How would you react if a doctor told you that your diabetes or cancer was due to adversities experienced during childhood and how you coped with them? 

Let’s take an example to understand how adverse childhood experiences (ACEs) can shape complex behavioural patterns that lead to health risks and diseases. Mr. Appu, a 40-year-old male, was recently diagnosed with diabetes. He has been advised to lose weight, change his diet, and modify his lifestyle. He discovered this during a routine health check. Though he has a family history of diabetes, his father only started medication when he was 52. Mr. Appu wonders why he developed diabetes so early and, after some online research, attributes it to factors like refined flour, carbonated drinks, work stress, and his current lifestyle. 

His wife reports that Mr. Appu stress-eats and binges on food whenever he works late at night to stay alert for client calls. Mr. Appu admits that he is very anxious about finishing work on time, and his job often requires him to work odd hours to service clients in different time zones. He started this habit of stress eating while preparing for his 10th-grade exams. He recalls gaining 10-15 kgs in about six months when he was studying 12-14 hours a day for the JEE entrance exam. He wasn't serious about his studies until the 9th grade. He remembers being ridiculed by cousins and family for scoring only 70%, especially when he expressed his desire to clear the IIT entrance exams. That experience of being mocked was the first of many that left him feeling insecure. Even today, he fears that his work and efforts are not appreciated enough. 

Childhood Trauma and Health: 

The Adverse Childhood Experiences (ACE) Study of 1998 revealed a concerning link between traumatic childhood events, such as abuse and neglect, and long-term health issues, including heart disease and mental health disorders. For instance, individuals with four or more adverse experiences are twice as likely to develop heart disease compared to those without, highlighting the need for early intervention and support. 

Adverse childhood experiences like bullying, physical abuse, loss of parental support, socio-economic difficulties, and family disputes can put a child or adolescent at risk for mental health complications. This often leads to maladaptive coping mechanisms like substance abuse, unsafe lifestyle choices, and risky behavior, which increase the risk of both physical and psychological illnesses. Experiences of childhood sexual abuse can severely affect an individual’s psyche, making them feel vulnerable for years, affecting their relationships, self-image, eating habits, and even sexual behaviour. Children and adolescents who go through such experiences can develop psychiatric conditions like PTSD, stress-related disorders, depression, and anxiety. Many are unable to share these experiences with caregivers due to the fear of being blamed or labelled as "weak-minded." These traumas often prevent them from healing or trusting others.

While major traumas such as natural disasters, accidents, or severe abuse can disturb most individuals, research shows that neglect and lack of care can also significantly impact a person’s life choices and limit access to growth opportunities. Both abuse and neglect can cause and maintain generational cycles of trauma, which can be passed down from one generation to the next. 

The Treatment Process: 

• Establishing Safety and Stabilization:
  The first phase focuses on ensuring safety and managing physical and psychological symptoms. It involves restoring sleep, appetite, and helping the individual relax.
• Psychotherapy and Psychosocial Interventions:
  Therapy focuses on understanding and addressing the consequences of trauma.
• Family or Community-Based Support:
  In cases of chronic stress, individuals need support groups or family-based interventions to restore a therapeutic environment.
• Reintegration, Skill Building, and Growth:
  This phase helps the individual regain lost functions, social roles, and work on building resilience and skills. 

When trauma-related concerns are not addressed, people may develop mind-body issues such as headaches, body pains, migraines, obesity due to poor lifestyle choices, and addictions. While treating these symptoms is important, full recovery requires creating a restorative environment. In today’s fast-paced, target-oriented world, such environments are not always available. Medications may help treat disorders, but often, mental health practitioners must work with families and caregivers to help individuals adapt and create a healthier environment. This is where psychotherapy and psychosocial interventions play a crucial role.

Importance of Trauma-Informed Care: 

Trauma-informed care focuses on understanding how trauma affects individuals and ensuring that everyone involved in healthcare, social services, and legal services is aware of this impact. The healing process must ensure trust, safety, and empowerment for the individual. This requires training professionals to recognize and address the effects of trauma. 

Building Resilience: 

How someone responds to adverse events depends on how their brain interprets and makes sense of them. This evaluation varies based on a person’s temperament, coping skills, past experiences, and available support. While adversity can build resilience, helping individuals develop resilience is also a crucial part of healing. There is a need for community-level awareness and skill-building opportunities to help children and adults alike build resilience. 

By understanding how childhood adversity can impact both mental and physical health, we can better support individuals like Mr. Appu in managing not just the symptoms of diseases like diabetes but the underlying causes rooted in their early experiences.

-   Dr Avinash G Kamath, Child & Adolescent Psychiatrist, KMC Hospital, Dr B R Ambedkar Circle, Mangaluru.