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The enduring effects of abuse and related adverse experiences in childhood

A convergence of evidence from neurobiology and epidemiology

European Archives of Psychiatry and Clinical Neuroscience volume 256, pages 174–186 (2006)Cite this article

Abstract

Background

Childhood maltreatment has been linked to a variety of changes in brain structure and function and stress–responsive neurobiological systems. Epidemiological studies have documented the impact of childhood maltreatment on health and emotional well–being.

Methods

After a brief review of the neurobiology of childhood trauma, we use the Adverse Childhood Experiences (ACE) Study as an epidemiological “case example” of the convergence between epidemiologic and neurobiological evidence of the effects of childhood trauma. The ACE Study included 17,337 adult HMO members and assessed 8 adverse childhood experiences (ACEs) including abuse, witnessing domestic violence, and serious household dysfunction. We used the number of ACEs (ACE score) as a measure of cumulative childhood stress and hypothesized a "doseresponse" relationship of the ACE score to 18 selected outcomes and to the total number of these outcomes (comorbidity).

Results

Based upon logistic regression analysis, the risk of every outcome in the affective, somatic, substance abuse, memory, sexual,and aggressionrelated domains increased in a graded fashion as the ACE score increased (P <0.001). The mean number of comorbid outcomes tripled across the range of the ACE score.

Conclusions

The graded relationship of the ACE score to 18 different outcomes in multiple domains theoretically parallels the cumulative exposure of the developing brain to the stress response with resulting impairment in multiple brain structures and functions.

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Authors and Affiliations

  1. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Adult and Community Health, 4770 Buford Highway, N.E., MS K-67, Atlanta, Georgia 30341-3717, USA

    R. F. Anda MD, MS, Sh. R. Dube MPH & W. H. Giles MD, MS

  2. Dept. of Preventive Medicine, Southern California Permanente Medical Group (Kaiser Permanente), San Diego, CA, USA

    V. J. Felitti MD, FACP

  3. Depts. of Psychiatry and Radiology, Emory Center for Positron Emission Tomography, Emory University School of Medicine,Atlanta,GA, Atlanta VA Medical Center, Decatur, GA, USA

    J. D. Bremner MD

  4. Dept. of State Health Services, Texas Health and Human Services Commission, Austin, TX, USA

    J. D. Walker MD

  5. Private Practice in Addiction and Trauma Medicine, Atlanta, GA, USA

    Ch. Whitfield MD

  6. The Child Trauma Academy, Houston, TX, USA

    B. D. Perry MD, PhD

  7. Ministry of Children’s Services, Alberta, Canada

    B. D. Perry MD, PhD

Authors
  1. R. F. Anda MD, MS
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  2. V. J. Felitti MD, FACP
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  3. J. D. Bremner MD
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  4. J. D. Walker MD
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  5. Ch. Whitfield MD
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  6. B. D. Perry MD, PhD
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  7. Sh. R. Dube MPH
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  8. W. H. Giles MD, MS
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Additional information

The ACE study was supported under cooperative agreement #TS–44–10/11 from the CDC through the Association of Teachers of Preventive Medicine and a grant from the Garfield Memorial Fund.

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Anda, R.F., Felitti, V.J., Bremner, J.D. et al. The enduring effects of abuse and related adverse experiences in childhood. Eur Arch Psychiatry Clin Neurosci 256, 174–186 (2006). https://doi.org/10.1007/s00406-005-0624-4

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  • DOI: https://doi.org/10.1007/s00406-005-0624-4

Key words

  • child development
  • neurobiology
  • stress
  • childhood abuse
  • domestic violence
  • substance
  • mental health