Episode 41
How your childhood may have affected your health.
Welcome back to Season 2 of the Mind Your Fibro podcast, episode 41
If you are just starting to follow this podcast and want to learn about fibromyalgia, I recommend starting with episode 1 of season 1. Also, please download the season 1 episode guide that will guide you through the content of season 1 – where I talk about what fibro is and how it is diagnosed and treated. Other episodes cover pain science, the pain-stress connection, self-care, diet, exercise, and sleep. This season also includes important topics on grief, relationship, and pushing & crashing. Use season 1 to keep track of your progress; the link to download is in the show notes- https://www.rheumcoach.com/season1
My podcast episodes intend to provide information, but if any of this is triggering or activating your nervous system, please pause, do some self-care, and talk to someone. This is not intended to add more pain but rather provide education, another reason for self-compassion, show the common humanity of our experiences, and that you are not alone in your struggle.
It's been a couple of weeks since my last episode. Even though I had the intention to record it sooner, life happens. We had a death in the family, a birthday party for my now six-year-old, Mother's Day, and lots of school events that somehow all packed to be packed into the month of May. Life is truly 50/50, good & bad, happy & sad, gives us profound lessons, and many more reasons to appreciate it.
So, last week, my relative died of old age and dementia. While visiting him in the hospital, I spoke with one of the hospital volunteers, Mark, a delightful elementary school principal who spends his free time volunteering at the hospital with the program "No one dies alone." As we chatted about his volunteering, Mark mentioned that his father volunteered at the hospital and his father's legacy and impact on his children, including faith and service. As I sat next to my relative, who has been gradually declining over the last few years, and now slowly transitioning to his afterlife, I thought of his legacy, and it was not the legacy one hopes to pass on to his children. He traumatized all his children, ex-wife, other relatives, and friends. He was traumatized as a child, living with a mother who had tuberculosis, in and out of treatments, which contributed to his issues with attachment, mental illness, chaotic lifestyle, and inability to cope with life stressors. He was tormented, and he was the tormentor—the legacy of multigenerational trauma.
During the rheumatology fellowship training at the Mayo Clinic, I learned about risk factors or triggers of developing fibromyalgia, with stress and trauma being one of the most common. But not until later I started to connect the dots of how stress and trauma affect our health, both mental and physical.
In 2021, I came across the book, "What Happened to You?: Conversations on Trauma, Resilience, and Healing" by Oprah Winfrey and Dr. Bruce Perry, psychiatrist, neuroscientist, and trauma expert. As I listened to this book on Audible, the explanation of how our brain and nervous system develop, the stories and the psychological and health effects that come from facing trauma and adversity at a young age, literally shifted overnight my mindset as a physician, seeing patients from the perspective of "What's wrong with you?" to "What happened to you?."
The more time I spent observing and talking to my patients and family, the more they revealed to me that most of us experienced some type of psychological trauma. Trauma, like stress, is universal.
So today, I will talk about Adverse childhood experiences or ACEs. What happened to you as a child that could explain your health challenges today. Later I will speak of positive childhood experiences and resiliency.
ACEs are adverse childhood experiences that harm children's developing brains, changing how children respond to stress that leads to changes in their nervous and immune systems, damaging so profoundly that the effects show up decades later.
The CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study is one of the largest investigations of childhood abuse and neglect, household challenges, and later-life health and well-being. The study was conducted by the Centers for Disease Control, CDC, and Kaiser P Permanente health insurance company, in the mid-1990s with a group of patients insured through Kaiser Permanente. The initial study focused on how stressful or traumatic childhood experiences have negative neurodevelopmental impacts that persist over the lifespan and increase the risk of various health and social problems in adults.
The 17,000 participants surveyed were asked about their experiences with childhood maltreatment, family dysfunction, and current health status and behaviors.
The ACE study found that childhood trauma leads to the adult onset of chronic diseases, depression and other mental illnesses, violence and being a victim of violence, incarceration, multiple marriages, employment challenges, and financial and social problems.
The ACE survey has 10 experiences; you can find the survey in the show notes.
The 10 ACEs the original researchers measured were physical, sexual, and verbal abuse; physical and emotional neglect; a family member who is: depressed or diagnosed with other mental illness; addicted to alcohol or another substance; in prison; witnessing a mother being abused; losing a parent to separation, divorce or other reason.
People have an ACE score of 0 to 10. Each type of trauma counts as one, no matter how many times it occurs.
Later studies and other ACE surveys have expanded the types of Adverse childhood experiences to include racism, gender discrimination, witnessing a sibling being abused, witnessing violence outside the home, witnessing a father being abused by a mother, being bullied by a peer or adult, involvement with the foster care system, living in a war zone, living in an unsafe neighborhood, losing a family member to deportation, etc.
The CDC-Kaiser Permanente ACE Study and subsequent research show that 2/3 or 67% of people in the U.S. have at least one ACE.
Many reported experiencing a divorce or parental separation or having a parent with a mental and/or addiction.
Adverse childhood experiences often occur together - if you have one, there's an 87% chance that you have two or more. Almost 40% of the original sample reported two or more ACEs, and 12.5% experienced four or more. Because ACEs occur in clusters, many subsequent studies have examined the cumulative effects of ACEs rather than the individual effects of each.
Adults who had ACEs as children engaged more in high-risk health behaviors such as smoking, alcohol, and drug abuse, promiscuity, had severe obesity and also had more chronic health problems, including depression, heart disease, stroke, autoimmune conditions, chronic pain, cancer, chronic lung disease and lived not as long. People with an ACE score of 6 or higher are at risk of their lifespan being shortened by 20 years. People with an ACE score of 4 are twice as likely to be smokers and seven times more likely to be alcoholics.
Compared to an ACE score of zero, having 4 adverse childhood experiences was associated with 700% increase in alcoholism, a doubling of risk of being diagnosed with cancer, and a four-fold increase in emphysema.
An ACE score above six was associated with a 30-fold (3000%) increase in attempted suicide.
What's particularly startling is that the 17,000 ACE Study participants were mostly white Californians, middle- and upper-middle class, college-educated, and all had jobs and great health care, as they were all holders of Kaiser Permanente insurance.
This research was replicated by 36 other states, large cities, schools, healthcare systems, other countries, and over 64,000 juvenile offenders in Florida's juvenile justice system. The Florida Juvenile justice system showed that only 2.8% of offenders reported no childhood adversity, much lower than CDC's study done in 1998, which was 34%.
I found additional data from the Florida juvenile justice system survey worth mentioning - The Florida study showed higher rates of all 10 ACEs in girls than in boys, with an average composite score of 4.29 ACEs for females and 3.48 for males. Nearly half of girls reported five or more ACEs compared with 27.4 % of boys. The biggest contrast between the genders was sexual abuse, at 31 %for girls and 7% for boys. It was shown that males tend to lash outward, while females "have more internalizing behaviors, mental health symptoms, and self-mutilation," which I suspect contributes to fibromyalgia statistics as well – we see more women with fibromyalgia than men.
During the next episodes, I will be discussing the ACE and fibromyalgia connection and the resiliency score.
I hope this season of the Mind Your fibro podcast will help many people, not only those with fibromyalgia but their support circle, including family, friends, co-workers, and clinicians.
If you are a listener, thank you for your support. If you know someone who can benefit from listening, please share. Let's create a global awareness of trauma.