ACES in Mental Health

Understanding the factors that shape our psychological well-being has become crucial and are an important area of interest in preventative care and addressing health disparities. One such factor that has garnered attention is ACES, or Adverse Childhood Experiences. These experiences, often invisible to others outside the childhood family home, can have a profound impact on our mental health throughout our lives. In this post, we’ll delve into the world of ACES, exploring what they are, why they matter, what it means if you’ve had many of them, and what the current research landscape looks like.

What are ACES: Adverse Childhood Experiences

In the world of mental health, ACES are short for Adverse Childhood Experiences. This refers to a range of experiences that could occur during childhood which are adverse (ie. disadvantageous for children growing up compared to those who didn’t have these experiences).

These experiences can include physical, emotional, or sexual abuse, neglect and household dysfunction, such as growing up with substance abuse, mental illness, or violence in the household. The concept of ACES gained significant traction through the CDC-Kaiser ACE Study published in 1998, which demonstrated the pervasiveness of these experiences and their potential lifelong impact.

The original study asked participants 10 yes or no questions to identify if they experienced the adverse childhood experience before the age of 18. The questions asked of study participants included (*paraphrased below):

• Did a household member often swear at you, insult you, put you down, or humiliate you, or act in a way that made you afraid that you might be physically hurt?

• Did a household member often push, grab, slap, or throw something at you, o ever hit you so hard that you had marks or were injured?

• Did an adult or person at least five years older than you ever sexually abuse or assault you?

• Did you often feel that no one in your family loved you or thought you were important or special, or your family didn’t look out for each other, feel close to each other, or support each other?

• Did you often feel that you didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you, or your parents were too intoxicated to take care of you or take you to the doctor if you needed it?

• Were your parents ever separated or divorced?

• Was your mother or stepmother often physically abused?

• Did you live with anyone who was a problem drinker or an alcoholic?

• Was a household member depressed or mentally ill, or did a household member attempt suicide?

• Did a household member go to prison?

What Did the Research Show

The connection between ACES and lifelong health outcomes is profound. Firstly, the research showed that ACES are very common; most of the study participants had at least one, and more that 20 percent had three or more ACES.

They found that the more ACES a person had experienced, the more likely they were to have also had health disparities in their adult life. They were more likely to have anxiety, depression, or other mental health concerns, or addiction. While this might seem like common sense, it wasn’t at all at the time of the study. Socially, individuals who have experienced ACES are more likely to struggle with relationships, employment, and overall life satisfaction. Additionally, and more unexpectedly however, many physical health concerns such as cancer, diabetes, high blood pressure, heart disease, and obesity were also found at higher rates in the individuals who experienced more ACES. According to the CDC, “at least 5 of the top 10 leading causes of death are associated with ACES”.

What is also significant is that many ACES do not require direct physical harm – these are about being exposed to (or not exposed to) an experience. Witnessing violence between other household members, experiencing emotional or verbal abuse, and experiencing emotional neglect are adverse childhood experiences. Scientifically, ACES can trigger a cascade of biological responses, affecting brain development, stress regulation, and even immune function.

What if I Have Had Many ACES

If you find yourself tallying up a high number of ACES, it’s important to remember ACES are common, with most people having had one, and still a significant number of the population identifying as having many. For many individuals in counselling, it can be surprising, and even validating, to learn that direct and indirect experiences from growing up can have a significant impact. Sometimes people have the idea that if they didn’t experience a certain type of situation directly (eg. physical abuse) then it can’t have really had much of an impact (or thoughts such as “other people had it worse, I don’t have anything to complain about”).

 Likewise, it is important to remember that while no one has control over the experiences they were dealt as children, you are also not defined by your past. While multiple ACES can increase the risk of mental health challenges, they do not seal your fate. Similarly, if you are a parent, you now have much more control over the experiences your children grow up alongside than you ever did when you were a child.

“You do the best you can until you know better. Then when you know better, do better”

-Maya Angelou

You can also consider protective factors you may have experienced growing up such as positive friendships, doing well in school, and having caring adults in your life (including mentors and role models).

Seeking professional counselling can also be helpful in addressing aspects of past events that are impacting your daily life. Therapeutic interventions, such as trauma-focused therapy, cognitive-behavioral therapy, and support groups, can empower you to overcome the hurdles presented by your past. Building a strong support system of friends, family, or support groups can also make a significant difference. Stories of resilience and recovery from individuals who have faced numerous ACES affirm that hope is deserved.

While much progress has been made in understanding the link between ACES and mental health, there is still much to learn. The psychology of trauma, particularly ongoing childhood experiences such as emotional neglect, and intergenerational trauma are rapidly developing areas and research is ongoing.