Available online at:
https://cc.arcabc.ca/islandora/object/cc%3Apsycjournal

J Camosun Psyc Res. (2024). Vol. 6(1), pp. 14-23.
Submitted Summer 2023; accepted May 2024.

How Adverse Childhood Experiences Contribute to
Increased Risk for Anxiety Disorders in Adulthood.
Authors: Christine Lee*
Supervising Instructor: Cate Pelling, Psyc 250 (“Psychopathology”)
Department of Psychology, Camosun College, 3100 Foul Bay Road, Victoria, BC, Canada V8P 5J2
*Corresponding author email: mi-hong@hotmail.com

ABSTRACT
Anxiety disorders are not only extremely common, but they also have a long-term adverse
impact on the lives of people of all ages worldwide. One of the known risk factors for developing
such psychopathology is adverse childhood experience (ACE). Although there has been much
interest in understanding the causal relationship between ACE and physical and mental wellbeing in adults, data on how ACE may impact individuals differently in terms of increased risk
for anxiety disorders is lacking. This article investigates how biological (neurological, gene
methylation, and gene-environment) and psychosocial (attachment) factors influence a person’s
susceptibility to ACE-related adulthood anxiety. The type of trauma, gender differences, and the
total number of adversities emerged as three themes from the literature review on anxiety risk
factors for individuals with ACE. Research suggests that early, multiple, repeated emotional
traumas may have a greater adverse long-term effect, particularly in females. However, early
adversity does not predispose children to develop psychopathologies since a secure attachment
may lessen the detrimental impact of trauma and protect children from adverse experiences.
1. Introduction
Anxiety disorders are highly prevalent
and disabling mental health conditions for
all ages worldwide that often develop in
childhood and persist throughout adulthood
if left untreated (Cai et al., 2023; Felitti et
al., 1998; Van der Kolk, 2019). In Western
nations, the illness affects around 18 % of
the population, with an average onset age of
11 years (Donner & Lowry, 2013). In 2019,
over 15% of adults in the U.S. experienced
mild, moderate, or severe anxiety symptoms
(Terlizzi & Villarroel, 2020). ACE is a
common major risk factor for the
development of anxiety symptoms and
disorders. Approximately 64% of U.S.

adults reported having at least one type of
ACE before age 18, and almost one in six
(17.3%) reported having four or more types
of ACE (Centres for Disease Control [CDC],
2023). In Europe, 23.5% of people had one
ACE, while 18.7% had two or more ACE
(Bellis et al., 2019). In addition, ACE was
attributed to about 30% of cases of anxiety
in North America and more than a quarter in
Europe (Bellis et al., 2019).
Although studies have been conducted on
the impact of childhood trauma on
children’s well-being and adult behavior
(Downey & Crummy, 2022), data on how
ACE may contribute to increased risk for
anxiety disorders in adulthood is lacking.
This research gap limits our understanding
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of how ACE may affect individuals
differently. Therefore, by investigating the
biological, psychological, and social factors
that influence a person’s susceptibility to
ACE-related adulthood anxiety, this article
aims to gain insight into the value of an
effective early intervention as a prevention
strategy against common psychopathology.
1.1 Defining and Measuring ACE
ACE is described as a traumatic event
that children and adolescents under the age
of 18 have encountered. It is categorized
into three groups: abuse, neglect, and
household challenges (American Psychiatric
Association, 2013; CDC, 2023; Crouch et
al., 2019; Felitti et al., 1998). The
Diagnostic and Statistical Manual of Mental
Disorders, Fifth Edition (DSM-5) recognizes
ACE factors in the chapter titled “Other
Conditions That May Be a Focus of Clinical
Attention.” However, since an ACE does not
meet the criteria for mental disorders, this
section is only intended to document
additional relevant information that may
affect the diagnosis, prognosis, or treatment
of a patient (American Psychiatric
Association, 2013). Renowned psychiatrists
such as Van der Kolk (2014) have supported
including the diagnosis of developmental
trauma disorder in the DSM-5 due to the
importance of an adequate diagnostic
framework in applying effective, timely, and
less costly treatments to individuals
(Bremness, 2014; Van der Kolk, 2009).
However, the proposal was denied, and the
efficacy of the conceptual framework for
developmental trauma disorder has remained
a point of contention.
Although ACE is not a mental diagnosis,
a lot has been learned recently about how
trauma impacts children through the ACE
Study run by the CDC and Kaiser
Permanente (CDC, 2023; Felitti et al., 1998;

LaNoue et al., 2020). Using a retrospective
self-reported survey of the ACE
Questionnaire, which included questions on
childhood abuse, neglect, and family
dysfunction, the study examined different
demographic groups at a single point in
time. According to the findings, ACE is
significantly more widespread than
previously acknowledged, and it has a
profound impact on adults’ mental and
physical health even a half-century later,
even leading negative behaviors and
emotions to be passed down from generation
to generation (Felitti et al., 1998; LaNoue et
al., 2020; Osofsky & Groves, 2018). The
ACE score continues to be utilized today as
a screening tool, although some concerns
regarding its limitations are being raised
(Anda et al., 2020).
1.2 Anxiety Disorders in the DSM-5
The DSM-5 recognizes 11 anxiety
disorders with features of persistently
negative mood states, physical tension, and
excessive worry about future threats
(American Psychiatric Association, 2013).
Anxiety disorders are found to commonly
co-occur with other mood and anxietyrelated disorders, particularly with
depression, and several physical conditions
(Barlow, 2021; Mackenzie et al., 2011).
According to Ruscio et al. (2017),
individuals whose presentation meets the
criteria for generalized anxiety disorder are
also likely to have met or currently meet the
criteria for various anxiety and unipolar
depressive disorders.
2. Literature Review
Three themes emerged from the literature
analysis on anxiety risk factors for adults
with ACE: (a) type of trauma, (b) gender
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disparities, and (c) an overall number of
adversities.

experiencing the same type of potentially
stressful incident.

2.1 Theme 1: Type of Trauma

2.2 Theme 2: Gender Disparities

Studies have found that the kind of abuse
that victims experience might affect the
outcomes and post-trauma symptoms (De
Bellis & Zisk, 2014; Downey & Crummy,
2022). Based on anxiety self-reports from
1277 Finnish participants aged 65–77 years
old, Lähdepuro et al. (2019) investigated the
association between various forms of early
life stress (ELS) and anxiety symptoms in
late adulthood. The data showed that
childhood emotional trauma, which
frequently co-occurs with physical trauma
but often remains unrecognized, was most
strongly correlated with anxiety symptoms
in late adulthood, even after controlling for
other ELS elements. This finding suggests
that emotional trauma functions as an
independent risk factor for anxiety. In
contrast, the relationship between physical
trauma and anxiety symptoms above the
clinical threshold was no longer significant
when controlling for emotional trauma
(Lähdepuro et al., 2019).
Similarly, LaNoue et al. (2020)
investigated self-reports from 679 adults
with multiple ACE episodes, with a mean
age of 45.73. The participants believed that
childhood emotional abuse had the greatest
psychological impact, whereas sexual and
emotional abuse together had the most
negative psychological impact. Furthermore,
neglect alone had the least harmful effects.
The study also revealed that perceived threat
and self-reported impact ratings predicted
mental health outcomes more accurately
than the actual occurrence of stressful events
(LaNoue et al., 2020). The findings suggest
that people’s subjective perceptions of their
experiences may play a role in acquiring a
range of psychiatric symptoms after

In addition to certain types of traumas,
being a female has also been found to be a
risk factor for adulthood anxiety symptoms,
with girls and women being twice as likely
as males to develop general anxiety
disorders (American Psychiatric
Association, 2013; Anxiety & Depression
Association of America [ADAA], 2021;
Canuto et al., 2018; Donner & Lowry, 2013;
Kessler et al., 2012). According to Terlizzi
& Villarroel (2020), in the US in 2019,
19.0% of women experienced anxiety
symptoms compared to 11.9% of men.
Women are also more likely than men to
have four or more ACE and are significantly
more mentally affected by ACE (CDC,
2023; LaNoue et al., 2020). A crosssectional survey of 4,344 US adults with a
mean age of 54.1 years revealed that the
prevalence of anxiety disorders was 11.4%
higher for females with three to five ACE
(Whitaker et al., 2021). The finding suggests
that a synergistic relationship between ACE
exposure and gender may play a key role in
determining an individual’s vulnerability to
anxiety (CDC, 2023; Whitaker et al., 2021).
2.3 Theme 3: Overall Number of Adversities
Another possible mechanism by which
ACE raises the risk of anxiety is the
accumulation of repeated childhood stressful
episodes, or “stress pileup” (Allen, 2005, pp.
16-18; CDC, 2023). According to
Lähdepuro et al. (2019), early life stress
accumulation increases the levels of late
adulthood anxiety symptoms and the
likelihood of clinically severe anxiety in
older adults. Although impactful, one-off
childhood stresses, such as being separated
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from one’s parents during a war or
experiencing a death in the family, were not
significantly linked to anxiety symptoms
later in life. On the other hand, the
accumulation of only two stressors
considerably raised the likelihood of
experiencing clinically significant anxiety,
suggesting that the number of stressors may
further increase the possibility of late-life
anxiety. One potential explanation for this
result may be that stressful experiences early
in life alter brain structures, making certain
individuals more sensitive to future life
stressors while also compromising their
physical and mental health (Lähdepuro et
al., 2019).
Other studies further support a direct
correlation between the number of ACE and
late-life negative outcomes such as chronic
disease, incarceration, and employment
difficulties (CDC, 2023). A psychiatrist
Lenore Terr (2003) classified childhood
trauma-stress conditions into two categories:
type I and type II. She claimed that type I
traumas− unforeseen, single shocking
experiences−have a different impact on
children than type II traumas, which are
prolonged and repeated exposure to intense
events over many years. Children who
encounter type II trauma may develop selfdefense and coping mechanisms to
safeguard themselves through a range of
mental alterations that may later account for
certain psychotic thought patterns and
anxiety disturbances in adulthood (Terr,
2003). Van der Kolk (2019) also noted the
distinction between single and ongoing child
maltreatment. He claimed that isolated
episodes result in distinct conditioned
behavioral and biological reactions to
reminders of the trauma, such as those
documented in the posttraumatic stress
disorder (PTSD) diagnosis. Chronic trauma,
on the other hand, has far-reaching impacts

on neurobiological development (Van der
Kolk, 2019).
3. Conceptualization
3.1 Biological Factors
Childhood is a critical developmental
period for the brain. During this time, the
brain undergoes tremendous change,
including simultaneous neuronal
proliferation and pruning, as well as
extensive rewiring of existing neuronal
connections (Jeong et al., 2021). Although
brain plasticity can be adaptive, it also can
change when the negative effects of early
traumatic life experiences accumulate
(Allen, 2005).
The hypothalamic-pituitary-adrenal
(HPA) axis is one region of the brain that
may be impaired by early childhood
exposure to high levels of stress and trauma
(De Bellis & Zisk, 2014; Kuhlman et al.,
2015; Luo et al., 2022; Tyrka et al., 2016).
The HPA axis is a neuroendocrine system
that governs the body’s response to stress
(Sheng et al., 2021). In adults with anxiety
disorders, ACE has been linked with
persistent HPA axis sensitization and
significantly higher cortisol reactivity (De
Bellis & Zisk, 2014). When the HPA axis is
over-activated, stress hormones are secreted
in excess and the body remains
hypervigilant in anticipation of impending
danger.
Childhood trauma may not only increase
the vulnerability to anxiety by dysregulating
the HPA axis (De Bellis & Zisk, 2014; Luo
et al., 2022), but various forms of ACE may
also have diverse effects on HPA-axis
functioning (Kuhlman et al., 2015). Physical
abuse, in particular, may be associated with
faster responses to acute stress while
emotional abuse may be related to delayed
cortisol recovery from acute stress
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(Kuhlman et al., 2015). Interactions between
each genetic variation and increased levels
of emotional neglect may also be associated
with heightened reactivity to anger and fear
in the dorsal amygdala, which is crucial in
emotional processing and has an activating
influence on the HPA axis (De Bellis &
Zisk, 2014
Childhood maltreatment is also found to
have a strong adverse correlation with
resting-state functional connectivity (RSFC)
between the left centromedial amygdala
(CMA) and the left anterior insula (Luo et
al., 2022). The amygdala, the primary stress
response limbic system responsible for the
emotional processing and regulation of
fearful and threatening stimuli, is stimulated
when stressors associated with the traumatic
event are processed by biological sensory
systems via the thalamus (De Bellis & Zisk,
2014). Amygdala dysfunction is found in
clinically anxious individuals due to
elevated cortisol levels through the
transmission of a fear signal to neurons in
the prefrontal cortex, hypothalamus, and
hippocampus. Furthermore, anomalies in
amygdala activation and other biological
stress systems are caused by increased
activity in the locus coeruleus and
sympathetic nervous system (De Bellis &
Zisk, 2014; Luo et al., 2022). The
relationship between ACE and the
alterations in amygdala structure and
function suggests that early-life stress has a
stronger influence on the left hemisphere,
which increases the risk of developing
anxiety disorders in adulthood (Luo et al.,
2022).
Furthermore, epigenetic DNA alterations
are a mechanism through which the
biological response to ACE may influence
gene activity and expression. In particular,
methylation of glucocorticoid signaling
genes is involved in adversity-induced HPA
axis dysfunction in children (Allen, 2005;

De Bellis & Zisk, 2014; Hernando-Herraez
et al., 2015; Tyrka et al., 2016). While gene
methylation may be the most stable form of
epigenetic modification that regulates the
stress response, there is growing evidence
that it is plastic during childhood and into
adulthood, increasing the biological risk
generated by early stress exposure, which
can lead to long-term consequences (Allen,
2005; Tyrka et al., 2016). In response to
stressful stimuli, the glucocorticoid receptor
(GR), which is distributed throughout limbic
brain regions and numerous other organ
systems, engages a negative feedback loop
that inhibits further cortisol release through
cortisol binding at the hypothalamus and
pituitary to prevent the damaging effects of
extreme or chronic activation (Tyrka et al.,
2016). Prolonged stress and glucocorticoid
treatment impede neurogenesis, cell
proliferation, and dendritic branching in the
hippocampus and promote cell loss and
atrophy. When glucocorticoids decrease GR
levels over time, structural changes in brain
circuitry that are critical for emotional and
behavioral adaptation may occur. Therefore,
when risk genes and childhood trauma
combine, epigenetic alterations in the
neurobiological stress system due to geneenvironment interactions may result in a
variety of adult emotional, behavioral, and
neurobiological abnormalities (De Bellis &
Zisk, 2014). These excessive stress-induced
changes in methylation of glucocorticoid
activity at receptors, as well as changes to
the sensitivity of this system, may explain
associations between early adversity and risk
for stress-related anxiety disorders (Tyrka et
al., 2016).
3.2 Psychological & Social Factors
Children are particularly vulnerable to the
long-term impacts of interpersonal trauma.
Their susceptibility is due to a complete
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reliance on their caretakers for survival and
a lack of the cognitive and behavioral skills
necessary for effectively comprehending and
responding to distressing circumstances
(Allen, 2005; Downey & Crummy, 2022).
Early traumatic experiences, particularly
those caused by their parents, have been
linked to a variety of adulthood challenges
such as low self-esteem, feelings of
inadequacy, emotional dysregulation, and
anxiety symptoms as a result of insufficient
early bonding (Downey & Crummy, 2022).
Not all children are impacted by the same
adversity in the same way or to the same
extent, though, since most children are able
to recover when given adequate support
from an attentive caregiver (Substance
Abuse and Mental Health Services
Administration [SAMHSA], 2023). The
degree to which children are vulnerable to
the long-term effects of trauma exposure
may be significantly influenced by the
reliable and consistent presence of a
supportive, caring, and sensitive family
member or caregiver (SAMHSA, 2023).
The importance of social support in terms
of secure attachment in early childhood has
been extensively studied by many
researchers. John Bowlby (1973, 1979,
1980, 1982, 1988) found that people are
born with a need to form close emotional
bonds with their caregivers, and the earliest
bonds formed by children with their
caregivers have a tremendous impact that
continues throughout life. Through her study
on attachment theory, Mary Ainsworth
proposed that the mother-infant attachment
style depends on the mothers' emotions,
behavior, and responsiveness and that
sensitive mothers are more likely to form
secure attachment styles with their children
(Ainsworth et al., 1978). Her research
comparing disrupted mother-child bonds to
normal mother-child relationships reported
that a child's lack of a mother figure leads to

adverse developmental effects even in later
life (Ainsworth et al., 1978). According to
Van der Kolk (2019), early patterns of
secure attachment are important for children
to learn to trust their feelings and to
understand the world. The experience of
being understood provides children the
confidence to trust their abilities and the
capacity to seek help from others (Allen,
2005; Van der Kolk, 2019). On the other
hand, children with insecure attachment
struggle to trust others for support and are
unable to regulate their emotional states,
which can lead to excessive anxiety, anger,
and longings to be cared for throughout their
lives (Allen, 2005; Van der Kolk, 2019). As
a result, while insecure attachment can
magnify the harmful effects of childhood
trauma, secure attachment can mitigate the
detrimental impact in both childhood and
adulthood.
4. Conclusion
There has been much interest in
understanding the causal relationship
between ACE and physical and mental wellbeing in adults. Recent studies suggest that
early, multiple, repeated, emotional traumas
may have a greater adverse long-term effect,
particularly in females. This is because
children are more likely than adults to lack
the cognitive and behavioral capacities to
comprehend distressing situations and
respond to them effectively. Therefore,
trauma may trigger abnormalities in early
relationships and stable attachment
formation that affect brain development,
emotion control, and self-perception. These
abnormalities also lead to a wide range of
associated psychological and physiological
illnesses, including adulthood anxiety. The
environment, epigenetics, and an
individual's genetic makeup appear to have
an impact on their vulnerability to
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developing late-life psychopathologies.
However, studies have found that adversity
does not predestine children to poor
outcomes because secure attachment can
lessen the negative impact of trauma and
shield children against adverse experiences.
Although the impacts of ACE have been
investigated, further research is required due
to several shortcomings of the available
data. One of the research limitations is the
use of retrospective self-report
questionnaires, which are subject to
reporting bias due to lengthy recollection
times. The second challenge of evaluating
developmental consequences is the inability
to track and monitor developmental changes
over time. Because existing data on anxiety
symptoms only reflect on a single point in
time, it is impossible to determine if anxiety
symptoms have been persistent throughout
the life course or have only recently
developed. In order to track the long-term
impact of ACEs across a person's lifespan,
longitudinal data are required. Another
obstacle is that since anxiety disorders are
often comorbid with other mood or anxietyrelated disorders, it is difficult to study the
anxiety symptoms in isolation. Lastly, the
implications of not including developmental
trauma disorder as a distinct diagnosis in the
DSM-5 must be investigated because having
an adequate diagnostic framework is crucial
for providing effective, timely, and less
costly treatments to those suffering from
such prevalent mental illnesses.
References
Allen, J. G. (2005). Coping with trauma:
hope through understanding (2nd ed.).
American Psychiatric Pub.
American Psychiatric Association. (2013).
Other conditions that may be a focus of
clinical attention. Diagnostic and
statistical manual of mental disorders

(5th ed.). https://doiorg.libsecure.camosun.bc.ca:2443/10.117
6/appi.books.9780890425787.Other_Con
ditions_Z_codes
Anda, R. F., Porter, L. E., & Brown, D. W.
(2020). Inside the adverse childhood
experience score: strengths, limitations,
and misapplications. American journal of
preventive medicine, 59(2), 293–295.
https://doi.org/10.1016/j.amepre.2020.01.
009
Ainsworth, M. D. S., Blehar, M. C., Waters,
E., & Wall, S. (1978). Patterns of
attachment: A psychological study of the
strange situation. Lawrence Erlbaum.
Anxiety & Depression Association of
America [ADAA]. (2021, September 16).
Facts. https://adaa.org/living-withanxiety/women/facts#:~:text=Recent%20
research%20has%20found%20that,men%
20to%20stress%2Drelated%20disorders.
Barlow, D.H., Durrand, V.M., Hoffman,
S.G., & Lalumiere, M.L. (2021).
Abnormal psychology: An Integrative
Approach (6th Canadian Edition).
Toronto, Ontario, Nelson Education.
Bellis, M. A., Hughes, K., Ford, K., Ramos
Rodriguez, G., Sethi, D., & Passmore, J.
(2019). Life course health consequences
and associated annual costs of adverse
childhood experiences across Europe and
North America: a systematic review and
meta-analysis. The Lancet. Public health,
4(10), e517–e528.
https://www.pacesconnection.com/g/peac
e4manasota/fileSendAction/fcType/0/fcO
id/487710682534957778/filePointer/4877
10682534957891/fodoid/4877106825349
39563/PIIS2468266719301458.pdf
Bowlby, J. (1973). Attachment and Loss:
Vol. 2. Separation: anxiety and anger.
Basic Books.
Bowlby, J. (1979). The Making and
Breaking of Affectional Bonds. Tavistock.
Bowlby, J. (1980). Attachment and Loss:
Vol. 3. Loss, sadness and depression.
Basic Books.
20

Lee - J Camosun Psyc Res. (2024). Vol. 6(1), pp. 14-23.

Bowlby J. (1982). Attachment and Loss:
Vol. 1: Attachment (2nd ed). Basic
Books.
Bowlby, J. (1988). A Secure Base: Parentchild attachment and healthy human
development. Basic Books.
Bremness, A., & Polzin, W. (2014).
Commentary: developmental trauma
disorder: a missed opportunity in DSM
V. Journal of the Canadian Academy of
Child and Adolescent Psychiatry =
Journal de l'Academie canadienne de
psychiatrie de l'enfant et de l'adolescent,
23(2), 142–145.
Cai, J., Li, J., Liu, D., Gao, S., Zhao, Y.,
Zhang, J., & Liu, Q. (2023). Long‐term
effects of childhood trauma subtypes on
adult brain function. Brain & Behavior,
13(5), 1–9. https://doiorg.libsecure.camosun.bc.ca:2443/10.100
2/brb3.2981
Canuto, A., Weber, K., Baertschi, M.,
Andreas, S., Volkert, J., Dehoust, M. C.,
Sehner, S., Suling, A., Wegscheider, K.,
Ausín, B., Crawford, M. J., Da Ronch,
C., Grassi, L., Hershkovitz, Y., Muñoz,
M., Quirk, A., Rotenstein, O., SantosOlmo, A. B., Shalev, A., Strehle, J., … &
Härter, M. (2018). Anxiety disorders in
old age: psychiatric comorbidities,
quality of life, and prevalence according
to age, gender, and country. The
American journal of geriatric psychiatry:
official journal of the American
Association for Geriatric Psychiatry,
26(2), 174–185.
https://doi.org/10.1016/j.jagp.2017.08.01
5
Centers for Disease Control and Prevention
(CDC). (2023, June 29). Adverse
Childhood Experiences (ACEs).
https://www.cdc.gov/violenceprevention/
aces/index.html
Crouch, E., Probst, J. C., Radcliff, E.,
Bennett, K. J., & McKinney, S. H.
(2019). Prevalence of adverse childhood
experiences (ACEs) among US children.
Child Abuse & Neglect, 92, 209–218.

https://doi.org/10.1016/j.chiabu.2019.04.
010
De Bellis, M. D., & Zisk, A. (2014). The
biological effects of childhood trauma.
Child and adolescent psychiatric clinics
of North America, 23(2), 185–vii.
https://doi.org/10.1016/j.chc.2014.01.002
Donner, N. C., & Lowry, C. A. (2013). Sex
differences in anxiety and emotional
behavior. Pflugers Archiv : European
journal of physiology, 465(5), 601–626.
https://www.ncbi.nlm.nih.gov/pmc/article
s/PMC3805826/
Downey, C., & Crummy, A. (2022). The
impact of childhood trauma on children’s
wellbeing and adult behavior. European
Journal of Trauma & Dissociation, 6(1).
https://doiorg.libsecure.camosun.bc.ca:2443/10.101
6/j.ejtd.2021.100237
Elzinga, B. M., Spinhoven, P., Berretty, E.,
de Jong, P., & Roelofs, K. (2010). The
role of childhood abuse in hpa-axis
reactivity in social anxiety disorder: a
pilot study. Biological psychology, 83(1),
1–6.
https://doi.org/10.1016/j.biopsycho.2009.
09.006
Felitti, V. J., Anda, R. F., Nordenberg, D.,
Williamson, D. F., Spitz, A. M.,
Edwards, V., Koss, M. P., & Marks, J. S.
(1998). Relationship of childhood abuse
and household dysfunction to many of the
leading causes of death in adults: the
adverse childhood experiences (ACE)
study. American Journal of Preventive
Medicine, 14(4), 245-258.
https://doi.org/10.1016/S07493797(98)00017-8
Hernando-Herraez, I., Garcia-Perez, R.,
Sharp, A. J., & Marques-Bonet, T.
(2015). DNA Methylation: Insights into
Human Evolution. PLoS genetics, 11(12),
e1005661.
https://doi.org/10.1371/journal.pgen.1005
661
Jeong, H. J., Durham, E. L., Moore, T. M.,
Dupont, R. M., McDowell, M., Cardenas21

Lee - J Camosun Psyc Res. (2024). Vol. 6(1), pp. 14-23.

Iniguez, C., Micciche, E. T., Berman, M.
G., Lahey, B. B., & Kaczkurkin, A. N.
(2021). The association between latent
trauma and brain structure in children.
Translational psychiatry, 11(1), 240.
https://doi.org/10.1038/s41398-02101357-z
Kessler, R. C., Petukhova, M., Sampson, N.
A., Zaslavsky, A. M., & Wittchen, H. U.
(2012). Twelve-month and lifetime
prevalence and lifetime morbid risk of
anxiety and mood disorders in the united
states. International Journal of Methods
in Psychiatric Research, 21, 169-184.
https://doi.org/10.1002/mpr.1359
Kuhlman, K.R., Geiss, E.G., Vargas, I.,
Lopez-Duran, N.L. (2015). Differential
associations between childhood trauma
subtypes and adolescent HPA-axis
functioning. Psychoneuroendocrinology,
54, 103–114.
https://www.sciencedirect.com/science/ar
ticle/abs/pii/S0306453015000347
Lähdepuro, A., Savolainen, K., Lahti, M.,
Eriksson, J., Lahti, J., Tuovinen, S.,
Kajantie, E., Pesonen, A., Heinonen, K.,
& Raikkonen, K. (2019). The impact of
early life stress on anxiety symptoms in
late adulthood. Sci Rep, 9, 4395 (2019).
https://doi.org/10.1038/s41598-01940698-0
LaNoue, M. D., Cunningham, A. T., Kenny,
L. C., Abatemarco, D., & Helitzer, D.
(2020). What do adults think about their
adverse childhood experiences (ACEs),
and does it matter? Community Mental
Health Journal, 56(7), 1255–1261.
https://doiorg.libsecure.camosun.bc.ca:2443/10.100
7/s10597-020-00580-0
Luo, L., Yang, T., Zheng, X., Zhang, X.,
Gao, S., Li, Y., Stamatakis, E. A.,
Sahakian, B., Becker, B., Lin, Q., &
Kendrick, K. M. (2022). Altered
centromedial amygdala functional
connectivity in adults is associated with
childhood emotional abuse and predicts
levels of depression and anxiety. Journal

of affective disorders, 303, 148–154.
https://doi.org/10.1016/j.jad.2022.02.023
Mackenzie, C. S., Reynolds, K., Chou, K.
L., Pagura, J., & Sareen, J. (2011).
Prevalence and correlates of generalized
anxiety disorder in a national sample of
older adults. The American journal of
geriatric psychiatry: official journal of
the American Association for Geriatric
Psychiatry, 19(4), 305–315.
https://doi.org/10.1097/JGP.0b013e31820
2bc62
Osofsky, J. D., & Groves, B. M. (Eds.).
(2018). Violence and trauma in the lives
of children. Praeger, an Imprint of ABCCLIO, LLC.
Ruscio, A. M., Hallion, L. S., Lim, C. C. W.,
Aguilar-Gaxiola, S., Al-Hamzawi, A.,
Alonso, J., Andrade, L. H., Borges, G.,
Bromet, E. J., Bunting, B., Caldas de
Almeida, J. M., Demyttenaere, K.,
Florescu, S., de Girolamo, G., Gureje, O.,
Haro, J. M., He, Y., Hinkov, H., Hu, C.,
de Jonge, P., … & Scott, K. M. (2017).
Cross-sectional comparison of the
epidemiology of DSM-5 generalized
anxiety disorder across the globe. JAMA
psychiatry, 74(5), 465–475.
https://doi.org/10.1001/jamapsychiatry.20
17.0056
Sheng, J. A., Bales, N. J., Myers, S. A.,
Bautista, A. I., Roueinfar, M., Hale, T.
M., & Handa, R. J. (2021). The
hypothalamic-pituitary-adrenal axis:
development, programming actions of
hormones, and maternal-fetal
interactions. Frontiers in behavioral
neuroscience, 14, 601939.
https://doi.org/10.3389/fnbeh.2020.60193
9
Substance Abuse and Mental Health
Services Administration. (2023, June 28).
Recognizing and Treating Child
Traumatic Stress. U.S. Department of
Health and Human Services.
https://www.samhsa.gov/childtrauma/recognizing-and-treating-childtraumatic-stress
22

Lee - J Camosun Psyc Res. (2024). Vol. 6(1), pp. 14-23.

Terlizzi, E. P., & Villarroel, M. A. (2020).
Symptoms of generalized anxiety
disorder among adults: United States,
2019. NCHS Data Brief, (378), 1-8,
https://www.cdc.gov/nchs/products/datab
riefs/db378.htm
Terr, L. C. (2003). Childhood traumas: An
outline and overview. Focus, 1(3), 322334. https://doi.org/10.1176/foc.1.3.322
Tyrka, A. R., Ridout, K. K., & Parade, S. H.
(2016). Childhood adversity and
epigenetic regulation of glucocorticoid
signaling genes: Associations in children
and adults. Development and
psychopathology, 28(4pt2), 1319–1331.
https://doi.org/10.1017/S0954579416000
870
Van der Feltz-Cornelis, C. M., Potters, E.
C., Van Dam, A., Koorndijk, R. P. M.,
Elfeddali, I., & Van Eck van der Sluijs, J.
F. (2019). Adverse Childhood
Experiences (ACE) in outpatients with
anxiety and depressive disorders and their
association with psychiatric and somatic
comorbidity and revictimization. Crosssectional observational study. Journal of
Affective Disorders, 246, 458–464.
https://doiorg.libsecure.camosun.bc.ca:2443/10.101
6/j.jad.2018.12.096
Van der Kolk, B. A., Pynoos, R. S.,
Cicchetti, D., Cloitre, M., D’Andrea, W.,

Ford, J. D., & Teicher, M. (2009).
Proposal to include a developmental
trauma disorder diagnosis for children
and adolescents in DSM-V. Unpublished
manuscript.
https://complextrauma.org/wpcontent/uploads/2019/03/ComplexTrauma-Resource-3-JosephSpinazzola.pdf
Van der Kolk, B. A. (2014). The body keeps
the score: brain, mind, and body in the
healing of trauma. Viking Press, 2014.
Van der Kolk, B.A. (2019). Developmental
trauma disorder: a new, rational
diagnosis for children with complex
trauma histories. Traumatic Stress
Institute.
https://traumaticstressinstitute.org/wpcontent/files_mf/1276541701VanderKolk
DvptTraumaDis.pdf
Whitaker, R. C., Dearth-Wesley, T.,
Herman, A. N., Block, A. E., Holderness,
M. H., Waring, N. A., & Oakes, J. M.
(2021). The interaction of adverse
childhood experiences and gender as risk
factors for depression and anxiety
disorders in US adults: a cross-sectional
study. BMC Public Health, 21(1), 2078.
https://doiorg.libsecure.camosun.bc.ca:2443/10.118
6/s12889-021-12058-z

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