average Adverse Childhood Experiences (ACE) score of psychiatry residents and providers

[adrenocorticotropicana]

Is it okay to statistically poll this forum for participants' ACE scores? In particular, because psychiatrists treat many patients with high ACE scores, I in particular would like to know approximately what the average ACE score of psychiatric treatment providers is.

(I'm premed but my major motivation for considering medicine is psychiatry, in particular because my ACE score is 6.)

---

Members don't see this ad.

 

[Mass Effect]

I doubt many people are going to take a poll of something like this when their "vote" will be publicly displayed.

 

[adrenocorticotropicana]

i meant to have the aggregate results public, not the individual votes. i think i fixed it.

 

[SourceOfDenial]

It might be helpful to also see if everyone knows what ACEs are or read/was taught the original articles in residency. My experience has been that a minority of residents know about the study.

 

[OldPsychDoc]

Here's one--Take The ACE Quiz — And Learn What It Does And Doesn't Mean

 

[hamstergang]

In particular, because psychiatrists treat many patients with high ACE scores, I in particular would like to know approximately what the average ACE score of psychiatric treatment providers is.

Can you expand on the thought here? I have a guess but don't like assuming what others are thinking.

 

[Ceke2002]

Here's one--Take The ACE Quiz — And Learn What It Does And Doesn't Mean

Wait, that's it? 10 questions. How are you going to reduce the myriad of potential childhood abuse/trauma situations down to only 10 questions? Or for that matter score someone's risk factors based on how many questions they answer yes to (even one yes answer is likely to have an impact one would think). Admittedly I've only just now heard of this thing, but at first glance it sounds like the oppression olympics trauma style to me.

*goes to look up more info on ACE studies*

 

[OldPsychDoc]

Wait, that's it? 10 questions. How are you going to reduce the myriad of potential childhood abuse/trauma situations down to only 10 questions? Or for that matter score someone's risk factors based on how many questions they answer yes to (even one yes answer is likely to have an impact one would think). Admittedly I've only just now heard of this thing, but at first glance it sounds like the oppression olympics trauma style to me.

*goes to look up more info on ACE studies*

Primarily one should think of it only as a screening tool, to start a longer, deeper conversation.
But if a guy can score a 2 just by having an alcoholic dad who was prone to make shaming, belittling outbursts at times, you can see that folks scoring 4, 7, and higher might indeed have some issues that need deeper exploration, and could well be experiencing serious health sequelae in adulthood.

 

[Ceke2002]

Primarily one should think of it only as a screening tool, to start a longer, deeper conversation.
But if a guy can score a 2 just by having an alcoholic dad who was prone to make shaming, belittling outbursts at times, you can see that folks scoring 4, 7, and higher might indeed have some issues that need deeper exploration, and could well be experiencing serious health sequelae in adulthood.

Okay, that makes more sense. Thanks.

 

[FlowRate]

The results so far reflect what's already known--and somewhat intuitively obvious--about ACE's: they tend to cluster such that a minority of people have many ACE's whereas the median is none or few.

Having first- or second- hand experience with an issue can help with developing empathy, but it's neither necessary nor desirable.

 

[Ceke2002]

Having first- or second- hand experience with an issue can help with developing empathy, but it's neither necessary nor desirable.

*nods in agreement* Yes, absolutely. You can obviously still develop a sense of understanding when it comes to treating different conditions, without having to have first understood those same conditions through personal experience. If anything I would think having direct experience would increase the possibility of (counter) transference, and require the therapist to perhaps be more vigilant/aware of this potential than they might with other therapeutic situations.

 

[adrenocorticotropicana]

It's hardly the same as medicine, but a large portion of trained rape crisis advocates in the ER are past survivors of sexual assault, domestic or intimate partner violence.

The ACE questionnaire is ten questions -- a quick clinical inventory. Other rapid clinical inventories such as the Glasgow coma scale and the APGAR scale (which the ACE scale is probably inspired by) miss a lot of things as a quick-assess tool, but it also picks up a lot of things.

 

[SourceOfDenial]

Wait, that's it? 10 questions. How are you going to reduce the myriad of potential childhood abuse/trauma situations down to only 10 questions? Or for that matter score someone's risk factors based on how many questions they answer yes to (even one yes answer is likely to have an impact one would think). Admittedly I've only just now heard of this thing, but at first glance it sounds like the oppression olympics trauma style to me.

*goes to look up more info on ACE studies*

Given the original ACE study is one of the most important public health investigations in the last 20 years, I'm amazed at how it still is not regularly integrated into psychiatric teaching. It should be a core article in understanding how harmful childhood trauma is to the development of individuals and systems, both from a psychological perspective but also chronic illness lens. I think it somewhat speaks to the fact that psychiatry, and medicine as a whole does not really want to grapple with childhood abuse/neglect and how pervasive it is within our culture. STAR*D, CATIE trial...these are all standard landmark studies we are taught as psychiatrists, and both have been cited by subsequent articles much less frequently than the ACE study. Somehow the other social sciences, mental health fields and public health literature understood the power of ACEs more than psychiatry.

The results so far reflect what's already known--and somewhat intuitively obvious--about ACE's: they tend to cluster such that a minority of people have many ACE's whereas the median is none or few.

It's intuitively obvious but so frequently missed by providers. I often look back and wonder how often I missed the trauma component of a patient, and think about how a better understanding of that could have led to me offering different treatments, or having a more complete understanding of a persons development and life.

 

[WisNeuro]

Given the original ACE study is one of the most important public health investigations in the last 20 years, I'm amazed at how it still is not regularly integrated into psychiatric teaching. It should be a core article in understanding how harmful childhood trauma is to the development of individuals and systems, both from a psychological perspective but also chronic illness lens. I think it somewhat speaks to the fact that psychiatry, and medicine as a whole does not really want to grapple with childhood abuse/neglect and how pervasive it is within our culture. STAR*D, CATIE trial...these are all standard landmark studies we are taught as psychiatrists, and both have been cited by subsequent articles much less frequently than the ACE study. Somehow the other social sciences, mental health fields and public health literature understood the power of ACEs more than psychiatry.

While important, it often gets over-generalized. Remember that the most common reaction to adversity and trauma is resilience. Look at the good work of people like Rutter, Tugade, Werner, Frederickson, Masten, and Garmezy, to name a few. In fact, we've found that when we prime people for pathology following a traumatic event (early CISD) we actually make it worse and cause psychopathology rather than reduce it. It's fine to be better at dealing with psychological trauma, but we also need to be well-versed in psychological resilience. Otherwise, you run the risk of being a hammer and only seeing nails.

For anyone that is interested in citations, let me know. I spent several years researching/publishing on trauma and resilience from a neurological/psychophysiological perspective.

 

[adrenocorticotropicana]

In fact, we've found that when we prime people for pathology following a traumatic event (early CISD) we actually make it worse and cause psychopathology rather than reduce it.

Can you explain and summarize the literature a little further? I guess my personal experiences are interfering with my ability to see your argument clearly.

 

[WisNeuro]

Can you explain and summarize the literature a little further? I guess my personal experiences are interfering with my ability to see your argument clearly.

The quick and dirty summary is that in longitudinal studies, children from significantly adverse backgrounds (low SES, abuse, significant parental psychopathology, etc) will develop similarly to their peers without similar adverse experiences throughout childhood in terms of outcomes such as occupational success, psychopathology, etc. So, resilience is the default mode for most. We definitely need to help those that do not follow the default path, for a variety of reasons. But, it is just as dangerous to assume that adverse experiences in childhood will lead to negative outcomes for all, as it to assume that everyone will be fine after such experiences. We need to know the nuances of trauma and resilience in our populations if we wish to treat it adequately.