ACE Studies and the significance of shame

In the 1990s, the healthcare provider Kaiser Permanente recruited Dr. Vincent Felitti in San Diego to help them to uncover why they were experiencing an epidemic of obesity.

I talk about these studies more elsewhere, but just to note that it was found that 55% of the people in the clinic who were experiencing severe obesity had experienced childhood sexual abuse. The excess weight served a positive protective factor for the people that we are unable to see. The study was then expanded to look at the correlation between other types of adverse childhood experiences (ACEs) and adverse situations in adulthood.

This study was initially conducted with 286 people. To make these findings into an epidemiological study, questionnaires were handed to each person who came into Kaiser Permanente (akin to a visit to your GP). In total over 17,000 people took part in the study.

ACEs studiesPatients were asked to complete two questionnaires. The first questionnaire asked them to say whether they experienced each of 10 categories of childhood adversity, such as neglect, violence between parents and substance abuse in parents. They were also asked to select which conditions they were now experiencing in adulthood, such as addiction, depression, diabetes, smoking, heart disease, stroke and suicide attempts.

The patients were given the time to complete the questionnaires. When they subsequently saw their doctor or nurse practitioner, the practitioner would say, “I notice that you experienced x when you were a child. I am so sorry that happened to you. You should not have had to go through that. Would you like to talk about it?” In response, 60% of people chose to talk about it and explore how it had affected them in adult life and 40% declined.

The really interesting point is that by asking these questions, there was a 35% decrease in outpatient visits and an 11% decrease in hospital admissions. This accounted for $billions of savings in healthcare costs!

So what was happening?

shame and healthWell we know that confession has been used as a means to bring relief to people’s circumstances for over 1800 years.  It appears that something similar was going on here. By someone listening to what had happened to a person and by receiving them warmly, with acceptance and giving them validation, the person was able to release their shame surrounding the event.

So this showed what an impact unresolved shame has on our bodies and minds. It shows the importance of having a supportive community to overcome this.