When trying to make sense of their brain symptoms or psychiatric diagnosis, many, will make the distinction between their experiences (what happened to them) and their physiology. They may point to a stressful childhood or to physiologic root causes, including genetics.
In this episode, I’ll talk about why our early experiences (adverse and positive) and our physiology and biochemistry are inseparable. This is important to highlight, because if we’ve had difficult or traumatic childhood experiences that are impacting our biochemistry, addressing such downstream effects can more easily set us on a path to healing. Similarly, if we focus only on the biochemical and forget our lived experience, our healing can be limited. I was going to say our healing can be incomplete, but I don’t think healing is ever complete and being in relentless pursuit of completeness is in opposition to healing. What our bodies and minds are really after is a sense of safety and belonging.
In this episode, I discuss:
The research into Adverse Childhood Events (ACEs) and health outcomes (at a population level)
How early adversity can impact our physiology, biochemistry and thus neurotransmitter functioning
Why ACEs scores are less meaningful at an individual level
The role of Positive Childhood Experiences (PCEs) on mitigating the effects of adversity in childhood
The gift of neuroplasticity and resources to help teach/train/rewire our nervous system to feel safe.
Adverse Childhood Experiences (ACEs) & Risk of Later Mental & Physical Conditions
Using ACEs or Adverse Childhood Experiences scores, researchers have attempted to measure the health outcomes for those with especially challenging and potentially traumatic childhood experiences. This research is meaningful for large populations to help identify trends, gauge prevalence and guide public health strategies.
Four or more Adverse Childhood Experiences is often the threshold used in research to assess the risk for later mental and physical health issues.
ACEs scores are not used to make determinations about an individual. I wouldn’t, for example, do an ACE score for someone I’m seeing and then believe that I can predict their future health outcomes.
We each have our own story, our own potential for resilience, and our own positive experiences. We also have our own genetic factors impacting our stress tolerance.
Adverse Childhood Experiences include:
Abuse- emotional, physical, sexual
Neglect - emotional, physical
Household - substances use, mental illness, suicidal thinking or behavior, divorce or separation, incarceration, domestic violence
Other - bullying, systemic racism (an often overlooked trauma), community violence, exposure to war, natural disaster, witnessing an act of terrorism, poverty (I would add: loss of a parent, parent with a serious illness, serious childhood illness and medical trauma)
When Childhood Adversity is Less Obvious
While we don’t necessarily need to go hunting down adversity and trauma in our childhoods if it is not there, there are some who describe events from their childhood that appear to have been extremely stressful and that would not be picked up on ACEs scores. They unknowingly describe covert abuse and emotional neglect, often from an emotionally immature and narcissistic parent(s), though they don’t recognize those experiences as abuse or neglect. Examples would be:
Gaslighting - a parent denying a child’s reality
Minimizing - dismissing a child’s feelings
Backhanded compliments - ”joking” insults
Withholding affection - refusing to communicate or give physical affection
“Guilt trips” - shifting the focus onto the parent’s emotional needs as opposed to the child’s
It’s like smoke. The abuse is there, but the child can’t put their finger on it. They can’t grab it and know that it is wrong. Even as adults, they may not recognize what they endured until they have opportunities to observe or be in healthier relationships or experience a trusting therapeutic relationship. Many, however, will gravitate to partners who are like their abusive parent. We know what we know, and we can’t know what we don’t know.
Adverse Childhood Events and Health Outcomes
The more the ACEs,...
The greater the risk of chronic health conditions, such as heart disease, diabetes and cancer
The greater the risk of depression, anxiety, and suicidality. One study found that those with 4+ ACEs were 8 times more likely to have a mental health condition compared to those with none.
The greater the likelihood of “health risk behaviors” - smoking, alcohol and drug use, decreased physical activity. It has been estimated that ACEs account for roughly two-thirds of serious drug use cases.
The greater the potential for poorer social outcomes - decrease in education, missed work and underemployment
How Early Stress Impacts Our Physiology & Biochemistry
I’ve talked about this in detail in previous newsletters, but here I hope to connect some of those dots more generally. Though I separate the areas below, they are constantly interacting and influencing one another.
Neurophysiology - In our first three years, our autonomic nervous system, our limbic system and even our hemispheric (think right brain-left brain) differentiation are being wired in ways to promote our survival. If we were neglected, pathways around self-reliance may have been reinforced. If we were abused, pathways around freezing, dissociating, or checking out may have been reinforced (as opposed to our fighting or fleeing, which could have caused us more harm). If we had emotionally immature parents, we may have learned at an early age that our well-being depended on staying tuned into their needs, instead of our own. Repeated experiences reinforce neuronal pathways. It’s how we learn to ride a bike. It’s also how we learn to survive as young children when our safety was dependent on proximity to our caregivers (independent of how healthy they were).
Psychological, Cognitive & Emotional - Our early experiences shape our beliefs about ourselves, others, the future and the world. Thoughts that we are unworthy, that others are threatening, that the future is bleak and the world is unsafe lead to further physiologic stress. Our emotional expression and reactivity is also shaped by early life. To get our needs met, we may have learned to bury our emotions or to amplify them. What worked then may not now.
Hormonal Pathways - If we’ve had early trauma or early attachment disruption or a lack of a good enough attachment experience, we can be in a chronic state of physiologic stress. Our HPA axis may have been chronically activated, leading to higher cortisol (which can impact some of that early wiring I referenced). Higher cortisol results in higher catecholamines (dopamine and norepinephrine) and higher blood sugar that feeds problematic microbes. This impact on the diversity of our microbiome can contribute to inflammation and problems with our metabolism. Many people struggle with their weight because of chronic stress from early life.
Stress Neurotransmitters - Catecholamines will increase, specifically dopamine and norepinephrine (think adrenaline). These can contribute to symptoms like anxiety, insomnia, and restlessness and more.
Inflammation - Chronic and persistent stress drives inflammation. Our immune system is activated to prepare to address injury. Childhood adversity even impacts the expression of genes for certain cytokines (inflammatory mediators). One study found a link between childhood adversity and a decrease in methylation at a particular gene, resulting in high IL-6 levels. This cytokine has been found to amplify the risk of irritable bowel disease (IBD), asthma, lupus, diabetic kidney disease, atherosclerosis and hypertension. Our brain can become inflamed as well. Chronic brain inflammation leads to neurodegeneration.
Oxidative Stress impacts nutrient levels that impact neurotransmitters. Chronic stress can result in a depletion of antioxidants, including zinc, a big player when it comes to neurotransmitter functioning and brain-related symptoms. Zinc also has an important role in supporting the immune system (and preventing inflammation). Signs of oxidative stress include
Copper zinc imbalances - When copper is relatively high compared to zinc, we can have problems with inattention, hyperactivity, and insomnia.
Increased Pyroles. Pyrroles increase when we are under stress and if we’re in chronic stress, they can be chronically high. High pyroles cause a depletion in zinc and B6, (needed to make neurotransmitters like serotonin, dopamine, norepinephrine and GABA). Because of this, pyrrole disorder can include a wide range of brain-related symptoms.
Methylation can even be impacted by early trauma and attachment disruption. Methylation can impact the expression of ma genes that we may otherwise never hear from (such as the one that relates to IL-6 that I referenced)
Though you won’t hear about the referenced biochemical “downstream” effects (high pyroles, copper zinc and methylation imbalances) in ACEs research, they’re important because they can be addressed using targeted nutrient protocols and make it much easier for someone to regain or learn for the first time, what it means to feel safe and what it means to think clearly, so they can do the very things in their life that promote health and wellbeing.
Experience Treating Children With Severe Early Trauma
Prior to becoming a holistic and functional psychiatrist, my psychiatric practice specialized in treating children who had early trauma and attachment disruption. Most of the children were adopted from international orphanages or the foster care system.
After training with the Walsh Research Institute, I started to address nutrient imbalances, things like pyrrole disorder, copper zinc imbalances and methylation imbalances in these children who were considered the most difficult to treat. I was surprised when most had quick and positive responses, as others would (who seemed to have more “genetic loading” to their brain symptoms). Their ability to engage in attachment-based therapies improved significantly.
This experience dramatically shifted the way I thought about mental health and again drives home the point that we can’t separate out our experience from our biochemistry.
What About Positive Childhood Experiences?
As I mentioned, ACEs scores don’t tell us much about outcomes for a given individual, in part, because they don’t account for the positive childhood experiences that appear to mitigate some of the effects of early adversity.
The Positive (Adaptive) Childhood Experiences study looked at almost 6200 individuals with 4 or more ACEs and looked at the effect of having positive childhood experiences. The results were encouraging. Those who had only 0-2 PCE’s had a 60% risk of depression or poorer mental health, while those with 6-7 PCE’s, had a 20% risk of depression or poorer mental health.
What types of positive childhood experiences were reported? And, how can we help provide them?
Relational
Felt able to talk to family about feelings
Felt family stood by them in difficult times
At last 2 non-parent adults who took an interest in them
Felt safe and protected by an adult in their home
Community
Enjoyed participating in community traditions
Engagement & Belonging
Felt a sense of belonging in high school
Felt supported by friends
Just as ACEs can impact physiology, so can PCEs. Positive experiences would reinforce neuronal pathways around a sense of security, safety, resilience and belonging. Any of them could lower the stress response and thus lower inflammation, oxidative stress and the likelihood of secondary neurotransmitter dysfunction.
Tools for Healing
While such neuroplastic changes happen in the context of healthy relationships, it’s important to remember that we also have a relationship with ourselves. We ultimately become our own caregiver and are tasked with providing our own sense of safety.
As adults, we have access to many tools, including psychotherapy, limbic system retraining, vagal nerve interventions and being intentional about tapping into our “right brain.” Because someone took my episode on tapping into the right brain and made a Cliff Notes version, I’ll share it here: “simplify - gratitude list - letting go - mindfulness - notice others as part of the same humanity - be embodied notice your breathing - sing, dance, stretch, move - exercise to be in your body - be in nature - do something spontaneous- create - shift your thoughts to do for a higher good ask the universe to use you
Are Some of Us More Vulnerable to the Same Trauma?
Aside from differences in Positive Emotional Experiences, we can also differ in our genetic vulnerability to the impacts of trauma and stress. Two people with the same ACEs and PCEs can still have very different outcomes. One may go on to have health challenges, mental health issues, substance use, and underemployment over their lifespan, while the other thrives.
Arguably, some of us come into the world already “wired for danger,” to borrow a phrase from Dr. Sharron Meglathery, MD whose RCCX theory I look forward to discussing further. Some of us already have an sensitized or even enlarged amygdala (for genetic reasons, as opposed to early life stress hormones impacting the amygdala). And that enlarged amygdala could contribute to an exaggerated sense of threat, which trauma would only further amplify. In a future episode, I’ll discuss genetic factors that appear to contribute to this “wired for danger,” high sensitivity, and increased vulnerability to the effects of trauma.
We Can All Play a Role in Positive Experiences
There have been many movies illustrating the power of having a positive adult, community or peer group on the life of a child who has experienced a great deal of adversity
Good Will Hunting was the first to come to my mind. After my daughter’s insistence, I recently watched “Crip Camp: A Disability Revolution.” This documentary chronicles how a 1970s summer camp for teenagers with disabilities (put on by a group of “hippies”) led to a community that became activists leading the way to the passage of the Americans with Disabilities Act. The camp not only changed the life of those who went to the camp, it ended up changing the world.
I’d love to know what story or even experience you think of when you consider the power of positive childhood experiences. And, as always, I welcome any other comments and questions.
Until next time,
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Medical Disclaimer:
This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having.
