Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults

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   The more kinds of adversity a child goes through, the higher their adult risk of disease and early death climbs, dose by dose — which makes childhood a public-health variable, not a private matter.

   Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults · 1998

   Risk does not jump at a threshold, it climbs dose by dose with the number of kinds of adversity.

   The study asked seventeen thousand insured adults in California about ten things that happened before they turned eighteen: physical, emotional and sexual abuse; neglect; violence against the mother; a parent with mental illness, with an addiction, absent or imprisoned. Each kind ticked is worth one point. What counts in this model is not the severity of a single episode but the number of kinds — which is why it is called a score and not a diagnosis. The result that changed preventive medicine is the shape of the curve: risks do not jump at a threshold, they climb steadily with the score, for heart disease, lung disease, depression, addiction and attempted suicide. A score of four or more was associated with several-fold increases in a number of them. The proposed mechanism is not mystical: chronic stress during the years when the regulation circuits are built leaves an alarm system recalibrated, and the behaviours that soothe in the short run — smoking, alcohol, eating — become solutions with a deferred price.

   “Our findings suggest that exposure to abuse or to household dysfunction during childhood contributes to some of the leading causes of death in adults.”

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