How childhood trauma affects health across a lifetime | Nadine Burke Harris


In the mid-’90s, the CDC and Kaiser Permanente discovered an exposure
that dramatically increased the risk for seven out of 10 of the leading
causes of death in the United States. In high doses, it affects
brain development, the immune system, hormonal systems, and even the way our DNA
is read and transcribed. Folks who are exposed in very high doses have triple the lifetime risk
of heart disease and lung cancer and a 20-year difference
in life expectancy. And yet, doctors today are not trained
in routine screening or treatment. Now, the exposure I’m talking about is
not a pesticide or a packaging chemical. It’s childhood trauma. Okay. What kind of trauma
am I talking about here? I’m not talking about failing a test
or losing a basketball game. I am talking about threats
that are so severe or pervasive that they literally get under our skin
and change our physiology: things like abuse or neglect, or growing up with a parent
who struggles with mental illness or substance dependence. Now, for a long time, I viewed these things in the way
I was trained to view them, either as a social problem —
refer to social services — or as a mental health problem —
refer to mental health services. And then something happened
to make me rethink my entire approach. When I finished my residency, I wanted to go someplace
where I felt really needed, someplace where I could make a difference. So I came to work for
California Pacific Medical Center, one of the best private hospitals
in Northern California, and together, we opened a clinic
in Bayview-Hunters Point, one of the poorest, most underserved
neighborhoods in San Francisco. Now, prior to that point, there had been only
one pediatrician in all of Bayview to serve more than 10,000 children, so we hung a shingle, and we were able
to provide top-quality care regardless of ability to pay. It was so cool. We targeted
the typical health disparities: access to care, immunization rates,
asthma hospitalization rates, and we hit all of our numbers. We felt very proud of ourselves. But then I started noticing
a disturbing trend. A lot of kids were being
referred to me for ADHD, or Attention Deficit
Hyperactivity Disorder, but when I actually did
a thorough history and physical, what I found was that
for most of my patients, I couldn’t make a diagnosis of ADHD. Most of the kids I was seeing
had experienced such severe trauma that it felt like something else
was going on. Somehow I was missing something important. Now, before I did my residency,
I did a master’s degree in public health, and one of the things that they teach you
in public health school is that if you’re a doctor and you see 100 kids
that all drink from the same well, and 98 of them develop diarrhea, you can go ahead
and write that prescription for dose after dose
after dose of antibiotics, or you can walk over and say,
“What the hell is in this well?” So I began reading everything that
I could get my hands on about how exposure to adversity affects the developing brains
and bodies of children. And then one day,
my colleague walked into my office, and he said, “Dr. Burke,
have you seen this?” In his hand was a copy
of a research study called the Adverse Childhood
Experiences Study. That day changed my clinical practice
and ultimately my career. The Adverse Childhood Experiences Study is something that everybody
needs to know about. It was done by Dr. Vince Felitti at Kaiser
and Dr. Bob Anda at the CDC, and together, they asked 17,500 adults
about their history of exposure to what they called “adverse
childhood experiences,” or ACEs. Those include physical, emotional,
or sexual abuse; physical or emotional neglect; parental mental illness,
substance dependence, incarceration; parental separation or divorce; or domestic violence. For every yes, you would get
a point on your ACE score. And then what they did was they correlated these ACE scores
against health outcomes. What they found was striking. Two things: Number one, ACEs are incredibly common. Sixty-seven percent of the population
had at least one ACE, and 12.6 percent, one in eight,
had four or more ACEs. The second thing that they found was that there was
a dose-response relationship between ACEs and health outcomes: the higher your ACE score,
the worse your health outcomes. For a person with an ACE score
of four or more, their relative risk of chronic
obstructive pulmonary disease was two and a half times that
of someone with an ACE score of zero. For hepatitis, it was also
two and a half times. For depression, it was
four and a half times. For suicidality, it was 12 times. A person with an ACE score
of seven or more had triple the lifetime risk
of lung cancer and three and a half times the risk
of ischemic heart disease, the number one killer
in the United States of America. Well, of course this makes sense. Some people looked at this data
and they said, “Come on. You have a rough childhood,
you’re more likely to drink and smoke and do all these things
that are going to ruin your health. This isn’t science.
This is just bad behavior.” It turns out this is exactly
where the science comes in. We now understand
better than we ever have before how exposure to early adversity affects the developing brains
and bodies of children. It affects areas like
the nucleus accumbens, the pleasure and reward
center of the brain that is implicated
in substance dependence. It inhibits the prefrontal cortex, which is necessary for impulse control
and executive function, a critical area for learning. And on MRI scans, we see measurable differences
in the amygdala, the brain’s fear response center. So there are real neurologic reasons why folks exposed
to high doses of adversity are more likely to engage
in high-risk behavior, and that’s important to know. But it turns out that even if you don’t
engage in any high-risk behavior, you’re still more likely
to develop heart disease or cancer. The reason for this has to do with
the hypothalamic–pituitary–adrenal axis, the brain’s and body’s
stress response system that governs our fight-or-flight response. How does it work? Well, imagine you’re walking
in the forest and you see a bear. Immediately, your hypothalamus
sends a signal to your pituitary, which sends a signal
to your adrenal gland that says, “Release stress hormones!
Adrenaline! Cortisol!” And so your heart starts to pound, Your pupils dilate, your airways open up, and you are ready to either
fight that bear or run from the bear. And that is wonderful if you’re in a forest
and there’s a bear. (Laughter) But the problem is what happens
when the bear comes home every night, and this system is activated
over and over and over again, and it goes from being
adaptive, or life-saving, to maladaptive, or health-damaging. Children are especially sensitive
to this repeated stress activation, because their brains and bodies
are just developing. High doses of adversity not only affect
brain structure and function, they affect the developing immune system, developing hormonal systems, and even the way our DNA
is read and transcribed. So for me, this information
threw my old training out the window, because when we understand
the mechanism of a disease, when we know not only
which pathways are disrupted, but how, then as doctors, it is our job
to use this science for prevention and treatment. That’s what we do. So in San Francisco, we created
the Center for Youth Wellness to prevent, screen and heal the impacts
of ACEs and toxic stress. We started simply with routine screening
of every one of our kids at their regular physical, because I know that if my patient
has an ACE score of 4, she’s two and a half times as likely
to develop hepatitis or COPD, she’s four and half times as likely
to become depressed, and she’s 12 times as likely
to attempt to take her own life as my patient with zero ACEs. I know that when she’s in my exam room. For our patients who do screen positive, we have a multidisciplinary treatment team
that works to reduce the dose of adversity and treat symptoms using best practices,
including home visits, care coordination, mental health care, nutrition, holistic interventions, and yes,
medication when necessary. But we also educate parents
about the impacts of ACEs and toxic stress the same way you would for covering
electrical outlets, or lead poisoning, and we tailor the care
of our asthmatics and our diabetics in a way that recognizes that they may
need more aggressive treatment, given the changes to their hormonal
and immune systems. So the other thing that happens
when you understand this science is that you want to shout it
from the rooftops, because this isn’t just an issue
for kids in Bayview. I figured the minute
that everybody else heard about this, it would be routine screening,
multi-disciplinary treatment teams, and it would be a race to the most
effective clinical treatment protocols. Yeah. That did not happen. And that was a huge learning for me. What I had thought of as simply
best clinical practice I now understand to be a movement. In the words of Dr. Robert Block, the former President
of the American Academy of Pediatrics, “Adverse childhood experiences are the single greatest
unaddressed public health threat facing our nation today.” And for a lot of people,
that’s a terrifying prospect. The scope and scale of the problem
seems so large that it feels overwhelming to think about how we might approach it. But for me, that’s actually
where the hopes lies, because when we have the right framework, when we recognize this to be
a public health crisis, then we can begin to use the right
tool kit to come up with solutions. From tobacco to lead poisoning
to HIV/AIDS, the United States actually has
quite a strong track record with addressing public health problems, but replicating those successes
with ACEs and toxic stress is going to take determination
and commitment, and when I look at what
our nation’s response has been so far, I wonder, why haven’t we taken this more seriously? You know, at first I thought
that we marginalized the issue because it doesn’t apply to us. That’s an issue for those kids
in those neighborhoods. Which is weird, because the data
doesn’t bear that out. The original ACEs study
was done in a population that was 70 percent Caucasian, 70 percent college-educated. But then, the more I talked to folks, I’m beginning to think that maybe
I had it completely backwards. If I were to ask
how many people in this room grew up with a family member
who suffered from mental illness, I bet a few hands would go up. And then if I were to ask how many folks
had a parent who maybe drank too much, or who really believed that
if you spare the rod, you spoil the child, I bet a few more hands would go up. Even in this room, this is an issue
that touches many of us, and I am beginning to believe
that we marginalize the issue because it does apply to us. Maybe it’s easier to see
in other zip codes because we don’t want to look at it. We’d rather be sick. Fortunately, scientific advances
and, frankly, economic realities make that option less viable every day. The science is clear: Early adversity dramatically affects
health across a lifetime. Today, we are beginning to understand
how to interrupt the progression from early adversity
to disease and early death, and 30 years from now, the child who has a high ACE score and whose behavioral symptoms
go unrecognized, whose asthma management
is not connected, and who goes on to develop
high blood pressure and early heart disease or cancer will be just as anomalous
as a six-month mortality from HIV/AIDS. People will look at that situation
and say, “What the heck happened there?” This is treatable. This is beatable. The single most important thing
that we need today is the courage to look
this problem in the face and say, this is real
and this is all of us. I believe that we are the movement. Thank you. (Applause)

87 comments

Crazy, and my mother tells me to just get over the damage she caused me as a child when she was a severe drug addict cause it was “over 20 years ago”

This was amazing. How do we get everyone on the same page? I see this was posted in 2015, yet things are the same. Truly amazing and insightful but fear that most medical practice is about the bottom line and not the actual healing. Also, like she said, we need to look at ourselves but many will not. This science is definatly a move in the right direction for all of humanity and a true cure for a lot of societies ills. Keep pushing! This needs to happen!

It won't happen because the toxic stress is by design. They WANT to break kids in this way so that they can indoctrinate them and turn them into useful worker drones. Kids who aren't abused are more confident, more outspoken and more willing to challenge authority and society does not want that. The cruelty is the point. If anything, the society would see the adverse health effects of their own abuse as a feature as that would mean people would die earlier and so could be replaced with fresh units quicker.

Jesus all those are yes.
Also, I have been diagnosed with:
Tourette's syndrome
ODD
Dextroscoliosis
Fibromyalgia
Clinical depression
Polyarthritis
Hypermobility
Hypothyroidism
Pernicious anemia

I've thought for a while that it HAS to affect the physical along with everything else it does.

If you live this life and know people that have the same childhoods this is not news. It is only eye opening and an Ahha moment for those that have no knowledge or concern over the matter. This is why Holistic health and Eastern medicine is needed. High prays goes out to this very Astute Doctor for doing her research and connecting the dots for the rest of the world.

Bad parenting is a health crisis.
If you have stable, well adjusted, loving parents. You don't know how lucky you are…

Thank you for bringing awareness to this issue.

I made a video about my personal experience with complex PTSD: https://youtu.be/rusmspJx0Yk

I knew that I have alot of childhood trauma but I didn't think I would score 8 on the ACE's 🙁 I need fucking therapy now. Just made me realize how bad it really was.

ABSOLUTELY right on the money. So yes very true. Trauma or environmental trauma hurt kids when they become adults.. absolutely.

Many times in my childhood I suddenly without an eviction notice became homeless. Once by a fire with nothing but the clothes on my back I write about it in my memoir. As a child, it's a shock as an adult it's devastating. My Stars Are Still Shining I live with my pain of abuse.https://readersfavorite.com/book-review/my-stars-are-still-shining

Im from the philippines and beating ur kids here to instil discipline is cosidered 'normal". My dad's parents beat them, they did a very old school of parenting. My grandparents were good providers and loved their children, no question. My dad also used the same style of upbringing on us. He would beat us if we did something wromg. I grew up with fear of my dad. Also had anxiety and depression. A few years ago, i decided to take back my life and heal myself mentally and emotionally. I am a work in progress. Im 35 now, i love my dad but we are not close and we have zero connection. Ive realized now that my dad is still a child who was forced to grow up, get married and have kids at such an early age. He didnt have the chance to get to know himself and really heal himself from childhood trauma that he also passed on to us.

I really needed to watch this! my mother was not the best mom. I need serious therapy because of this mother of mines.

just took the test. i got an ace score of 5. ive been through depression all my life pretty much. and i really am trying so hard to get better.

This is such a huge issue. I’m glad she and others are looking to fix the problem form the source. We don’t need anymore bandaids.

Isn't it crazy how many of us had such terrible experiences in childhood? I'm reading all these comments and I'm thinking about how it would have been if we could have talked with each other in this moments of abusive behaviour. This would have meant the world to me. I always felt so lonely and no one could understand. With all these stories, I am feeling so sorry for all of us who had to deal with things a kid shouldn't be dealing with.
Love to all of you.

My ace score is an 8. I have preschool ptsd. I was diagnosed by a kaiser doctor when i was seven and eight for nightmare disorder and ptsd. I wasn’t told anything. Neither was my mother. They didn’t explain anything to us. Even now they dont warn us of this. I’m now 22 and went in for breast discoloration and pain and they write me off even knowing my past. I feel lied to. This study was known when i went in. And even now people aren’t making this commonplace knowledge.

THIS is a doctor. Most doctors, in my experience, treat the symptom not the problem. And what I love most about this is that schools, at least in my area, are educated on ACES and what we can do on an educational level, as well as childcare level (I know local YMCA and Boys&Girls clubs take this training as well), to help children. I love this, especially since my ACE score was/is higher than most people I know or am surrounded by.. It helps me help others though.

That was an amazing Ted talk. I believe its in every zip code and all races. It does not discriminate. You are an awesome woman doing great work. Thank you! ❤️

One of the best TED deliveries and subject matter I'd ever watched. Grateful the dislike number is under 1,000 but smh to the current 774 really???!!!

She just publicly outed why so many endure PTSD today. Poor parenting of children moves up to less resilient adults who then face societies 'systems' where injustice, cruelty, lack of basic understanding re-traumatises adults until brain function is so impaired, they cannot work.

Good. I just want to die anyways. Life isn't worth living. I would have a high ace score. No one helped me growing up. Even now. I can't help myself….

This young lady is so spot on. I had a traumatic and cruel childhood. Beaten and unloved by strangers. I grew into adulthood thinking I was not worthy of life itself. Every time I tried to achieve something for myself, I saw myself as a failure. However, I met my husband and he turned life around for me. Gradually, over the years I achieved success in my career along with improved health. I will take to the grave the years of abuse I suffered and the frustration knowing that my mind could have accomplished so much more from life had I had the love and security which, rightfully, should be every child’s right.

This just placed my heart in my stomach! God I wish this woman had been around in Central WI in 1990 when, at the age of 12 I had already lost two parents: my biological father to a motorcycle accident, and my step-dad/adopted father to health problems! When I then went on to be raised by a lower middle-class, single mother who worked full-time, who had a series of psychologically abusive boyfriends, who she probably only put up with because she was a lonely woman who'd lost 2 husbands, and was now trying to raise a teenager alone. I have always knew in my soul that these, among other childhood traumas have affected me my whole life, even to this day, as a 41 year old! I SO wish this woman had been around back then, and that somehow my mother had heard about her discoveries and was able to implement treatment for me! There are SO many things that would be different for me now! This TED Talk was both heart-wrenchingly dead-on, and affirming to what I knew in my soul was true!

Unfortunately enough, it’s not profitable for the medical industry to truly heal and help people. Only keep them dependent on costly prescriptions.

Wow this perception helps so much, knowledge is key for me to heal, i am now 30 years old and just now receiving help from a therapist , after being sexually abused by my father my entire childhood and them emotionally abused by my mother i have had to relearn everything my therapist suggested i write a book so I did and now that its out i feel relieved.

Sacrifice in Silence: Under a Blanket Full of Guilt (Angel Mari Book 1) https://www.amazon.com/dp/B07XFFN73R/ref=cm_sw_r_cp_api_i_DeNCDbCJJQ5YS

2019 “Respect and dignity.” Furthermore: (Monaco!!) 👀👀🔥🔥🇲🇨💯 • “human rights” 👀👀🔥🔥🇲🇨🇲🇨🇵🇱💯💯💯 • “Respect and dignity, 2019?”

A lot of these clinicians, doctors, counselors, teachers, parents are still dealing with there own trauma and don’t know how to help or , like she said, are overwhelmed.

She says there's a movement ….. I don't feel a movement.
Do you honestly think the situation is better? This is dated Feb 2015 it's not better in Sept 2019.

Very good analogy of the bear coming home every night. My father hit me often from the age of 9 to 16. Every time he was at home I had to walk on egg shells not to get him agitated since most of the time he was drunk anyway. 20 years later I suffer from anxiety and panic attacks. The good news is I broke the cycle of violence and I do not treat my kids the same way.

It took me a while to realize I experienced childhood trauma. I've struggled with variety of mental illnesses my entire life, all of which started showing themselves at a very young age. However, my parents are super strict, traditional Christians and absolutely refused to admit I had any problems. Whenever I acted out or told them I was struggling, they would punish me by either hitting me with a wooden spatula, making me sit with soap in my mouth for ten minutes, or lock me in their room for hours until I apologized for my behavior.
It didn't take me long to realize that showing any negative emotions or asking for help would mean I would be punished.
Now I'm 18 and still absolutely refuse to ask for help or to talk about my emotions. I've gone to therapy and lied the whole time just telling my therapist what she wanted to hear. It got to the point that I attempted suicide twice because I'd rather die than admit to anyone that I was suffering so badly.
My parents really ruined my life.

She's brilliant and spot on. I am 52 years old. Have turned my life around and working on being heeled from childhood and adult. Trauma. When she listed the childhood ACEs I checked off all but one.

I cried while listening. Big bald adult. Brought me back to my childhood with a bear attacking me every day. Anticipating him every night and shaking.
I never beat my kids like he did to me I thought it is the only thing I need to exclude. But I did tons of emotional damage to my family which I didn't realize until I ended up in a ditch on a freeway of life lying face down in a mud. I became a bear, vicious cycle.
I started recovery so I don't hurt anyone anymore.

It seems that if a child had an ACE score of just one but that experience – say, physical abuse – was frequent, of extreme severity and of a long enough duration, the percentages of likelihood of disease and suicide for that child could be just as high as those of a child with a higher ACE score.

when a child experience some wrong doings from people who was supposed to protect and care for him,
all of his world is turned upside down. it is so hard to trust, and feel comfortable around people again.

Incredible!!! Incredible incredible woman!!! And this got me in goosebumps in certain moments!!
That's exactly right!! It's in ALL OF US!! It's not just zip codes of poverty and problematic patterns. It's in the affluent too!!
This was such a moving and informative talk. I wish all health care would actually take this seriously and roll that across the world!! It should be common practice!!

This really hit home and made me think. I grew up with two (mentally and emotionally) abusive step parents and I struggle with depression and concentration. I never made the correlation.

I have the idea that many of these people come to suffer with self-esteem issues; as they never had the love and safety they have wished for. So even if you do grow into an adult, there is still lots of healing required. I do believe in neuro-plasticity, the ability of the brain to adapt to a more healthy environment. Magic mushrooms show much promise in this regard, please don't resort to these without doing any research though. Keep doing your best folks. Peace and love.

"Adverse childhood experiences are the single greatest undressed public health threat facing our nation today."

The 1st thing I thought of was all those poor kids being caged at the border and what will be the broader consequences of what has happened to them, both personally and socially?

But the bear that comes home has told.. nay, yelled at me and my brothers that she isn't the bear at all…

Guess im wrong then lol

doctors ARE trained to screen for childhood abuse or risk, so are teachers and police. i don’t understand why she’s doing a TED talk on someone else’s research. domestic violence and sexual abuse are huge issues, that is the block, discuss the positive interventions that reduce this kind of trauma so people believe kids can get better from this and you’ll see change. educate about the intervention not the problem.

I WAS ABUSED BY MY MOTHER SHE BEAT ME DAY AND NIGHT MY TEACHERS WERE A INSPIRATION TO ME THEY TOLD ME STAY IN SCHOOL,GET YOUR EDUCATION THATS SOMETHING NONE CAN TAKE AWAY ,I FINISHED SCHOOL WENT TO NURSING SCHOOL GOT MY DEGREE WHEN YOUR HELPING SOMEONE IT HELPS YOU HELP YOURSELF

The reason such things are not being addressed is because they are the most essential ingredient in social engineering; it's NO accident. An emotionally damaged/empty population is absolutely limited, susceptible to fear campaigns and materialism!

I think abusive parenting is a cycle and it is very painful to deal with for the parents. I mean, if you were beat as a punishment when you were a child, so you beat your child for punishment, how do you help those people? Also about mental illness. How do you help the ones you love the most but you know if you try to get them to see a counselor if they are your parent?? It's just not easy but its not their fault:(

Her work is being used in California and Oregon… not sure where else, but I believe it 100%. As a Naturopath, I have treated many adults with childhoods and teenage years with much trauma. My job is to prevent illness and help reverse illness that exists via mind, body and spirit. If can catch precursors to illness both mental and physical in the pediatric arena, health will improve dramatically. Of course I am not discounting a proper way of eating and exercise as extremely important. Also mindfulness meditation. I worked at CPMC at about the same time she was there. I wish I would have known about her work then. Share this video, because it is true.

So I’m an 8, and the other two were kind of but not really (like I saw my bio dad being taken away by police a lot but he was never imprisoned, which is one of my under 5 memories) so… what next? How can you combat this or develop resilience? As an adult what can I do to mitigate the effects?

I can't remember much about my abuse, and according to my mum, she stopped it instantly when I told her. So she could have totally saved me in so many ways. I have trust issues, abandonment issues, anxiety, and an attachment disorder. But it could have been worse.
This talk really shows how much our brains can effect our bodies. Our brains are our greatest ally, and our greatest enemy. It effects us so much.

This just makes me think. "What about the foster kids going in bad homes over and over?" They must be so at risk. Those poor, poor kids. Just solidifies my dream to foster kids and give them safe homes someday.

I grew up with parents that were always angry. I was too afraid to go to them for anything. Well, I should say I didn't know you could go to them for help. I didn't know they weren't going to hurt each other when they were yelling and screaming. I grew up disassociating with what was going on at home and school. I thought I was so dumb kid because I wouldn't know what the teacher was talking about after disassociating in school. Nobody saw this. I didn't know it until I was almost 50. I just thought I was so wrong and bad. I still have no one to turn to and my last counselor I suggested we find someone else because she doesn't have the time for me. She said this in a voicemail after I asked about getting afternoon appointments. And she'd already asked me if I really wanted to continue. What? So I thought she had information that would help me, that would help me feel grounded and whole. But instead all I feels abandoned. I just wish life was finished. 🙁

Having to migrate to the U.S.- a foreigner’s perspective of the U.S. is similar to that as living in a bubble. I grew up in a diverse neighborhood, and community. And can honestly say; not once was I exposed to the tragic history of the U.S.; but that is what public education does, shelter you from despicable acts. I’m grateful, and thankful to have been educated with the plight of African-Americans. It was a virtual reality game which I was exposed to, but it helped me understand and accept my roots like never before. Diversity is important, but so is knowing one’s history to level up the playing field. But next time, educate kinder. Remember that people don’t know what you know, or your thoughts unless you share.

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