Virtual Wounds: Reimagining Adverse Childhood Experiences (ACEs) in the Digital World

The Adverse Childhood Experiences (ACEs) study established a definitive link between early-life trauma and health disparities. However, there remains a lack of systematic reviews examining adverse experiences that occur specifically within digital environments. This review examines the emerging evidence linking these “virtual wounds” to physical, mental, and emotional health outcomes, highlighting the unique mechanisms and impacts of digital adversity. The aim is to synthesize existing research and examine how traditional ACE frameworks can be adapted to include adverse online experiences and explore their potential clinical implications and calls for future research. Additionally, this review proposes a theoretical assessment tool for Adverse Online Childhood Experiences (AOCEs) (See Appendix) for future validity testing. Using an integrative review methodology, an analysis of more than 300 articles was conducted to develop categories of online adverse experiences and a proposed digital ACE assessment tool. Databases used for reviews included Google Scholar, PubMed, PsycINFO, ScienceDirect, and SpringerLink, with article dates ranging from 2014 to 2025. Analysis revealed 6 main categories of online adverse experiences. All reviews were analyzed using a thematic analysis. Results informed the proposed ACOEs measure detailed in the discussion section. To remain relevant in an increasingly digital world, the ACEs framework must be expanded to include AOCEs. This integrative review proposes a preliminary conceptual framework to support practitioners in adapting screening tools and interventions to account for the unique, pervasive, and developmentally salient nature of AOCEs.