Hello,

Kindly paraphrase the story below and utilize insights from the book “The Deepest well” to be sure the answers to the questions below are accurate.

• 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?
• 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.
• Discuss survival and resiliency theory. Relate two surprising facts that Dr. Harris points out about the ACE study.
• What physical, psychiatric, and substance use disorders are associated with adverse childhood events? Give three examples from Dr. Harris’s patients.
• Explain how the “dysregulated stress response” and Dr. Harris’s depiction of “BEARS” are related.
• How is DNA modified by traumatic experiences, and what are the sequelae?

The Deepest Well

Adverse Childhood Experiences

Traumatic situations that happen to a kid before age 18 are known as adverse childhood experiences (ACEs) (Matjasko et al., 2022). ACEs can be avoided and take many different forms, and ACEs may impact an individual’s health from childhood into adulthood (Matjasko et al., 2022). These traumatic occurrences frequently result in toxic stress in youngsters, which raises their risk of substance abuse problems, chronic illnesses, and sometimes even suicide (Matjasko et al., 2022).

Abuse of ACEs can take many different forms (Matjasko et al., 2022). The three basic types of abuse are sexual, physical, and psychological (Guinn et al., 2022). Physical and emotional neglect is also considered equally damaging to a child’s development (Guinn et al., 2022). The exact elements that these types of abuse and neglect create make up ACEs, sometimes in conjunction with a psychiatric condition in the home, aggression in the home or neighborhood, or even divorce or parental separation (Burke Harris, 2018).

Abuse Encountered in The Deepest Well

In her book, Burke Harris (2018) covered a variety of types of abuse. Diego, a little kid who had ceased developing in height after being sexually assaulted by a family friend continuously at four years old, was encountered (Burke Harris, 2018). Then there was Trinity, a young woman being assessed for ADHD because she was experiencing troubles at school (Burke Harris, 2018). Trinity had a mother who could no longer care for her because of her heroin addiction (substance use disorder in the home). After careful analysis of the child’s ACE score and the presentation of clinical characteristics, Trinity was identified as having Grave’s disease rather than ADHD (Burke Harris, 2018). When Trinity was assessed, the clinic had been screening for ACEs, and there was clinical justification for the physical assessment to be finished (Burke Harris, 2018). Then there was a small family, Charlene, a young mother, and Nia, her 5-month-old child (Burke Harris, 2018). Both patients at Bayview Clinic had ACEs, but Nia arrived to establish care and address worries that she was not gaining weight (Burke Harris, 2018). Nia was diagnosed with failure to thrive after exhibiting indications of mental and physical maltreatment when she first arrived at Bayview. Charlene undoubtedly experienced her ACEs; however, we were unaware of them (Burke Harris, 2018).

Stress Response System

Numerous brain regions comprise the brain’s stress response system (Burke Harris, 2018). The fearful center is located in the amygdala, a limbic system component that regulates a person’s feelings, memory, motivation, and behavior (Burke Harris, 2018). To restrain impulsivity and violence, the prefrontal cortex and the locus coeruleus collaborate (Burke Harris, 2018). Additionally, the prefrontal cortex governs people’s organization, judgment, and reasoning (Burke Harris, 2018). Then there is the hippocampus, which controls the formation and storage of memories, and the ventral tegmental area (VTA), which produces dopamine to make one feel good, resulting in motivation, reward, and perhaps addiction (Burke Harris, 2018).

Dysregulated Stress Response

Whenever our stress response system is ineffective or, even worse, overactive, dysfunction can result (Agorastos et al., 2019). The limbic system sets off the hypothalamic-pituitary-adrenal (HPA) axis, which regulates our stress response by eventually releasing cortisol (Agorastos et al., 2019). The false alarm theory states that when the alarm system or amygdala is overactive due to stress, it prevents a person from being able to discern between what is frightening and what is not (Burke Harris, 2018). Anxiety, arousal, and aggression rise when the locus coeruleus (LC) is overactive because this releases more noradrenaline (Burke Harris, 2018).

The prefrontal cortex loses its capacity for impulse control, prolonged concentration, and problem-solving abilities as a result of both LC and amygdala impairment (Burke Harris, 2018). Once more, the amygdala interferes with the hippocampus’s ability to form short-term and long-term memories (Burke Harris, 2018). Repeated stress can make dopamine receptors less sensitive, which makes the brain and body require more dopamine to produce the same joyful impact (Burke Harris, 2018).

As demonstrated, neurobiology, behavior and immune system function alterations can result from stress response system abnormalities (Agorastos et al., 2019). Consequently, mental health issues, chronic illnesses, and an increase in dangerous behaviors are ultimately brought on by this (Agorastos et al., 2019).

The Bear

Even though very few people have ever really seen a bear in their lifetime, many of us would still believe it to be a deadly and frightening animal. A massive animal like a bear has been conditioned in the brain to be frightening and capable of endangering humans simply by existing. Any time a child experiences toxic stress, whether from abuse, neglect, or another cause, their fight, flight or freeze response is triggered (Guinn et al., 2022). This reaction occurs whether the child is in front of a bear or experiencing abuse. Your body experiences some physiological changes when your stress system releases cortisol and adrenaline, including an increase in heart rate, blood pressure, fast breathing, pupil dilation, reduced digestion, and profuse sweating. The bear stands for the ACEs, which serve as the brain’s persistent reminder of something ominous in our surroundings. Something we ought to fear but which is frequently unavoidable. We must educate people about ACEs and identify risk and protective factors, just as we have done with closed trash cans in national parks like Yellowstone to deter bears (Guinn et al., 2022). Children should not have to live alone in the woods as though a million bears surround them.

References:

Agorastos, A., Pervanidou, P., Chrousos, G.P. & Baker, D.G. (2019). Developmental trajectories of early life stress and trauma: A narrative review on neurobiological aspects beyond stress system dysregulation. Frontiers in Psychiatry, 10(118), 1-25. https://doi.org/10.3389/fpsyt.2019.00118

Burke Harris, N. (2018). The deepest well: Healing the long-term effects of childhood trauma and adversity. Mariner Books.