According to the CDC, about 61% of adults report experiencing at least one
traumatic/adverse event in childhood (ACE), while approximately 16% report experiencing four or more adverse events. New studies are starting to look at the impact ACEs have on psychobiological development. Exposure to traumatic experiences during childhood produces stress that is toxic to the individual and that impacts the development of the hypothalamus pituitary adrenal axis (HPA)[1] [2] which leads to chronic stress and depletion of several key nutrients needed in the body. While typical treatment for childhood trauma is psychological in nature, given the strong link between toxic stress and nutritional depletion, there is evidence that suggests adding nutritional therapy to the healing protocol can aid in this type of trauma recovery. Helping re-establish normal functioning of the HPA stress response system and brining balance to the biological aspects of the body will help adult survivors recover themselves.
Adverse childhood events and the link to adult mortality was established in a landmark study done at Kaiser Permanente from 1995-1997. For the study they divided adverse childhood experiences into 7 different categories which covered a range of abuses (psychological, physical, sexual) and household dysfunctions (substance abuse, mental illness, violence towards mother, criminal in household). They then devised a questionnaire based on these categories and asked a large group of insurance patients to answer it. [3] For each yes answer a participant reported they received 1 point on the ACE score assessment with a possible ACE score ranging from 0-7. The study then went on to identify a strong accumulative link between ACE scores and lifestyle factors that lead to poor health and potentially early death.3 The higher the ACE score reported by the adult, the higher risk factors they had for mental issues such as depression or suicide attempts, and they were of higher risk for all leading causes of death in the US. 3
Exposure to traumatic experiences during childhood produces stress that is toxic to the individual and is in part what leads to major health issues later in life.[4] [5] The National Scientific Council defines childhood stress in three main ways. Positive stress is typically mild in severity and short in duration with the biological system of the child returning to baseline quickly after the stressor is removed. Tolerable stress is more prolonged and/or severe in nature and will have more of an impact on the development of the child’s brain, however the child can recover after the stressor is removed, given adequate time, and social resources to do so. Toxic stress is ongoing prolonged stress response, repeatedly activating the hypothalamus pituitary adrenal axis (HPA), with no time for the biological system to recover. Toxic stress is the type of stress children with high ACE scores experienced growing up, and is the type that can produce dysregulation in the HPA stress response that persists into adulthood. 1
Often, in part due to the chronic exposure to toxic stress, children that grew up in environments peppered with adverse events, often times struggle with CPTSD as adults. PTSD (post-traumatic stress disorder) is defined as a disorder that occurs when people have experienced a shocking, traumatic and/or terrifying event which causes multifaceted issues in daily life. These issues can range from flashbacks, constant feelings of fear/panic even when the environment is safe, sleep disturbances and depression/anxiety to just name a few. These symptoms can last for months, or years, and the treatment is typically phycological and/or medicinal in nature.
Complex PTSD is a relatively new term used to describe the issues that people experience when abuse, trauma, or adverse events are chronic in nature, and there is an inability to escape or do anything about them. This is certainly the case when children are in environments where adverse events are the norm. CPTSD is not defined in the DSM-V as a separate disorder from PTSD, but more and more clinicians are seeing and recognizing certain key differences between the two disorders.[6] CPTSD differs also in how it shows up symptomatically in a person’s life. CPTSD is hallmarked by changes in emotional regulation as an adult, continual disassociation from feelings and experiences in life, relationship difficulties, deep feelings of shame and guilt that erode self-image, substance abuse issues, anxiety/depression/personality disorders, and distorted perceptions of the world. As with PTSD, the treatment for this disorder is most often a variety of psychotherapy and/or drug therapy to help manage symptoms.
While there are no direct studies that look at nutritional therapeutic interventions for adults suffering from the effects of CPTSD, as you will see in this series, if we break down what happens to the body during prolonged and toxic stress in childhood, we find ample evidence and space for nutritional therapy to help with recovery in adulthood. Recent research and books such as “The Body Keeps the Score” by Bessel ban der Kolk or “What Happened to You? Conversations on Trauma, Resilience, and Healing” by Bruce D. Perry and Oprah Winfrey shed light on what happens to the body, and the biological systems during trauma, and paves the way for other types of therapies to help survivors. The approach to heal prolonged childhood trauma, needs to treat the person in a holistic way integrating mind, body, and spiritual healing modalities to have the greatest chance at successful integration for the person. These articles were designed to give some insight into how nutritional therapy can aid trauma survivors/CPTSD sufferers with recovery and can hopefully be used in tandem with other healing modalities to foster more positive outcomes.
References
[1] Jiang S, Postovit L, Cattaneo A, Binder EB, Aitchison KJ. Epigenetic Modifications in Stress Response Genes Associated With Childhood Trauma. Front Psychiatry. 2019;10:808. Published 2019 Nov 8. [2] Trickett PK, Noll JG, Putnam FW. The impact of sexual abuse on female development: lessons from a multigenerational, longitudinal research study. Dev Psychopathol. 2011;23(2):453-476. [3] Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998;14(4):245-258. [4] Franke HA. Toxic Stress: Effects, Prevention and Treatment. Children (Basel). 2014;1(3):390-402. Published 2014 Nov 3. [5] Shonkoff JP, Garner AS; Committee on Psychosocial Aspects of Child and Family Health; Committee on Early Childhood, Adoption, and Dependent Care; Section on Developmental and Behavioral Pediatrics. The lifelong effects of early childhood adversity and toxic stress. Pediatrics. 2012;129(1):e232-e246. [6] Karatzias T, Shevlin M, Fyvie C, et al. Evidence of distinct profiles of Posttraumatic Stress Disorder (PTSD) and Complex Posttraumatic Stress Disorder (CPTSD) based on the new ICD-11 Trauma Questionnaire (ICD-TQ). J Affect Disord. 2017;207:181-187.
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