• Catherine Lott

ACE scores and eating disorders


children playing outside



I'm in the process of finishing my clinical trauma specialist certification, and it's got me thinking (again!) about the powerful and persistent links between trauma and eating disorders. These links are often misunderstood and also not treated appropriately. The brain beset by the paralysing anxiety and disordered thinking resulting from starvation will 'reset' with nutritional rehabilitation, but the intrusive threat response which comes from painful prior learning,this needs something else too.


What is the ACE test?



The ACE test was first developed in the 1990s and consists of 10 questions to determine Adverse Childhood Experiences. The ACE study was conducted by Kaiser Permanente , Vincent Felitti and the Centres for Disease Control and Prevention. It tracked long-term health outcomes and found a very strong connection between adverse childhood experiences (ACEs) and significant lifetime health, social and behavioural problems.



Childhood trauma is common


The study found that adverse childhood experiences are very common. Sixty-seven percent of people have at least one ACE. Forty percent of people have two or more ACEs. And 20% of people have four or more ACEs.


ACEs tend to occur in clusters: 87% of individuals who reported one ACE reported at least one additional ACE. Twenty-eight percent of participants reported physical abuse and 21% reported sexual abuse.


The most common Adverse Childhood Experiences were found to be:


  • Physical abuse

  • Sexual abuse

  • Emotional abuse

  • Physical neglect

  • Emotional neglect

  • Mother treated violently

  • Household substance abuse

  • Household mental illness

  • Parental separation or divorce

  • Incarcerated household member


It is important to note, for any of us who may be tempted to assume these experiences were found to be most common in diverse and under-privileged populations, the ACE Study spans a broad socio-economic population, and Adverse Childhood Experiences were found to be common among the more privileged populations (white, college-educated).


Health impact of childhood trauma


The science is clear: early adversity dramatically affects a person’s health across their lifetime. The ACEs results show that adverse childhood experiences can contribute to health problems decades later. These include chronic diseases such as heart disease, cancer, stroke, and diabetes. These are among the most common causes of death and disability in the West.


Behavioural impact of childhood trauma


The number of ACEs is strongly associated with adulthood high-risk health behaviours. These include smoking, alcohol and drug abuse, promiscuity, and severe obesity. ACEs are correlated with mental health conditions including depression, heart disease, cancer, chronic lung disease and shortened lifespan.


an ACE score of 6 is associated with 20 years lower life expectancy and was associated with a 3000% increase in attempted suicide.


An ACE score of 4 is associated with A 700% increase risk of alcoholism

2 x increase risk of being diagnosed with cancer, and

A 400% increase risk of emphysema


Childhood trauma and eating disorders


Eating disorders are often biologically inherited and tend to run in families. Research suggests that inherited these genetic factors contribute approximately 56% of the risk for developing an eating disorder. There are also a number of biological factors implicated, such as abnormalities in the structure or functioning of the hypothalamus. We can think of these as the pre-disposing factors, whereas the focus of this post is on the links between eating disorders and trauma.


Several clinical studies link childhood trauma and eating disorders. For example, one study found a history of sexual abuse is common among individuals who exhibit disordered eating (Gustafson & Sarwer, 2004). Women in larger bodies were 27% more likely to report a history of childhood physical or sexual abuse (Alvarez, Pavao, Baumrind, & Kimerling, 2007).

There are numerous studies linking sexual trauma, in particular, to the development of eating disorders. Women with a history of childhood sexual abuse had a higher prevalence of problematic eating and eating disorders. (Fuemmeler, et. al., J Trauma Stress 2009 “Adverse childhood events are associated with obesity and disordered eating”)


While most people think of anorexia, the most common eating disorder (in the USA) is binge eating disorder. Binge eating has been directly linked to ACEs. It is believed that binge eating may sometimes be a method for soothing anxiety, fear, anger or depression caused by ACEs.

Those who have bulimia may use the binge-purge process to self-soothe. Those with a diagnosis of anorexia may find restriction to be the most numbing and soothing behaviour.


This is why, where present,(many people with an ED will have an ACE score of 0), ACEs trauma must be treated to heal from an eating disorder.


Childhood trauma leads to chronic stress


The link between ACEs and poor health outcomes and negative chronic behaviour is likely because exposure to early adversity:

Affects the nucleus accumbens, Inhibits the prefrontal cortex and Causes measurable differences in the amygdala


Childhood trauma causes brains and bodies to undergo physical changes. Adrenaline and cortisol response rates are altered, and the body lives in a chronic fight/flight response, under tremendous chronic stress. This chronic stress impacts the immune system, hormonal system, and even the epigenetic code. This can increase the likelihood of developing an eating disorder.


ACEs drive maladaptive coping mechanisms. These behaviours, such as eating disorders, can be a way to self-soothe when faced with anxiety and negative arousal. It makes sense to reach for a self-soothing behaviour to feel better. This hypersensitivity may be physiologically driven based on adverse childhood experiences.


This can feel bleak and a little overwhelming, I get that, ( I'll admit right now, because it's nothing to be ashamed of , my ACE score is 5). But it's not destiny. The negative outcomes shown in the ACE Study are based on people who did not receive care and intervention for their traumatic experiences. Those of us who learn resilience are able to reverse much of the damage inflicted by adverse childhood experiences.


"This is treatable. This is beatable. The single most important thing we need today is to look this problem in the face and say this is real. And this is all of us.”

Dr. Nadine Burke Harris



Any thoughts or questions, or If you want help or support with an eating disorder or with trauma, just reach out. :)




Thanks to:

J Eric Gentry,phd


Ginny Jones