When rating systems get too real

Updated: May 19

A few years ago, I made a major career change from the radio industry to health care. I was hired to work for a community health center in the behavioral health field and felt on top of the world. To be able to do something like this with little experience and a leap of faith was not unfamiliar to me though.

On a personal level, my own life and my family’s life was coming together. I’ve always considered myself resilient, capable of doing my own “self-therapy” and thinking through my issues. I had the ability to dig down deep to the “root” of any problem and then put in countermeasures to fix the problem. Even though I had a hysterectomy six months before, I still physically felt the best I had in years. (I had chronic endometriosis, which was misdiagnosed for years.) I’d married the love of my life a couple years before, and my son was starting high school at one of the top high schools in the nation. What could I possibly have to complain about?

On a professional level, I was a sponge in every learning opportunity. While I worked on the administrative side of the business, I attended trainings for the clinical staff as well, just to learn more about this new world.

How 10 questions on the ACE childhood trauma exam turned my life upside down

A couple months in, I attended a new staffer training called “Trauma Informed Care”—as many of our clients have extensive trauma histories.

Our Child & Family Services Director was leading the class and handed out a small questionnaire. On the top page read the word “ACE.” (This link is a great resource on ACE, and some of the corresponding health outcomes that were reviewed that day.) I scanned through a series of questions about childhood experiences. Because I love to try to predict what is coming, I thought, “I bet they’re going to look at how rough your childhood was, and then we will have another one about us as adults to and see who aced recovering from adverse experiences.”

The instructor for this questionnaire asked us to go through the questions and give ourselves a point for each one we experienced. She emphasized that we would not be sharing these answers with everyone. So with pen in hand, I went through the questionnaire. Here is how I remember the internal conversation going:

1. Did a parent or other adult in the household often or very often swear at you, insult you, put you down and/or threaten you in a way that made you think that you might be physically hurt?

Hmm. Tough one. My dad had a habit of insulting and putting me down on a frequent basis, but he apologized for it lots of times. So does that count? As a heavyset kid, I climbed a circular ladder at the playground and was afraid to come back down. He asked me if he should go home to get sticks of butter to help me climb down. Typically, the insults were when he was drunk or had been drinking, but it also usually happened anytime he was around other people—like other family members. It was almost like he was one of those mean high school or frat boys who thought it was hilarious to be mean to others if it meant he could make others laugh. He just happened to use me as a target.

I have pretty vivid memories of wanting to share things that I thought were legitimate talents based on other people’s feedback, like singing, and then he would make a comment like, “Um, yeah, I think you need to consider other career options.” (This was when I was 12 or 13.) But I only saw him every other weekend. So even if it happened “often” when I was with him, did it really count as “often” when I only saw him 20–30 days a year? My mom would swear at us. But again, I’m not sure that I could consider it “often.” How frequent is often? Does once a week or so count?

If someone asked me if I had been verbally or emotionally abused, my answer would have been no. So I gave myself a .5 on this one (not the way you score it, by the way.)

2. Did a parent or other adult in the household often push, grab, slap or throw something at you? Or, ever hit you so hard that you had marks or were injured?

Again, what counts as “marks” or “injured”? Would lumps and tenderness on my head for a few days count? Or, a red stinging slap mark on my face? If someone asked me if I was physically abused, my answer would have been no. I had two distinct memories of physical force that superseded any hard arm grabs, screaming, etc.

The first scenario was with my dad when I was in late middle school. It was an awful situation deserving of a whole separate blog about the incident, but the long and short of it was that he open-handed slapped me across my face full force at a family Christmas party on Christmas Eve. (He was very drunk, but I’m sure he would tell you he was completely in control and not drunk.) That is also the only time I recall what I would consider totally inappropriate physical force from my dad.

The second scenario was with my mom. I missed the school bus, so she had to drive me to school. I was maybe a freshman in high school and going through a mouthy phase. Due to the rush, I was still getting ready in the car and had a wooden hairbrush I brought to brush my hair. Sitting in the passenger seat, I can’t remember what I said, but I have no doubt it was a smart-ass remark.

Next thing I remember is my mom ripped the brush from my hands and began wailing on my head. I was cowering, holding my hands up to protectively guard my head while she kept hitting me. She hit my hands, occasionally my head, etc. I remember yelling for her to stop and crying, while simultaneously finding the frame of mind to also be fearful we were going to get into a car wreck. I won’t try to put a time estimate on it. It felt like a long time to me, but if you asked her, she may say she only took three swings (it was way more than three swings).

I remember trying to clean up my face before she pulled up to the school so it wouldn’t be obvious I was crying. I reached up to touch my head, legitimately concerned that I could possibly be bleeding from my head, and felt how sore to the touch it already was. In my anger, as I got out of the car I said, “When I get inside the school, I am telling them what you did to me.” Of course I didn’t mean it. How could I possibly go that route after already holding onto so much guilt over the scenario that happened with my dad when I was in first grade? But I wanted her to be fearful of it. I remember her trying to apologize and negotiate, but I closed the car door and walked away.

In my first-period class, I was called to the office. I thought, “How do they know something happened? Did she tell on herself?” When I got to the office, they told me I had a phone call. I thought for sure it was my mom calling to apologize. I asked if they knew who it was and they said, “I think it may be your dad.” I was very confused then. Apparently my mom called him at work, knowing he was a weakness for me, and told him what had happened. She panicked, thinking that Division of Children and Family Services (DCFS) was going to take me and my brother away. I don’t remember the exact words, but the gist of it was my dad telling me not to say anything and that this won’t happen again.

He was right, she never did anything like that again. So, another .5? So tricky.

3. Did an adult or person older than you ever touch or fondle you or have you touch their body in a sexual way? Or, try to or actually have oral, anal or vaginal sex with you?

How does “not that I can remember” rate? If someone were to ask me if I was sexually abused, I would say no.

However, I have a troubled past that makes it difficult for me to know the definitive answer to this question. As mentioned in another post, I became hyper-interested in sex at a pretty young age, even before puberty really hit. I was engaging in sexually promiscuous activities like finding men online, while I was in middle school, who wanted me to undress on a webcam. I wanted them to tell me what to do. I remember feeling embarrassed and ashamed that I was doing it and did not know where the compulsion was coming from. It was mostly posing and light touching. I was too young and too embarrassed to do much more, but I remember it being a very specific niche of interaction I was chasing.

Then as puberty hit, I had a lot of issues and my mom took me to an Ob/Gyn. She got me up on her exam table with no problem. But as soon as she was getting ready to exam me, I lost my mind. I had a full-on, animalistic, panicked response out of nowhere. I screamed, cried hysterically, fought her and begged for her to stop. While I was losing it, she barely had a chance to examine anything, other than determining that my hymen was not in place. I was maybe 12 or 13 at the time. She asked if I was sexually active, did I have any accidents that could have caused this, was I sexually abused, etc.

Both my mom and I denied all the questions. Then, the doctor asked my mom to leave the room. I remember her being very sweet, quiet and calm as she asked me about sexual abuse and told me that my response to her exam is very typical of something she would see from someone who had been sexually traumatized. She said this was a safe place for me to talk to her about anything that may have happened to me. I meant it, sincerely, when I said I don’t remember anything like that happening.

I remained a virgin until college. My first love was my first. I still remember vividly that when he tried to digitally penetrate me, I once again completely lost my mind. Physically shaking and crying, it was like my whole body was recoiling in horror. But as we learned through trial and error, regular sex was totally fine. It was just the fingers.

That nuance has continued all my life. The volatility of my shaking, screaming, crying and flight response calmed considerably over the years. (Child birth exams force you to deal with it even if you don’t want to.) My Ob/Gyn was very kind and understanding with me. But to this day, I avoid it if I can. Anytime it does happen, I feel the insides of my body tensing and my head yelling, “Run away! Fight! Anything to stop this.”

This is when I get flashbacks to the first grade incident where the sexual abuse video stirred something up in me that made me extremely uncomfortable to the point I felt I needed to talk with the teacher and was trying to put the pieces together.

I still don’t remember anything at all that remotely resembles any sexual abuse. I have mentally inventoried family members and feel confident that it was not any of them. Whether something happened is still a question mark for me.

So where does that fall on the scale? Eh, another .5. (Do you see a theme beginning?)

4. Did you often feel that no one in your family loved you or thought you were important or special? Or, your family didn’t look out for each other, feel close to each other or support each other?

Oh boy, this one is harder to give a .5. I realized that part of why I was so uncomfortable with these questions was I immediately wondered what would my mom or dad think? It would hurt their feelings, and they might even flatly deny these things. What parents want to hear that their kid didn’t feel loved, wasn’t special, that the family wasn’t close and didn’t support one another?

That said, I knew with this one being about how “I” felt, it was going to have to be a 1.

Between my mom’s depression stints where she was very unavailable, working full time and often wanting her evenings for herself, then her boyfriends and friends, I often felt alone. My mom was a disinterested party. I knew she loved me. She showed me lots of attention in the hobbies I participated in and talents I wanted to nurture. She was very supportive in attending every show, every practice and every game. She definitely liked the proud parent role, bragging about what I accomplished or wanting me to show off my talents to others. At home though, I felt somewhat invisible. By middle school, when I adopted myself out to Cindy’s family, I remember feeling like I wasn’t really missed or needed at home. It didn’t really matter if I were there or not.

With my dad, I frequently felt like I was not important or special. There were the obvious things like him choosing his mistress over staying at home, as a family, with me. He chose work and his wife over extra days I could have spent at his house when I was begging for it. There were all sorts of shows, practices and games he wouldn’t attend. There was always a reason. I also, with my young mind, felt that his refusal to stop drinking was a measurement of a lack of love and importance of me in his life. My dad frequently put me down through teasing (on topics that always had truth to them) and making fun of things I was proud of—like my singing.

From a very young age, I detached from the sense of being a family unit and the idea of “family.” We never had very strong structures or deep and meaningful bonding activities. My dad was the outlier, as I felt similar in personality to him and felt like he was successful—despite his struggles. I admired the appearance of his life—having nice things, a clean, nice house, tidy cars. He always seemed to be trying to give me life advice, sometimes years way in advance of my age. I kept thinking if I could just absorb enough of what I could learn from him, maybe I could be like him when I was older. Of course, I always sought approval and affirmation as well. He rarely approved of things and always had a critical eye. I could win an award where 100 people piled praise on me. If my dad didn’t compliment me for it or show interest, it was a worthless award and I was no longer proud of it, mentally disqualifying it as holding any value.

5. Did you often feel that you didn’t have enough to eat, had to wear dirty clothes and had no one to protect you? Or, your parents were too drunk or high to take care of you or take you to the doctor if you needed it?

Ugh, another uncomfortable one. The answer should be 1, but I immediately feel bad like my mom would be offended. But I did go to school with dirty clothing and not having showered. I did go through periods of time where she was not really available to be much of a caretaker. I did have times where there was little to nothing to eat, or we were living on drive-through meals.

As far as “too drunk,” what are we talking about here? Once? Twice? Does driving drunk with us in the car constitute “not taking care of us”? Tricky, these things. Then, sure. Very frequently? Then, no.

This one is a 1, too.

6. Were your parents ever separated or divorced?

Finally an easy one! Yes. 1.

7. Was your mother or stepmother often pushed, grabbed, slapped or had something thrown at her? Was she sometimes, or often, kicked, bitten, hit with a fist or hit with something hard? Or, ever repeatedly hit over at least a few minutes or threatened with a gun or knife?

Oh good, another relatively easy one. Other than the memory of the fight in the hallway where I believe my mom was pushed, and lots of verbal yelling, berating, etc., there was no real physical violence I can remember there.

I’m going with zero on this one.

8. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?

Another easy one. Yes, my dad has been a lifetime (mostly) functional alcoholic. 1.

9. Was a household member depressed or mentally ill or did a household member attempt suicide?

Apparently, all the hard ones were at the beginning. Clearly, I found some rabbit holes to dig around in. Mom was definitely depressed. Dad was depressed, too. At a young age, I didn’t recognize that his alcoholism was him self-medicating guilt and depression. My brother was depressed. Like my dad, he self-medicated through any substance he cold get his hands on.

But then, did having a hoarded house (I’ll speak on that in another post) qualify as a household member being mentally ill? Does having your dad call you and talk about wanting to kill himself, or ways he wants to commit suicide when he was drunk, count?

I guess that’s another 1.

10. Did a household member go to prison?

Is it telling if my first question is, “Well, for how long?” Thankfully, my dad was never in prison for extended periods. However, he was drunk tanked for driving under the influence (DUIs) many times. There were court hearings and worry that he was going to be sent away. I distinctly remember there being times where my mom would be on the phone with my grandma, and I’d listen in on the conversations. She would talk about how my dad had hidden arrests from her, and she would read in the newspaper that he had spent the night in jail. She wondered how he got bailed out and who bailed him out.

I was particularly worried about him after another DUI when I was in high school. He already had his license taken away and was on community service for the last one. He was arrested driving without his license, under the influence. I remember being very fearful this was going to be the time he was going to jail for a long time. Somehow, with enough money and good lawyers, he got off with having to participate in a treatment program, extended loss of his license (which I’m pretty sure he continued to drive without—he’s never been one for rules) and more community service.

Let’s give this one a .5 again.

Time to tally these up—.5 + .5 + .5 + 1 + 1 + 1 + 0 + 1 + 1 + .5 = 7.

That seems like a good starting point if this assessment works the way I am figuring it does. This means there’s a lot of room for improvement as an adult. I also remember feeling pretty proud that my son’s score would maybe be a 2 on this scale (divorce and mental illness).

Facing my truth: The childhood trauma I didn't know I had

So, as I sat there with my score of 7 (or 5 if you do not let me have my .5 point scores) I waited for the next round of questions. Instead, what followed was a video of a TED Talk from Nadine Burke Harris. She outlined what the ACE Study was and why this questionnaire was relevant.

As she threw out the threshold of a “4 or more” as the line for almost every negative health outcome, I remember feeling a pit in my stomach because I knew even if dropped every .5 I had given myself, I’d still be at a 5.

The messaging on how those experiences impact your health outcomes was smothering. I felt embarrassed and could barely breathe. Once the video was over, she put up more slides, reviewing more negative outcomes correlating with these scores. Each one an additional punch to the gut and seemingly more relevant to me, including childhood asthma issues and hormonal issues. The one that did me in was the statistic that someone with my score dies, on average, 20 years earlier than someone with a low ACE score. I was devastated. But I’m normal, I remember thinking.

I went back to my office after the training, consumed with my thoughts and trying to decide what I could do with this new knowledge. I felt like I had been given a terminal diagnosis through no fault of my own and no map on what to do now. I think I made it until that afternoon before I was at the director’s door asking if I could talk to her personally about her training.

I shared with her how interesting the training was, but I was surprised that I had a higher ACE score and seeing those statistics concerned me. I asked her what can be done now that I’m an adult, if I want to reduce my chances of these things. She was surprised to hear my score was high, and she commented that I must have been a very resilient child. That was the first time someone referred to me as resilient. I took it as a compliment; I’d like to think I turned out pretty OK.

She asked me if I had ever participated in therapy before. I told her just court-ordered therapy, but it wasn’t anything I remembered or meaningful. She suggested that I use our company’s Employee Assistance Program (EAP), and to try the six free sessions with a trauma focus.

Looking back, I was a childhood asthmatic (hospitalized annually). I had chronic reproductive/hormone issues, which were determined to be low production of progesterone where I was told I’d need injections or to take pills to get pregnant when I was older. I also had appendicitis, my gall bladder removed, chronic endometriosis, irritable bowel syndrome (IBS), polycystic ovarian syndrome, and (in the last couple of years) fibromyalgia and diabetes. I am also considered morbidly obese. Yikes, right?

I had not had any mental health diagnoses or treatment until recent years (although, I’ve struggled with anxiety for as long as I can remember, and depression and impulsive/manic spurts since college).

But it was assessments like these that showed me a hard reality I’d ignored: I’d survived through a lot.


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