April is Child Abuse Prevention month. The most common type of maltreatment is neglect. Adverse Childhood Experiences (ACEs), including all types of abuse and neglect, have increasingly become a high priority in the health care industry. Individuals with ACEs have been known to develop chronic illnesses later in life. Further research suggests that females with IBS suffer from comorbid mental disorders, including depression and anxiety. Could addressing ACEs help prevent patients from developing IBS, and other anxiety-induced disorders later in life?
It Starts with the Brain and the Gut
Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders. IBS is common in around 5–10% of the general population, and some symptoms, like constipation, are more prevalent in women than men. While stress does not cause IBS, experts say symptoms stem from a disconnect in the way the brain, nervous system, and gut interact, causing abdominal pain and discomfort and altered bowel habits (diarrhea, constipation, etc.). Because of this connection between the brain and the gut, experts have begun to make a connection between ACEs, especially experiences that cause mental and emotional stress, and IBS.
Many additional studies have found higher prevalence rates of ACEs, including physical, sexual, or emotional abuse, among IBS patients compared to healthy individuals or the general population. IBS presents more severe symptoms in individuals who have experienced abuse and causes higher risks of comorbid disorders, such as depression. Therefore, ACEs are related both to the development of IBS and additional psychological disorders down the road.
Gender Plays a Role
IBS is more prevalent in females than in males. IBS affects around 25 to 45 million people in the U.S. 2 in 3 IBS patients are females. 1 in 3 are males. Experts suspect hormones play a big role in women’s increased risk of IBS during puberty.
Estrogen and progesterone obstruct “smooth muscle contraction,” which typically occurs in the walls of the stomach and intestines. High estrogen and progesterone rates can slow digestion and cause constipation and other IBS-related symptoms. Women diagnosed with IBS have expressed more severe symptoms during menstruation, such as soft bowel movements, severe bloating, and increased abdominal pain.
What Does This Mean for Providers?
AFMC’s Chief Medical Officer, Dr. Chad Rodgers, says this correlation between ACEs and IBS further reinforces what providers already know: “A lot of chronic diseases can be connected back to trauma early in life. The more ACEs you have, the more likely you are to deal with chronic disease later in life.” Knowing about this relationship benefits practice.
ACEs have also been linked to a higher risk of chronic illnesses:
Depression
Cardiovascular Disease
Diabetes
Chronic Bronchitis/Emphysema
Evaluating medical, social, and family history is part of building a relationship with a patient. “You don’t have to necessarily know exactly what happened to your patient,” Dr. Rodgers says. “From knowing that your patient experienced trauma and that they’re a woman with stomach issues, you can increase your thought that they might be struggling with IBS.” Patients may have an illness that a CT scan or lab work will not pick up, so it’s important that providers can shift their mindset from “What is wrong with you?” to “What happened to you?” which is, Dr. Rodgers says, the mantra of ACEs.
Due to the trauma they experience, patients may deal with symptoms in different ways. “Some patients may have a very high pain tolerance, and others, due to trauma, may experience pain very differently,” Dr. Rodgers explains. “That should set off a lightbulb in their mind.” As providers, taking better care of patients means understanding the impact of trauma on a patient’s health. “Many patients report improvement in their symptoms just because they feel like their doctor knows or understands them,” Dr. Rodgers says. Providers acknowledging a patient’s trauma improves a patient’s overall health.
It's important that providers shift their mindset from 'What's wrong with you?' to 'What happened to you?'
For patients with IBS, one approach Dr. Rodgers suggests is to say “I know you have IBS and it’s been really bad. Do your symptoms get worse when your anxiety or depression is worse? Depression and anxiety have been linked to making IBS symptoms worse.” Through this nonjudgmental approach, providers can reach common ground with patients and help the patient work with the provider to improve their health.
Arkansas Foundation for Medical Care (AFMC) has always worked in hospitals, clinics, nursing homes, and other organizations to improve healthcare. “A couple years ago, we realized that not everything can be solved in the exam room,” Dr. Rodgers says. “80% of health is determined by what happens outside of a clinical setting.” This realization sparked interest at AFMC to build knowledge on trauma-informed care and ACEs. Our ACEs research has grown into an ACEs coalition and an annual ACEs Summit (the 2023 summit is coming up in August).
AFMC’s ACEs Coalition
AFMC encourages professionals and laypersons who look after or care for children to join our ACEs coalition. Our coalition meets virtually or in person to learn how ACEs and toxic stress affect individuals and their families, how people can build resilience to cope with ACEs, build stable, positive relationships with the children in our lives, ensure that our community has the resources people need to cope with ACEs and toxic stress, and spread the word to others. Our coalition includes tools, best practices, and advice from keynote speakers who help individuals with ACEs cope with stress and turn their trauma into opportunities to grow.
Subscribe to our ACEs News & Notes Newsletter to receive reminders about ACEs information and events.
Spread the Word about Child Maltreatment and ACEs
It is important that health care professionals continue to educate their patients and care teams on the importance of addressing ACEs. The Child Welfare Information Gateway has released a National Child Abuse Prevention Month outreach toolkit for 2023. The toolkit provides graphics, GIFs, social media images, email signatures, and other media that you can use to get the word out. The toolkit also includes ways that you can stay connected.
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