The Whole View, Season 3 Ep 27: Understanding ACE Trauma w/ Sarah Marikos

Welcome Sarah Marikos to the Whole View! This week, Stacy and Sarah dive into ACEs, or Adverse Childhood Experiences, the science behind them, and how they increase our understanding of social justice and mental health, both in children and adults. Sarah gives listeners an inside look into how ACE trauma works, what goes into ACE scores, and how they can help us better understand ourselves and our loved ones. 

Find Sarah: 

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Key Takeaways


  • Stacy was introduced to ACE, Adverse Childhood Experiences, through training to be a treatment care foster resource parent. Generally, it’s more widely known after the last few years of social justice awakening and mental health. While she still applies her training on a daily basis at home, Stacy has come to understand its impact much more broadly.
  • If we don’t understand how trauma impacts children for their entire lives, we can’t do all the things science tells us that we can do to prevent ACEs or childhood trauma or what we know we can do to support children and families who’ve experienced it.
  • “ACE” is the scientific name for 10 factors of toxic-stress, producing really bad outcomes for kids and can impact us for our entire lives. For example, when one experiences four or more categories of childhood exposure, compared to those who had experienced none, they:
    • had 4-12 times the increased health risks for alcoholism, drug abuse, depression, and suicide attempt; 
    • a 2- to 4-fold increase in smoking, 
    • poor self-rated health, 
    • ≥50 sexual intercourse partners, and subsequent sexually transmitted disease; and 
    • a 1.4- to 1.6-fold increase in physical inactivity and severe obesity. 
  • The number of categories of adverse childhood exposures has a graded relationship to the presence of adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease. This compounds, and we recognize stress as the greatest impact on our health.
  • Furthermore, ACEs add stressors without a means for most young people to learn healthy coping skills. Consequently, maladaptive behaviors causing isolation, self harm, binge eating, etc. can result in adult findings.

ACE Trauma & What It Can Teach US

  • As trauma increases, the relationship of adult risks in including disease also increase. Additionally, emotional struggles increase, leading to a higher likelihood of self harm, suicidality, and disordered eating.
  • Autoimmune diseases are specifically linked to childhood trauma. Moreover, science has shown if we have an autoimmune disease and a high ACE score, we have exposed our body to a lot of different types of stress.
  • Generally, all of this compounds and creates physical and emotional trauma. If we don’t address or work through the trauma, these adverse childhood events it carries forward into subsequent generations and compounds into generational trauma.
  • Sarah has seen this in the foster care system, different parts of her own life, making it much more difficult to navigate in adulthood.

Understanding ACE Trauma

Firstly, The term ACEs comes from a landmark Kaiser Permanente-CDC study from 1997. It looked at ten types of stressful or traumatic events that fall into three categories:

  • Abuse
    • Physical abuse
    • Emotional abuse
    • Sexual abuse
  • Neglect
    • Physical neglect
    • Emotional neglect
  • Household challenges
    • Household member with mental illness
    • Witnessing domestic violence
    • Household member with substance abuse
    • Incarcerated household member
    • Divorce or separation of parents
  • In fact, they are so common that 2 out of 3 of us have at least one. Risk factors begin at one and become higher with the more traumatic experiences a child faces before the age of 18.
  • Altogether, millions of us have experienced discrimination, poverty, and racism as kids, and these experiences can have similar impacts as ACEs. Additionally, other common childhood adversities beyond the ten ACEs in the original study include the following.
    • Discrimination based on race, ethnicity, gender identity or sexual orientation (such as LGBTQ+), religion, learning differences, or disabilities
    • Poverty
    • Racism, systemic and institutional
    • Other violence, like getting bullied, experiencing violence yourself, or seeing others get hurt in your neighborhood, community or school
    • Intergenerational and cultural trauma, like the displacement and genocide of indigenous people, slavery, and the Holocaust
    • Separation from a parent or caregiver because of immigration or foster care
    • Other big changes in life, like migration or immigration, being a refugee or seeking asylum, moving to a new area where you don’t know anyone, or separation from someone important to you
    • Bereavement and survivorship, like having a relative or caregiver die, or surviving an illness, injury or accident, or natural disaster
    • Adult responsibilities as a child, like caring for someone who’s sick or disabled, or being the one responsible for getting food on the table at a young age

Topics discussed

  • The landmark Kaiser Permanente-CDC study assessed around ten thousand adults and studied 7 categories of  Adverse Childhood Experiences: psychological, physical, or sexual abuse; violence against mother; or living with household members who were substance abusers, mentally ill or suicidal, or ever imprisoned. 
  • The number of categories of these adverse childhood experiences was then compared to measures of adult risk behavior, health status, and disease. The results showed that more than half of respondents reported at least one, and one-fourth reported ≥2 categories of childhood exposures. We found a graded relationship between the number of categories of childhood exposure and each of the adult health risk behaviors and diseases that were studied. [source
  • Additionally, a study from 2012 looked at the follow-up results of the original study in 2005. They looked at the total number of ACEs used as a measure of cumulative childhood stress for hospitalizations for any of 21 selected autoimmune diseases and 4 immunopathology groupings.
  • Sixty-four percent reported at least one ACE. Compared with persons with no ACEs, persons with ≥2 ACEs were at a 70% increased risk for hospitalizations and 100% increased risk for rheumatic diseases. Childhood traumatic stress increased the likelihood of hospitalization with a diagnosed autoimmune disease decades into adulthood.
  • Furthermore, these findings are consistent with recent biological studies on the impact of early life stress on subsequent inflammatory responses. [source]

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Studies & Sources



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Note: Stacy and her guests are not medical professionals. This podcast is for general educational purposes and NOT intended to diagnose, advise, or treat any physical or mental illness. We always recommend you consult a licensed service provider.

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