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

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)

100 thoughts on “How childhood trauma affects health across a lifetime | Nadine Burke Harris

  1. A big part of this issue is that a LOT of parents are abusive, whether they intend to be or not. Most standard forms of parenting involve multiple abusive elements. Some of us even become abusers ourselves after the abuse we experienced is long gone. Abusive people don't want to look themselves in the eye and admit that they've done what they have. Instead, they passively form this network of people who turn a blind eye to abuse to protect themselves from consequences. Doctors are not exempt from this. Nobody is. Anybody could be an abusive parent or family member who is afraid to admit it, and for that reason they won't sanction any change that draws attention to that fact.

  2. My bears were at home at school at my grandparents in the foster homes….even… relationships and parents of those people… Ive had maybe a total of 3 years of my life… without a "bear" this last year being one of those… Id like to at least make it to 70…but I can't get treatment… I've tried and tried ..but im in WV and im basically invisible… My support is 4 people and only one is actually capable of support the rest…too young or disabled. I feel like im here treating myself…my own dr and therapist…i am getting better but at a painful slow crawl cus…being broken and abused and uneducated how do you treat yourself? Sometimes i fantasize that someone like this women would hear me ..and I'd get help…tbh. i dont want to die…and i do fear for my life because of my mental health issues. Very lonely feeling.

  3. Just hearing about the bear analogy caused me to cry. Years of childhood trauma creates scars that don't seem to go away. My believe in God and healthy relationships have saved me from involving myself in any unhealthy coping skills.

  4. And this isn't just an issue for children! It's a WAKE UP PARENTS…and a note to adults to GET THEIR STUFF TOGETHER and heal, themselves. Stop the cycle.

  5. I knew there will be a connection somewhere, between childhood trauma and health, physical medical health not just mental health. Thanks for this. Confirmation. Lets all keep working for the betterment of the future generations. This is one of the best TED talk I've seen. Well done Doctor, real good job. Wishing you more strength.

  6. Wait the medical world dosen't want to use the study… Mental well being is directly linked to physical well being. Wouldn't it make it easier for them to keep this on fill. Oh wait, right. If you salve the issue they stop coming back, then you don't have anyone to push pills on. Oh capitalism, is that you in there? Seems every time a logical idea that would better the world gets put on the table you shoot it down likely for the all mighty dollar. We know you're in their capitalism! Now you come outta there, or We're coming in after you.

  7. Her use of "substance dependence " jumped out and slapped me across the face in the best way possible. Language is powerful and i feel like people don't see it much

  8. At 14, I sued my parents, divorced them, and went into foster care. Today, I'm well adjusted, and VERY healthy. I've even had wonderful, long-term romantic relationships. However, do NOT mention the "M" word (marriage). I immediately feel fear, suffocation and a need to BOLT right through the closed front door. PTSD? Untreated, I'm now 56, no children and I've never been married. Still running.

  9. Agreed, parenting classes should be a big part of the prenatal care. I hate how the system adopts a, wait and see, attitude towards child abuse. In other words the integrity of the child must already be compromised before action is taken to protect them. We could do a whole lot better than that.

  10. I think my isolation is from abuse. Or adhd. Or maybe i do not have adhd as u say. My depression and suicidal actions during the old me probably from abuse.

  11. How can we move forward in addressing the current public health crisis of gun violence within the lens of ACEs and mental illness?

  12. I watched this with a lump in my throat and tears in my eyes. I’m 40 and have spent my entire adult life recovering from childhood. I’ve also spent over a decade doing everything in my power to become a person capable of parenting my own kids in ways that mean they don’t. My eldest daughter is autistic, and my biggest concern is the amount of stress she can add to a situation when there is very little stress actually there.

  13. We live in a world I call JerrySpringerville. This one television show has normalized aberrant behavior and made outrageous behavior look cool. THIS IS NOT NORMAL! What is worst is generational bad behavior in "ADULTS" which continue the problems.

  14. There may not be a ‘bear in the woods’ anymore for most people’s lives but there are ‘pedos on the web’ and ‘psychopaths near you’.
    Maybe mental illness is a side effect of trying to fight an increasingly abstract and adulterated concept of danger. Maybe it’s important to retain some of the biological pathways if it retains its potency. Maybe society should try and trigger it more but in particular, relevant way?
    The trouble I have with science is the part where it’s interpreted as if it’s absolute truth. It’s always been filtered through a lens of an observer, cultured in a certain paradigm and carried by a zeitgeist.

  15. The adults,make the children the problem do to behavior of being fed up with the real problems created by the caretakers

  16. I'm facing this now,iv been so sick,iv fought hard just to not commit suicide ,but by the grace of God and alot study isolation from abusers I'm getting better.applying real solution to the right problems does wonders .drugs and alcohol are a simptom usually later stage of disfuntion it is not the cause but the wrong coping skills but now this video is much more stable for reality

  17. I am glad I clicked on this Video!
    This absolutely make sense.
    I will pay more attention.
    I was raised by physically, emotionally amd mentally abusive single mother may her Soul Rest in Peace!
    I am sure if she knew it will affect negatively,she would have raised differently.
    I will keep trying to better myself and definitely will rais my daughter differently!!!

  18. Really love this, even shared it on my social. Everyone should watch this ♡ I was diagnosed with bpd,depresdion and anxciety cause of my abusive childhood. I was seeking help when I got pregnant and learned EVERYTHING about this topic, and now I think Im actually a really good parent ♡ blessed with a beautiful kid that always get love, answears and safety.I never though I would live and even get the chance to be a parent ♡ My EQ is superhigh thanks to all of this selfhelp

  19. So imagine the legacy of the transatlantic slave trade on the victims and their descendants? The results of past trauma seems to now be embedded in black people's DNA make up, more than in any other race. The book Post Traumatic Slave Syndrome is a must have in understanding past trauma experienced by black people. Dr Joy DeGruy, the author has captured those issues and countless other issues for Black people in her well researched book. The solution to trauma is not through medication but in fact can be a three fold approach; change the person, change the situation or do both.

  20. What she says is right.i was sexually abused from i was 3 til i was 14yrs old by my grandfather.and now i have had 5 cardiac arrests,the first time i was clinically dead for 16minutes,ended up in a coma in the hospital,thank Allah i was visiting my mother the first time it happened,if not i would be dead now.i had heart surgery and now i have an ICD and a pacemaker(2in one)and the ICD have saved my life the other 4 times my heart have stopped,shokran Allah!!!i dont wish this situation on anybody,its like you are just walking around waiting for the next time it will stop,and what if the ICD doesnt work next time?

  21. It's weak up time this video shows a way of life we need to change
    For ower children and their children. Information we need to fallow. There's a big problem it's up to us to fix it you and I are living with this delay

  22. 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”

  23. 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!

  24. 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.

  25. Jesus all those are yes.
    Also, I have been diagnosed with:
    Tourette's syndrome
    Clinical depression
    Pernicious anemia

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

  26. 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.

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

  28. Thank you for bringing awareness to this issue.

    I made a video about my personal experience with complex PTSD:

  29. 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.

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

  31. 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.

  32. 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.

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

  34. 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.

  35. 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.

  36. 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.

  37. 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.

  38. 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.

  39. 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! ❤️

  40. 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???!!!

  41. 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.

  42. 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….

  43. 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.

  44. 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!

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

  46. 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)

  47. 2019 “Respect and dignity.” Furthermore: (Monaco!!) 👀👀🔥🔥🇲🇨💯 • “human rights” 👀👀🔥🔥🇲🇨🇲🇨🇵🇱💯💯💯 • “Respect and dignity, 2019?”

  48. 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.

  49. 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.

  50. 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.

  51. 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.

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