The Lasting Impact of Adverse Childhood Experiences on Adult

Mental Well-Being

Kexin Li

College of Arts and Science, New York University, NY 10003, U.S.A.

Keywords: Adverse Childhood Experience (ACE), Attachment Styles, Parental Styles, Substance Abuse.

Abstract: Adverse Childhood Experiences (ACE) have long been assumed to have significance relating to the long-

term consequences for adult mental health. Multiple factors and aspects of one’s developmental stage can

lead to different outcomes. This paper explores the underlying mechanisms of ACE from attachment styles,

parental styles, and substance abuse aspects. Data were analyzed based on different attachment styles with a

focus on insecure attachment style and the possible cause, along with potential risks leading to mental

disorders. Parental styles were evaluated based on emotional and physical responsiveness and availability.

Substance abuse was specifically investigated within the college student population. Researchers mostly

employed self-reported questionnaires when collecting data, participants varied across nationality, ethnicity,

gender, and age, focusing on the age group of 18-25; some were longitudinal, and most were cross-sectional.

Based on the research conducted, evidence indicates that authoritarian parental styles have a higher potential

to form insecure attachment styles which is detrimental to future mental health, as well as substance abuse.

1 INTRODUCTION

Kaiser Permanente, working with the Centers for

Disease Control and Prevention, first introduced the

concept of ACE back in 1998. Over the past decades,

mental health, especially adolescent mental health,

has been a growingly popular topic and has gained an

increased amount of attention. One’s developmental

stage is undoubtedly one of the most crucial stages

over the lifespan; it sets the fundamental base for

one's future performance.

Built upon an extensive amount of studies on

ACE, the study examines the long-lasting physical

and psychological effects of chronic stress during

participants’ developmental stages across multiple

aspects of their lives. With a spectrum of potential

trauma one could have gone through and witnessed

during childhood, such as parental neglect, abuse,

dysfunctional or unconventional household, and

substance abuse; some individual at risk not only

suffers internally but also face difficulties navigating

social dimensions daily such as forming relationships

with unhealthy attachment styles.

Parenting styles play one of the most significant

roles when shaping child development. Many

researches have indicated the emotional availability

and disciplinary decisions of the primary caregivers

have both direct and indirect impacts on an

individual’s development; including but not limited

to attachment styles, mental health, emotional

stability, and future outcomes. The study also states

parents who experienced ACEs themselves and the

perpetuating cycles that would normally carry on to

the next generation of dysfunctional parenting. In

detail, this researcher hopes to explore the long-

lasting impact of parenting behaviors and their

relationship with parental ACEs, and possible ACEs

of the next generation.

Lastly, substance abuse is being studied especially

on its relationship with Adverse Childhood

Experiences. With many studies revealing the

positive correlation between two events, researchers

aim to target their participants into specific groups

based on their life stages. College students across

almost all ethnicities and genders, as well as both men

and women of age over 50. With distinct study groups

and respective impacts, interventions and precautions

could be taken at early stages.

2 ATTACHMENT STYLES

The Attachment theory developed by John Bowlby

indicates that interpersonal emotional bonding

412

Li, K.

The Lasting Impact of Adverse Childhood Experiences on Adult Mental Well-Being.

DOI: 10.5220/0014116400004942

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 2nd International Conference on Applied Psychology and Marketing Management (APMM 2025), pages 412-416

ISBN: 978-989-758-791-7

patterns formed during one’s early childhood,

especially during infancy. Bowlby states the primary

caregiver’s emotional availability and responsiveness

towards the child is the setting stone for one’s

development of self-worth and expectation. This

influence is deeply profound due to the internal

methodology that the child would form given whether

or not they believe they are worthy of someone else's

attention and their level of expectation for emotional

responses. Therefore, one’s perception, interaction,

and roles they will play in close relationships during

the foreseeable future would be impacted heavily

(Papandrea, 2022).

Fearful and avoidant attachment styles are often

formed due to abuse and neglect from both physical

and emotional aspects, sexual abuse can be involved

as well; the study indicates these variables that cause

trauma have a negative correlation to the formation of

secure attachment style (Erozkan, 2016). Adults who

experience attachment disorders generally receive an

“inconsistent and unpredictable” style of care during

their childhood, they have been described as those

hard to “settle and pacify” when in distressed

situations. Children who have experienced trauma

which is commonly admitted as the worst factor

possible during one’s developmental stage, often

develop a self-defense mechanism directed toward

individuals and environments where they would

typically form secure relationships and bonds,

particularly with their primary caregiver. Naturally

after trauma, "representation of anger and

frightening" figures are being established instead of

loving and caring, therefore children are constantly

under alert when they should have been feeling safe

and free to express themselves. Furthermore, the

causation of insecure attachment style not only affects

one’s ability to form close and intimate relationships

with others in their life, but also it affects the normal

development of their brain.

This research conducted by Erozkan had 940

participants from the same university where the data

of 29 participants were excluded before analysis due

to uncompleted instruments and central biases

demonstrated (Erozkan, 2016). Therefore, a total of

911 answers were used, containing 54% female and

46% male, all between the age range of 19-24,

spreading through freshmen to seniors about 22-30%

each. This research employed a cross-section model

to navigate through the connection between ACE and

attachment style. Participants were required to fill out

two self-reported questionnaires: the Childhood

Trauma Questionnaire and the Relationship Scales

Questionnaire (Erozkan, 2016). In the Childhood

Trauma Questionnaire, participants were asked to rate

on a 1-5 scale whether they believe they have been

physically, emotionally, sexually abused and

neglected. The Relationship Scales Questionnaire

contained 30 items in the form of a Likert scale where

participants self-reported based on the four different

types of attachment. Data were collected and

analyzed through SPSS and LISREL, Pearson

product-moment correlation analysis, and structural

equation modeling. The researcher also applied

structural equation modeling to data and qualitative

presumptions to find out the causal relationship. The

result of the experiments demonstrates the significant

relationship between negative childhood experiences

and attachment styles. This study supported the

provocation of insecure attachment style

development linked to childhood trauma empirically.

The majority of the participants who reported as

insecure and attached have suffered from both neglect

and abuse either physically or emotionally and some

sexually. Erozkan’s study also states that survivors of

sexual abuse have a higher level of proness towards

the development of insecure attachment styles. The

limitation of this study was the instruments employed

where the data were collected solely based on self-

reported questionnaires. Generally, it is well known

that self-reported data may carry biases of not

accurate observations and slightly wrongful self-

reflect; especially when answering questions about

personal events such as childhood trauma. However,

the researchers did utilize multiple modeling to avoid

the limitation of cross-sectional study where causal

inferences are normally limited.

The role of impaired emotional regulation and

insecure or avoidant attachment style were explored

regarding ACEs and university students in China.

Experiments were conducted in different cultural

settings. Data were collected from all three time

points, September 2020, two months later, and

January 2021, where the questionnaires were

conducted, however, the researcher only included

answers that participants chose the same topic in all

three times. The result shows that although ACEs

might not directly link to depression; the insecure

attachment style and emotional dysregulation caused

by ACE play an indistinct role in one’s development

of depression in a temporal sequence (Ye et al.,

2024).

With Freud’s psycho-sexual development

theories, a child develops skills that are life-long,

significant, and impactful through different stages

until the age of 12, the delay caused by any

unresolved issue leads to one’s fixation at a certain

stage permanently causing damage. As this is a rather

controversial topic, the empirical proof of trauma-led

The Lasting Impact of Adverse Childhood Experiences on Adult Mental Well-Being

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distrust, avoidant, anxious, and insecure attachment

styles are supported by different researchers. As

humans, a child has the nature of seeking comfort and

love from a primary caregiver, however, if their need

is not fulfilled, due to high expectations, the

disappointment would also be higher than being let

down by others.

In another research, the relationship between

defense mechanisms and attachment styles is studied;

1487 students from two California high schools

participated in this research, and they all completed

questionnaires corresponding to defense

mechanisms, psychiatric symptoms, and attachment

styles (Laczkovics et al., 2020). After analyzing the

data collected, researchers indicate that a secure

attachment style with a positive self-image is

correlated with higher levels of mature defense

mechanisms; on the other hand, higher levels of

underdeveloped defense mechanisms would lead to

greater possibility of forming insecure attachment

styles and potential risk of psychopathology

(Laczkovics et al., 2020).

In conclusion, ACEs have been identified as one

of the most significant factors in shaping individual

attachment styles, therefore impacting one’s mental

health state.

3 PARENTAL STYLES

Authoritative, Authoritarian, permissive and

rejecting-neglecting parenting are different types of

parenting styles. Parents who are able to provide

timely responses and take on the role of parents in a

responsible manner by stating clear expectations to

their children are authoritative parents. By providing

a warm and supportive environment to nurture,

children often become courageous and able to express

their emotions freely.

According to Rowell and Neal-Barnett (2022),

parenting typically seeks to guarantee child’s

physical well-being and foster their cognitive,

emotional, and social development as they grow into

adulthood. Researchers state that salient parenting is

not only established beyond emotional availability

but also proper discipline strategies (Rowell & Neal-

Barnett, 2022). Moran et al. explained the unresolved

attachment and adverse childhood experience of the

parents generally would carry over to their

relationship with their children as well, due to their

own deprivations of emotional closeness and

accumulated stress (Moran et al., 2008). Rowell and

Neal-Barnett stated that all of the factors listed

"disengagement, intrusiveness and hostility and

decreased responsiveness, sensitivity and structure"

are accounted for reasons leading to insecure

attachment styles (Rowell & Neal-Barnett, 2022). As

mentioned above in the attachment style section, the

lack of attention and abuse could potentially be

detrimental to formation of secure attachment style.

Moreover, the parents who have experienced ACEs

themselves generally struggle with proper discipline

measures as they were victims of inappropriate

parenting. As most learn from their own experience

and what one witnessed, they are lacking necessary

information. Due to the impact of ACEs, being a

parent, especially when disciplinary decisions are in

need, situations are normally stressful; with

dysfunctional management of emotions, aggressive

behaviors are often employed as the most "direct and

effective” parenting styles. “Regarding discipline

techniques, parents with a history of adversity,

specifically neglect, physical abuse, and sexual abuse,

reported an increased use of problematic parenting

practices that included permissive and authoritarian

styles of discipline, physical punishment” (Rowell &

Neal-Barnett, 2022); this result was concluded in

their systematic review of 27,645 adult participants,

which sixteen of the studies were cross-sectional and

10 were longitudinal (Rowell & Neal-Barnett, 2022).

The inconsistency of parental emotions would carry

the adversity of emotional disorder and mental illness

to the next generation.

Authoritarian parents often ask more than

provide. They are "non-negotiable and expect

obedience even if there is a lack of explanation for the

rules" (Kazourra, 2024). Children are less likely to

share their personal emotions as they have low

expectations towards responding. As many studies

explore the lack of emotional connection between

parents and child and an excessive amount of control,

children would develop passive attitudes.

As humor brings people closer by sharing

laughter, researchers find that individuals raised with

authoritative parenting style have affiliative humor

where both foster strong emotional bonds under

supportive and positive environments. Kazourra’s

study explores the relationship between ACEs,

parenting styles and personality, also humor type; it

is believed that by making self-defeating jokes, one is

intentionally trying to cope, however due to the

maltreatment experienced, improper adaptation is

formed (Kazourra, 2024).

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4 SUBSTANCE ABUSE

“Approximately 50% of students acknowledged a

history of family-based ACE and 23% reported

multiple ACE, findings that substantiate prior work

documenting a relatively high prevalence and co-

occurrence of family stressors among students"

(Forster et al., 2018). The study analyzed data from

the 2015 American College Health Association's

National College Health Assessment II which

consists of a diversified race at California State

University; 2953 participants were college students

since the researchers believed that they are

particularly vulnerable to substances since they are

experiencing higher than ever pressure in their lives

(Forster et al., 2018). On top of the original survey, 6

questions regarding the topic of ACE were added, for

example, if they have lived with someone who drank

too much, used illegal drugs, or if they have been

sweared at in their own home by a parent or any adult;

or if they have ever been physically and verbally

abused. Moreover, participants were asked amount of

days within the past 30 days they have consumed

substance, alcohol or marijuana. By taking into

consideration the ethnicity and gender of the

participants, the result shows that “one in four

students reported using illicit drugs or misusing

prescription medications and approximately 25%

engaged in the use of more than one substance within

the last year is concerning” (Forster et al., 2018).

Limitations to this study are similar to those of

other researchers mentioned above, due to the nature

of cross-sectional design, it does not allow causal

conclusions; though the participants were widely

diversified within race; the outcome is presumably

only to the liking of those who are college students

and live in a similar urban setting. However, the target

of this study is to shed light on this extremely

important transitional phase of someone who is

stepping out into the real world that requires "greater

responsibility and independence”. By linking the

impact of ACEs and the significant correlation to

substance abuse, early interventions and screening of

ACE should be prioritized due to the multiple strong

relationships between mental disorders and substance

abuse.

Older adults and issues raised within their

community are often overlooked. According to data,

the amount of mental and substance use disorders

(MSUDs), is steadily increasing. Study reveals that

under comparison, women were more likely to be the

victim of ACEs in the group of age 50+ participants,

however, researchers also found "the association

between some ACEs and mental disorders was also

stronger among men than among women, even

though women had significantly higher rates of

mental disorders than men” (Choi et al., 2017).

Researchers found that nearly 51.7% of the

participants have experienced one or more types of

ACEs, in all, parental substance abuse was one of the

most common ACEs reported. Individuals who

experienced parental abuse and neglect, as well as

witnessed parental substance abuse typically

associated with a significant increase in possible

MUSDs. Choi N. G, et al, state in their research that

the strength between the positive association of ACEs

and MSUDs remains consistent for all MSUDs (Choi

et al., 2017). This particular study shares common

limitations of cross-sectional data and

misconceptions about self-awareness in self-reported

surveys. Moreover, Cavanaugh et al., also discussed

the relationship between ACEs and MSUDs

(Cavanaugh et al., 2015).

5 DISCUSSION

Based on prior research, the crucial association

between ACE and the emergence of mental disorders

is studied and highlighted from aspects such as

parenting, attachment styles, and substance abuse.

The long-lasting childhood trauma has a profound

impact on adulthood from multiple different aspects

including being unable to engage in healthy intimate

relationships due to insecure attachment styles

formed under authoritarian parenting styles. Parents

who were exposed to ACEs themselves when they

were children have difficulties breaking the cycle

since they lack role models. Study indicates the direct

correlation with heightened susceptibility to mental

disorders including depression and anxiety and

exposure to abuse and neglect from both physical and

emotional aspects. With the lack of guidance to

develop appropriate coping strategies and critical

emotional regulation, one would experience higher

levels of mood swings therefore causing more

possibility in seeking comfort elsewhere such as

misuse of substances to escape from their

unbreathable reality. Future research should focus

more on longitudinal studies to explore more

causality and collect data beyond self-reported

surveys.

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6 CONCLUSION

These researches are consistent with prior research,

by reiterating these issues from detailed aspects,

researchers can reinforce populations’ understanding

of ACEs and their unavoidable long-lasting impacts.

To solve insecure attachment styles, parents cannot

overlook their responsibility, emotional availability,

and demands daily as part of their parenting

strategies. Being able to provide a loving and

supportive environment creates a safe nest for

children to explore their surroundings and express

their curiosity freely. These researchers, hope to shed

light on ACE so early interventions can be put in

place before unsavable damages are done.

Moving forward, research regarding attachment

styles should be conducted beyond self-reported

questionnaires and employ longitudinal study as

much as possible due to the limitation of cross-

sectional experiments.

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