A therapist recently posed a key question about adverse childhood experiences (ACEs): what is the benefit to a patient of their family doctor knowing this information?
The benefit, which can be considerable, derives from relieving the long-term psycho-social consequences of ACEs. The two most fundamentally important of these consequences are low self-esteem and unrecognized anger about the ACEs. A helpful initial approach to the first is to point out to the ACE survivor that a hero in our society is someone who has overcome a difficult mental or physical challenge for a good cause. ACE survivors have done exactly that. If they can view themselves in these terms they will move toward a reversal of the low self-esteem that is the most common legacy of ACEs. This is of fundamental importance in reversing many of the negative health and social behaviors common in ACE survivors.
A helpful initial approach to the unrecognized anger is to ask the ACE survivor to imagine a child they care about growing up exactly as the survivor did. (ACE survivors often struggle to recognize the magnitude of the difficulty they endured as children, until they imagine it happening to a child they know). Then, when they feel ready, I ask them to write a letter (rarely mailed) to the person(s) who mistreated them, expressing their memories and emotions as completely as they can.
After these initial steps, counseling with a therapist who has interest and expertise in helping adult ACE survivors is an obvious follow-up.
My experience with the above is based on detailed interviews with over 4000 ACE survivors referred to me for medically unexplained symptoms or refractory functional syndromes (mostly irritable bowel but also fibromyalgia and many others). Not only did these typically improve in response to the above but I often noticed improvement in substance abuse (including tobacco), eating disorders, depression, anxiety and willingness to move on from dysfunctional personal relationships. Self-care skills also tend to improve substantially.
A group of experts in treating the long-term health consequences of ACEs has collectively created the Psychophysiologic Disorders Association (PPDA). We are offering a one day conference to teach treatment techniques (primarily aimed at mental health practitioners but all health care professionals are welcome) on Saturday, Oct 6, 2012 at the New York Academy of Medicine, co-sponsored by NYU. (Registration will be via the website.) There is also much more information in Chapter 3 of my book which you can read more about on the Book Overview page. (All earnings from the book and from my speaking fees are donated to the PPDA which is a 501(c)(3) non-profit.)