Jane Ellen Stevens

The effects of adverse childhood experiences touch every part of us

Dr. David McCollum was for years an emergency room physician and  is one of the co-founders of the Academy on Violence & Abuse, an organization aimed at health professionals. It provides education and research on the effects of violence and abuse on people’s health.

Early on in his work, McCollum became aware of the connection between childhood trauma and health problems. He integrated his awareness into his emergency room practice by asking questions when he thought patients’ health problems might be related to events that had happened in their past. I’ll post some of those stories later. The outcomes were very surprising, including a woman who came to the ER with chronic pelvic pain. After she answered “All three” when McCollum asked her if she’d been verbally, physically or sexually abused, and a discussion ensued at how it could affect her current health, her pain dissipated.

After a while, McCollum began probing the medical literature for research about the link. He found so much information that he used a mind-mapping program to organize it. He put together COLEVA — Consequences of Lifetime Exposure to Violence and Abuse. It’s an interactive map that depicts how childhood trauma affects every system in our body.  This map has much more impact than a list of research publications. You’ll have to go to the site to explore the map — I couldn’t embed it in this post.

COLEVA was something McCollum did in his spare time, and he ran out of spare time in February 2011, its last update. As demonstrated in a previous post, the research continues to grow and expand. And here are two more recent studies:

Neglect impairs brain development — This very good story by LATimes reporter John Bardin covers recent research that is another in a series by the Bucharest Early Intervention Project, which has followed 136 Romanian orphans since 2000, when they were infants. Some are in orphanages, others with families. Using MRI scans, the researchers found that the brains of the institutionalized children had less white matter, the brain tissue that connects parts of the brain. The study was published in the Proceedings of the National Academy of Sciences.

Child abuse linked to higher odds for cancer as an adult— Confirming findings from the CDC’s ACE Study, researchers at Purdue University in West Lafayette, Ind. used data from more than 2,100 U.S. adults who took part in the National Survey of Midlife Development, according to the story on HealthDay.com. The study was published in the Journal of Aging and Health.

When McCollum and I chatted, he wasn’t sure that people would be interested in this. I think otherwise. What do you think?

9 comments

  3. Thank you for this valuable article! Talk to those with cancer and many will say they feel it came from experiencing toxic stress recently in their lives. I believe toxic stress in adulthood can lead to cancer. Also worth noting a rescue dog I knew died of lung cancer. He lived about 10 years. Eight of those years he was tied up outside to a post. This fits the findings from the ACE study: http://tiny.cc/ace-chart1. He, also, suffered from severe PTSD.

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    • Thanks for the link, Liz. Indeed, researchers are discovering that people who experience trauma as an adult also suffer consequences. All the more impetus to figure out ways to prevent or provide ways to build in resiliency to help get past the trauma. Very sad about the dog.

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  4. This kind of research and information is so important to know and understand. I will definitely be sharing and thank you for this article and all the others you post to your blog. Your work overall is critical to stopping the cycle of substance abuse and addiction, the field within which I work.

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  5. This is excellent information. The question I would like to pose to Dr. McCollum is what he does in the emergency room setting to support people who have traumatic histories, his recommendations for sensitive practices for ER staff, etc. Thank you.

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    • Thanks for your question, Cheryl. I’ll be doing some posts with more information about how Dr. McCollum integrated ACE concepts in his work soon. (I’ll also alert him to your question so that he can provide an answer.)

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    • Cheryl,

      Thank you for giving me an opportunity to share what I do. The question is one that many ask. I’ll answer it in several ways:

      I believe that it is the professional responsibility of physicians or other direct care providers to seek to find the true cause of a patient’s malady, wherever it may lie.

      Once one start’s asking questions about life experiences, the patterns become very clear. I can’t feel proud of the service I provide if I don’t address life adversity when it clearly plays a role in the presenting problem.

      I avoid the words violence and abuse. I don’t have one set of questions that I use, but some that come to mind are:

      We all experience stress in our lives. Is there anything that is more stressful than usual?
      Do you look forward to going to work in the morning?
      Is your relationship with your partner everything you would like it to be? If not, what is missing?
      Do you have concerns about your children?

      Life has been a struggle for you, hasn’t it?
      I suspect that you have had more than your fair share of challenges in your life; are you willing to share that with me?
      Many times when I see problems similar to yours, I find that there has been a significant history of things happening earlier in life that shouldn’t have happened or that you wish hadn’t happened to you. Is that right? I’ll explain the connection in a little bit, but first I’d like to understand a little better the challenges you faced as a child.

      No wonder you feel the way you feel. It makes perfect sense to me. YOu’ve seen a lot of specialists without any answers. I’m sure that has been frustrating. You may feel like they are telling you it is all in your head, but it is not. I know it is real. Even though it is not “in your head,” it may be in your brain. I call it brain pain and science has now shown us how this happens.

      It’s not your fault. You didn’t ask to be hurt or treated abusively. That is what life brought you. IT wasn’t fair. Society didn’t do a very good job of protecting you. I’m sorry that those things happened; they shouldn’t have.

      I accept you for who you are. I know that you didn’t chose to have the problems you have. I know that the alcohol/drugs/? is your way of coping, of getting through the day when you don’t know how you are going to make it otherwise.

      There is hope for you. You’ve been able to share with me some very emotional things. That’s good. It’s important to be able to put your feelings into words and share your history with me in a way that I can understand better how to help you.

      There is a light at the end of the tunnel for you, but you have to make the commitment to yourself that you want to go there. I can’t fix it for you, but I know it can be done; I’ve seen it before and I’ve seen people come out on the other side feeling much better.

      Can I call someone? (crisis worker, advocate, social worker, counselor, your personal physician) and share what we’ve been talking about?

      IF there is time, or if I feel it may be helpful, I will go through the ACEs concept, the categories, and the science that has now developed to help us understand why these things happen (chronic illnesses) long after the original abuse. I explain about the hormonal changes and brain neurons, but I also reassure them that the brain is “plastic;” that it can be retrained and remolded at least to some degree.

      Generally I can do this within a 20-30 minute time frame. In the ED, I don’t have a schedule to follow. Sometimes I am not able to address the issues fully, but I try to at least give the patient a clue as to what I think is going on. I can also break up the discussion into smaller segments, see other patients, then come back to continue the discussion. It is as important as anything else we do. It may be another way to save a life.

      These are a few things that come to mind. I no longer practice due to disability and early retirement. My last patient contact was about 8 months ago.

      I hope this helps in some way. Good luck to you.

      Dave McCollum

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