were identified during a public health study in America in the 1990s1 which clearly demonstrated a link between the types of events listed above and problems later in life, including:
- Mental illness
- Substance abuse
- Relationship problems
- Chronic illness
- Lower life expectancy
Awareness of ACEs has had a significant impact on several areas of therapeutic and social provision and interventions, including recognizing symptomatic behavior (such as addiction and depression) as normal reactions to abnormal experiences2 and focusing on trauma history during client intakes3. Back in 2013, when I was doing my training, there was a lot of talk about ACEs, and I didn't have one to play.
I grew up in a financially comfortable family with two parents, neither of whom had any issues with addiction or mental illness. I didn't even score 1 in terms of ACEs. So why were my mental and physical health issues every bit as bad—or more severe in some cases—than the other people in my breakout group?
It wasn't until I started to work with clients that I became aware that childhood trauma is sometimes so subtle and so well hidden behind a veneer of fragile stability that it not only goes unnoticed at the time but also can be impossible for an adult to detect in their own life. Suffering this type of hard-to-name childhood trauma comes with another thing—guilt. Like me, so many of my clients felt guilty about feeling anxious/depressed/abusing substances when "there are people out there with real problems." One client told me, "I know it sounds awful, but it'd be easier if I'd been abused or something—something that I could relate to how terrible I feel about myself—but I had an OK upbringing."
I visited therapist after therapist, and I would not accept that I had experienced trauma in my childhood because I hadn't experienced an ACE and felt spoiled and self-indulgent for trying to find a root to my problems. Despite the fact that I was a very sad, anxious child—obese, lonely, and consumed with suicidal thoughts—and despite the fact that my adult life had been plagued by anxiety, depression, addiction, and relationship problems, I couldn't allow myself to make the links to my childhood.
It took a very understanding therapist to help pull back the curtain to reveal the degrees of physical (including being a severely obese child) and emotional neglect, which were obscured by the smokescreen of a large, loud, wealthy family with two parents. I finally took ownership of the impact that being bullied at school had had on me and of the impact of being socially isolated from the age of 10, from which age I was homeschooled. I also, far later, realized that my "hyper-sensitive" and "weird" behavior as a child was due to undiagnosed Autism Spectrum Disorder. It took me a long time to accept that all of these childhood events had been every bit as traumatic as anything in the ACE questionnaire.
Establishing someone's ACE score can be a useful starting point to help them make the links between their present and their upbringing. However, it's important to remember that the list of ACE questions isn't exhaustive and that an ACE intake should just be a starting point for further investigation. When we're thinking about our own lives, we need to remember that emotional and verbal abuse can take the form of subtle criticism, in the guise of caring, and that parents may have mental health issues, such as Narcissistic Personality Disorder (NPD), which are never diagnosed, but which impact their children in the same way.
It's crucial to accept that you could have been emotionally neglected, despite growing up in a family with two employed parents and regularly holidays, and that being hit as a child is very clearly physical abuse, even if you didn't realize how bad it was at the time. In terms of our own self-development and self-acceptance, let's take a much broader view of what ACEs are and accept the impact our childhoods may have had on our current issues—no matter how comfortable it may have looked to other people.
1. Fellitti, V.J., Anda, R.F., Nordenberg, D. (1998) Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults, The Adverse Childhood Experiences (ACE) Study, American Journal of Preventive Medicine, 14 (4), 245-258
2. Evans A, & Coccoma P. (2014) Trauma-informed care: how neuroscience influences practice, New York: Routledge; 2014.
Van der Kolk, B. (2014) The body keeps the score. New York: Viking
3. Harris M. & Fallot R.D. (2001) Envisioning a trauma‐informed service system: a vital paradigm shift. New Directions for Mental Health Services. 2001(89):3–22. doi: 10.1002/yd.23320018903