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November 05, 2004

Adult troubles follow childhood woes

By Bill Bishop -- The Register-Guard

Within 10 minutes, Dr. Vincent Felitti notices the faces of adults in his audience change after he begins his lectures on research showing that adverse childhood experiences cause obesity, addiction and chronic diseases decades later.
Not everyone can handle the shock when they connect the dots in their own lives, he says.

"Some people flee the room," Felitti says. "Some have asthma attacks."

Felitti saw the reactions again Wednesday as he spoke in Eugene to hundreds of social workers and law enforcement officials at the 20th Western Regional Symposium on Child Abuse and Sexual Assault.

Felitti didn't go looking for the connections. It came up in his work with morbidly obese patients after he began researching why people dropped out of the weight-loss program at Kaiser Permanente's Department of Preventive Medicine in San Diego, where he works.

During a comprehensive survey of their individual histories, Felitti says, he was shocked to learn 55 percent had been sexually abused as children. He repeated the surveys with different interviewers, different patients, and got the same result.

It turned out that some patients clearly linked their weight gain to their sexual trauma. Some unconsciously used weight as a defense against being molested again.

"The thing that is posing as the problem is the solution to problems that are well-concealed," Felitti says.

Felitti's discovery grew into the Adverse Childhood Experiences study, the largest yet done on the links between adult diseases and adverse childhood experiences such as sexual abuse, losing a parent, or growing up around domestic violence.

The research, designed by the federal Centers for Disease Control, involved nearly 18,000 patients at the huge San Diego medical facility.

The study documented strong links between childhood trauma and heart disease, obesity, sexually transmitted disease, diabetes, depression, suicide attempts, alcoholism and intravenous drug use decades later, Felitti says. A book on the project is to be published next year.

"This plays out in everyday living on a pretty broad scale," Felitti says.

The simplest pattern to understand is adult smoking. But that leads to much bigger questions about addiction, generally.

The study found that the more abuse a child suffers, the higher the probability the person will be a heavy smoker as an adult. While smoking leads to many types of disease, the finding leads to medical questions that challenge the current understanding of addiction, Felitti says.

Smokers are self-medicating with nicotine, which is an antidepressant and anti-anxiety drug. Other patients self-medicate with street drugs, such as methamphetamine, which is in a family of drugs first marketed in the 1930s to fight depression, Felitti says.

"This is more important than you think at first, because of the implications," he says.

Felitti argues that depression is a normal response to abnormal life experiences. The belief that depression is caused by neurochemical imbalance focuses on chemistry as opposed to the cause, he says.

In another example, Felitti compares brain scans from a normal 3-year-old and a 3-year-old in an orphanage. The scans show vastly less brain activity in the orphan, suggesting that the child's life experience is impairing its brain development, Felitti says.

How the research may eventually affect medical treatment is a major unanswered question, Felitti says.

However, the research has been used on 400,000 adults over the past eight years in the San Diego center's weight loss clinic. The key is helping patients recognize the underlying reasons they seek comfort in overeating - and addressing those issues to change the behavior, Felitti says.

"The person may be very, very resistive," he says.

When the research is considered for treating other major diseases, it clearly points to the need for parent education programs that explain normal child development and encourage supportive parenting, he says. Prevention is the best medicine, he says.

"There is no undoing this. There is no way of bringing them back good-as-new," Felitti says. "Not a chance."

THE ACE STUDY:

In the largest study of its kind, the Adverse Childhood Experiences study found that eight specific types of abuse and family dysfunction occurring during childhood disrupt social, emotional and intellectual development. The experience causes people to adopt unhealthy lifestyles that, decades later, lead to chronic disease and early death. The study carries potentially big implications for changes in medical treatment and disease prevention.

Abuse: Defined as recurrent physical or emotional abuse by a parent, or sexual abuse by anyone.

Family dysfunction: Defined as growing up in a household where someone was in prison; where the mother was treated violently; with a family member who was an alcoholic or drug user; where someone was chronically depressed, mentally ill or suicidal; where a parent was lost for any reason during childhood.

Prevalence: Each of the abuse and dysfunction factors counts as one. The higher the score, the greater the risk for serious adult health problems. Forty-eight percent of people have an ACE score of zero, 25 percent score 1, 13 percent score 2, 7 percent score 3, and 7 percent score 4 or more.

Information: On the Web at www.acestudy.org

Posted by Nealus at November 5, 2004 12:04 PM

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