How childhood adversity affects health

Childhood does not stay in the past. Research over the last 30 years shows that adverse childhood experiences (ACEs) are linked with many health problems later in life, in both the mind and the body.^1,2

That can be hard to read, especially if you lived through ACEs yourself. So keep one thing in mind as you read. These findings are averages across large groups of people. They describe risk, not fate. They cannot tell you what will happen to you.³ And many of the health problems linked to ACEs can be prevented or treated.

The ACE Study: where this research began

In the mid-1990s, researchers mailed a survey to adults who had recently had a routine checkup at a large health plan in California. About 9,500 people answered questions about their childhoods and their health.¹

More than half reported at least one of seven types of adversity. About 1 in 4 reported two or more.¹ The researchers then compared these answers with each person's health. Here is what they found:¹

• A steady stair-step pattern. The more types of ACEs people reported, the higher their rates of every risk and illness studied.
• Large links with mental health and substances. People with four or more types of ACEs, compared with none, were 4 to 12 times as likely to have had alcoholism, drug misuse, depression or a suicide attempt.
• Smaller links with health habits. They were 2 to 4 times as likely to smoke or to rate their health as poor.
• Links with disease. Higher ACE counts went along with more heart disease, cancer, chronic lung disease, liver disease and broken bones.

The types of adversity also tended to come together. Few people had just one.¹

What later research found

Many studies since then have found the same pattern. A 2017 review combined 37 studies with more than 250,000 adults. It compared people with four or more ACEs with people who had none.²

Results varied a lot from study to study.² Studies like these usually rely on adults recalling their childhoods. They can show links, but they cannot prove that ACEs caused the health problems.

A CDC analysis of about 144,000 adults in 25 states found similar results. Adults with four or more ACEs had about 5 times the odds of depression and nearly 2 times the odds of coronary heart disease, compared with adults who had none.⁷ The authors estimated that preventing ACEs could have prevented up to 21 million cases of depression and 1.9 million cases of heart disease in the U.S. These are modeled estimates, not proof.⁷

Mental health

The strongest links are with mental health.

• Depression and anxiety. ACEs are linked with higher rates of mental health problems such as these.² Among people with depression, childhood trauma is tied to an earlier start, more chronic or repeated episodes and more co-occurring conditions.⁶ See Depression and Anxiety.
• PTSD. Abuse and neglect raise the risk of posttraumatic stress disorder.⁸ If childhood memories still bring nightmares, flashbacks or a constant sense of danger, see Signs and symptoms of PTSD.
• Alcohol and drug use. These have some of the strongest links with ACEs.^1,2 If you drink or use drugs to quiet painful memories, help is available. See Substance use.
• Emotions and relationships. The CDC notes that ACEs can make it harder to form stable relationships and hold steady jobs.⁹ If strong emotions, shame or harsh self-talk are hard to manage, see Emotion regulation and Self-esteem.

Suicide risk

ACEs are linked with a higher risk of suicide attempts. In a study of more than 17,000 adults from the ACE Study, each type of adversity was linked with 2 to 5 times the risk of a suicide attempt. The risk rose with each additional type.¹⁰ Depression, alcohol problems and drug use explained part of the link.¹⁰ That matters, because these conditions can be treated.

The CDC lists suicide among the serious outcomes linked to ACEs.⁹ If you are having thoughts of suicide, you are not alone, and help works. Call or text 988 at any time. If you are in danger right now, call 911. See If you are thinking about suicide and make a safety plan.

Physical health

ACEs are linked with many long-term illnesses, including heart disease, lung disease, diabetes and some cancers.^2,9 The links with body illnesses are smaller than the links with mental health.² Several pathways seem to be involved:

• Stress biology. Long-lasting stress can affect the developing brain, the immune system and the body's stress response.^9,4
• Coping habits. Smoking, heavy drinking and other habits may begin as ways to cope with pain. In the ACE Study, smoking, alcoholism and severe obesity were all more common among people with more ACEs.¹
• Life chances. ACEs can affect schooling, jobs and income, which in turn affect health.⁹

Some people also have aches, stomach problems or tiredness with no clear medical cause. See The mind–body connection and What stress does to the body.

How adversity gets "under the skin"

Harvard's Center on the Developing Child describes three kinds of stress response in children:⁴

• Positive stress is brief and mild, like the first day at a new school. With a caring adult nearby, it helps a child learn to cope.
• Tolerable stress is more serious, such as a death in the family or a disaster. The brain and body can recover when the stress is time-limited and adults help the child through it.
• Toxic stress happens when strong, frequent or long-lasting hardship, such as abuse, neglect or violence, comes without enough supportive relationships to buffer it.

With toxic stress, the body's alarm system stays switched on. Over time, this can affect brain connections linked to attention, language and decision-making. It can also disrupt other body systems.⁴ A report from the American Academy of Pediatrics suggests that many adult diseases may begin with stress like this in early life.¹¹

There is good news in this science too. Supportive relationships, safer settings and less exposure to stress can help prevent or reverse many of these effects.⁴ The body and brain keep changing throughout life.

Averages, not predictions

This may be the most important part of this page.

A dose–response link means that groups with more ACEs have more health problems on average. It does not mean that a person with a high score will get sick. Many people with high scores stay healthy. Many people with no ACEs develop the same illnesses.

Researchers tested this directly. In two long-term studies, one in the U.K. and one in New Zealand, ACE scores predicted later health problems only a little better than flipping a coin.³ A fresh look at the original ACE Study data found the same thing.⁵ The authors concluded that ACE scores can show differences between groups, but they cannot accurately predict one person's risk.³

So use these findings as a reason for care, not a reason for fear.

What this means for you

If you had a hard childhood, these steps can protect your health:

• Tell your doctor, if you feel ready. Your history can help explain symptoms and guide care. You decide how much to share.
• Keep up with checkups. Ask about blood pressure, cholesterol, diabetes and cancer screening for your age.
• Look at your coping habits. If you smoke or drink to calm down, ask for help cutting back. See Alcohol.
• Take mental health seriously. Depression, anxiety and PTSD can be treated. People with childhood trauma benefit from depression treatment about as much as others.⁶ See Treatment.
• Build supports. Caring relationships protect at any age. See Protective factors and resilience and Healing as an adult.

Common questions

When to get help

See a doctor or mental health professional if:

• Low mood, worry, anger or numbness lasts for weeks or gets in the way of daily life
• You have nightmares, flashbacks or feel on guard much of the time
• You drink or use drugs to cope
• You have physical symptoms that worry you

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.