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We thank the authors for their feedback on our article (1). They have once again highlighted important points in their comments.

Dr. Trebin points out that the effects of adverse childhood experiences (ACEs) go beyond psychological consequences and also increase the risk of somatic or somatoform reactions. The focus of our article (1) was primarily on the psychosocial effects, and in particular on aggressive behavior, which to date has been much less investigated. In other articles, we have examined similar populations for the relationship between abuse and somatic problems, as well as for pain (2). This work shows a clear correlation between the number of experienced types of maltreatment in childhood and adolescence and a variety of somatic effects. For example, the risk of heart attack is 7.3 times higher if there had been four or more types of maltreatment. The results of the meta-analysis by Hughes and colleagues (3) also underline the point raised by Dr. Trebin, that the effects of ACEs are diverse and far-reaching and therefore require efforts for effective prevention and treatment. In this respect, we are particularly pleased that, after assessment by the German Council of Science and Humanities, we were given permission to build a research center for Multidimensional Trauma Sciences in Ulm. Starting in 2024, basic scientists and clinicians from all fields, ranging from trauma surgery to child and adolescent psychiatry, will be able to investigate the conditions of origin of trauma consequences in physical and psychological areas.

Dr. Lohbeck comments that, in addition to the categories listed in our article (1), other childhood experiences, such as bullying, can be important. In our study, we used the German version of the Adverse Childhood Experiences questionnaire (ACE-D) to obtain valid and comparable results. We agree with Dr. Lohbeck that a number of experiences should be considered, such as bullying or the death of a loved one. Further work from our groups also underscores the importance of maltreatment in institutions (4). In addition, Dr. Lohbeck points out the protective effects of families. We fully agree with this point. Social support is one of the most important resilience factors. It is particularly effective when there is at least one stable adult caregiver (5).

DOI: 10.3238/arztebl.2020.0134c

On behalf of the authors

Dr. phil. Andreas Witt

Prof. Dr. med. Jörg M. Fegert

Klinik für Kinder- und Jugendpsychiatrie/-Psychotherapie

Universitätsklinikum Ulm

andreas.witt@uniklinik-ulm.de

Conflict of interest statement

The authors of all contributions declare that no conflict of interest exists.

1.
Witt A, Sachser C, Plener PL, Brähler E, Fegert JM: The prevalence and consequences of adverse childhood experiences in the German population. Dtsch Arztebl Int 2019; 116: 635–42 VOLLTEXT
2.
Witt A, Brown R, Plener PL, Brähler E, Fegert JM, Clemens V: Kindesmisshandlung und deren Langzeitfolgen–Analyse einer repräsentativen deutschen Stichprobe. Zeitschrift für Psychiatrie, Psychologie und Psychotherapie 2019; 67: 100–11 CrossRef
3.
Hughes K, Bellis MA, Hardcastle KA, et al.: The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Public Health 2017; 2: e356–e66 17)30118-4">CrossRef
4.
Witt A, Rassenhofer M, Allroggen M, Brähler E, Plener PL, Fegert JM: The prevalence of sexual abuse in institutions: results from a representative population-based sample in Germany. Sex Abuse 2019; 31: 643–61 CrossRef MEDLINE
5.
Domhardt M, Münzer A, Fegert JM, Goldbeck L: Resilience in survivors of child sexual abuse: a systematic review of the literature. Trauma Violence Abuse 2015; 16: 476–93 CrossRef MEDLINE
1.Witt A, Sachser C, Plener PL, Brähler E, Fegert JM: The prevalence and consequences of adverse childhood experiences in the German population. Dtsch Arztebl Int 2019; 116: 635–42 VOLLTEXT
2.Witt A, Brown R, Plener PL, Brähler E, Fegert JM, Clemens V: Kindesmisshandlung und deren Langzeitfolgen–Analyse einer repräsentativen deutschen Stichprobe. Zeitschrift für Psychiatrie, Psychologie und Psychotherapie 2019; 67: 100–11 CrossRef
3.Hughes K, Bellis MA, Hardcastle KA, et al.: The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Public Health 2017; 2: e356–e66 CrossRef
4.Witt A, Rassenhofer M, Allroggen M, Brähler E, Plener PL, Fegert JM: The prevalence of sexual abuse in institutions: results from a representative population-based sample in Germany. Sex Abuse 2019; 31: 643–61 CrossRef MEDLINE
5.Domhardt M, Münzer A, Fegert JM, Goldbeck L: Resilience in survivors of child sexual abuse: a systematic review of the literature. Trauma Violence Abuse 2015; 16: 476–93 CrossRef MEDLINE

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