Assessment and Planning

Higher ACE scores correlate with increased risk of chronic disease, mental illness, substance use, and early death in adulthood — a dose-response relationship.

Abuse (physical, emotional, sexual), neglect (physical, emotional), and household dysfunction (domestic violence, household substance use, mental illness, incarceration, parental separation/divorce). The first 1998 CDC-Kaiser report used seven categories; neglect and separation/divorce were added in later analyses.

Trauma from prolonged, repeated, often interpersonal exposure beginning in childhood, causing problems with affect regulation, self-concept, and relationships. Complex PTSD is an ICD-11 diagnosis, not a DSM-5-TR diagnosis.

Fight, flight, and freeze are the classic automatic threat responses; 'fawn' (appeasing the threat) is a widely used clinical addition.

A state in which repeated, uncontrollable adversity leads a person to stop trying to change their situation, even when change becomes possible.

The sympathetic nervous system rapidly releases adrenaline (epinephrine), raising heart rate, breathing, and alertness; the slower HPA axis adds cortisol. Together they prepare the body to confront or flee a threat.