Adverse Childhood Relationship Experiences: The Most Underestimated Risk Factor for Chronic Illness


From Chronic Illness Trauma Studies blog: “If you’ve heard of adverse childhood experiences (ACEs) and have a low score (such as 1 or ‘zero ACEs’), you may still suspect that trauma has somehow affected your health but feel like your doctors and the research are missing something important.

Or you may have a high ACE score and feel that it was the emotional abuse or neglect that was the hardest.

In other words, you recognize that your childhood was difficult – you got yelled at a lot, or had to be a pleaser to keep things running smoothly in your family, or you learned that being quiet and invisible was the best way to get by, or you lost a parent and lived with a family that never really recovered from this or some other trauma.

This post introduces the huge and unrecognized impact of one of the ACEs known as emotional neglect. I refer to these as adverse childhood relationship experiences (ACREs). This post will help you assess links between ACREs and chronic illness. It also shares the science.

Life may feel like a slog. Your body may be incredibly sensitive to treatment (even tiny doses make you worse or don’t work or stop working after a while). You may have PTSD, complex PTSD or a chronic illness (or all three) and feel that it relates to trauma but have nothing that validates your hunch.

Adverse childhood relationship experiences (ACREs) draw from the science that recognizes how these kinds of difficult relationships influence the nervous system, epigenetics and health.

ACREs refers to emotional neglect and abuse in childhood. Experiences such as not feeling seen, having had no one to turn to with difficult feelings when you were a child, having had little sense of connection with others in your family, having not felt safe or protected or loved even though there was no abuse or violence (or if there was violence or abuse), having been treated as though you were invisible or the problem or weak or stupid. And more.

Adverse childhood relationship experiences increase risk for chronic illness, PTSD and complex PTSD. ACREs represent what are also known as attachment wounds, developmental trauma, complex trauma and otherwise difficult early events that children experience when their parents are unable to be nurturing, supportive, kind and gentle, and to repair the inevitable mistakes that happen.

I have created the term ‘ACREs’ as a construct that links to the well-studied science of adverse childhood experiences (ACEs). ACEs have shown us that 10 kinds of trauma influence risk for chronic health conditions in children and adults – losing a parent such as from divorce, separation or death; physical, emotional and sexual abuse; physical or emotional neglect; having a parent with a mental illness or who abuses substances; witnessing violence in your home; having had a household member who’s gone to jail (which, like other ACEs, is usually related to yet other ACEs in the family). ACEs are the tip of the trauma iceberg and show us that other kinds of trauma influence longterm health too.

Research has demonstrated that ACREs – the RELATIONSHIP factor – can also have important and similar effects as well.

The value of understanding ACEs and ACREs? When we recognize that early adversity is indeed a risk factor for our symptoms, it gives us the context to find new tools for healing. Because reversing symptoms, recovering, improving and even reversing the effects of trauma is possible. It may not be a quick fix, but the effects of trauma are more common than we’ve thought – and not as solid or permanent.

In addition, there are positive experiences that make us more resilient in childhood as well as in adulthood. I’ll share some of that encouraging research below, including the single question that one family physician discovered that helps identify risk vs. resilience.

Even more good news? Being sick, having a chronic illness. living with mysterious or difficult-to-diagnose symptoms, having PTSD or complex PTSD – is not in your head. It is not your fault. It’s in our nervous systems and immune systems, in our cell danger responses and more.

What we’re learning is that ACREs are ‘invisible ACEs.’

And there is a link between ACREs and chronic illness and other chronic symptoms.

ACREs are among the hardest types of adversity to recognize. This is because the families we grow up in feel normal to us. It’s all we’ve known. They feel like they were normal even when they have been especially difficult. Because children tend to think it’s their fault when things aren’t going right in their environments or in their families. Or when their parents are stressed or anxious or upset.

Since starting to look into the research 20 years ago as well as working to heal from my own chronic illness during this time period, I’ve come to believe that ACREs are among the single most underestimated source of risk for chronic illness and other chronic health conditions.”

Article →


Back to Around the Web


  1. “Well-meaning and loving parents can unintentionally do harm to a child if they are not well informed about human development … ” (Childhood Disrupted, pg.24).

    Regarding early-life trauma, people tend to know (perhaps commonsensically) that they should not loudly quarrel when, for instance, a baby is in the next room; however, do they know about the intricacies of why not? Since it cannot fight or flight, a baby stuck in a crib on its back hearing parental discord in the next room can only “move into a third neurological state, known as a ‘freeze’ state … This freeze state is a trauma state” (pg.123). This causes its brain to improperly develop.

    Also, how many non-academics are aware that it’s the unpredictability of a stressor, and not the intensity, that does the most harm? When the stressor “is completely predictable, even if it is more traumatic — such as giving a [laboratory] rat a regularly scheduled foot shock accompanied by a sharp, loud sound — the stress does not create these exact same [negative] brain changes” (pg.42). Furthermore, how many of us were aware that, since young children completely rely on their parents for protection and sustenance, they will understandably stress over having their parents angry at them for prolonged periods of time? (It makes me question the wisdom of punishing children by sending them to their room without dinner.)

    I did not know any of the above until I heavily researched the topic for specifics.

    I strongly believe that the wellbeing of all children — and not just what other parents’ children might/will cost us as future criminals or costly cases of government care, etcetera — should be of great importance to us all, regardless of whether we’re doing a great job with our own developing children. Sadly, due to the common OIIIMOBY mindset (Only If It’s In My Own Back Yard), the prevailing collective attitude, however implicit or subconscious, basically follows: ‘Why should I care — I’m soundly raising my kid?’ or ‘What’s in it for me, the taxpayer, if I support child development programs for the sake of others’ bad parenting?’

    While some may justify it as a normal thus moral human evolutionary function, the self-serving OIIIMOBY can debilitate social progress, even when social progress is most needed; and it seems that distinct form of societal penny wisdom but pound foolishness is a very unfortunate human characteristic that’s likely with us to stay.

    Report comment

  2. Considering that so much of our lifelong health comes from our childhood experiences, childhood mental health-care should generate as much societal concern and government funding as does physical health, even though psychological illness/dysfunction typically is not immediately visually observable.

    It’s known that trauma from unhindered toxic abuse typically results in a helpless child’s brain improperly developing. If allowed to continue for a prolonged period, it can act as a starting point into a life in which the brain uncontrollably releases potentially damaging levels of inflammatory stress hormones and chemicals, even in non-stressful daily routines. I consider it a form of brain damage.

    The lasting emotional/psychological pain from such trauma is very formidable yet invisibly confined to inside one’s head. It is solitarily suffered, unlike an openly visible physical disability or condition, which tends to elicit sympathy/empathy from others. It can make every day a mental ordeal, unless the turmoil is treated with some form of prescribed or illicit self-medicating.

    The wellbeing of ALL children — and not just what other parents’ children might/will cost us as future criminals or costly cases of government care — needs to be of real importance to us all, regardless of whether we’re doing a great job with our own developing children. A mentally sound future should be every child’s fundamental right — along with air, water, food and shelter — especially considering the very troubled world into which they never asked to enter.

    “It has been said that if child abuse and neglect were to disappear today, the Diagnostic and Statistical Manual would shrink to the size of a pamphlet in two generations, and the prisons would empty. Or, as Bernie Siegel, MD, puts it, quite simply, after half a century of practicing medicine, ‘I have become convinced that our number-one public health problem is our childhood’.” (Childhood Disrupted, pg.228).

    Report comment

    • I like some of what you said, but I don’t agree that the DSM would shrink in the absence of child abuse and neglect. The DSM serves a purpose that is very different than helping people recover from trauma. It enables psychiatry to justify intervening in situations where they don’t have the first idea how to help, and it also justifies blaming the victim when their “treatments” don’t work or do harm. There are WAY too many people making money off of the current system to think they’d just back off if humans suddenly became more sane. I think the greater hope would be that humans who were NOT abused in childhood would find it easier to recognize the false “authority” of psychiatrists in the area of “mental health” and that psychiatry would die a well-deserved death in the face of actual approaches that help people learn and grow spiritually rather than ones that try to “help” by disabling people’s brains with dangerous drugs.

      Report comment

      • I had tried accessing one-on-one therapy in our “universal” health care system; however, within there are very many important health treatments that are universally inaccessible, except for those with a lot of extra doe to blow.

        The only two health professions’ appointments for which I’m fully covered by the Canadian public plan are the readily pharmaceutical-prescribing psychiatry and general practitioner health professions? Such non-Big-Pharma-benefiting health specialists as counsellors, therapists and naturopaths (etcetera) are not covered for a red cent. I wonder whether that is just a coincidence?

        Western business mentality and, by extension, collective society allow the well-being of human beings to be decided by corporate profit-margin measures. And our governments mostly dare not intervene, perhaps because they fear being labelled anti-business by our avidly capitalist culture.

        Sadly, maximizing profits by risking the health or lives of product consumers will likely always be a significant part of the big business beast’s nature. But that does not mean that we should give in to it. Rather, it should be a call to society, and especially our elected leaders, that the economy and jobs be there foremostly for people, not for corporate profit’s sake.

        Report comment

  3. There’s a lot of research on this stuff. Paper after paper is published. But hardly anyone ever prevents any of this “trauma” when it’s actually happening.

    Psychiatric departments often end up just re-abusing abuse victims by labelling them and effectively turning them into lab rats for research and study. In the whole process, the guys doing psychiatry slowly improve their own social status and research careers while the victims turn into an underclass of society. It’s disgusting.

    Report comment

    • Too many people will procreate regardless of their questionable ability to raise their children in a mentally healthy/functional manner. If society is to avoid the most dreaded, invasive and reactive means of intervention — that of governmental forced removal of children from dysfunctional/abusive home environments — maybe we then should be willing to try an unconventional proactive means of preventing some future dysfunctional/abusive family situations. Being free nations, society cannot prevent anyone from bearing children. Society can, however, educate all young people for the most important job ever, even those who currently plan to remain childless.

      Sometimes I can’t help wondering: how many instances there have been wherein immense long-term suffering by children of dysfunctional rearing might have been prevented had the parent(s) received, as high school students, some crucial child development science education by way of mandatory curriculum?

      I’d like to see such curriculum implemented for secondary high school students, which could also include neurodiversity, albeit not overly complicated. If nothing else, the curriculum could offer students an idea/clue as to whether they’re emotionally/mentally compatible with the immense responsibility and strains of parenthood.

      Report comment

      • I think another vitally important question is how/why the current “mental health” apparatus does not SEE the very obvious connection between childhood adversity and adult “mental health” diagnoses. They spend decades researching the “biological underpinnings” of these “disorders,” and come up with 2, 3, 5% correlations, when childhood abuse/neglect/abandonment has associations at 80% or higher to most “disorders.” Seems like a case of intentional blindness. We’ll never be able to teach kids sufficiently about neurodiversity and the importance of healthy child rearing when the bulk of the “mental health” industry appears committed to denying that it matters!

        Report comment

        • When I asked a teachers’ union official over the phone (in 2017) whether there is any childrearing or child-development science curriculum taught in any school district, he immediately replied there is not. When I asked the reason for its absence and whether it may be due to the subject matter being too controversial, he replied with a simple “Yes”.

          This strongly suggests there are philosophical thus political obstacles to teaching students such crucial life skills as nourishingly parenting one’s children. To me, it’s difficult to imagine that teaching parenting curriculum would be considered more controversial than, say, teaching students Sexual Orientation and Gender Identity (SOGI) curriculum, beginning in Kindergarten, as is currently taught in many public schools.

          By not teaching child-development science to high school students, is it not as though societally we’re implying that anyone can comfortably enough go forth with unconditionally bearing children with whatever minute amount, if any at all, of such vital knowledge they happen to have acquired over time? I feel it is.

          A psychologically sound as well as a physically healthy future should be all children’s foremost human right—especially considering the very troubled world into which they never asked to enter—and therefore basic child development science and rearing should be learned long before the average person has their first child.

          “I remember leaving the hospital thinking, ‘Wait, are they going to let me just walk off with him? I don’t know beans about babies! I don’t have a license to do this. We’re just amateurs’.” —Anne Tyler, Breathing Lessons

          “It’s only after children have been discovered to be severely battered that their parents are forced to take a childrearing course as a condition of regaining custody. That’s much like requiring no license or driver’s ed[ucation] to drive a car, then waiting until drivers injure or kill someone before demanding that they learn how to drive.” —Myriam Miedzian, Ph.D.

          Report comment