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Recently I have been researching the fascinating field of childhood trauma and uncovered an interesting link between adverse childhood experiences and Hashimoto’s disease.
One of the studies I discovered came out of a large, important public health study, The ACE Study, but it focused specifically on cumulative childhood stress and autoimmune disease in adults.
What are adverse childhood experiences?
Adverse childhood experiences, or ACEs, are experiences that expose individuals under the age of 18 to childhood traumatic stress. These experiences include physical, emotional or sexual abuse; witnessing domestic violence; growing up with household substance abuse, mental illness, parental divorce, and/or the incarceration of a household member.
Who was studied?
A group of 15,357 adult Kaiser Permanente health maintenance organization members available for follow-up through 2005 was involved in this study. They were selected from the ACE Study, which was performed from 1995 to 1997.
These individuals are interesting because while many studies have looked at inner-city poor people of color, this study’s participants were mostly white, middle and upper-middle class college-educated San Diegans with good jobs and great health care.
This highly educated population was made up of 40 percent college graduates. Of the remaining individuals, 36% had some college education, 17% were high school graduates (i.e., they had 12 years of education). Only 7% had not completed high school.
What did they measure?
The study authors looked at the data from the ACE Study and created an ACE Score that included eight types of interrelated and co-occurring exposure to childhood adversity to measure cumulative childhood traumatic stress. So, the greater the number of adverse experiences, the higher the score.
The ACE Study Questionnaire is very simple and includes the following 10 questions.
“While you were growing up, during your first 18 years of life:
1) Did a parent or other adult in the household often …
Swear at you, insult you, put you down, or humiliate you?
Act in a way that made you afraid that you might be physically hurt?
2) Did a parent or other adult in the household often …
Push, grab, slap, or throw something at you?
Ever hit you so hard that you had marks or were injured?
3) Did an adult or person at least 5 years older than you ever…
Touch or fondle you or have you touch their body in a sexual way?
Try to or actually have oral, anal, or vaginal sex with you?
4) Did you often feel that …
No one in your family loved you or thought you were important or special? or
Your family didn’t look out for each other, feel close to each other, or support each other?
5) Did you often feel that …
You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you?
Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?
6) Were your parents ever separated or divorced?
7) Was your mother or stepmother:
Often pushed, grabbed, slapped, or had something thrown at her?
Sometimes or often kicked, bitten, hit with a fist, or hit with something hard?
Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?
8) Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?
9) Was a household member depressed or mentally ill or did a household member attempt suicide?
10) Did a household member go to prison?”
If the answer was yes to any of these questions, the respondents were allocated one point.
Next, the authors looked at those scores and compared them with the risk of 21 different autoimmune diseases that resulted in hospitalization. These illnesses included Graves’ disease, diabetes, irritable bowel syndrome, multiple sclerosis, Addison’s disease, and Hashimoto’s thyroiditis.
What did the study results show?
The study revealed that eight of the study participants had Hashimoto’s thyroiditis, and all of them were women.
In the study, women were 50% more likely than men to be hospitalized with an autoimmune disease. In fact, they were 50% more likely to suffer from any autoimmune disease within the same Th2-type grouping that Hashimoto’s belongs to.
Compared to the individuals with no ACEs, those with more than two ACEs were 80% more likely to be hospitalized because of a Th2-type autoimmune disease.
And with every extra ACE added to their score, participants were 20% more at risk of suffering from a Th2-type autoimmune disease.
Interestingly, the study also showed that the relationship between the ACE Score and autoimmune disease hospitalization was stronger among younger adults. In fact, those between the ages of 19 and 64 were twice as likely to be hospitalized as individuals over 65 years old.
What causes this relationship?
The reasons behind these findings is an interesting point of discussion. Around the same time the ACE Study was being done, parallel research was being performed on children’s brains and how they are affected by toxic stress.
Pediatric and neuroscientist researchers from Harvard, Rockefeller, and the Child Trauma Academy found that when children are overloaded with stress hormones, they have difficulties learning at school, trusting adults and developing healthy relationships with their peers.
To relieve their anxiety, depression, guilt, shame and other emotions, they easily turn to biochemical solutions, such as nicotine, alcohol, and drugs. They may find other ways to escape their problems, too, like engaging in high-risk sports, sex with various partners, over-achievement/work or overeating.
Research from that time also shows that childhood abuse changes the brain and brain waves. The brains of severely sexually abused women and maltreated children are actually smaller in certain areas.
The relationship between stress and autoimmune disease is still being researched, and larger studies are needed in this field. However, we do know that there is a connection between immune disorders, emotional disorders, and mental disorders. What we don’t understand yet, is why these connections occur, though some have further speculated that 80% of autoimmune disease patients are women because female individuals respond to stress differently than males because they produce more estrogen.
Dr. Hedberg’s Comments
During the research that compared autoimmune diseases and ACE Scores, only patients who were hospitalized were studied. This leads to the question: what about the individuals that didn’t go to the hospital due to Hashimoto’s or another autoimmune disease during that time?
From my experience, most patients visit their doctor at a clinic and aren’t hospitalized by Hashimoto’s, though some cases naturally result in hospitalization.
This was recognized by the authors of the study, who said of autoimmune diseases: “Autoimmune diseases were identified through hospitalizations and not outpatient data. Future studies may be strengthened through the use of clinical data because most autoimmune diseases are diagnosed through outpatient visits.”
Next, we must consider those in the general population who never receive Hashimoto’s diagnosis. The American Association of Clinical Endocrinologists (AACE) estimated that in the United States approximately 13 million people, or 4.78% of the population, have undiagnosed thyroid dysfunction. If true, this would represent approximately half of those with the disease.
The study also omitted patients over the age of 65.
However, this study is very useful and the findings that relate to ACE Scores appear to be very accurate. The estimated prevalence of childhood exposures to adverse experiences that the study revealed were almost identical to those reported in surveys of the general population.
They found that 16% of the men and 25% of the women met the case definition for contact sexual abuse. A national telephone survey of adults in 1990 conducted by a group of researchers using similar criteria, estimated that 16% of men and 27% of women had been sexually abused.
When it comes to physical abuse, 28% of the men in our study had experienced this abuse as boys. This closely parallels the 31% of men who had lived through the same type of experience and were examined in a population-based study of Ontario men.
In conclusion, this study is a great start and uncovers some very interesting connections between Hashimoto’s and cumulative adverse childhood experiences. The next step, of course, is to look at how to heal from ACEs in order to lower the risk of experiencing autoimmune diseases like Hashimoto’s, as well as potentially prevent the worsening of their symptoms.