Childhood adversity ‘gets under the skin’ As Nadine Burke-Harris puts it, as our biography becomes our biology. Early adversity alters a child’s developmental trajectory, triggering chronic inflammation and hormonal changes that can last a lifetime. It can alter how DNA is read and how cells replicate, create a vulnerability to many different diseases, both physical and mental. Many people ‘overcome’ early adversity and create successful lives only to develop lung cancer, stroke, heart disease or depression with little understanding of where these diseases came from.

If you have the right amount of each hormone, they all work together and the body functions normally. But if you change this delicate balance the system can begin to encounter problems. Maintain homeostasis is central to survival. Cortisol is released when the body senses a change in the environment that might throw it out of balance.

Dr. Vincent Felitti was running an obesity clinic in San Diego in the mid-1980’s. a strange thing was happening: The drop-out rate was highest amongst those who were most successfully losing weight. Just when they were close to reaching their goals, they would drop out permanently or return in a few months. Felitti and his colleagues could not understand what was going on.

He asked one of these successful patients what she thought might be happening here. The patient reported that she had started putting the weight back on after an older man in work had started flirting with her. It emerged that this patient had a history of incest at the hands of her grandfather. This began when she was 10, the same age at which she first began to put on weight. Felitti realised that the weight was an attempt to protect herself from the recurrence of this trauma. The weight gain was not the problem, but a solution to the problem of unwanted sexual attention. The same patterns showed up with other patients: Obesity was linked with abuse. Felitti found the same pattern with 186 patients. He got colleagues to screen their obese patients for abuse and they came back with the same results. This led to the landmark ACE study.

In the 1998 ACE study childhood adversity was broken down into ten categories: Emotional, physical and sexual abuse; physical and emotional neglect; substance abuse and mental illness in the household; the mother treated violently; Divorce or parental separation; criminal behaviour in the household. Each category counted for one point. The study was carried out with 17,000 largely middle-class people from San Diego.

It was discovered that 67% of the population had experienced at least one category of ACE. 12.6% had four or more categories. There was also a dose-response relationship between ACE’s and poor health outcomes. The higher your ACE score the greater the risk to your health.