Chronic Illness and Invisible ACEs: When your ACE score is 0

Today I want to introduce the importance of attachment bonds and how they affect risk for chronic illness by describing two experiences I’ve had with my parents. The Adverse Childhood Experiences (ACE) studies (1)Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study [see comments]. Am J Prev Med. 1998;14(4):245-58, (2)Felitti V, Anda R. Lifelong Effects of Child Maltreatment. In: Chadwick DL, Alexander RA, Giardino AP, Esernio-Jenssen DJ, Thackeray D, editors. Chadwick’s Child Maltreatment: Sexual Abuse and Psychological Maltreatment. 4th ed. Saint Louis, MO: STM Learning, Inc; 2014. p. 12. show us the tip of the iceberg regarding the effects of childhood trauma on adult health and well-being (3)see more on the ACE study research at the CDC. The 10 questions that determine our ACE scores are consistent with what other studies have found, which is that traumatic events, and not just the 10 specific areas of trauma identified in the ACE studies, are risk factors for chronic illness, including chronic fatigue (“ME/CFS”, “SEID”) (4)Heim C, Wagner D, Maloney E, Papanicolaou DA, Solomon L, Jones JF, et al. Early adverse experience and risk for chronic fatigue syndrome: results from a population-based study. Arch Gen Psychiatry. 2006;63(11):1258-66. Abstract. Like me, I suspect that many people with chronic illness have an ACE score of “0” until you look more closely. Like the ACEs in the study, chronic illness and invisible ACEs are linked. Both occur in the attachment relationship between kids and their parents. The invisible ACEs represent another, more subtle form of traumatic experience that is shaped by interactions with adult caregivers. These ACEs fly under the radar and can be difficult to recognize because they have to do with the way parenting teaches kids about safety, the availability of support, and how effective they can be in the world.

Early relationships shape our risk for chronic disease. I’ll introduce some of the research about attachment theory (5)more on wiki, which is showing us that children learn how to regulate their physiologies from the adults and environments they grow up in. Invisible ACEs are associated with parenting styles that lead to “insecure attachment.” These styles, I believe, increase the propensity for the freeze response. The examples I’ll be using show how normal these invisible ACEs can look and how they can occur even when parenting comes from the best of intentions and without abuse. They highlight what I suggest is an 11th question we should include for calculating the ACE score, because it can help identify the subtle attachment-related traumas that many of us with chronic illness and other health issues have likely experienced.

In this series on attachment I want to emphasize how experiences of difficulty in childhood are not a life sentence. I want to demonstrate how it is possible to reduce symptoms and better cope with the often unrecognized sequelae of trauma. Understanding the role of traumatic events in our lives gives us opportunities for reducing its effects through trauma therapy and other under-utilized tools for treating chronic illness. It gives us an option to proactively mobilize through silence and other forms of the freeze response.

My Parents

Parental trauma influences chronic illness and invisible ACEs. Childhood trauma, even when subtle, can increase risk for chronic physical illness.

I love my parents and there is no minimizing what they have given me in my life. I can still pick up the phone on any given day and have a conversation with both of them. They believe that my illness is real. I can laugh with my mother to the point where we are both cry-laughing together. My parents and I can sometimes connect around successes and projects and new ideas. I’ve learned to love camping and hiking and canoeing from my father. He read regularly to the two of us kids when we were little and I’ve developed skills for arguing my point from him. My parents had good intentions when they had us and we’ve had the opportunities to get good educations, to travel, and to choose careers that we wanted.

But here’s the challenge:

The challenge is that while parental love and good intentions are hugely important in a child’s life, they are not sufficient to protect children from the impacts of a parent’s own trauma. The role of trauma has long been unrecognized in our culture. It’s effects on physical health, in particular, remain essentially unacknowledged by our medical system. But the fact that we don’t see or recognize trauma doesn’t reduce its impact. It doesn’t negate the fact that trauma occurs in subtle as well as overt ways. Nor does it change the finding that trauma in one generation influences the health and well-being of the next.

I – Invisible ACE from my Childhood

Feelings?

Chronic illness and invisible ACEs are linked. Triggers for some of my recent symptoms include a trip to Santa Fe, where I experienced hospitalization and severe asthma in childhood, as well as the loss of my dog.

I took the pictures in this post on a trip to Santa Fe right after writing about how the past influences the present. It’s where I grew up, where I developed asthma and experienced the hospitalization and also where I lost my dog. I wonder whether the recent increase in symptoms, including fatigue, may have been triggered in part by this visit. We lived in the house above when we first moved there.

I felt a tremendous sense of isolation when I was hospitalized at the age of 5 or 6 following a severe asthma exacerbation. Our 3 cats had all had kittens at the same time and I was allergic. I was sent home after the first night but readmitted the next day with another spike in symptoms. The doctors wouldn’t let my parents bring me home the 2nd time until they had gotten rid of all 17 cats. And my dog.

Feelings of isolation and states of “freeze” and shut-down occur frequently in children who are hospitalized (6)See the work of James Robertson from the 1940s and 1950s on wiki. The experience of losing my dog compounded this sense of loss and aloneness. It was especially difficult because I believed Pom Pom had run away. I don’t remember having a way to share my feelings, to grieve, or to be comforted. What I sensed was confusion. From a child’s perspective, I wondered what was wrong with me that he could have left ME. My asthma was certainly the cause, and I learned about allergies, but not knowing the truth made it all more difficult. I learned as an adult that my Dad had actually taken the animals to the humane society so that they could be adopted. I’d known this about the cats, but not about my dog.

Being Unable to Express or Manage Feelings

Parental trauma can make it difficult to tolerate feelings - one's own as well as one's children's difficult feelings.

I use this example from my childhood because it seems so simple on the surface. Difficult things happen to all of us. Kids lose pets all the time. We are supposed to get over such experiences and move on. And sometimes we do.

But there is an element of isolation here that is important to recognize. My sense of aloneness may have been the result of trauma from my hospitalization. Or from my asthma attacks. I may have been too shut-down as a result of either or both to take in any nurturing support from my parents after my hospital experience. The lack of awareness about the impact of hospitalization on children, both culturally and medically, didn’t help my parents cope with its potential effects. The influence of one or two traumatic events, which could count towards a higher ACE score if we were to include other kinds of trauma, were not prevented or addressed.

From years of personal work and psychotherapy, however, as well as from my experience in the following example, I’ve come to see that there is more to this than one or two isolated traumatic events. It demonstrates a parenting style that does not allow for grief and other difficult emotions.

What I learned from the research and my training as a psychotherapist that I never knew as a medical doctor is that the support and availability of adult caregivers shapes and influences our bodies, emotions and thoughts. Kids and babies are not able to manage intense emotions by themselves and therefore need help in regulating difficult feelings. The way they learn to cope with stress, feel the sense of safety, and function in the world comes from interactions with their adult caregivers.

Parenting is a critical factor in helping children learn to regulate not only their own feelings and beliefs, but also their physiologies. (7)Schore, A. N. (2001). “The effects of secure attachment relationship on right brain development, affect regulation, and infant mental health.” Infant Ment Health J 22: 7-66. Full Text The capacity to interact with the world – both the internal and the external world – takes time to develop because our nervous systems and other organ systems are immature in childhood. We are designed to grow through interactions with our environments. It makes us more adaptable. This natural process occurs outside of conscious awareness and it is referred to as the ability to “self-regulate.” (8)Schore AN. Affect regulation and the origin of the self: the neurobiology of emotional development. Hillsdale, NJ: Lawrence Erlbaum; 1994, (9)National Research Council and Institute of Medicine. From Neurons to Neighborhoods: The science of early childhood development. Committee on integrating the science of early childhood development. Shonkoff JP, Phillips DA, editors. Board on children, youth, and families, Commission on behavioral and social sciences and education. Washington, D.C.: National Academy Press; 2000, full text of chapter 2; book on amazon Parenting styles influence our epigenetics (10)Francis RC. Chapter 6: Twigs, Trees and Fruits. Epigenetics: how environment shapes our genes. New York: W. W. Norton & Company; 2012. p. 65-76., (11)Nathanielsz P. Life in the Womb: the origin of health and disease. Ithaca, NY: Promethean; 1999, (12)Sroufe LA, Egeland B, Carlson EA, Collins WA. The Development of the Person: the Minnesota study of risk and adaptation from birth to adulthood. New York: Guilford Press; 2005.. The growth of little bodies, immature nervous and immune and other systems, is affected by the physical and emotional presence of adult caregivers and the degree to which parents can offer nurturing attuned connection (13)Diamond M, Hopson J. Magic Trees of the Mind: How to Nurture your Child’s Intelligence, Creativity, and Healthy Emotions from Birth Through Adolescence. USA, Penguin Group: Plume; 1999. Children need emotional availability and nurturing contact to develop in optimally healthy ways (14)Schore AN. Affect regulation and the origin of the self: the neurobiology of emotional development. Hillsdale, NJ: Lawrence Erlbaum; 1994.

II – Invisible ACE from Present Day

“We’ve Moved On”

When parents are unable to share in their childrens' excitement - such as their wedding - it may represent unresolved trauma.

When David and I got engaged in 2010 my parents responded with excitement and congratulations. When we visited 3 months later I introduced David to my parents and relatives for the first time and there was a large family gathering to celebrate. There were gifts and cake and joyful wishes for a happy journey together. We had decided to have our wedding a year later in the small village where we were gathered, and where I’d spent my childhood summers. It’s where my mother grew up and where her roots were. It’s where my parents were married. And my sibling too.

I was in my mid 40s at the time and this was the first marriage for both of us. I’d been single most of my life and this was a momentous and unexpectedly positive turn of events for me. I found it odd despite the busyness of that weekend with relatives that there was little to no conversation about wedding plans with my parents. There were very few questions. Little curiosity. Few wonderings about where we might hold the ceremony or what it might look like; about what I wanted and how we could make it work or whatever else it is that mothers and daughters talk about when preparing for this huge life transition. My parents responded to topics I brought up, but it felt like I was pulling teeth.

I decided to speak up, be direct and waited for a good moment to discuss my feelings with them.

I said simply that I was disappointed we weren’t talking more about my wedding.

My mother’s response was, “We’re really happy for you, but you got engaged 3 months ago and we’ve moved on.”

My father joined and agreed with her.

They explained that they were happy to help us with local details since we lived so far away, but that the wedding was ours to do and plan.

When I asked my mother about what might have guided her response a few years later she didn’t remember the conversation.

Insecure Attachment

The inability to meet a child's needs for connection and emotional comfort can lead to insecure attachment and increase risk for chronic physical illness.

This is an example of an invisible ACE. It’s a more exaggerated version compared to my daily interactions with my parents, yet it reflects the family dynamics I grew up with. It’s the same pattern as in example I, where it wasn’t possible to work through grief, except that this time I was unable to share my excitement. This parenting style still feels essentially normal to me because it’s what I know. Even as I write, I find a part of myself thinking, “Of course I shouldn’t have burdened my parents with details about a wedding.”

Children develop a secure attachment to their parents where there is awareness and support. (15)see more on attachment theory on wiki, as well as what we’ve learned about the role of attachment in helping children gain safety, care, and protection

A person who has positive expectations of both self and other is secure. Secure attachment is associated with an internalized [learned] sense of being worthy of care, of being effective in eliciting care when required, and a sense of personal efficacy in dealing with most stressors independently. Secure individuals are described as adaptable, capable, trusting, and understanding.” (16)Maunder RG, Hunter JH. Attachment and psychosomatic medicine: developmental contributions to stress and disease. Psychosom Med. 2001;63:556-67. p. 558, Abstract

Insecure attachment looks very different:

With this style, “characterized by ‘only sometimes’ type of caregiving, babies learn that the world and their ability to have an impact on it is basically inconsistent – sometimes things happen, sometimes they don’t – sometimes all their needs are met, and sometimes only some of them are. Infants learn that others are not dependable or consistent. They often also do not learn or understand emotions – their own or others’. (17)cited from this blog, which talks further about other styles of parenting that lead to insecure attachment. It also says more about secure attachment

Precursors to insecure attachment include “experiences of trauma, neglect, parental loss, and separation.” (18)Maunder RG, Hunter JH. Attachment and psychosomatic medicine: developmental contributions to stress and disease. Psychosom Med. 2001;63:556-67. Abstract Parenting styles that minimize, ignore or only intermittently meet children’s physical and emotional needs also lead to insecure attachment.

A national study found that insecure attachment exists in 35% or more of the adult population. (19)Mickelson, K. D., et al. (1997). “Adult attachment in a nationally representative sample.” J Pers Soc Psychol 73(5): 1092-1106, Abstract A separate, prospective study found that 35% of children at 18 months had insecure attachment. (20)Puig J, Englund MM, Simpson JA, Collins WA. Predicting Adult Physical Illness From Infant Attachment: A Prospective Longitudinal Study. Health Psychol. 2012, Abstract

As found in the ACEs in Felitti and Anda’s research, and as described in the post on ACEs using the example of Mason from the movie “Boyhood”, insecure attachment is common. But that does not make it “normal.” Insecure attachment reflects the impacts of parents’ own subtle and unrecognized trauma responses, which make it difficult for them to be attuning to their children’s needs for connection and protection. Adults with these parenting styles may love and care for their children but they respond to fear and grief, excitement or self expression by avoidance and silence, or by giving advice, denying, attacking, minimizing or invalidating feelings. These styles of parenting have become normalized in our culture. They are perceived as benevolent, especially when compared to overt abuse. But they are a form of trauma nonetheless and as a result, they have long-term effects on our health. Lack of support for the expression and resolution of emotions and connection is a big factor in invisible ACEs.

Chronic Illness and Invisible ACEs

The subtle unrecognized trauma of emotionally unavailable parents increases risk that a child will develop chronic illness later in life

Emotional and Psychological Health

Children with insecure attachment learn that difficult and overwhelming feelings are not appropriate. That they are not to be shared. Ultimately, they learn that painful emotions are not to be felt. As a result they may learn to “be good,” to play by the rules, to “be” happy, act nice. They develop beliefs that who they are is not important or acceptable. They may learn to be silent and to have trouble recognizing what they believe and feel and want unless it involves the feelings their parents can tolerate (21)Mate, G. (2003). When the Body says No: Understanding the stress-disease connection. Hoboken, NJ, Wiley & Sons.. They may also feel profoundly alone and isolated in the world.

I suspect that these behaviors and beliefs all represent forms of a freeze response because no other options exist in these family systems.

Feelings are actually designed to be experienced so that they can resolve. Children first learn this in the supportive relationship with their adult caregivers. Their hearts and minds and bodies are later able to do so as adults because they have learned that they can trust themselves, their feelings and bodies, and people. They have learned to self-regulate and to believe in themselves.

Unresolved feelings that I didn’t realize I still had have started rising to the surface in recent years. I’ve realized that, for lack of a better plan with what to do with them as a kid, I’ve developed an unconscious pattern of stuffing them. Right into my belly and gut, among other places. I suspect this pattern plays a role in my severe levels of constipation that seem unresponsive to everything I’ve tried.

Physical Health Consequences of Insecure Attachment

Parenting styles that are emotionally disconnected, shaming or blaming or avoidant of emotions lead to insecure attachment in children.

Maunder and Hunter looked at the research literature linking insecure attachment and chronic physical illness in 2001 (22)Maunder RG, Hunter JH. Attachment and psychosomatic medicine: developmental contributions to stress and disease. Psychosom Med. 2001;63:556-67. Abstract They found studies showing that insecure attachment was associated with physical illness in children, from recurrent ear infections and asthma (I had both), to cystic fibrosis, epilepsy, failure to thrive, and congenital heart disease.

They also found that the ACE studies provide strong evidence that insecure attachment is a risk factor for chronic physical illness. (23)Maunder, p. 560 The long-term effects of ACEs include increases in all types of cancer as well as in type 2 diabetes, heart and lung diseases, autoimmune diseases of all kinds, liver disease, skeletal fractures and more. Other studies have also found a higher incidence of childhood trauma in chronic fatigue. (24)Heim C, Wagner D, Maloney E, Papanicolaou DA, Solomon L, Jones JF, et al. Early adverse experience and risk for chronic fatigue syndrome: results from a population-based study. Arch Gen Psychiatry. 2006;63(11):1258-66. Abstract. PDF, (25)Heim C, Nater UM, Maloney E, Boneva R, Jones JF, Reeves WC. Childhood trauma and risk for chronic fatigue syndrome: association with neuroendocrine dysfunction. Arch Gen Psychiatry. 2009;66(1):72-80. PDF

Sroufe et al have been conducting a prospective study in Minnesota for 3 decades (26)Sroufe LA, Egeland B, Carlson EA, Collins WA. The Development of the Person: the Minnesota study of risk and adaptation from birth to adulthood. New York: Guilford Press; 2005. They, too, have found that insecure attachment in childhood increases risk for physical illness in adulthood:

… Individuals who were insecurely attached at both [12 months and 18 months] were four times more likely to report physical illnesses [as well as inflammation-related and nonspecific illnesses] at age 32 than those who were continuously secure early in life (27)Puig, J, Englund MM, Simpson JA, Collins WA. Predicting Adult Physical Illness From Infant Attachment: A Prospective Longitudinal Study. Health Psychol. 2012, p. 5

I’ve been trying to resolve my own patterns related to insecure attachment for decades. I am making progress, but it is taking a remarkable amount of effort, time and support. I see these patterns as contributors to my chronic fatigue. At the risk of restating this too often, it’s not because I’m weak. Or depressed. Or avoiding activity because of overly cautious parents in childhood. It’s not because it’s “all in my mind.” But because early life experiences shape our developing nervous systems as well as our beliefs about ourselves and the world. They shape whether we feel safe and therefore whether we can trust, relax and rest into the sense of being supported in our lives. They affect our physical health because our brains interact inseparably with our bodies, our emotions, and our psyches. It’s not just genetics that affect our health and physiologies, but also the life events we experience over the generations. It comes back to what I described in an earlier post on epigenetics and why chronic illness may be reversible.

Multigenerational Influences

Parents tend to raise their children the way they were raised and this is transmitted through epigenetics.

Parents

Parents tend to raise their children the way they were raised.

This is seen in humans and other mammals, where early maternal care influences epigenetics in the next generation. (28)Francis RC. Chapter 6: Twigs, Trees and Fruits. Epigenetics: how environment shapes our genes. New York: W. W. Norton & Company; 2012. p. 65-76., (29)Nathanielsz P. Life in the Womb: the origin of health and disease. Ithaca, NY: Promethean; 1999, (30)Hurley D. Grandma’s experiences leave a mark on your genes: Your ancestors’ lousy childhoods or excellent adventures might change your personality, bequeathing anxiety or resilience by altering the epigenetic expressions of genes in the brain. Discover. 2013 June 11 If one generation grows up feeling unsafe or having little support, this is what they unconsciously role model and reenact with their offspring. Via epigenetics. (31)Weaver IC, Cervoni N, Champagne FA, D’Alessio AC, Sharma S, Seckl JR, et al. Epigenetic programming by maternal behavior. Nat Neurosci. 2004;7(8):847-54. Abstract The effects of parenting are described as “a form of social inheritance mediated by epigenetic processes.” (32)Francis RC. Chapter 6: Twigs, Trees and Fruits. Epigenetics: how environment shapes our genes. New York: W. W. Norton & Company; 2012. p. 65-76, p. 71.

From living with my family, observing present-day interactions with relatives, and growing up with two grandmothers who I loved and know loved me, I see patterns of happy interaction on one level without real room for difficult emotions on another.

These patterns leading to insecure attachment are generations old.

My Dad and his two sisters were raised by an educated, hard working single mom right after the Depression and during World War II. His father abandoned them when he was two. My Dad’s reflections on his childhood are that things were pretty normal. He had cancer 20 years ago and his sisters, who were only 2 years younger, both developed chronic illnesses as adults (chronic fatigue and multiple chemical sensitivities). They remember aspects of their childhood as rough going.

My mom was born during the Great Depression. When I once asked her about her upbringing, she said, “If you were fed and clothed and housed in those days, how could you expect more?”

World Wars I and II and The Great Depression were a deeply stressful and often traumatic experience for an entire culture and a whole generation. They are examples of events that have had under-appreciated consequences.

As I’ll share in upcoming posts, experiences of loss can also make it difficult for a parent to connect to his or her children and stress “is a big suppressor of maternal behavior.” (33)described by Champagne in this article on epigenetics in Discover My mother’s father died when I was 15 months old. This likely affected her capacity to to bond and be nurturing.

Grandparents

Parental trauma often originates with trauma that occurred in our grandparent's lives.

Paternal Grandparents: My grandparents grew up in the early 1900s. My grandfather lost his mother to suicide when he was 6 years old and developed rheumatoid arthritis as an adult. My grandmother also lost her father at the age of 6 when he left to find work out West. He returned only for her mother’s funeral a decade later. Her mother died from an accidental overdose when the family doctor gave her medicine at her request to help her sleep. She’d been exhausted from taking care of her family during the influenza epidemic.

Maternal Grandparents. My grandmother took over the cooking for her family around the age of 11 when both of her parents became bedridden. Her mother had become an invalid when giving birth to her 13th or 14th child. Her father showed her the ropes before becoming bedridden soon after with some kind of spasms and pain.

For today, I want to introduce the possibility that, while my parents were raised with good intentions by their own parents, they may not have had warm, nurturing connection in their childhoods. I suggest that my experiences as a child are likely similar to what they experienced as kids as well.

Me

Leaving the nest of multigenerational trauma.

I too, have had difficulty with painful feelings – both my own and that of others in my life. I have learned a great deal about this pattern in my relationship with David. When he is upset or unhappy, especially if it has anything to do with me or something I’ve done, it feels as though he is complaining. I’ve found myself just wishing he’d stop and “get over it.” So that I won’t have to feel it. I’ve been learning how to sit with the anxiety that comes up in these situations, to actively listen so I can really hear what he is trying to say, and to be willing to look at myself and my actions. I’m still working on doing this with a nonjudgmental attitude towards myself and my feelings. I’ve had to practice tolerating conflict, identifying and expressing my opinion, and learning how to stand my ground if there’s something I see differently.

I’ve realized that these conversations trigger a sense that “it’s never enough.” It triggers a sense that I am not enough. And it is this deep sense of unworthiness that can make me defensive and want to attack him and his ideas and push him away.

My behaviors look just like what my parents do.

It’s been remarkably hard to work with these patterns. And it’s given me a sense of just how difficult certain patterns can be to feel, understand, and change. This kind of work is what my parents, and others, would probably have to do to become more connecting and emotionally available. They’d have to work through their trauma patterns that stem from early attachment wounds and that were compounded by other traumatic events in their lives.

I’m coming to see that I am a work in progress – and that therapy and working with my internal process may be lifelong. What’s greatly reassuring is that David and I can feel and see the changes – in both of us. We continue to learn from one another in these conversations, which are getting easier, less painful and resolving more quickly. We are learning how to share and play and live together. We are reaping from the work, and I am gaining a sense of safety, support and connection that is more than I realized was possible. They are what I always craved but never consciously realized.

Question 11: Identifying Covert ACEs

Adding question 11 to the ACE score: was there anyone you could talk to as a child, even if that person was the one who had triggered negative emotions? citing Gabor Mate

Family physician Gabor Mate has written a book looking at the role of life events in the shaping of chronic disease. (34)Mate, G. (2003). When the Body says No: Understanding the stress-disease connection. Hoboken, NJ, Wiley & Sons. He interviewed people with a variety of different illnesses for “When the Body Says No,” and presents the research suggesting factors that influence risk of cancer and chronic illnesses including MS, RA, lupus and more – are all similar to one another. Mate presents the one question I would add to the ACE questionnaire, because it can help many of us understand why our normalized childhoods may have actually been distressing to the point of affecting our long-term health (p. 128):

When, as a child, you felt sad, upset or angry, was there anyone you could talk to – even when he or she was the one who had triggered your negative emotions?

In a quarter century of clinical practice, including a decade of palliative work, I have never heard anyone with cancer or with any chronic illness or condition say yes to that question. Many children are conditioned in this manner not because of any intended harm or abuse, but because the parents themselves are too threatened by the anxiety, anger or sadness they sense in their child – or are simply too busy or too harassed themselves to pay attention. “My mother or father needed me to be happy” is the simple formula that trained many a child – later a stressed and depressed or physically ill adult – into lifelong patterns of repression.

Breaking the Taboos on ACEs

Chronic illness and invisible ACEs: breaking the taboos and speaking about parenting styles and childhood trauma

It turns out that my life’s work is about understanding how life experiences shape risk for chronic physical illness. The influences of my early experiences affect me daily and cannot be suppressed, repressed or avoided without consequences. The research in this area is extensive.

I have felt unable to speak of these subtle, easily judged, poorly understood risk factors in my personal life. This is in part because it was not possible to do so in my family. And also because speaking about difficult childhood experiences, which often involve our parents, is hard to do in our culture.

What is guiding my actions after years of sitting with the question of how to speak has to do with my increasing understanding of the role of life events in shaping my health. And how it impacts the health of others. I believe that many people with chronic illness have had experiences of invisible ACEs.

We need to stop blaming, shaming and judging people for having symptoms. We need to break the taboos about sharing difficulties that occur in childhood. (35)the taboos and secrecy around ACEs in our culture are part of the challenge of making changes, as mentioned in a presentation by Felitti, (36)Felitti refers to taboos and shame in a book chapter, “Felitti V, Anda R. Lifelong Effects of Child Maltreatment. In: Chadwick DL, Alexander RA, Giardino AP, Esernio-Jenssen DJ, Thackeray D, editors. Chadwick’s Child Maltreatment: Sexual Abuse and Psychological Maltreatment. 4th ed. Saint Louis, MO: STM Learning, Inc; 2014 Understanding ACEs – visible and invisible – can help us do that. It can also help prevent us from transferring the blame to parents and support them in seeking help for the challenges inherent to raising children in our society.

We are starting to make changes. A number of pediatricians and children’s clinics around the country are learning how to help parents with their own ACEs in ways that feel supportive. Schools are using this information to change how they treat students (37)here’s another school’s story, (38)see more on the ACEs too High news site about the latest research and developments in ACEs; The Blog’s editor and journalist, Jane Ellen Stevens, is also writing a book about ACEs due out later in 2015. Felitti’s clinic at Kaiser has seen over 400,000 patients since learning of the ACE findings. They have developed ways of asking patients about their ACEs that fit into routine medical care and that make it possible for people to begin to feel seen and heard (39)Felitti V, Anda R. Lifelong Effects of Child Maltreatment. In: Chadwick DL, Alexander RA, Giardino AP, Esernio-Jenssen DJ, Thackeray D, editors. Chadwick’s Child Maltreatment: Sexual Abuse and Psychological Maltreatment. 4th ed. Saint Louis, MO: STM Learning, Inc; 2014.

Here are 10 tools for working with chronic illness that I’ve been finding helpful. My main focus for ways of working with the effects of early attachment wounds include certain types of psychotherapy. (40)you can get a sense of the power of psychotherapy and other approaches for working with ACEs in the nearly 600 comments posted to date to an ACEsTooHigh blog post “Got your ACE score?” Some commenters have done a lot of psychotherapy over the years and are finding their way through their old traumas; many continue to do psychotherapy and have found it has transformed their lives for the better. Some are just beginning. Some never knew that it was possible to feel better. The responses are courageous, gritty, painful and heart warming. Some trauma therapists will have experience in working with patterns and trauma from early relationships and there’s a list of different approaches and links to find practitioners on the FAQ page. One can also work with a therapist who specializes in issues related to the parent-child relationship. Some work with parents and babies, others with children, adults and families. Here’s a website to help find therapists around the world. I’ll be writing about how one psychologist found a way to reduce and sometimes resolve symptoms of asthma in children by treating their mothers for traumatic events that occurred during the pregnancy, birth and infancy of their child. You can learn about Dr. Tony Madrid’s work at AsthmaBusters.

Ultimately, I want to heal. Explaining how my attachment experiences have affected me and sharing the research is empowering. My hope is that it will be informing and empowering to others too.

Related Posts:

The Chronic Illness Model: 11 Characteristics of Trauma and Early Life Events that Affect Risk for Chronic Illness

Adverse Childhood Experiences, “Boyhood”, and Risk for Chronic Illness

Risk for Rheumatoid Arthritis: Trauma in Childhood

10 Under-Utilized Tools for Treating Chronic Illness: Building on lessons from brain plasticity, epigenetics, and trauma

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