Why the ACEs Study Still Matters - And What It Means for All of Us

Few studies in the trauma world have had the cultural impact of the ACEs study - and yet, strangely, it’s still one of the least understood. If you’ve ever wondered why mental health professionals talk about childhood trauma with such urgency, or why so many therapists, coaches, practitioners, and trauma-informed organisations reference ACEs, this is the study that changed everything.

Let’s break down why it matters, what it really taught us, and what it means for the future of trauma-informed care.

A Quick Refresher: What Is the ACEs Study?

Led by Dr Vincent Felitti at Kaiser Permanente and Dr Robert Anda at the US Centers for Disease Control and Prevention (CDC) in the mid-1990s, the ACEs study followed over 17,000 mostly middle-class, insured adults. They were asked about ten categories of adversity before age 18 (things like physical, emotional, or sexual abuse, neglect, parental separation, mental illness, substance use, or incarceration in the home). Their answers were then compared with their health records and behaviours.

The results weren’t just surprising. They were seismic.

The Key Findings: ACEs and Health – What The Numbers Actually Showed

The big takeaway was a dose–response relationship:

The higher your ACE score, the higher your risk of serious health problems.

Some of the clearest links the study and follow-up analyses found:

• Heart disease – People with 4 or more ACEs had around 2–3 times the risk of ischemic heart disease compared with those with 0 ACEs.

• Stroke & cancer – Higher ACE scores were associated with increased risk of stroke, cancer, and chronic lung disease (COPD).

• Liver disease – Elevated rates of chronic liver disease and hepatitis.

• Mental health – Strong links with depression, anxiety, suicide attempts, and serious mental distress.

• Substance use – The risk of alcoholism, drug misuse, and smoking rose sharply with each additional ACE category.

• Sexual health – Higher risk of teen pregnancy, STIs, and sexual risk behaviours.

• Life expectancy – People with 6 or more ACEs were found to die on average nearly 20 years earlier than those with none in some analyses.

So this wasn’t just:
“Trauma makes life harder emotionally.”
It was:
“Trauma is showing up in heart attacks, lungs, livers, immune systems, behaviours, and mortality curves.”

In other words:
The body is carrying the imprint of childhood adversity.

How Deep It Goes: From Stress to Biology

The ACEs data gave scientific backing to what many survivors and practitioners already felt:

• chronic stress in childhood can keep the body in a constant state of threat

• that alters the stress response system (cortisol, adrenaline)

• it affects the immune system, inflammation, and metabolism

• it changes brain development, especially in areas related to regulation, memory, and threat detection

So when an adult shows up with heart disease, diabetes, or addictions, the ACEs study invites a deeper question:

“What happened to this person over time?”
not “What’s wrong with them?”

Replication: It Wasn’t Just One Study

Since the original research, ACE-type studies have been repeated in:

• the UK,

• other parts of Europe,

• Asia,

• Australia,

• and within specific communities and populations (e.g. indigenous groups, urban communities, youth services).

Most of these have found very similar patterns – higher ACE scores are consistently linked with:

• poorer physical health

• more mental health challenges

• increased substance use

• and social/relational difficulties

Different countries. Different cultures. Same nervous system.

What This Actually Means For Us

Here’s what the ACEs study really asks us to take seriously:

• Trauma is a public health issue, not just a mental health one.
  We’re not just talking about feelings; we’re talking about heart disease, cancer risk, chronic pain, and lifespan.

• Symptoms often make sense in context.
  Addiction, self-harm, compulsive behaviours, emotional reactivity - these can be adaptations to early experiences, not random “problems.”

• Prevention is everything.
  Supporting children, families, schools, and communities is literally disease prevention.

• Healing needs regulation and relationship, not shame.
  If trauma is stored in the body and nervous system, then safety, connection, and trauma-informed care are medicine.

For Traumality, it’s one of the pillars behind everything:
we’re not just “making content” - we’re speaking into a world where these patterns are real, measurable, and still under-recognised.

Who Takes ACEs Seriously – And Who Doesn’t (Yet)

Who recognises it:

• trauma therapists, psychologists, psychiatrists

• social workers and safeguarding teams

• many public health agencies

• trauma-informed schools and organisations

• researchers in neuroscience and mental health

In these circles, ACEs is now pretty much foundational.

Where it’s still under-recognised:

• general medical practice

• some hospitals and specialist clinics

• policy and commissioning structures

• systems still built around “diagnose and treat” rather than “understand and prevent”

Why Isn’t It Fully Integrated into Medical Care?

It’s not because the science is weak.
It’s because the systems around healthcare weren’t built with trauma in mind and in many ways, still aren’t.

Here are the real reasons:

1. Medicine is still built on a biomedical model, not a biopsychosocial one.

Doctors are trained to look for physical symptoms, diagnose illnesses, and prescribe treatments.
Childhood trauma doesn’t show up on blood tests or scans, so it often gets missed - even though its effects are written into the nervous system.

2. Psychiatry follows a medical model too.

Most psychiatric training is based on diagnostics, medication management, and symptom categorisation.
While trauma-informed psychiatry exists, it’s still not the norm.
Many psychiatrists receive minimal training in trauma, attachment, the nervous system, or developmental adversity.

3. Big Pharma shapes the system more than most people realise.

Medication isn’t “bad,” but it is profitable.
Trauma-informed care requires time, relationship, attunement, community support, and long-term investment.
Those things don’t fit neatly into a pharmaceutical-driven system that prioritises:

• short appointments

• symptom management

• fast interventions

• quick fixes

Trauma work is slower, deeper, and relational — the opposite of the current “efficiency-first” medical model.

4. Doctors don’t have the time or training to explore trauma safely.

A GP often has 8–10 minutes per patient.
Unpacking 10–20 years of adversity can’t happen in that window - and may not be safe unless the patient has support.

So even when a clinician knows trauma is relevant, the system doesn’t give them the space to work with it.

5. Trauma challenges the foundations of healthcare.

If ACEs were fully integrated into medicine, the entire structure of healthcare would need to shift toward prevention, early intervention, and relational care.
That requires cultural, financial, and structural reform - and most systems are decades behind.

6. It’s emotionally confronting.

Accepting the ACEs findings means acknowledging how many adults are suffering due to childhood environments that could have been prevented.
It forces society to look at:

• family systems

• poverty

• social inequality

• neglect

• domestic violence

• community breakdown

• intergenerational trauma

And those conversations are uncomfortable for institutions built around “treating symptoms” rather than addressing root causes.

Conclusion

The ACEs study didn’t just give us data – it gave us direction. It revealed how deeply our early environments shape our bodies, behaviours, relationships, and long-term health. It challenged outdated ideas about blame and willpower, and replaced them with a trauma-informed understanding of human development. And even though many medical systems haven’t fully caught up, the evidence is clear: when we recognise the impact of childhood adversity, we unlock more compassionate, effective ways to support people. This is the foundation of trauma-informed care — and the future Traumality is helping to build.