“Early Life Adversity” There is no doubt that too often psychological evaluations are incomplete, inaccurate and disappointing. The focus is almost always upon the individual following an injury with little reference to early life.
There is also the erroneous belief that if there has been past early life trauma that all current problems are “simply pre-existing.”
The term allostatic load (AL) was coined by McEwen and Stellar in 1993. Allostatic load is “the wear and tear on the body” which grows over time when the individual is exposed to repeated or chronic stress. It represents the physiological consequences of chronic exposure to fluctuating stress demands or the patient’s heightened response to repeated or chronic stress.
We know that the allostatic load and early life impacts high blood pressure, diabetes, inflammatory disease and most notably heart disease. Recent studies suggest that AL also impacts the patient’s experience of, and response to, pain.
We often cite functional capacity exams (FCE) in which the examiner notes that the patient’s responses are excessive and “non-biological” when, in fact, they may be the result of early life stressors, expectancies and fear.
Early life adversity
(ELA) can make a person stronger and more capable of dealing with pain and stress. However, quite often ELA has made the patient fearful of, and overly responsive to, discomfort and suffering. Do not forget that children attempt to stop abuse by crying out in pain.
The most common form of early life adversity is low socioeconomic status (SES) and associated poverty. Poor health behaviors, poor response to symptoms and dysfunctional relationships are more common in lower SES groups. In fact, those raised in a low SES tend to become adults of low SES and this, in turn, is linked to poor health behaviors (smoking, drinking, obesity and risk-taking behaviors).
Recent studies indicate that those who are reared in low SES families can mitigate some of their risk by educational achievement. However, the impact of physical and abuse persists, and the physical impact can be great; greater than a better education will overcome.
In fact, “early life circumstances have a lasting imprint on” physical functioning later in life.
Thus, to have a better understanding as to why a patient is noncompliant, angry, readily disappointed, and overly responsive to physical pain, the clinician must have a knowledge of the patient’s early life adversities. In this way we can determine what early life trauma contributes to their emotional responses, subjective complaints and maladaptive behaviors.
Friedman, E. M., Karlamangla, A. S. et al. (2015) Early life adversity and adult biological risk profiles. Psychosomatic Medicine, V77, 175-185.