How childhood trauma affects health across a lifetime | Nadine Burke Harris

In the mid-’90s, the CDC and Kaiser Permanente discovered an exposure
that dramatically increased the risk for seven out of 10 of the leading
causes of death in the United States. In high doses, it affects
brain development, the immune system, hormonal systems, and even the way our DNA
is read and transcribed. Folks who are exposed in very high doses have triple the lifetime risk
of heart disease and lung cancer and a 20-year difference
in life expectancy. And yet, doctors today are not trained
in routine screening or treatment. Now, the exposure I’m talking about is
not a pesticide or a packaging chemical. It’s childhood trauma. Okay. What kind of trauma
am I talking about here? I’m not talking about failing a test
or losing a basketball game. I am talking about threats
that are so severe or pervasive that they literally get under our skin
and change our physiology: things like abuse or neglect, or growing up with a parent
who struggles with mental illness or substance dependence. Now, for a long time, I viewed these things in the way
I was trained to view them, either as a social problem —
refer to social services — or as a mental health problem —
refer to mental health services. And then something happened
to make me rethink my entire approach. When I finished my residency, I wanted to go someplace
where I felt really needed, someplace where I could make a difference. So I came to work for
California Pacific Medical Center, one of the best private hospitals
in Northern California, and together, we opened a clinic
in Bayview-Hunters Point, one of the poorest, most underserved
neighborhoods in San Francisco. Now, prior to that point, there had been only
one pediatrician in all of Bayview to serve more than 10,000 children, so we hung a shingle, and we were able
to provide top-quality care regardless of ability to pay. It was so cool. We targeted
the typical health disparities: access to care, immunization rates,
asthma hospitalization rates, and we hit all of our numbers. We felt very proud of ourselves. But then I started noticing
a disturbing trend. A lot of kids were being
referred to me for ADHD, or Attention Deficit
Hyperactivity Disorder, but when I actually did
a thorough history and physical, what I found was that
for most of my patients, I couldn’t make a diagnosis of ADHD. Most of the kids I was seeing
had experienced such severe trauma that it felt like something else
was going on. Somehow I was missing something important. Now, before I did my residency,
I did a master’s degree in public health, and one of the things that they teach you
in public health school is that if you’re a doctor and you see 100 kids
that all drink from the same well, and 98 of them develop diarrhea, you can go ahead
and write that prescription for dose after dose
after dose of antibiotics, or you can walk over and say,
“What the hell is in this well?” So I began reading everything that
I could get my hands on about how exposure to adversity affects the developing brains
and bodies of children. And then one day,
my colleague walked into my office, and he said, “Dr. Burke,
have you seen this?” In his hand was a copy
of a research study called the Adverse Childhood
Experiences Study. That day changed my clinical practice
and ultimately my career. The Adverse Childhood Experiences Study is something that everybody
needs to know about. It was done by Dr. Vince Felitti at Kaiser
and Dr. Bob Anda at the CDC, and together, they asked 17,500 adults
about their history of exposure to what they called “adverse
childhood experiences,” or ACEs. Those include physical, emotional,
or sexual abuse; physical or emotional neglect; parental mental illness,
substance dependence, incarceration; parental separation or divorce; or domestic violence. For every yes, you would get
a point on your ACE score. And then what they did was they correlated these ACE scores
against health outcomes. What they found was striking. Two things: Number one, ACEs are incredibly common. Sixty-seven percent of the population
had at least one ACE, and 12.6 percent, one in eight,
had four or more ACEs. The second thing that they found was that there was
a dose-response relationship between ACEs and health outcomes: the higher your ACE score,
the worse your health outcomes. For a person with an ACE score
of four or more, their relative risk of chronic
obstructive pulmonary disease was two and a half times that
of someone with an ACE score of zero. For hepatitis, it was also
two and a half times. For depression, it was
four and a half times. For suicidality, it was 12 times. A person with an ACE score
of seven or more had triple the lifetime risk
of lung cancer and three and a half times the risk
of ischemic heart disease, the number one killer
in the United States of America. Well, of course this makes sense. Some people looked at this data
and they said, “Come on. You have a rough childhood,
you’re more likely to drink and smoke and do all these things
that are going to ruin your health. This isn’t science.
This is just bad behavior.” It turns out this is exactly
where the science comes in. We now understand
better than we ever have before how exposure to early adversity affects the developing brains
and bodies of children. It affects areas like
the nucleus accumbens, the pleasure and reward
center of the brain that is implicated
in substance dependence. It inhibits the prefrontal cortex, which is necessary for impulse control
and executive function, a critical area for learning. And on MRI scans, we see measurable differences
in the amygdala, the brain’s fear response center. So there are real neurologic reasons why folks exposed
to high doses of adversity are more likely to engage
in high-risk behavior, and that’s important to know. But it turns out that even if you don’t
engage in any high-risk behavior, you’re still more likely
to develop heart disease or cancer. The reason for this has to do with
the hypothalamic–pituitary–adrenal axis, the brain’s and body’s
stress response system that governs our fight-or-flight response. How does it work? Well, imagine you’re walking
in the forest and you see a bear. Immediately, your hypothalamus
sends a signal to your pituitary, which sends a signal
to your adrenal gland that says, “Release stress hormones!
Adrenaline! Cortisol!” And so your heart starts to pound, Your pupils dilate, your airways open up, and you are ready to either
fight that bear or run from the bear. And that is wonderful if you’re in a forest
and there’s a bear. (Laughter) But the problem is what happens
when the bear comes home every night, and this system is activated
over and over and over again, and it goes from being
adaptive, or life-saving, to maladaptive, or health-damaging. Children are especially sensitive
to this repeated stress activation, because their brains and bodies
are just developing. High doses of adversity not only affect
brain structure and function, they affect the developing immune system, developing hormonal systems, and even the way our DNA
is read and transcribed. So for me, this information
threw my old training out the window, because when we understand
the mechanism of a disease, when we know not only
which pathways are disrupted, but how, then as doctors, it is our job
to use this science for prevention and treatment. That’s what we do. So in San Francisco, we created
the Center for Youth Wellness to prevent, screen and heal the impacts
of ACEs and toxic stress. We started simply with routine screening
of every one of our kids at their regular physical, because I know that if my patient
has an ACE score of 4, she’s two and a half times as likely
to develop hepatitis or COPD, she’s four and half times as likely
to become depressed, and she’s 12 times as likely
to attempt to take her own life as my patient with zero ACEs. I know that when she’s in my exam room. For our patients who do screen positive, we have a multidisciplinary treatment team
that works to reduce the dose of adversity and treat symptoms using best practices,
including home visits, care coordination, mental health care, nutrition, holistic interventions, and yes,
medication when necessary. But we also educate parents
about the impacts of ACEs and toxic stress the same way you would for covering
electrical outlets, or lead poisoning, and we tailor the care
of our asthmatics and our diabetics in a way that recognizes that they may
need more aggressive treatment, given the changes to their hormonal
and immune systems. So the other thing that happens
when you understand this science is that you want to shout it
from the rooftops, because this isn’t just an issue
for kids in Bayview. I figured the minute
that everybody else heard about this, it would be routine screening,
multi-disciplinary treatment teams, and it would be a race to the most
effective clinical treatment protocols. Yeah. That did not happen. And that was a huge learning for me. What I had thought of as simply
best clinical practice I now understand to be a movement. In the words of Dr. Robert Block, the former President
of the American Academy of Pediatrics, “Adverse childhood experiences are the single greatest
unaddressed public health threat facing our nation today.” And for a lot of people,
that’s a terrifying prospect. The scope and scale of the problem
seems so large that it feels overwhelming to think about how we might approach it. But for me, that’s actually
where the hopes lies, because when we have the right framework, when we recognize this to be
a public health crisis, then we can begin to use the right
tool kit to come up with solutions. From tobacco to lead poisoning
to HIV/AIDS, the United States actually has
quite a strong track record with addressing public health problems, but replicating those successes
with ACEs and toxic stress is going to take determination
and commitment, and when I look at what
our nation’s response has been so far, I wonder, why haven’t we taken this more seriously? You know, at first I thought
that we marginalized the issue because it doesn’t apply to us. That’s an issue for those kids
in those neighborhoods. Which is weird, because the data
doesn’t bear that out. The original ACEs study
was done in a population that was 70 percent Caucasian, 70 percent college-educated. But then, the more I talked to folks, I’m beginning to think that maybe
I had it completely backwards. If I were to ask
how many people in this room grew up with a family member
who suffered from mental illness, I bet a few hands would go up. And then if I were to ask how many folks
had a parent who maybe drank too much, or who really believed that
if you spare the rod, you spoil the child, I bet a few more hands would go up. Even in this room, this is an issue
that touches many of us, and I am beginning to believe
that we marginalize the issue because it does apply to us. Maybe it’s easier to see
in other zip codes because we don’t want to look at it. We’d rather be sick. Fortunately, scientific advances
and, frankly, economic realities make that option less viable every day. The science is clear: Early adversity dramatically affects
health across a lifetime. Today, we are beginning to understand
how to interrupt the progression from early adversity
to disease and early death, and 30 years from now, the child who has a high ACE score and whose behavioral symptoms
go unrecognized, whose asthma management
is not connected, and who goes on to develop
high blood pressure and early heart disease or cancer will be just as anomalous
as a six-month mortality from HIV/AIDS. People will look at that situation
and say, “What the heck happened there?” This is treatable. This is beatable. The single most important thing
that we need today is the courage to look
this problem in the face and say, this is real
and this is all of us. I believe that we are the movement. Thank you. (Applause)

100 thoughts on “How childhood trauma affects health across a lifetime | Nadine Burke Harris

  1. She says there's a movement ….. I don't feel a movement.
    Do you honestly think the situation is better? This is dated Feb 2015 it's not better in Sept 2019.

  2. Very good analogy of the bear coming home every night. My father hit me often from the age of 9 to 16. Every time he was at home I had to walk on egg shells not to get him agitated since most of the time he was drunk anyway. 20 years later I suffer from anxiety and panic attacks. The good news is I broke the cycle of violence and I do not treat my kids the same way.

  3. It took me a while to realize I experienced childhood trauma. I've struggled with variety of mental illnesses my entire life, all of which started showing themselves at a very young age. However, my parents are super strict, traditional Christians and absolutely refused to admit I had any problems. Whenever I acted out or told them I was struggling, they would punish me by either hitting me with a wooden spatula, making me sit with soap in my mouth for ten minutes, or lock me in their room for hours until I apologized for my behavior.
    It didn't take me long to realize that showing any negative emotions or asking for help would mean I would be punished.
    Now I'm 18 and still absolutely refuse to ask for help or to talk about my emotions. I've gone to therapy and lied the whole time just telling my therapist what she wanted to hear. It got to the point that I attempted suicide twice because I'd rather die than admit to anyone that I was suffering so badly.
    My parents really ruined my life.

  4. She's brilliant and spot on. I am 52 years old. Have turned my life around and working on being heeled from childhood and adult. Trauma. When she listed the childhood ACEs I checked off all but one.

  5. I cried while listening. Big bald adult. Brought me back to my childhood with a bear attacking me every day. Anticipating him every night and shaking.
    I never beat my kids like he did to me I thought it is the only thing I need to exclude. But I did tons of emotional damage to my family which I didn't realize until I ended up in a ditch on a freeway of life lying face down in a mud. I became a bear, vicious cycle.
    I started recovery so I don't hurt anyone anymore.

  6. It seems that if a child had an ACE score of just one but that experience – say, physical abuse – was frequent, of extreme severity and of a long enough duration, the percentages of likelihood of disease and suicide for that child could be just as high as those of a child with a higher ACE score.

  7. when a child experience some wrong doings from people who was supposed to protect and care for him,
    all of his world is turned upside down. it is so hard to trust, and feel comfortable around people again.

  8. Incredible!!! Incredible incredible woman!!! And this got me in goosebumps in certain moments!!
    That's exactly right!! It's in ALL OF US!! It's not just zip codes of poverty and problematic patterns. It's in the affluent too!!
    This was such a moving and informative talk. I wish all health care would actually take this seriously and roll that across the world!! It should be common practice!!

  9. This really hit home and made me think. I grew up with two (mentally and emotionally) abusive step parents and I struggle with depression and concentration. I never made the correlation.

  10. I have the idea that many of these people come to suffer with self-esteem issues; as they never had the love and safety they have wished for. So even if you do grow into an adult, there is still lots of healing required. I do believe in neuro-plasticity, the ability of the brain to adapt to a more healthy environment. Magic mushrooms show much promise in this regard, please don't resort to these without doing any research though. Keep doing your best folks. Peace and love.

  11. "Adverse childhood experiences are the single greatest undressed public health threat facing our nation today."

    The 1st thing I thought of was all those poor kids being caged at the border and what will be the broader consequences of what has happened to them, both personally and socially?

  12. But the bear that comes home has told.. nay, yelled at me and my brothers that she isn't the bear at all…

    Guess im wrong then lol

  13. doctors ARE trained to screen for childhood abuse or risk, so are teachers and police. i don’t understand why she’s doing a TED talk on someone else’s research. domestic violence and sexual abuse are huge issues, that is the block, discuss the positive interventions that reduce this kind of trauma so people believe kids can get better from this and you’ll see change. educate about the intervention not the problem.


  15. The reason such things are not being addressed is because they are the most essential ingredient in social engineering; it's NO accident. An emotionally damaged/empty population is absolutely limited, susceptible to fear campaigns and materialism!

  16. I think abusive parenting is a cycle and it is very painful to deal with for the parents. I mean, if you were beat as a punishment when you were a child, so you beat your child for punishment, how do you help those people? Also about mental illness. How do you help the ones you love the most but you know if you try to get them to see a counselor if they are your parent?? It's just not easy but its not their fault:(

  17. Her work is being used in California and Oregon… not sure where else, but I believe it 100%. As a Naturopath, I have treated many adults with childhoods and teenage years with much trauma. My job is to prevent illness and help reverse illness that exists via mind, body and spirit. If can catch precursors to illness both mental and physical in the pediatric arena, health will improve dramatically. Of course I am not discounting a proper way of eating and exercise as extremely important. Also mindfulness meditation. I worked at CPMC at about the same time she was there. I wish I would have known about her work then. Share this video, because it is true.

  18. So I’m an 8, and the other two were kind of but not really (like I saw my bio dad being taken away by police a lot but he was never imprisoned, which is one of my under 5 memories) so… what next? How can you combat this or develop resilience? As an adult what can I do to mitigate the effects?

  19. I can't remember much about my abuse, and according to my mum, she stopped it instantly when I told her. So she could have totally saved me in so many ways. I have trust issues, abandonment issues, anxiety, and an attachment disorder. But it could have been worse.
    This talk really shows how much our brains can effect our bodies. Our brains are our greatest ally, and our greatest enemy. It effects us so much.

  20. This just makes me think. "What about the foster kids going in bad homes over and over?" They must be so at risk. Those poor, poor kids. Just solidifies my dream to foster kids and give them safe homes someday.

  21. I grew up with parents that were always angry. I was too afraid to go to them for anything. Well, I should say I didn't know you could go to them for help. I didn't know they weren't going to hurt each other when they were yelling and screaming. I grew up disassociating with what was going on at home and school. I thought I was so dumb kid because I wouldn't know what the teacher was talking about after disassociating in school. Nobody saw this. I didn't know it until I was almost 50. I just thought I was so wrong and bad. I still have no one to turn to and my last counselor I suggested we find someone else because she doesn't have the time for me. She said this in a voicemail after I asked about getting afternoon appointments. And she'd already asked me if I really wanted to continue. What? So I thought she had information that would help me, that would help me feel grounded and whole. But instead all I feels abandoned. I just wish life was finished. 🙁

  22. Having to migrate to the U.S.- a foreigner’s perspective of the U.S. is similar to that as living in a bubble. I grew up in a diverse neighborhood, and community. And can honestly say; not once was I exposed to the tragic history of the U.S.; but that is what public education does, shelter you from despicable acts. I’m grateful, and thankful to have been educated with the plight of African-Americans. It was a virtual reality game which I was exposed to, but it helped me understand and accept my roots like never before. Diversity is important, but so is knowing one’s history to level up the playing field. But next time, educate kinder. Remember that people don’t know what you know, or your thoughts unless you share.

  23. I was 40 + yrs old the first time I heard I love you from the lady that raised me I was so touched and cryed so much that day but as I look back on that day I think it was fake or something was eating up at her that's y she told me that

  24. And all these years the psychiatrists have lied and ripped off poor communities by recruiting their children to a life of deadly toxic medication with horrific side effects including death.. doctors are ruined millions of families

  25. Ridiculous and not true. I was badly physically abused as a child and teen as an adult I am in fantastic health. I have never felt better actually and unlike a lot of other adults I know I have no anxiety or depression (most of my friends and co-workers are taking anti-depressants and wellness classes for their bad mental health). The assumption that trauma manifests as physical illness later on in life is not a new theory, but it is only a theory and isn't true in many cases. The same idea that all childhood abuse victims will go on to develop serious mental illness – not true.

  26. my last comment was at the beginning but my ending comment is i am almost in tears this was the best ted talk ive seen yet

  27. I was molested from age 5-9 by multiple family members. Since the abuse, I’ve struggled with severe bipolar depression and anxiety. I don’t leave the house much , I can’t keep a regular job because of my manic episodes and I have a hard time maintaining relationships. I’ve made peace with one my abusers and was able to forgive them both, but the mental trauma is forever with me and there is no was I can escape it. Therapy and meds help, but it doesn’t seem to be enough. 🙁

  28. I’m sorry to say this but I am glad she made it clear the study was done on white ppl. Unfortunately, when a study is done on the majority group being minorities it gets dismissed and the steps to attempt the change of good does not get taken seriously.

  29. This is what psychologists have been talking about for years…… in most part of Africa, where abuse is seen as discipline, the effects are really disturbing but it is sad that our society don't even pay attention to us 🤦‍♀️🤦‍♀️

  30. I'm an adult. 30 years old now. Mom left at 4. Aunt and uncle put me through horrible physica, sexual and emotional abuse.
    I've been addicted to opioids and other dopamanergic drugs since I was 11. I've hurt my body greatly and am overweight now. I need a beta blocker to control my heartrate as stress causes it to race up to 130 bmp resting. I'm so sad and so depressed I need help and just don't know where to start. Am in a methadone program and have been doing much better than before the program and have managed to stay off of drugs. Still I'm so sad due to adversity. Any advice would be appreciated.

  31. That bear is my dad.

    I see my mom as a deer and my dad is a bear.
    The deer must do everything to love the bear so it wont kill her
    If she run, he run after
    So she stay
    Thats the evil circle

    I want her out of it

  32. The most powerful TEDtalk…thank you Dr. Harris for your delivery and all you do to make an impact on preventing mental illness across all lifespans

  33. Thank you for having the interest to dive deeper Nadine. It's unfortunate the medical 'institution' doesn't 'care', just prescribes. I'd love to see this rolled out across the world. It's not just necessary but imperative for the children are the future, and economy. From all aspects, healthier people in all manners contribute to a better society and cost 'the system' less.
    Starting with their health and wellbeing.
    I believe there's a scandinavian country putting a lot of money into their children, they seem to be the only ones on this planet doing so.
    Good luck with your Journey Nadine Burke, your'e an inspiration!

  34. I'm interested in those who gave this the thumbs down. Child abuser parents?? Parents in denial? Doctors who don't care? Curious… The studies are thorough and REAL.

  35. Great talk from a well spoken beautiful woman. Everything she said was right. Even though I wasn’t abused by my parents or family members, I was completely abused by my peers in school from being repeatedly bullied. Til this day, I struggle from mental illness. My experiences did change my brain and views in life. I’m seeking therapy though and going to fight through this every day and be reminded I can live a normal life as an adult.

  36. This answers so many questions! Mentally ill mother (hospitalized quite often since I was 2) alcoholic father (functional) and very demanding…and my wonderful type 1 diabetes among other issues. Thank you and sending love

  37. My ace score is 9. I have asthma, pcos, insulin resistance/metabolic syndrome, high blood pressure, auto immune deficiency. I am under 50 and already taking four heart meds and three other prescriptions.
    But I’m not suicidal, homicidal or a criminal. 👍🏻

  38. I love this Talk. Oftentimes people just think that it's a only a problem with a time expiration and to be able to link this is brilliant.

  39. And still anyone can have and raise a child, but we must have a license to do anything else including mental health care to treat what the parents or others have done to the child…. Why is parenting not required to be educated at least?

  40. I had all 3 ace. I'm in good health. I went to a physicist at 27. After that I saw thing how they are and live a good life now.

  41. Meh. Think most folk know that childhood trauma leads to delinquency, social problems, crime, addictions, mental health difficulties, poor health and so on – for some – to address the issue we need to end poverty. What she doesn't say is that trauma can also enrich a person; that the brain holds the potential to heal until old age before it starts to lose elasticity; that trauma is pervasive in mental health and poor health, it's not purely childhood trauma; that no one can avoid trauma, we all experience it at some point – it is a part of life and knowing what it is to human. What doesn't kill us makes us stronger. Yes it makes childhood and adolescence tough for sure – but when the individual 'seeks' the right help and support positive growth and development occurs.

  42. I was bullied in elementary school but it got worst in 5th grade so I basically was tramatized by it and now when my friends or anyone wants me to go out in the world do stuff all I say is "I'm not ready" or "I don't feel like it, maybe later" I stay in my room almost every single day because I have this thing inside my mind saying that they are talking about me and even if I do go when I do and I'm around a lot of people I tend to zone out, get dizzy, and feel terrible and it's because having the thought of people talking about me makes me feel insecure about myself

  43. Absolutely amazing! My abuse has ruined the my life with illness. Something serious needs to be done! In England there is no help, as a result I am Agoraphobic for twenty six years. Only the expects can help .

  44. After 25 years of dysfunction, I've finally realized I was abused by my father as a very, very young child. He was psychopathic, and Ive been suffering the consequences my entire life. After having been diagnosed with basically every mental disorder, I have recently been diagnosed with DID, or dissociative identity disorder. My mom told me one of her memories of me when i was 3 was that i said, "Mommy, I hear voices!"
    She never thought anything of it. My mom was innocent, but entirely unaware of any of the abuse, or the latter. Please, please be aware of any type of abuse, be it involuntary or not. I've suffered, and suffer every single day because of what happen to me. Question yourself, question your family, because you can save someones life.

  45. I'm 34 and battling childhood traumas (plus traumas in my adult life)…. I have my own daughters now. I am trying to forgive those who've hurt me (forgiveness is for me to bring peace) because they too suffered from childhood trauma. Not saying it was right but now as a parent I see some things within myself that are coming forth that I've NEVER experienced until after giving birth. I choose to break the cycle and bring love into not only my two daughter's lives but my own. I have to be the parent and parent figure I never had. I hope all who are affected find peace and healing. ❤️💕 💕

  46. Very inspiring talk! Would love to see the conversation continue with common objections to this kind of intervention. A few off the top of my head might include denial and not wanting to betray family dynamics to the medical/public sphere.

  47. Who is this woman? We seem to forget VERY FEW doctors the Most High has graced the medical fields with! Fascinating. On top of it, you can tell she CARES! That is the secret ingredient in the Sauce, PASSION!

  48. I'm in my 50's, both my parents experienced mental illness and my mother made multiple suicide attempts. The first one I witnessed when I was 5 yo. Not one adult reached out to talk to me about the event except to tell me that she accidentally swallowed poison instead of medicine. It was as if I was a puppy that didn't think or understand feelings. I never had counseling, a mentor, etc. What was worse than the childhood trauma is that everyone assumed I was fine because that is what was easier for them. When adults are uncomfortable with situations, they do their best to ignore and move on. But only recently have I begun to see the impact all of it. My childhood trauma created dysfunction that affected my own parenting, no matter how much I tried not repeating language and behaviors, I developed my own

  49. Just part of the NWO. Pure evil. They want the children. Vaccines destroy brains and immune systems – becoming lifetime customers of Pharma

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