Fig. 2

Physiologic Impact of Adverse Childhood Experiences (ACEs) – An inverted pyramid model of physiologic change following ACE exposure over a lifetime. The darkest shaded section represents the total population of ACE-affected individuals and progresses to the lightest, labeled premature death, which affects the lowest percentage of the ACE-affected population relative to the conditions that precede it. [5, 31, 32, 76]. HPA Axis: Hypothalamic–Pituitary–Adrenal Axis; SAM Axis: Sympathetic-Adrenal-Medullary axis