Commentary by Binny Chokshi, MD, MEd
Published October 2023

Almost half of American children have faced at least one potentially traumatic early childhood experience. The Substance Abuse and Mental Health Services Administration (SAMHSA) defines trauma as “an event, series of events, or set of circumstances experienced by an individual as physically or emotionally harmful or life threatening with lasting adverse effects on the individuals functioning and mental, physical, social, emotional, or spiritual well-being.”

Traumatic exposures can have a profound impact on health and well-being, highlighted in the seminal study conducted by Felitti et. al, which underscores the impact of ten specific childhood traumas, now commonly known as adverse childhood experiences (ACEs), by demonstrating how exposure to ACEs can lead to risky health behaviors and poor health outcomes in a dose dependent manner.

The relationship between trauma exposure and poor physical and mental health outcomes is the toxic stress response. In the presence of frequent or sustained exposures to adverse experiences, an individual’s stress response system can be chronically activated. Often referred to as the neurobiology of trauma, the body’s response to the chronic stress response can lead to structural and chemical disruptions in the brain, which can impact risky behaviors and mental health. Furthermore, a chronic toxic stress response can lead to increased inflammatory pathway leading to potential impact on all organ systems, increasing risk for suboptimal physical health.

Keywords: toxic stress; vertical integration; stress response; community; social isolation; adverse childhood experiences; ACEs; violence; PTSD