ACEs: What do we make of the hand we’re dealt?

What are ACEs?

The ACE (Adverse Childhood Experience) Study was once called “the most important public health study you’ve never heard of.” But by now, you may have heard of it, seen a movie about it, or seen an ACE questionnaire in your intake paperwork at your doctor’s office. That’s because ACEs are increasingly part of how we understand our health and our world. Learning more about how ACEs specifically impact trans survivors of sexual violence can offer us insight into our minds, bodies, and experiences and the connections forged between them. These are connections that we did not always have control over, but that, with knowledge, we may begin to reclaim.

The ACE study was led by Kaiser Permanente and later the Centers for Disease Control and Prevention (CDC).  It studied an initial 17,000 people (and more in the years that followed) and examined links between ACEs and adults’ health. This data showed unambiguously that adverse childhood experiences have a profound impact on lifelong health.

In fact, ten types of traumatic experiences (including sexual abuse) are linked to many of the leading causes of death such as heart disease, addiction, and suicide. Further, the more types of ACES someone has experienced (represented by their “ACE score” between 0 and 10), the greater their chances of disease and other negative health outcomes.

How do ACEs Work?

That link between trauma and health is formed in two ways:

• As pediatrician Dr. Nadine Burke Harris explained on “This American Life,” toxic stress directly prevents the body and brain from fully functioning:

“If…you’re walking through the forest and you see a bear… your body releases a ton of adrenaline…which is your short-term stress hormone, and something else called cortisol, which tends to be more of a long-term stress hormone.”

These stress hormones impede the body’s regular systems from functioning—your immune system, your digestive system, etc., because your body is prioritizing survival. “And,” continued Burke, “the other thing that it does– it kind of shuts off the thinking portion of your brain, that executive function cognitive part…And that’s really good if you’re in a forest and there’s a bear. The problem is when that bear comes home from the bar every night.”

For trans survivors of childhood sexual abuse, the “bear” who committed violence against them may have lived in their home, their neighborhood, or their school.  Over time, as the body redirects energy away from vital organs and functioning, and toward the stress response and survival, body systems are worn down and just don’t function as well, leading to disease.

• The other way ACEs lead to poor health outcomes is through the coping skills we use to make the pain of trauma more tolerable: behaviors like smoking, drinking, using drugs, having unprotected sex, and playing dangerous sports.

While these behaviors are often vilified, they have also given gifts to those who use them, gifts like comfort and survival.

“Public health experts, social service workers, educators, therapists and policy makers commonly regard addiction as a problem. Some, however, are beginning to grasp that turning to drugs is a normal response to serious childhood trauma, and that telling people who smoke or overeat or overwork that these are bad for them and that they should stop doesn’t register when those approaches provide a temporary, but gratifying solution.” –Jane Steven

Trans People & ACE Scores

Just this past year, there was some groundbreaking research on the ACE scores of transgender people in particular.  It found that trans people have higher ACE scores than their non-trans counterparts. Specifically, the research found high rates of childhood emotional abuse, physical neglect, and emotional neglect among trans folks; these elevated rates explained 17.6% of the difference in mental health between trans and non-trans people.

We often refer to violence when we talk about trauma and abuse, but this finding (and the ACE studies in general) show that trauma is not always violent, and that yelling at, isolating, or neglecting a child can be just as harmful to the brain and body as physical or sexual abuse. The research demonstrates that trans people, often targeted in childhood—likely for their gender nonconformity or its primitive beginnings—bear the pain of these forms of abuse and bullying because of harmful social norms around gender-conformity.

Trans survivors may also experience the trauma of sexual violence at some point(s) in their lives.  As these violent and verbal traumas compound, “the body remembers” and the impact adds up.

Is There an Antidote?

Folks who work in fields related to trauma tend to think of resilience, or the ability to bounce back and recover, as the counterpart to trauma. According to the blog, ACEs Too High, “resilience research shows that the appropriate integration of resilience factors — such as asking for help, developing trusting relationships, forming a positive attitude, listening to feelings — can help people [with high ACE scores] improve their lives.”

An adult survivor of trauma may have had resilience factors such as supportive social networks in childhood, while the abuse was taking place, or they may have them now in adulthood, aiding them in living well in spite of trauma. [At the bottom of this page is a quiz on resilience.]

But resilience is complicated. It is not a neat calculation, a scale to weigh how much pain and how much privilege someone was afforded.

As Christine Cissy White wrote, “Many see resilience as a possible antidote to the avalanche of adversity in the world. However, many trauma survivors, with experiences that are often minimized, marginalized or medicalized, are often frustrated by what seems like excessive funding for or fascination with resilience. It can seem as though resilience and protective factors can get overemphasized while the prevention and treatment of ACEs ends up sidelined – as though human suffering might be optional if it’s served up with enough resilience.”

Trans people in particular are often living with trauma that targeted them because they are trans—in other words, because of social norms that absolutely need to change, and you have a right to be angry about that. The trauma of our nation and our world doesn’t end simply by shoring ourselves up with resilience on an individual level.

And yet, in survivors’ own lives, it can be helpful to remember their strengths and just how powerful they are.

Trans people also have sources of resiliency specific to our communities, like strong community and chosen family, help-seeking, and introspection that allowed us to recognize our gender. These are virtually unstudied by researchers, but they are real—our own special kind of magic.

What is most important to note is that even now, resilience can be developed and deepened. Our minds and bodies are flexible and there is much to claim and reclaim even decades after trauma.

What to do with this Information?

You can calculate your own ACE score here.

Sometimes learning about ACEs can feel heavy (particularly if there’s a high ACE score to discover), as if one is suddenly bearing the weight of their traumas on their back, or in their body. But this discovery can also allow recognition of other truths:

• The most critical take-away is that if you are suffering with addiction or illness, mental or physical, it is not your fault. You are not to blame for the trauma that set these physical processes in motion. Often, survivors have been told their whole lives that it is all their fault: their executive dysfunction, their poor grades, their “bad” habits, their diseases, and even their traumas themselves. Part of healing is undoing that conditioning and recognizing our blamelessness and our drive to survive and cope.
• In the face of dangerous coping tools that have nonetheless allowed you to survive, harm reduction is a valid, acceptable, and loving way to manage in the wake of trauma.
• Although brains have been shaped by trauma, they can also be reshaped by healing. For some trans survivors, coming out and naming their identity is a part of that healing process and an act of reclamation. Our free online trans survivor guide, which discusses ACEs, may also be a helpful part of your journey. Our other resources are listed here.

Research has shown that writing, mindfulness, yoga, and specific forms of therapy can help with recovery from trauma.

But this journey is individual. What guides and enlivens you? ACEs can be one part of the process of finding the resources that help you feel more whole and free.