Unlocking Clues to Current Health in Past History: Childhood Trauma and Healing


Adverse childhood experiences can have enduring effects on patients’ health, but these four steps can help promote healing.

Fam Pract Manag. 2019 Mar-Apr;26(2):5-10.

Author disclosures: no relevant financial affiliations disclosed.

“I can’t lose weight! I barely eat, and I keep getting bigger,” says Patient M, a complaint you’ve heard from her for months now, causing both of you to grow frustrated. After being diagnosed with type 2 diabetes a year ago, she has made no progress with her weight loss, and her A1C continues to climb. At today’s visit, you intended to confront her on her poor choices, but when you reviewed her chart briefly before entering the exam room, you noticed her newly completed adverse childhood experiences (ACE) screening was positive for multiple items. So, you take a deep breath, turn away from the computer, look her in the eyes, and say, “That sounds so frustrating. What do you think is going on with your weight?”


ACEs are traumatic events viewed negatively by a child and beyond his or her control. They can have an indelible impact on individuals’ lifelong health, outlook on life, and how they respond to everyday occurrences.

Each year more than one billion children worldwide are exposed to direct or indirect violence.1 In the United States, at least one in four children has experienced child neglect or abuse (physical, emotional, or sexual) at some point in their lives, and one in seven children experienced abuse or neglect in the last year.2 Repeated and chronically negative events suffered by children can be damaging not only to the individuals who experience them but also to future generations and the surrounding community, impacting future violence perpetuation and perpetration, health, and opportunity.3

Fortunately, the experience of childhood trauma does not predestine a person to negative health. Growing evidence suggests that prevention strategies are effective and could improve the lives of those affected while reducing the costs associated with the consequences of childhood trauma.1 Family physicians can play a critical role in the lives of patients, families, and communities by taking the following steps to address childhood trauma.


  • Adverse childhood experiences (ACEs), such as abuse or neglect, can have an indelible impact on individuals’ lifelong health.

  • Because of the prevalence and impact of trauma, practices should consider adding a 10-question ACE screening tool to their workflow.

  • Simple shifts in practice can help physicians provide treatment, referral, or emotional support to trauma survivors in a safe, caring, and confidential environment.


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Dr. Leasy is assistant professor of clinical family and community medicine at the Lewis Katz School of Medicine, Temple University, Philadelphia....

Dr. O’Gurek is associate professor of family and community medicine and director of urban community health at the Center for Bioethics, Urban Health, and Policy at Temple University.

Dr. Savoy is associate professor of family and community medicine and chair of the Department of Family and Community Medicine at Temple University.

Author disclosures: no relevant financial affiliations disclosed.

Send comments to fpmedit@aafp.org, or add your comments to the article online.


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1. Hillis SD, Mercy JA, Saul JR. The enduring impact of violence against children. Psychol Health Med. 2017;22(4):393–405....

2. Finkelhor D, Turner HA, Shattuck A, Hamby SL. Prevalence of childhood exposure to violence, crime, and abuse: results from the National Survey of Children’s Exposure to Violence. JAMA Pediatr. 2015;169(8):746–754.

3. Trauma-Informed Care in Behavioral Health Services. Rockville, MD: SAMHSA; 2014. https://store.samhsa.gov/system/files/sma14-4816_litreview.pdf. Accessed Jan. 31, 2019.

4. Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998;14(4):245–258.

5. Pachter LM, Lieberman L, Bloom SL, Fein JA. Developing a community-wide initiative to address childhood adversity and toxic stress: a case study of the Philadelphia ACE task force. Acad Pediatr. 2017;17(7):S130–S135.

6. Glowa PT, Olson AL, Johnson DJ. Screening for adverse childhood experiences in a family medicine setting: a feasibility study. J Am Board Fam Med. 2016;29(3):303–307.

7. Goldstein E, Athale N, Sciolla AF, Catz SL. Patient preferences for discussing childhood trauma in primary care. Perm J. 2017;21:16–055.

8. Trauma-informed approach and trauma-specific interventions. SAMHSA website. https://www.samhsa.gov/nctic/trauma-interventions. Accessed Nov. 20, 2018.

9. Ravi A, Little V. Providing trauma-informed care. Am Fam Physician. 2017;95(10):655–657.

10. Spotlight: Building Resilient and Trauma-Informed Communities. Rockville, MD: SAMHSA; 2017. https://store.samhsa.gov/search_results?k=Building+Resilient+and+Trauma+Informed+Communities. Accessed Nov. 4, 2018.


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