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Tuesday, Sep 26, 2017
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Psychological trauma can scar health for years

For years, Carolyn Hennecy blamed her heart attack on genetics. Family history also had to be responsible for a subsequent heart surgery and a mini-stroke suffered last year, she thought. What else could trigger such profound cardiac disease in a woman who just turned 60? The Lakeland native never connected her heart health to a significant, painful trauma that started when she was 7. But new research shows the sexual molestation she experienced — and other similar childhood abuse — may be directly linked to the leading killer of American women today. "I'm now convinced it played a part," Hennecy said.
The idea that adverse childhood experiences affect an adult's physical health is not new; researchers have looked at the connection for more than a decade. But new analysis of heart attack and stroke data implies that childhood trauma could increase a woman's risks of cardiovascular disease between 45 percent and 62 percent. The findings create a challenge for crisis counselors who know survivors often overlook the importance of visiting the doctor or maintaining good health. And physicians don't normally dig that deep into a patient's history. "When clients are stuck in survival mode, they can't worry about their physical or mental health," said Leslie Kille, director of trauma recovery services for The Crisis Center of Tampa Bay. Heart disease is responsible for killing nearly 316,000 American women a year, more than 1 in every 4 deaths, Centers for Disease Control and Prevention data show. Physicians traditionally look for known heart disease risk factors in women, such as obesity, smoking, hypertension and diabetes. But the new study linked those factors to only 40 percent of cardiovascular events experienced by survivors of childhood abuse, said Janet Rich-Edwards of Brigham and Women's Hospital in Boston. She was the lead author of the study that analyzed the health history of more than 67,000 women.   * * * * *   Hennecy was 7 when a member of her extended family sexually abused her for the first time; the molestations continued until she was 15. By the time she graduated from Lakeland High in 1969, she felt "damaged" and fell into an abusive 16-year marriage, she said. "It's a relentless stress when you have to walk on eggshells 24 hours a day," said Hennecy, a domestic violence advocate and author. "I knew the stress had some bearing on me." She left the marriage in 1985, but the physical toll of the abuse didn't reveal itself until a decade later. Hennecy was 45 when she suffered a heart attack in 1996; another heart surgery followed in 2005. This past April, she spent several days in the hospital before being diagnosed with a mini-stroke. The repercussions of earlier abuse were far greater than she ever realized. "The relentless effect that domestic violence and sexual abuse has on a victim or survivor will creep on them for the rest of their life," she said. Hennecy, who often serves as a public speaker about domestic violence, first mentioned her abuse history to her cardiologist two years ago. In hindsight, she wishes all victims shared this important information with their doctors sooner. "I would like to see doctors ask this specific question," she said. "It has become a question that must be asked of women by cardiologists. This cannot be ignored." Stephen Mester, a cardiologist at Brandon Regional Hospital, said "it would be extraordinarily uncommon" for a cardiologist to ask specific questions about childhood abuse. Doctors do look for clues often tied to victims of abuse, such as depression or anxiety. But ultimately it's the patient's choice whether to share, he said. "Most physicians try to be open-ended with questions about issues at home," said Mester, who added that doctors report possible abuse only to appropriate authorities. "We ask about a number of broad issues that could open the conversation up." He says education is critical to reaching women at increased risk for heart disease. Treatment centers are a good resource, but that won't reach women living in abusive situations. "They need to realize it's not their fault," Mester said.   * * * * * Victims need to know that a doctor's office is a safe place to speak, said Kille, from the Crisis Center. It's common that adult victims also were abused as children, meaning many women now in abusive relationships could be at increased health risk, she said.   It's critical that survivors are proactive with their health. A heart attack or sudden news of heart disease could be emotionally devastating to those who experienced domestic violence, Kille said. "You feel like you lose control all over again," she said. It's been about a decade since counselors at the Crisis Center started integrating physical health into their treatment programs. They encourage exercise, stress-busting breathing techniques and other activities as a way "to find a little balance," Kille said. The approach stems in part from the landmark Adverse Childhood Experiences Study, known as ACE, launched in the late 1990s by the CDC and Kaiser Permanente's Health Appraisal Clinic in San Diego. More than 50 scientific articles, based on the health history of 17,000 people, have linked poor adult physical health to childhood abuse, neglect and household dysfunction. Kille said it's important that the public understands the correlation between childhood abuse and health, and the need to treat body, mind and spirit. Otherwise, victims won't heal. "The whole goal of treatment is to get people to stop identifying themselves by the victimization," she said. "We want them to start to dream." Hennecy agrees. She wants to warn women to be proactive and address their heart health before it's too late. "It's important we open up that line of communication," she said. "We need to tell them, 'This is what you are up against.' "

mshedden@tampatrib.com (813) 259-7365

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