Childhood Sexual Abuse and Long-Term Health

This week I’d planned to write about childhood sexual abuse (CSA) and posttraumatic stress disorder (PTSD). In beginning to research, what I found instead were several articles and research studies describing the connection between CSA and long-term physical health as an adult. So, while I still plan to investigate CSA and PTSD, this week I was drawn into the articles about physical health because, among other diseases, the words “autoimmune disease” jumped off the page at me. Without getting into my medical history, I’ve been diagnosed with a couple of the autoimmune diseases mentioned in these studies as being associated with CSA, so you can see why I’m interested.

I want to emphasize, though, that every article stressed that every case of any of the diseases mentioned doesn’t necessarily indicate an abusive childhood. There are probably hundreds of thousands of people who have autoimmune diseases and who also had a loving and nurturing childhood. There isn’t a “cause and effect” relationship proven by the studies, but there is a proven association. In order to prove cause and effect, a study would have to take two groups of children who are healthy, use one as the control group, and then deliberately expose the other group to sexual abuse and follow both groups into adulthood. You can see why that kind of study will never happen.

So what is the association between CSA and long-term health issues? There is a lot of information available about a study, called the Adverse Childhood Experiences (ACE) Study, conducted by Kaiser Permenente’s Department of Preventative Medicine in San Diego and the U.S. Centers for Disease Control and Prevention. The initial phase of the ACE Study was conducted in 1995 through 1997, with over 17,000 participants, averaging age 57. The medical status of the participants is still being tracked. The participants were given ten categories of trauma and asked to identify any they had experienced prior to age 18. Here’s the list, and as you can see, CSA is not the only trauma associated with long-term health outcomes:

• Psychological abuse (by parents)
• Physical abuse (by parents)
• Sexual abuse (by anyone)
• Emotional neglect
• Physical neglect
• Alcoholism or drug use in home
• Loss of biological parent before age 18
• Depression or mental illness in home
• Mother treated violently
• Imprisoned household member

The results of the study concluded a direct relationship between the number of ACEs and disease later in life. Increasing ACE scores were proportionally related to patients who suffered from depression, alcoholism, drug addiction, and suicide. That list doesn’t seem extraordinary. What was surprising was the correlation between increasing ACE scores and diseases with no obvious connection to traumatic events, such as lupus, fibromyalgia, rheumatoid arthritis, Hashimoto’s thyroiditis, and irritable bowel syndrome (all autoimmune diseases); coronary artery disease; heart disease; cancer; and even musculoskeletal issues.

Some of the articles I read gave very medically detailed reasons why there’s a correlation between childhood trauma (one of the papers focused solely on CSA) and these particular diseases. I’m not a doctor, but what I took away from all the medical jargon is that chronic long-term stress (as happens with CSA) causes high levels of circulating cortisone and other related stress chemicals. Over time these hormones and chemicals affect the development and function of the immune system. They also cause inflammatory reactions in very small blood vessels, causing them to close down, which turns whatever part of an organ or tissue they were supplying into scar tissue.

One article, “Long-Term Health Outcomes of Childhood Sexual Abuse” by Debra Rose Wilson, PhD, MSN, RN, and Mariesa R. Severson, MSN, RN, explains that trauma and early negative experiences affect the development and even structure of the brain:

The brain shows a pervasive stress response having a long-term effect on immune function. Brain wave patterns change. The brain’s response to inflammation and healing is altered. Neurotransmitter levels adapt to these abnormal levels. The biological changes in the brain are even more profound if the abuse was early, pervasive, or severe.

They go on to say, “Trauma in early childhood predisposes the individual to autoimmune diseases later in life.”

The immune system also plays an important role in cancer prevention. One of the designers of the ACE Study, Dr. Vincent Felitti, explains:

We are all producing low levels of malignant cells at all times. They are readily processed out by our immune systems and we never know the difference. Therefore, getting cancer means one of two things: either you are producing malignant cells at an accelerated rate as might occur from being a heavy smoker or from exposure to dangerous amounts of radiation, etc.; or your body’s ability to recognize and process out those cells is impaired. One form of impairment comes from damage to your immune system while taking immunosuppressant drugs after organ transplantation. Another form comes from chronic major stress over prolonged periods of time.

This . . . has obvious relevance to our finding of increased rates of cancer in high ACE score patients as well as the fact we found increased rates of autoimmune diseases in high ACE score patients.

My own thoughts after reading Dr. Felitti’s explanation is that immunosuppressant drugs are also prescribed to help control many autoimmune diseases like rheumatoid arthritis and lupus. Couple that fact with the long-term high levels of chronic stress chemicals of CSA and how is the risk of getting cancer affected in a CSA survivor with an autoimmune disease or two?

A follow-on study to the ACE Study concluded that CSA survivors showed signs of hardening of the arteries in the neck, an early marker of heart disease. This marker wasn’t connected to traditional risk factors, such as obesity, smoking, or cholesterol, and wasn’t seen in women in the study who weren’t abused. Carotid artery ultrasound also showed increased levels of plaque build up in CSA survivors.

One of the most interesting facts I found in all of this reading came when Dr. Felitti added trauma-related questions to his practice’s patient medical questionnaire. He asked questions like “Have you ever lived in a war zone?” and “Have you ever been held prisoner, tortured, raped, or molested as a child?” With the use of the new questionnaire, in the subsequent year, he saw a 35 percent reduction in doctor office visits and an 11 percent reduction in emergency room visits. His conclusion:

We believe we illustrated the profound importance of helping people talk about the worst secrets in their lives and enabling them to go home still accepted afterwards. I slowly came to see that what we had done showed that asking and listening and accepting was doing. That was a rather profound realization.

His realization is one that I identified years ago when I began to share my own worst secret. Speak… Read more here.

So what does all of this mean to an abuse survivor like me? It means the next time I see my primary care doctor, I’m going to share my history of CSA and ask her if she’s familiar with the ACE Study and the proven association of certain very serious diseases and childhood sexual abuse. It could be a conversation you might want to consider having with your own doctor.