This article demonstrates that exposure to stress prior to adulthood can result in persistent effects on both mental and physical health. Exposure to violence and abuse can alter the function of the hypothalamic-pituitary-adrenal (HPA) axis throughout one's life, and these changes are accompanied by increased incidence and severity of major depressive disorder, posttraumatic stress disorder, and other anxiety disorders, somatic diseases. The strong and robust effects of early life abuse on lifelong mental and physical health have led to neurobiological theories of potential mechanisms underlying these adverse effects. Alterations in the HPA axis, a major mediating pathway of the stress response, contribute to the long-standing effects of early life trauma. Recognition of the biological consequences and transgenerational impact of violence and abuse has critical importance for both disease research and public health policy. Figures and references