An illustration depicting a little boy glaring at his drunken mother, passed out on the floor

DID: The ACE Study

A new and profoundly important paradigm for understanding overwhelming emotional pain has emerged over the last few years, with the potential to change the way we conceptualize human suffering across the whole spectrum of mental health difficulties. It is an evidence-based synthesis of findings from trauma studies, attachment theory and neuroscience, which offers new hope for recovery. It also presents a powerful challenge to the biomedical model of psychiatry in that it is based on scientific evidence that substantiates and attests to what many individuals with first-hand experience of mental health problems have always known — that the bad things that happen to you can drive you mad.

A New Paradigm for Understanding Severe Mental Distress

The CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study revolutionizes the way we think about the body and mind.

The ACE Study settles the question of whether we are shaped by genetics or the environment: we are shaped by both.  Nature Versus Nurture: Where We Are in 2017

The ACE study proves that child abuse causes enduring neurological damage that can affect a person’s health and quality of life throughout the lifespan.

The body of a frightened child floods with hormones and prepares to fight, run, or die.

In less than an instant, the amygdala sends an alarm to the hippocampus, which tells the adrenal glands to release adrenaline.

Adrenaline increases heart rate and breathing, oxygen goes to the muscles and brain, which increases hearing and sharpens eyesight.

Adrenaline wears off and cortisol takes over; cortisol is a longer acting stress hormone designed keep the body alert.

Illustration from Harvard Medical School
Understanding The Stress Response, Harvard Medical School

If a child fears for his life, he may freeze and go numb.

For a prey animal in the wild, numbing is a blessing.

For abuse survivors, it means gaps in memory

During the fight, flight or freeze response the brain inhibits the prefrontal cortex.

The prefrontal cortex is responsible for retrieving memories. 

The memory is there but the brain can’t retrieve it.

A chronically abused child lives in fear which damages the structure and
functioning of a the brain. Harvard University

The toll of chronic fear on physical health includes:

  • Immune system dysfunction
  • Endocrine system dysfunction
  • Autonomic nervous system alterations
  • Sleep/wake cycle disruption
  • Eating disorders

The toll of chronic fear on emotional health includes

The Pyramid of effects of abuse on the lifecycle
Abuse Affects the Life-cycle

It takes nine months for the fetus to become a baby that can survive beyond
the womb.

Between birth and the age of two, we have no words; for the first ten years of our  lives, we are helplessly dependent on our parents and communities for our physical and psychological well being.

Child abuse is a betrayal of unconditional trust.

You don’t just ‘get over it’.

People with dissociative disorders report the highest occurrence of abuse and childhood neglect among all psychiatric disorders. This suggests dissociation is the ultimate reaction to significant trauma. Links between Trauma, PTSD, and Dissociative Disorders

A 2018 review found changes in the structure of the brain in people with DID. These changes are complex and  include decreased limbic activity, increased frontal lobe activity, and changes in communication between these two regions.

An illustration depicting a little boy glaring at his drunken mother, passed out on the floor
Child Abuse Lasts a Lifetime

DID is something done to you, like the rapes and daily beatings.

One must accept what happened and make peace with it.

Acceptance means seeing what might have been and grieving the loss.

Acceptance means letting go of the idea that I brought it on myself, that I am shameful and not good enough, and it means not letting the dismissive arrogance I sometimes encounter gnaw at my soul.

Acceptance means holding abusers accountable for the messes they make.

Acceptance means believing the abuse will end.

I am not completely there.

How do I accept the evil of child abuse when the abuse never ends?

For now, broken but better is the best I can do.

DID: When Everything is a Trigger

Get Your ACE Score

(C)Rob Goldstein 2019

‘Child Abuse Lasts Forever” (C) Rob Goldstein 2019

All other graphics were found online and are used here for educational purposes.

55 thoughts on “DID: The ACE Study

  1. Your post presents some very interesting findings in a fair and straightforward presentation. Thank you. Although I was never physically abused as a child, there was emotional, hurtful damage done from careless words and attitudes. Your post makes me think SOME of the mental/physical issues I deal with today started way-back-then, perhaps. My surge of adrenalin in potentially psychically threatening situations is definitely a real thing, and wherever it developed or started from, although unknown is a very REAL thing.

    Liked by 1 person

    1. It’s logical that our developing brain would be affected by environmental factors before and after birth. The thalidomide tragedy is dramatic example of how combinations of chemicals can interfere with the normal development of a fetus. And you’re right, verbal and psychological abuse is insidious and just as harmful as physical abuse. Thanks for reading the post and leaving a comment.

      Liked by 1 person

  2. A beautiful image to go with this post, Rob. The doll looks different to me.
    This study information is not just important, it is validating. Thanks for adding your mindful elaboration. Hugs on the wing.

    Liked by 1 person

    1. Thanks you for reading it and leaving a comment. It’s a fascinating study and it may revolutionize the treatment of mental illness. Wouldn’t it be nice if we could prevent it by giving our children the resources they need to thrive?

      Liked by 1 person

      1. I sense that Americans want to restore elements of the New Deal. It;s not like the United States doesn’t have a history of investing in its citizens. I frankly don’t understand the confusion over the differences between outright socialism and regulated capitalism. The generation that gained the most from the fully funded public education and safety net programs is still alive and should still have functioning memories.

        Liked by 1 person

    1. I was surprised to log into twitter this morning to see Senator Elijah Cummings use the ACE study to argue against Trump’s Family separation policy. For me it’s a relief and a blessing. It’s difficult not to internalize stigma so on some level I blame myself for this beast of an illness. Knowing that medical science can prove why and how it happens is comforting. Perhaps we will discover new ways to treat trauma. Thanks for stopping by, Mary. 🙂

      Liked by 2 people

    1. The higher the score the greater the chance that some of aspect of your childhood was abusive. A good rule of thumb is, if you keep letting abusers into your life, you were probably abused.


    1. I’ll be honest Irene; the Trump administration is taking a huge toll on me. My therapist tells me that therapists in general are seeing more symptoms in patients as trump escalates his gas lighting and abuse. Trump behavior triggers my symptoms and makes me feel crazy. The last straw was the photo of trump using an infant whose parents died in a massacre as a prop. That infant is an orphan because of trump’s abuse of the power of the president. All I could think of is how violated that child will feel when he’s old enough to realize why his parents were murdered. I can’t stand to see how easy it is for a rich psychopath to get away with the psychological abuse of an entire nation.


      1. I hear you, Robert.
        I can only agree with you, he is an abuser. I view him as a narcissist at high level. He will never do anything, if he doesn’t get anything. Unfortunately there are several of his kind in the top of many countries at the moment. I hope, that people in those countries will wake up, before it is too late.
        They destroy everything around them.

        Liked by 1 person

      2. I agree, Irene. Today was another terrible day. Now he’s launching anti-Semitic attacks and has thinks he’s the savior. The difference between trump’s presidency and life in an alcoholic family ruled by an abusive narcissist is zero. Thank you for giving me a chance to vent a bit. 🙂


  3. I found this full of good information. Thank you for sharing this. I went to the Ace link. I strongly believe in the later life issues on the whe body, mind and soul. Hopefully its a trend that will diminish .

    Liked by 1 person

  4. Thank you for sharing, Rob. I studied the ACE a while back and most of my clients suffered from it with different degrees. Yes, understanding, accepting, and recognizing what triggers the current behaviors help. Nobody is completely there, it’s a daily coping. Thank you again!

    Liked by 2 people

    1. Thank you, Miriam. So much has changed in the decade since my diagnosis. The ACE study is a compelling argument for treatments that use a combination of approaches, including structured settings and psychotherapy.

      Liked by 2 people

      1. Neuro-biology confirms many of Freud’s ideas. Our childhoods and cultural experiences have a profound effect on our minds. It’s good to see the ‘mind’ return as a factor in our discussions of policies related to health care.

        Liked by 1 person

    1. Thanks John. Now that we know the medical and social cost of poverty and violence on our children, I hope we can put an end to political theater and get down to crafting policies designed to protect the health and well being of our children. All of them. I hope. Thank you for stopping by and leaving a comment. 🙂

      Liked by 2 people

      1. Very true. Our leadership in government is a disgrace. I’m talking both the executive and legislative branch. It’s like watching a group of kindergarten kids on a playground. Meanwhile nothing of substance is getting done.

        Liked by 1 person

      2. Right John. It doesn’t have to be like this and I sense the millennial generation is willing to sacrifice for something better. I don’t know how it got this bad but I do know we as a species have the power to change it. The problem is one of will. The prognosis is not good. We have the catastrophic climate scientists predicted in the 1960’s, and our climate policies are actually moving backward. If Homo Sapiens doesn’t survive, I hope whatever intelligence rises after ours does. Our self-destruction is a tragedy, but this planet, and the universe, and life will go on.

        Liked by 1 person

      3. It’s possible the multiverse is full of intelligent life, but not the kind that makes tools. We have dozens of examples of this on Earth. My favorite fantasy is we’ll perfect self replicating AI based robots and send them to explore other planets and solar systems before we go extinct.

        Liked by 1 person

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