How Adverse Childhood Experiences Affect Your Health and Relationships Decades Later
LAST UPDATED: APRIL 2026
The ACE Study — one of the largest investigations in public health history — revealed something that most driven women intuitively sense but rarely have language for: what happened to you in childhood is still happening in your body, your relationships, and your health, decades later. This article explains the science, the specific pathways, and what you can actually do about it.
- The Migraine That Wasn’t About Migraines
- What Adverse Childhood Experiences Are
- The Biology of How ACEs Alter the Body
- How ACEs Show Up in Driven Women’s Relationships
- ACEs and the Professional Body: Health Consequences in Ambitious Women
- Both/And: The Wound and the Resilience
- The Systemic Lens: ACEs Are Not an Individual Problem
- What Healing the ACE Burden Actually Looks Like
- Frequently Asked Questions
The Migraine That Wasn’t About Migraines
Lisa had been to four neurologists. She’d had every scan, tried every medication protocol, kept a meticulous migraine diary for two years. She was 41, ran the operations division of a regional healthcare system, and had managed debilitating migraines three to four times a month for nearly a decade. Nobody had asked her about her childhood. Nobody had connected her body’s alarm system to the years she spent as the oldest child in a household where her father’s drinking made every evening unpredictable and every morning a triage.
When she came to therapy — originally for “work stress” — and we started mapping her history, the pattern was unmistakable. The migraines correlated strongly with periods of heightened relational uncertainty or conflict. Her immune system, her nervous system, and her cardiovascular markers all told a version of the same story her mind had been trying not to tell. She wasn’t broken. She was someone whose childhood had reorganized her physiology around a threat that was long gone — but whose body hadn’t gotten the memo.
Lisa’s story is not unusual. It’s, in fact, exactly what decades of research predicted. Understanding what adverse childhood experiences actually do to the body and the relational brain is the first step toward addressing what’s happening — and what’s possible.
What Adverse Childhood Experiences Are
Adverse childhood experiences are defined as potentially traumatic events that occur in childhood, typically before age 18. The original ACE Study, conducted by Dr. Vincent Felitti, M.D., internist and founder of Kaiser Permanente’s Department of Preventive Medicine, and Dr. Robert Anda, M.D., epidemiologist at the Centers for Disease Control and Prevention, surveyed over 17,000 adults on ten categories of childhood adversity: physical abuse, emotional abuse, sexual abuse, physical neglect, emotional neglect, household substance abuse, household mental illness, witnessing domestic violence, incarcerated household member, and parental separation or divorce. The study found that ACEs are common across all demographics and that their effects are cumulative: each additional ACE significantly increases the risk of negative outcomes across health, relationship, and social domains. Dr. Felitti and Dr. Anda published their landmark findings in the American Journal of Preventive Medicine in 1998, fundamentally changing how public health researchers understand the relationship between childhood adversity and adult outcomes. (PMID: 9635069) (PMID: 9635069)
In plain terms: ACEs are the hard things that happened in your household before you turned 18 — abuse, neglect, instability, violence. The research shows that these experiences get under your skin in a literal, biological way, shaping your health and relationships for decades.
What’s critical to understand about the ACE categories is that they include both overtly traumatic experiences and the quieter, relational ones — emotional neglect, household dysfunction, parental separation — that often don’t feel like “real” trauma. The woman who grew up with a distant, emotionally unavailable parent, or in a household where one parent’s addiction shaped every family dynamic, carries ACE burden even if she describes her childhood as “fine.” This is one of the most important clinical insights of the research: you don’t have to have been physically harmed to carry significant adverse childhood experience.
The original study also found that ACEs are strikingly common. Roughly two-thirds of adults report at least one ACE. More than one in five report three or more. This isn’t a marginal clinical finding about a small population — it describes most people, including most of the driven, professional women who read this site. The question isn’t whether you have ACEs. The more useful question is what your specific ACE burden is, how it’s showing up, and what to do about it.
Understanding childhood emotional neglect — one of the quietest ACE categories, and one of the most common in the women I work with — is particularly important for driven professionals who grew up in households that were functionally adequate but emotionally impoverished.
The Biology of How ACEs Alter the Body
The mechanism by which adverse childhood experiences create lasting physical and psychological effects is now one of the most well-documented areas of trauma research. Understanding it demystifies what might otherwise feel like random suffering — and makes the case for taking it seriously.
Chronic stress in childhood — the kind produced by ACEs — activates the hypothalamic-pituitary-adrenal (HPA) axis, the body’s primary stress response system. Under normal circumstances, this system activates in response to threat, then returns to baseline when the threat passes. In children exposed to ongoing adverse experiences, the HPA axis becomes calibrated to a chronically elevated state of readiness. The stress hormones cortisol and adrenaline that were adaptive in the threatening environment become chronically elevated — or, in some cases, the system eventually down-regulates in a pattern of chronic depletion that presents as exhaustion, shutdown, or collapse.
Dr. Bruce Perry, M.D., Ph.D., senior fellow at the ChildTrauma Academy and author (with Maia Szalavitz) of The Boy Who Was Raised as a Dog: And Other Stories from a Child Psychiatrist’s Notebook, has documented extensively how this neurological re-calibration affects developing brain architecture — particularly in regions governing emotion regulation, threat assessment, and relational attunement. These effects aren’t metaphorical. Neuroimaging studies show measurable differences in amygdala volume, prefrontal cortical development, and hippocampal function in individuals with high ACE scores compared to those with low scores. (PMID: 16311898) (PMID: 16311898)
The long-term health consequences of this neurobiological reorganization are substantial and well-documented. The original ACE Study found that individuals with four or more ACEs have significantly elevated rates of ischemic heart disease, cancer, chronic lung disease, liver disease, depression, and substance use disorders, compared to individuals with zero ACEs. The dose-response relationship is linear: more ACEs, worse outcomes — across almost every health domain measured.
The toxic stress response is distinguished from positive (manageable) stress and tolerable (significant but buffered) stress by its intensity, duration, and the absence of sufficient adult support to buffer the child’s experience. The National Scientific Council on the Developing Child, based at Harvard University and chaired by Dr. Jack Shonkoff, M.D., professor of child health and development, defines toxic stress as the activation of the stress response system in the absence of buffering relationships — resulting in lasting disruption of developing brain architecture and physiology. Unlike tolerable stress, which a child can metabolize with adequate support, toxic stress produces lasting neurobiological changes that persist into adulthood.
In plain terms: Toxic stress is what happens when a child faces too much, for too long, with too little support. It changes how the body and brain are built — not temporarily, but structurally, in ways that can last a lifetime without intervention.
RESEARCH EVIDENCE
Peer-reviewed findings that inform this clinical framework:
- 67% experienced at least one ACE (PMID: 9635069)
- 4-12-fold increased risk for alcoholism, drug abuse, depression, suicide attempt with 4+ vs 0 ACEs (PMID: 9635069)
- 45% of US children experienced at least 1 ACE; 10% experienced 3+ ACEs (PMID: 32963502)
- 48.1% prevalence of ≥1 ACEs; every additional ACE increases multimorbidity odds by 12.9% (PMID: 39143489)
- Pooled OR 2.20 (1.74-2.78) for heavy alcohol use with 4+ vs 0 ACEs (PMID: 28728689)
How ACEs Show Up in Driven Women’s Relationships
The relational effects of ACEs are where most driven women feel the impact most acutely — because the wound that formed in relationship most visibly re-emerges in relationship. Understanding the specific pathways helps name what’s happening without shame.
Sunita is a 39-year-old attorney and mother of two who came to therapy describing herself as “emotionally unavailable” in her marriage. Her husband had said he felt like he was living with someone who was never quite present, and she knew he was right — she just didn’t know why. When we mapped her history, the pattern became clear: she’d grown up in a household where her mother’s chronic illness created years of unpredictability, and her father coped by working late and coming home emotionally depleted. Nobody in Sunita’s household was reliably present. She’d adapted by becoming self-sufficient — not needing anyone, not expecting anyone, not letting herself want much. In her marriage, that adaptation was the very thing threatening the intimacy she consciously wanted.
ACEs affect adult relationships through several well-documented pathways. Attachment patterns are shaped profoundly: children in ACE-affected households often develop anxious, avoidant, or disorganized attachment styles — patterns of relating that then play out in adult partnerships in predictable but often invisible ways. Understanding how emotionally immature parents shape adult relationships illuminates these dynamics in detail.
Disorganized attachment — the style most associated with high ACE scores — is particularly relevant for driven women because it tends to produce what researchers call “approach-avoidance” relational dynamics: a simultaneous desperate desire for closeness and a terror of it. This isn’t a character flaw or a choice. It’s a neurological inheritance from childhood experiences in which the people who were supposed to be safe sources of care were also sources of threat. When the attachment figure is simultaneously the source of comfort and danger, the developing nervous system has nowhere to go — it learns to need and to flee at the same time. In adult relationships, this shows up as pushing people away precisely when they get close enough to matter, oscillating between intense connection-seeking and sudden withdrawal, and a pervasive difficulty allowing dependence even when the relationship is genuinely safe.
Affect regulation is another key pathway. When children grow up in households where their emotional experiences are not consistently met with attuned responses, they develop impaired capacities for emotional regulation — not because they’re weak but because the neurological infrastructure for regulation is built in relationship and wasn’t adequately established. As adults, this can look like emotional flooding, chronic shutdown or numbness, or dramatic swings between the two. In driven women, the shutdown end of the spectrum often predominates — they’ve become very good at managing their internal states by not feeling them.
Trust and safety in relationships are also profoundly affected. When the people who were supposed to be safe sources of care were also sources of harm or unpredictability, the nervous system learns that closeness is risky. This can produce a pattern of pushing people away just when intimacy deepens — not a choice, but an automatic protective response.
ACEs and the Professional Body: Health Consequences in Ambitious Women
In driven women specifically, the health consequences of ACEs are often obscured by the very adaptations that made them successful. The woman who has been running on hypervigilance and cortisol since childhood may not notice until her forties that her immune system is chronically compromised, that she can’t sleep without substances or exhaustion, that her autoimmune condition worsened precisely when her life got more stable — counterintuitively, because she finally let herself feel what her body had been carrying all along.
The ACE-health connection is mediated by the chronic elevation of stress hormones and inflammatory markers over time. Research published in major medical journals including JAMA, The Lancet, and Pediatrics has documented associations between high ACE scores and elevated rates of: autoimmune conditions (including fibromyalgia, rheumatoid arthritis, and lupus); cardiovascular disease; obesity and metabolic syndrome; cancer; chronic pain; sleep disorders; and gastrointestinal conditions including IBS and IBD. The body, in other words, keeps a ledger — and the entries from childhood remain active, silently accumulating interest, until they can be processed.
For driven women, this ledger is often opened during periods of transition or relative stillness — postpartum, after a business exit, during a significant relationship crisis. The presenting complaint is frequently somatic: fatigue, pain, insomnia, immune dysregulation. These women have been managing the ACE burden through activity and accomplishment, and when the pace slows, the body surfaces what’s been waiting. Lisa’s migraines, in this frame, were her body’s way of flagging a debt that needed attention. Understanding this as a relational trauma and complex PTSD presentation — not a medical mystery — is what opened the door to real treatment.
Both/And: The Wound and the Resilience
The ACE research is sobering, and it’s important to sit with its weight rather than immediately pivoting to reassurance. Decades of accumulated physiological impact are real. The relational patterns formed by childhood adversity are real. And at the same time — the research is equally clear that ACE burden is not destiny.
Protective factors matter profoundly. The same research that documented the health risks of ACEs also documented what buffered them: consistent, attuned relationships — at least one stable, caring adult in childhood; and in adulthood, quality therapeutic relationships, community connection, and the development of what researchers call “executive function” or reflective capacity. The brain is plastic. The nervous system can reorganize. The body can heal. Not perfectly, not without effort, and not instantly — but genuinely, measurably, and in ways that show up in both subjective wellbeing and objective health markers.
“You may shoot me with your words… But still, like air, I’ll rise.”
Maya Angelou, Poet and Memoirist, “Still I Rise,” And Still I Rise: A Book of Poems
Sunita eventually came to describe her healing with what I thought was unusual precision: “I’m not unlearning who I became. I’m adding onto who I am. The self-sufficiency isn’t bad. I’m just not leading with it out of fear anymore.” That distinction — between healing as loss and healing as expansion — is exactly the both/and that ACE work makes possible. You don’t have to give up what kept you safe. You get to choose when and with whom you put it down. Learning to build the kinds of genuinely connected relationships that serve as adult buffering experiences is itself part of what healing looks like.
The Systemic Lens: ACEs Are Not an Individual Problem
The framing of adverse childhood experiences as an individual-level health risk obscures a critical systemic truth: ACEs are disproportionately distributed across society along lines of race, class, gender, and geography. The same conditions — poverty, neighborhood violence, housing instability, parental incarceration, lack of mental health resources — that create ACEs are themselves products of structural inequities. The child who grows up with five ACEs didn’t cause her own adversity. She grew up in a system that distributed that adversity unequally and provided inadequate resources to buffer it.
Understanding this systemic dimension matters for several reasons. First, it removes the shame that often accompanies self-disclosure of childhood adversity. Women who’ve internalized the cultural narrative of the self-made person often experience their childhood wounds as failures of character — evidence that they came from the wrong kind of background. The systemic lens reminds us that ACEs were imposed, not chosen, and that the burden of healing shouldn’t fall exclusively on the individual who experienced them.
Second, it points toward the limits of purely individual healing approaches. Intergenerational trauma — the transmission of ACE burden from one generation to the next through both neurobiological and relational pathways — can only be interrupted at both the individual and the systemic level. The mother who heals her own ACE burden reduces the likelihood that her children will carry it forward. But the community that ensures every child grows up with adequate food, housing, education, and access to caring adults is doing the same work at scale. Both matter. Neither is sufficient alone.
What Healing the ACE Burden Actually Looks Like
Healing the ACE burden doesn’t require erasing what happened. It requires addressing what happened — specifically, at the level where the wound lives, which is in the body, the nervous system, and the patterns of relationship. This is not a linear process, and it’s not one that can be fully accomplished alone. But it’s eminently possible, and it produces changes that are real and lasting.
The most effective approaches to ACE-related healing are those that address the nervous system directly — somatic approaches (somatic experiencing, trauma-sensitive movement, body-based meditation), EMDR, and body-inclusive relational therapies. Talk therapy that stays at the level of insight can provide essential understanding and is a valuable component of healing — but without addressing the neurobiological dimension, it tends not to move the core patterns.
For women with high ACE scores, healing also often involves addressing the physical health consequences that have accumulated. This means working with healthcare providers who understand the ACE-health connection — who won’t simply manage symptoms but will ask about history and treat the whole person. Functional medicine practitioners, trauma-informed physicians, and integrative health providers increasingly offer this frame. Lisa, after beginning trauma-informed therapy, also worked with an integrative neurologist who understood the migraine-nervous system-stress connection. Her migraines decreased by 70% in eight months. Not because of a new medication — but because her nervous system was finally receiving treatment for the right diagnosis.
Relational healing is equally essential. Because ACEs are fundamentally relational in origin, healing requires corrective relational experiences — the experience of being genuinely seen, safe, and valued by another person over time. The therapeutic relationship provides this in a specific, protected way. Close friendships, partnership, and community can also provide it, to the extent that those relationships are safe and attuned. Building and maintaining connections that support this kind of healing is its own meaningful work.
If you’d like to understand your own ACE profile more concretely and explore what healing might look like for your specific history, working directly with a trauma-informed therapist is the most efficient path. The work you do for yourself also, inevitably, reverberates forward — into your children’s nervous systems, your family system, and the relational legacy you leave.
One aspect of ACE-informed healing that doesn’t get enough attention is the process of meaning-making — the way that individuals who heal most completely from adverse childhood experiences aren’t those who simply process the pain, but those who eventually develop a coherent, integrated narrative that makes sense of what happened without minimizing it or being consumed by it. This is what developmental psychologists call “narrative coherence,” and research consistently shows it as one of the most powerful predictors of both personal wellbeing and secure parenting. Developing that coherent narrative — the story of what happened to you, how it shaped you, how you’ve grown, and what it means — is a central task of the therapeutic process, and it takes time. It can’t be rushed. But it’s worth protecting the space for it, because the coherence that comes from this process is a form of integration that makes nearly everything else in your life easier to navigate. For women doing this work, the Strong & Stable newsletter community is a space to stay in conversation with the ongoing dimensions of this process.
I also want to acknowledge one more dimension of the healing journey that the ACE research literature sometimes understates: the role of the body as an active partner in recovery, not just a site of damage. The same physiological systems that recorded the adversity — the HPA axis, the immune system, the autonomic nervous system — are also remarkable systems of healing and adaptation when given the right conditions. Practices that directly engage the body’s regulatory systems — trauma-sensitive yoga, somatic experiencing, breath-based practices rooted in the neuroscience of the vagus nerve, and trauma-informed movement — all have emerging evidence bases for reversing aspects of the biological sequelae of ACEs. When Dr. van der Kolk wrote that the body keeps the score, he was also pointing toward the address where healing would need to be sent. The body that carried what happened is also the body that can, with the right support, gradually reorganize itself around safety. That reorganization — felt in the loosening of chronic tension, the deepening of breath, the nervous system’s growing capacity to rest — is one of the most quietly profound dimensions of ACE-informed healing. You’re not just healing your history. You’re healing your physiology. Both are possible. Both matter. (PMID: 9384857) (PMID: 9384857)
Lisa, two years after beginning her healing journey, told me that she rarely gets migraines anymore. Her neurologist noted the change. Her immune markers improved. But the thing she mentions most — the thing she didn’t expect — is that she finally feels like someone who belongs in her own life. Not just someone who survived it and built something impressive on top of the rubble. Someone who actually lives it. That distinction — between surviving and inhabiting — is what ACE-informed healing makes possible. It’s available to you, regardless of how many years of forward-momentum you’ve built on top of what happened. The foundation can be rebuilt. The body can be heard. The nervous system can reorganize around something other than threat. And you don’t have to do it alone. Understanding your specific wound pattern is a good place to begin.
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Q: I had a difficult childhood but I turned out fine. Do ACEs still affect me?
A: “Turning out fine” by external measures — career success, functional relationships, absence of crisis — doesn’t indicate that ACE burden isn’t present or active. Many women with significant ACE scores have developed extraordinary functional capacities alongside the wound. The wound can coexist with achievement, with loving relationships, with a life that looks good on the surface. The question is what it’s costing you — in physical health, in the quality of your inner life, in the depth of your intimate relationships, in what you’re modeling for children in your orbit. ACEs don’t always announce themselves dramatically. They often show up in the quiet patterns: the insomnia, the chronic tension, the relationships that never quite feel safe enough, the success that never quite feels like enough.
Q: My childhood wasn’t abusive — it was just chaotic or “not ideal.” Does that count?
A: Yes. The ACE categories include household dysfunction — a parent with substance use disorder, household mental illness, witnessing domestic violence, parental separation — as well as emotional neglect, which doesn’t require overt abuse. Children need emotional attunement, stability, and consistent care to develop in healthy ways. When those conditions are absent — even in the absence of explicit trauma — the developing nervous system is still affected. Many women with chaotic, unstable, or emotionally impoverished childhoods have significant ACE burden even if they can’t point to a single dramatic incident. “Not ideal” absolutely counts.
Q: If ACEs are linked to health problems, should I be talking to my doctor about my childhood history?
A: In an ideal world, yes — and many trauma-informed physicians now routinely ask about ACE history as part of preventive care. In practice, many conventional physicians aren’t trained in this framework and won’t ask. If you have chronic health conditions — autoimmune issues, cardiovascular risk factors, chronic pain, sleep disorders — that have been difficult to treat and aren’t responding fully to standard approaches, it’s worth raising your childhood history with your physician or seeking out an integrative or functional medicine provider who understands the ACE-health connection. The treatment isn’t to re-traumatize yourself by disclosing to an unprepared doctor. It’s to ensure your care team understands the whole context.
Q: Will knowing my ACE score change what I do?
A: For many women, naming the ACE score provides genuine relief — it’s a clinical confirmation that what they’ve felt vaguely for years is real and has a documented impact. It can also reduce self-blame and increase motivation to seek the right kind of support. That said, the score itself isn’t a prescription. Two people with the same ACE score can have very different presentations depending on the protective factors they had available, the specific nature of their experiences, and the coping strategies they developed. What the score gives you is a starting point and a frame — not a destiny or a to-do list. Use it as an invitation to curiosity, not a verdict.
Q: Can I heal from ACEs even if my life is currently stable and the adversity is long past?
A: Absolutely — in fact, current life stability is often a prerequisite for doing this work, not an obstacle to it. Healing from ACEs requires sufficient safety in the present to access the past without being overwhelmed. When life is in crisis, the priority is stabilization. When there’s a foundation of relative stability, that’s precisely when deeper processing becomes possible. Many women find that they arrive at this work in their thirties and forties, when external life has stabilized enough that the internal landscape finally surfaces. That timing isn’t a failure to have dealt with things earlier — it’s often the natural sequence of healing.
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Annie Wright is a licensed psychotherapist (LMFT #95719) and trauma-informed executive coach with over 15,000 clinical hours. She works with driven, ambitious women — including Silicon Valley leaders, physicians, and entrepreneurs — in repairing the psychological foundations beneath their impressive lives. Annie is the founder and former CEO of Evergreen Counseling, a multimillion-dollar trauma-informed therapy center she built, scaled, and successfully exited. A regular contributor to Psychology Today, her expert commentary has appeared in Forbes, Business Insider, Inc., NBC, and The Information. She is currently writing her first book with W.W. Norton.
