Tuesday, January 05, 2010

A difficult childhood = health risks?

I know from my own experience that childhood traumas can turn into psychological issues in adulthood. Now new results from a long-term study in California suggest that certain kinds of childhood traumas can translate into other kinds of health risks.

As reported in Time magazine, researchers at Kaiser Permanente have found correlations between certain kinds of traumatic events in childhood--sexual, physical, and emotional abuse--and elevated risks of heart attack, stroke, depression, emphysema, and, yes, my favorite bugaboo, obesity.

Here's a quote from the Time story:

"For the past several decades, the ACE study has recorded reports of negative childhood experiences in more than 17,000 patients. Adverse experiences include ongoing child neglect, living with one or no biological parent, having a mentally ill, incarcerated or drug-addicted parent, witnessing domestic violence, and sexual, physical or emotional abuse. . . . Compared with a person with no adverse childhood experiences, or ACEs, a person with four or more has almost double the risk of obesity. Having four or more ACEs more than doubles the risk of heart attack and stroke, and nearly quadruples the risk of emphysema. The risk for depression is more than quadrupled. Although many of these outcomes could reflect the influences of genes and other environmental influences — beyond those occurring in childhood — the tight relationship between increasing ACE numbers and increasing health risks makes the role of child trauma clear."

Some of these correlations seem straightforward, like the one between ACEs and emphysema, which can be explained at least in part by higher levels of smoking-as-self-medication. But this study takes the correlation a step further:

"Early adverse experience can disrupt the body's metabolic systems," says Dr. Jack Shonkoff, director of Harvard's Center for the Developing Child. "One of the cornerstones of biology is that our body's systems when they are young are reading the environment and establishing patterns to be maximally adaptive." Researchers also posit that high levels of stress hormones caused by ACEs can wear down the body over time. A temporary spike in blood pressure in response to a stressful event may be useful to power an adaptive fight-or-flight response, but over the long term constant high blood pressure could raise a person's risk for heart attack and stroke. Studies have also found that consistently elevated levels of stress hormones, like cortisol, can lead to permanent damage in certain brain regions linked to depression.

Even more interesting, they suggest that such stress-induced physiological changes can be passed down through the generations through epigenetics, changes in the traits expressed by genes that don't come from mutations in DNA.

Fascinating stuff. What it suggests to me is yet another refutation of Cartesian dualism. What we think and feel and experience may shape us in more ways than we know.

What do you think?


Anonymous said...

I totally agree. I know that myself, my obesity is directly related to having been sexually abused as a child. In fact, I can actually remember the first time I overate for emotional reasons. I was reaching for another cookie when I was 8 years old and thought to myself "You're only eating that because you feel bad." My response to myself was "So?" I apparently couldn't think of a rebuttal. :P I've since healed from those issues quite a bit (it's a lifelong process) and no longer binge eat, but as we all know that doesn't mean the weight goes away. Overeating is a coping mechanism, but then being fat causes its own kind of mental stress in society, so I have no doubt it increases risk factors for stress-based disease.

Courage said...

I guess it doesn't mean I should love myself any less, but I definitely had adverse childhood experiences, and I am fat today. I can't really make a direct link like Anonymous above - I think my fatness is caused mostly by genetics, with help from a lot of eating during my teenage years. Honestly, though, I have no way of knowing whether I'd have been the same size anyway.

Harriet said...

Well, exactly. There's no way to know. What I take away from the whole epigenetics concept (and please, those of you who are more knowledgeable than I, help me out here) is the idea that while past experiences can change us, so can present experiences and choices. I heard Norman Doidge give a talk a while ago and he emphasized the plasticity of the brain. He talked about the fact that its very plasticity helps create habits of behavior and thinking. He compared neural pathways to a sledding run down a hill; the first time or two you go down you're apt to wander off course, but each time you go down, you define the path more and more and, conversely, make it harder to deviate from the run. This image has stayed with me.

Jane Cawley said...

Vulnerability Genes of Plasticity Genes (full text)

And here are some epigenetics resources:
Insteresting stuff!

Harriet said...

I was hoping you'd come through, Jane!

Erin S. said...

My concern with this study is that the average 'man on the street' that reads something in Time or Newsweek or on the internet and automatically assumes it is not only 100% true but that it applies 100% of the time, is now going to have yet another completely unfounded accusation to hurl at people.

"Your kid is fat therefore you must be sexually abusing them!" or "Oh you're fat, you poor dear was it your father who molested you?"

Not that there is a solution for that... the people who believe 100% of anything they read applies 100% of the time can't be swayed by facts anyway heh.

Harriet said...

I know. For a while there it was the default assumption about people with EDs, and for some people it still is: Everyone with anorexia or bulimia had to have been sexually abused. Very tedious.

I think abuse of any kind inspires coping mechanisms of various kinds. What kind of coping mechanism depends on many factors, including your genetic makeup, biological predisposition, and environment.

Anonymous said...

Erin - This isn't new. One boyfriend (an all-but-dissertation phd in sociology) insisted I was "repressing memories of my abuse" and that once I "recovered" them my weight would go down naturally.

Never mind that the whole "recovered memories" BS had been largely discredited at that point.

familyfeedingdynamics said...

As a specialist in childhood feeding, I also wonder what kind of structure exists in a chaotic household. Could kids rely on their parents to feed them, or did they have to fend for themselves? Was there food insecurity (due to neglect, permissive or authoritarian parenting?) What about poverty? What about sleep deprivation? There are so many variables. For kids to eat well and learn to feed themselves, they need a lot of support and providing. Maybe some of these homes didn't have that. Perhaps that is as much a factor as the ACE. Interesting stuff, but again I worry that it will be another reason to "blame" the fat person.

IrishUp said...

I just went and spent lunch digging around on the CDC's website of the ACE study, and there is a lot that is problematic:
1. I couldn't find any validation studies of the individual adverse events included in the scoring system, or rationale for their inclusion. NOT to say that items like sexual abuse are NOT expected to be an adverse experience for anyone. But looking at the list, there is a high degree of overlap between a lot of the events. And including divorce or single-parent household as an ACE is, shall we leave it at culturally suspect?
2. The data are from Kaiser-Permenante patients, who self-selected into the study. This may or may not impact the generalizability.
3. The age & gender distributions of the participants substantially different from the US population at large.
4. The questionnaires that participants filled out are, in my opinion, extremely problematic and leading in terms of their construction.
IDK, I am unimpressed with the quality of the study design. I am therefore highly suspicious of any findings based on it.

Harriet said...

Irish, Thanks for doing that! As a writer I know the power of words; how you ask the question, how you even conceptualize the question, can make all the difference in how it is answered. I guess it doesn't surprise me to hear your thoughts on the study. It's a bit of a relief really. Because like other commenters I worry about this being used both to perpetuate harmful stereotypes and to blame. And God knows we don't need any more of that.

IrishUp said...

Happy to, Harriet!
Srsly, I would be surprised the CDC is even involved with this, had it not been for our previous administration. In contrast to this, NHANES (the national health study) is really very well constructed and generates good data, even if the lead authors and people reporting on the results willfully misinterpret the findings.

Most of the publications that the ACE study has generated have been in second and third tier medical publications - no New Eng. Jnl, no JAMA, no Lancet, etc. That alone is fairly telling. Another thing is that I can't tell, from any of the abstracts I can access, if any socio-economic status data is linked to the study, or if SES is adequately controlled for. The questionnaires do ask about parental levels of education, but considering that the 35% of participants >60yo were raised by the people who benefitted from the creation of all the best progressive programs the US has come up with (Medicare, Social Security, and the GI bill being the top 3), even that is going to be iffy.

I'm being long-winded here, but my suspicion is that this study is designed to push an agenda, not to really inform preventative medicine for the next generation.

Bill Fabrey said...

IrishUp may be right to be suspicious. Too many studies are used to "push agendas". One of the most popular public health agendas at the moment is to eliminate obesity in our time. That's a winner when it comes to securing research grant money. But it comes uncomfortably close to sounding like "eliminate fat people" to my ears.

In some (but not all) obesity, compulsive eating at some point in a subject's life is or was undoubtedly a factor. In some (but not all) compulsive eaters, childhood stress in being brought up in a dysfunctional family is undoubtedly a factor. Unfortunately, there are no simple answers, and usually the public only wants to hear one simple answer. The media, as well as diet capitalists, is usually happy to give them one.

Danielle said...

This is already being presented in Child Development Courses. I just finished the course last quarter, and this subject was hit hard. Thankfully the correlations were presented in a fair manner- no one seemed to take it to an extreme (but obviously this is in the controlled context of an educational institution).

In my own experience. When in treatment for my eating issues- the group there for binge eating (and the side effect, obesity) had some of the most tragic stories of childhood I have ever heard. I really think that it is the golden combination influence of genetics and environment, but specifically with the environment triggering it.

Tough stuff.

Anonymous said...

It bears remembering that epigenetic changes can result from a number of factors. I would hate for people to walk away thinking that a tough childhood was the only (or main) factor.

Harriet said...


hepfat said...

Interesting study. I agree with the comments above who express concerns about people gleaning the wrong assumptions when they see a study like this, though. It's really important to remember that when you're reading a scientific study, we shouldn't infer more than what the study says - there are going to be more studies based on questions the original study brings up.