The research included in this bibliography indicate that ongoing relational trauma, particularly in childhood, affects a number of physical systems (e.g., cardiovascular/circulatory, endocrine, autoimmune), resulting to an array of serious, often life-threatening comorbid medical conditions in survivors (e.g., cancer, diabetes, cardiac and inflammatory diseases, sleep disorders). The first large study to document this was the CDC-Kaiser Permanente adverse childhood experiences (ACE) study conducted in the US from 1995 to 1997. The study indicated the more adverse events in a child’s life the more likely they were to develop serious illnesses in adulthood. The physical ramifications of traumatic stress are partially explained in the well known book “The Body Keeps the Score” by Bessel van der Kolk:

Under normal circumstances people react to a threat with a temporary increase in their stress hormones. As soon as the threat is over, the threat hormones dissipate and the body returns to normal. The stress hormones of traumatized people, in contrast, take much longer to return to baseline and spike quickly and disproportionately in response to mildly stressful stimuli. The insidious effects of constant elevated stress hormones …. contribute to many long term health issues. (p. 48)

In 2019 the US Centers for Disease Control and Prevention published the report Childhood Trauma Is A Public Health Issue And We Can Do More To Prevent It, confirming that childhood trauma is a serious and costly public health issue. Given that there are over 11,000 members here at OOTS representing over 70 countries, it is our position that complex relational trauma is epidemic and in need of concerted efforts by all governments and medical/mental health professionals to prevent, intervene, treat and provide far more services and support than are currently available. From a strictly financial standpoint, in the long term this would save a great deal of money due to increased health of citizens and reduced pressure on mental/physical healthcare systems. From a human perspective survivors would be able to live the life we deserve and reduce the intergenerational transmission of relational trauma would be reduced which bodes well for humanity. These are no small things.

Agorastos, A., Nicolaides, N., Bozikas, V., Chrousos, G., & Pervanidou, P. (2020). Multilevel interactions of stress and circadian system: Implications for traumatic stress. Frontiers in Psychiatry, 10, 1003. https://doi.org/10.3389/fpsyt.2019.01003

Agorastos, A., Pervanidou, P., Chrousos, G., & Baker, D. (2019). Developmental trajectories of early life stress and trauma: A narrative review on neurobiological aspects beyond stress system dysregulation. Frontiers in Psychiatry, 10, 118. https://doi.org/10.3389/fpsyt.2019.00118

Agorastos, A., Pervanidou, P., Chrousos, G., & Kolaitis, G. (2018). Early life stress and trauma: Developmental neuroendocrine aspects of prolonged stress system dysregulation, 17(4), 507–520. https://doi.org/10.1007/s42000-018-0065-x

Badley, E., Shields, M., O'Donnell, S., Hovdestad, W., & Tonmyr, L. (2019). Childhood maltreatment as a risk factor for arthritis: Findings From a population-based survey of Canadian adults. Arthritis Care & Research, 71(10), 1366–1371. https://doi.org/10.1002/acr.23776

Baumeister, D., Akhtar, R., Ciufolini, S., Pariante, C., & Mondelli, V. (2016). Childhood trauma and adulthood inflammation: A meta-analysis of peripheral C-reactive protein, interleukin-6 and tumour necrosis factor-α. Molecular Psychiatry, 21(5), 642–649. https://doi.org/10.1038/mp.2015.67

Boscarina, J. (2006). Post Traumatic Stress Disorder and physical illness: Results from clinical and epidemiologic studies. Annals of the New York Academy of Sciences, 1032: 141–153. https://nyaspubs.onlinelibrary.wiley.com/doi/abs/10.1196/annals.1314.011

Brindle, R., Cribbet, M., Samuelsson, L., Gao, C., Frank, E., Krafty, R., Thayer, J., Buysse, D., & Hall, M. (2018). The relationship between childhood trauma and poor sleep health in adulthood. Psychosomatic Medicine, 80(2), 200–207. https://doi.org/10.1097/PSY.0000000000000542  

Brown, M., Thacker, L. & Cohen, S. (2014). Association between adverse childhood experiences and diagnosis of cancer. PLOS ONE 8(6), e65524. https://doi.org/10.1371/journal.pone.0065524 

Cattaneo, A., Macchi, F., Plazzotta, G., Veronica, B., Bocchio-Chiavetto, L., Riva, M., & Pariante, C. (2015). Inflammation and neuronal plasticity: A link between childhood trauma and depression pathogenesis. Frontiers in Cellular Neuroscience, 9, 40. https://doi.org/10.3389/fncel.2015.00040

Coelho, R., Viola, T., Walss-Bass, C., Brietzke, E., & Grassi-Oliveira, R. (2014). Childhood maltreatment and inflammatory markers: A systematic review. Acta Psychiatrica Scandinavica, 129(3), 180–192. https://doi.org/10.1111/acps.12217

Danese, A., & Baldwin, J. (2017). Hidden wounds? Inflammatory links between childhood trauma and psychopathology. Annual Review of Psychology, 68, 517–544. https://doi.org/10.1146/annurev-psych-010416-044208

Danese, A., & Lewis, S. (2017). Psychoneuroimmunology of early-life Stress: The hidden wounds of childhood trauma? Neuropsychopharmacology, 42(1), 99–114. https://doi.org/10.1038/npp.2016.198

Danese, A., Moffitt, T., Harrington, H., Milne, B., Polanczyk, G., Pariante, C., Poulton, R., & Caspi, A. (2009). Adverse Childhood Experiences and adult risk factors for age-related disease: Depression, inflammation, and clustering of metabolic risk markers. Archives of Pediatrics & Adolescent Medicine, 163(12), 1135–1143. https://doi.org/10.1001/archpediatrics.2009.214  

Danese, A., Moffitt, T., Pariante, C., Ambler, A., Poulton, R., & Caspi, A. (2008). Elevated inflammation levels in depressed adults with a history of childhood maltreatment. Archives of General Psychiatry, 65(4), 409–415. https://doi.org/10.1001/archpsyc.65.4.409

Dube, S., Fairweather, D., Pearson, W., Felitti, V., Anda, R., & Croft, J. (2009). Cumulative childhood stress and autoimmune diseases in adults. Psychosomatic Medicine, 71(2), 243–250. https://doi.org/10.1097/PSY.0b013e3181907888 

Gouin, J., Glaser, R., Malarkey, W., Beversdorf, D., & Kiecolt-Glaser, J. (2012). Childhood abuse and inflammatory responses to daily stressors. Annals of Behavioral Medicine, 44(2), 287–292. https://doi.org/10.1007/s12160-012-9386-1

Heim, C., Nater, U., Maloney, E., Boneva, R., Jones, J., & Reeves, W. (2009). Childhood trauma and risk for chronic fatigue syndrome: Association with neuroendocrine dysfunction. Archives of General Psychiatry, 66(1), 72–80. https://doi.org/10.1001/archgenpsychiatry.2008.508

Holman, D., Ports, K., Buchanan, N., Hawkins, N., Merrick, M., Metzler, M., & Trivers, K. (2016). The association between Adverse Childhood Experiences and risk of cancer in adulthood: A systematic review of the literature. Pediatrics, 138(Suppl 1), S81–S91. https://doi.org/10.1542/peds.2015-4268L

Hovdestad, W., Shields, M., Shaw, A., & Tonmyr, L. (2020). Childhood maltreatment as a risk factor for cancer: Findings from a population-based survey of Canadian adults. BMC Cancer, 20(1), 70. https://doi.org/10.1186/s12885-019-6481-8

Iqbal, A., Kumar, S., Hansen, J., Heyrman, M., Spee, R., & Lteif, A. (2020). Association of Adverse Childhood Experiences with glycemic control and lipids in children with Type 1 Diabetes. Children, 7(1), 8. https://doi.org/10.3390/children7010008

Jakubowski, K. P., Cundiff, J. M., & Matthews, K. A. (2018). Cumulative childhood adversity and adult cardiometabolic disease: A meta-analysis. Health Psychology, 37(8), 701–715. https://doi.org/10.1037/hea0000637

Kajeepeta, S., Gelaye, B., Jackson, C., & Williams, M. (2015). Adverse childhood experiences are associated with adult sleep disorders: A systematic review. Sleep Medicine, 16(3), 320–330. https://doi.org/10.1016/j.sleep.2014.12.013

Karatzias, T., Howard, R., Power, K., Socherel, F., Heath, C., & Livingstone, A. (2017). Organic vs. functional neurological disorders: The role of childhood psychological trauma. Child Abuse & Neglect, 63, 1–6. https://doi.org/10.1016/j.chiabu.2016.11.011

Kelly-Irving, M., Mabile, L., Grosclaude, P., Lang, T., & Delpierre, C. (2013). The embodiment of adverse childhood experiences and cancer development: Potential biological mechanisms and pathways across the life course. International Journal of Public Health, 58(1), 3–11. https://doi.org/10.1007/s00038-012-0370-0  

Kempke, S., Luyten, P., De Coninck, S., Van Houdenhove, B., Mayes, L., & Claes, S. (2015). Effects of early childhood trauma on hypothalamic-pituitary-adrenal (HPA) axis function in patients with Chronic Fatigue Syndrome. Psychoneuroendocrinology, 52, 14–21. https://doi.org/10.1016/j.psyneuen.2014.10.027

Lewin, M., Lopachin, J., Delorme, J., Opendak, M., Sullivan, R., & Wilson, D. (2019). Early life trauma has lifelong consequences for sleep and behavior. Scientific Reports, 9(1), 16701. https://doi.org/10.1038/s41598-019-53241-y

Mate. G. (2004). When the Body Says No: The Hidden Cost of Stress. Toronto: Vintage Canada.

McWhorter, K., Parks, C., D'Aloisio, A., Rojo-Wissar, D., Sandler, D., & Jackson, C. (2019). Traumatic childhood experiences and multiple dimensions of poor sleep among adult women. Sleep, 42(8), zsz108. https://doi.org/10.1093/sleep/zsz108

Ports, K., Holman, D., Guinn, A., Pampati, S., Dyer, K., Merrick, M., Lunsford, N., & Metzler, M. (2019). Adverse Childhood Experiences and the presence of cancer risk factors in adulthood: A scoping review of the literature from 2005 to 2015. Journal of Pediatric Nursing, 44, 81–96. https://doi.org/10.1016/j.pedn.2018.10.009

Shields, M., Hovdestad, W., Pelletier, C., Dykxhoorn, J., O'Donnell, S., & Tonmyr, L. (2016). Childhood maltreatment as a risk factor for diabetes: Findings from a population-based survey of Canadian adults. BMC Public Health, 16(1), 879. https://doi.org/10.1186/s12889-016-3491-1

Suglia, S., Koenen, K., Boynton-Jarrett, R., Chan, P., Clark, C., Danese, A., Faith, M., Goldstein, B., Hayman, L.,  Isasi, C., Pratt, C., Slopen, N., Sumner, J., Turer, A., Turer, C., & Zachariah, J. (2018) Childhood and Adolescent Adversity and Cardiometabolic Outcomes: A Scientific Statement From the American Heart Association.  Circulation, 137(5), e15–e28. https://doi.org/10.1161/CIR.0000000000000536

Sullivan, K., Rochani, H., Huang, L., Donley, D., & Zhang, J. (2019). Adverse Childhood Experiences affect sleep duration for up to 50 years later. Sleep, 42(7), zsz087. https://doi.org/10.1093/sleep/zsz087  

van der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma. Penguin Books: New York.