summer 2023 wk 6 ACE

What is the definition of an adverse childhood event (ACE)? Are there different types of abuse? How many types of abuse did Dr. Harris encounter?

 

Adverse Childhood Experiences (ACE)’s are any traumatic events experienced as a child, which could fall into the category of abuse(sexually, physical, emotional, verbal, psychological) but also could be a significant traumatic event, such as a parent’s death or witnessing a bad car accident. Abuse is one of the ACEs described but can take on many forms spanning from more traditionally defined types of abuse (verbal, sexual, physical) extending into areas of “silent” abuse or abuse not traditionally recognized or acknowledged as such (i.e. emotional or psychological abuse, neglect) but equally damaging to a child’s psyche (Li, Carracher, & Bird, 2020). The author elaborates on at least 21 forms of “abuse” but might be better recognized as trauma including neighborhood or school violence, parent deportation and disappearance, and hunger/neglect (Harris, 2018).

 

Discuss mental instability, substance use, and generational transmission. How is Dr. Harris coping with patients in these situations, and what skills will you incorporate into your practice? Explain your reasoning.

 

The chronic stress reaction in children with ACEs enlarges the Amygdala aka “the brain’s fear center” which is responsible for the regulation of emotions and excessive activation causes excessive inappropriate fear and emotional reactions to things that do not warrant such a response. Another area affected is the Locus Coeruleus which regulates aggression and impulsive behavior, causing “anxiety, arousal, and aggression” in excess. Finally, the prefrontal cortex controls our ability to make appropriate decisions and not react impulsively to situations. All three of these areas create a significant degree of chronic “mental instability”.

 

Substance use is common in people who have experienced ACEs in childhood as the ventral tegmental area of the brain that regulates “rewards, motivation, and addiction” and this area is dysregulated in its ability to react appropriately to dopamine and therefore it requires higher levels of dopamine to feel good. This leads to a craving for high-risk activity or drugs and alcohol which trigger a higher level of dopamine release. Dr. Lewis reports that experiencing four or more ACEs increased the likelihood of smoking by 2.5 times, drinking alcohol by 5.5 times, and taking IV drugs by 10 times as compared to individuals with lower ACE scores.

 

Dr. Harris went on further to elaborate on how these changes within the body as a reaction to chronic stress exposure are passed along generation after generation as the maladaptive responses to stress affected individual’s ability to react appropriately to stress throughout their lifetime inevitably negatively affecting their interactions and ability to properly support their own children appropriately perpetuating the same maladaptive patterns in their children which then affects their children and so on.

 

Carrying this knowledge forward, I will seek to utilize a set of skills based on acceptance, early identification through screening, and prompt intervention for those individuals identified as having high ACE scores. The goal in mind is alleviating some of the repercussions of chronic stress on the individual’s lifelong health and potential disease states, as well as the health of their descendants. The identification of risk to further generations is important to ascertain the magnitude and extent that we as practitioners have the potential to influence with interventions with hopes of creating a rippled effect for future generations which is far greater than the administration of a simple pill.

 

Discuss survival and resiliency theory. Relate two surprising facts that Dr. Harris points out about the ACE study.

 

The survival and resilience theory is a shift of focus in care from disease to health by building on clients’ strengths and enabling an improved “ability-to-bounce-back” from the stress of life (Van Breda, 2001). The theory stems from observations of children who seemed better able to succeed despite significant life stresses (Van Breda, 2001). These children demonstrated higher levels of resiliency which is described as the “ability to maintain competent functioning in the face of major life stressors” (Van Breda, 2001). This shift onto stroking the positives to get more positive leaves the child in less of a victim mode and presents them as a survivor of their circumstances (Van Breda, 2001).

 

One fact that I found surprising from the ACE study was the higher risk of obesity correlating with higher ACE scores (anywhere from 2-4 percent increased risk depending on the number of ACEs). What a profound realization! Maybe instead of coming down on people for being overweight, we can recognize that they have higher tendencies for this (hopefully early on) so that we can assist them into a healthier life path. Additionally, the specific states that were noted to have higher levels of ACE scores make me wonder what specifically these states have in common to create these higher rates. My bet would be fewer resources in those states with fewer positive interventions in place to combat ACE occurrences.

 

What physical, psychiatric, and substance use disorders are associated with adverse childhood events? Give three examples from Dr. Harris’s patients.

 

Adversity in childhood leaves patients more susceptible to various disease states and disorders. One example of this is Dr. Harris’s patient Diego who had experienced sexual trauma at a young age and now presents with growth arrest, eczema, and asthma (Harris, 2018). His trauma experiences continued into his teenage years when he witnessed a friend being shot and which triggered the worsening of his asthma symptoms (Harris, 2018).

 

Another example was the patient “Donna”, an incest victim at the age of four, who suffered from uncontrolled diabetes and a significant weight problem (Harris, 2018). This correlates with twice the risk for obesity in patients with significant ACE scores and then this includes its sequelae, i.e. diabetes, cardiovascular disease, etc (Harris, 2018).

 

Another instance in Dr. Harris’s patient population was the patient participating in nighttime sleep-eating behaviors and therefore significant struggle with weight (Harris, 2018). The obesity risk for these patients is monumental when you consider all of the disorders this puts people at risk for so all of those should be listed underneath this risk category to fully demonstrate the magnitude of the impact this has on ACE patients. Although Dr. Harris did not specifically mention any patient who developed alcoholism, she does cite that patients are at a higher risk for alcoholism and smoking (Harris, 2018). The impact of these two addictions is as profound within the U.S. population as obesity is as the resulting complications are monumental.

 

Explain how the “dysregulated stress response” and Dr. Harris’s depiction of “BEARS” are related.

 

Dysregulated stress responses are those that occur in reaction to a significant trauma for an extended period of time or “prolonged adversity” when there is a lack of support from the adults in the child’s life (Harris, 2018). This changes the process of maturation and alters the structure within the brain and throughout the other systems in the body (Harris, 2018). The result is a child put in a more vulnerable state with increased susceptibility to dysfunction and dysregulation (i.e. diseases, negative effects on cognition) (Harris, 2018).

 

Dr. Harris relates the normal stress response as the one that would occur should you encounter a bear in the woods (Harris, 2018). Your brain turns into overdrive mode and shuts off your thinking because there’s no second-guessing, you just need to react and react fast with everything you have(Harris, 2018). To accomplish this, the hypothalamic-pituitary-adrenal axis triggers the release of stress hormones (Cortisol) which helps humans adapt to chronic stress by “raising blood pressure and blood sugar”, blocking rational thought processes, and creating instability in mood states (Harris, 2018).

 

The other system activated is the sympatho-adrenomedullary (SAM) axis which initiates the release of adrenaline and noradrenaline increasing blood pressure, opening airways, strengthening heartbeat and increasing rate, optimizing muscle strength in skeletal muscles, and converting “fat to sugar for energy” to optimize the system (Harris, 2018). This priming of the system prepares the body to do one of the following: Stay and fight the bear, flee the bear, or freeze hoping the bear will overlook you (Harris, 2018). This response eventually subsides as you reach safety from the bear.

 

Dr. Harris describes an abnormal stress response as a situation where you don’t ever reach this safety point and refers to this as the bear being “in the cave with you” aka something within your environment that repeatedly sets off the stress response as often as multiple times per day (Harris, 2018). She then states that the bear is any of the ACE’s she describes for these children (Harris, 2018). When this happens the control over these responses is lost which is named a “disruption of feedback inhibition” (Harris, 2018). This means that instead of switching these systems off, it leaves them activating randomly allowing these responses to happen in situations where it is not warranted wreaking havoc all through the body, i.e. growth inhibition, impaired reproduction, hormone dysregulation, etc (Harris, 2018).

 

How is DNA modified by traumatic experiences, and what are the sequelae?

 

Dr. Harris describes the effect that adversity has on a person’s DNA is that the modified stress response is communicated to the person’s offspring changing the epigenome which a collection of “chemical markers” sitting on the DNA that regulate which genes to transcribe and which do not (Harris, 2018). These are inherited but can be altered by environmental changes, i.e. exposure to significant, prolonged stress with the purpose of adaptation dictating life-long future reactions to stress based on those experiences (Harris, 2018).

 

These changes impact the person’s reaction to stress throughout their life and trigger various dysfunction and disease states throughout the body (Harris, 2018). While this is important to realize, it is even more pertinent to address the fact that these markers can also be altered by positive environmental states promoting changes that can occur even in adulthood with the potential to reverse these negative epigenetic states caused by trauma (Harris, 2018). This means that although these states have occurred, interventions implemented into adulthood can have a profound positive impact on a person’s health and cancel out these increases in health risks.

 

References:

 

Harris, Li, E. T., Carracher, E., & Bird, T. (2020). Linking childhood emotional abuse and adult depressive symptoms: The role of mentalizing incapacity. Child abuse & neglect, 99, 104253. doi:10.1016/j.chiabu.2019.104253

 

Harris, N. B. (2018). The deepest well. New York, NY: HarperCollins Publishers.

 

Karatekin, C., & Hill, M. (2019). Expanding the original definition of Adverse Childhood Experiences (ACEs). Journ Child Adol Trauma, 12, pp. 289–306. doi:10.1007/s40653-018-0237-5

 

Van Breda, A. D. (2001). Resilience theory: A literature review. Pretoria, South Africa: South African Military Health Service. Retrieved from: Sciencedirect.com.

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