While I try to respond to inquiries from readers, recent accounts in the press have prompted this month’s post. It should be mentioned that the development of chronic conditions and the association with child abuse was the topic of my dissertation. That work reflects in this month’s post.
Childhood should be carefree, playing in the sun; not living a nightmare in the darkness of the soul. ~Dave Pelzer, A Child Called “It”
Virtually everyone is familiar with the term Posttraumatic Stress Disorder, or PTSD. And while PTSD has been recognized for many decades, it has been known historically by different names including Battle Fatigue, Soldier’s Heart, and Shellshock. Whatever the name, it is Psychological Trauma. While there are some agreed-upon definitions of posttraumatic stress disorder, the bottom line, at least from a physiological and neurological standpoint, PTSD results when an event or series of events have completely overwhelmed the person’s stress adaptation system.
The Stress Response System
What exactly this stress adaptation system is and how it works has only recently been discovered. In 1976, an endocrinologist named Hans Selye proposed a neurophysiological model for understanding what he termed the mind/body connection. He suggested that stress reactions were based on perception and cognition, showing that a person’s perception had a direct effect on their biological systems through a psychological stress response. Dr. Selye came to recognize this response in his patients: those who suffered from higher rates of disease, ranging from infections to cancers, reported having experienced psychological trauma.
A Product of Nature
The stress response system evolved for one purpose: surviving an attack. Often know as the fight or flight response, researchers have now added a third state, known as freeze, as some mammals tend to simply stay still to avoid a threat. The fight/flight/freeze response evolved among mammals to help them survive threats through a complex system of endocrine glands, hormones, and neurochemicals known as the Hypothalamic-Pituitary-Adrenal, or HPA system.
The HPA works through the perception of danger. Being attacked, or seeing another attacked, or perceiving oneself in mortal danger of attack or death, can stimulate the HPA system to prepare the body fight, flee, or freeze in help it to survive. The fight/flight/freeze response is governed by the HPA and prepares the body to meet the threat through the manipulation of glucocorticoids, primarily cortisol, corticotrophin-releasing hormone (CRH) and arginine-vasopressin (AVP). The HPA response causes significant changes in major organ systems as a response to the threat. Digestion slows, blood flow is reduced to the skin (to reduce blood loss by cuts, bites, scrapes) and the blood flow to the arms, legs, shoulders, brain, eyes, ears and nose increases (allowing the brain to think faster, preparing the muscles to run or fight, increasing the hearing to detect threat sounds, and dilating the pupils to focus). The body will begin to sweat to avoid overheating during fight or flight (giving off a particular ‘stress odor’ or diaphoresis, which is detectable by humans and other mammals, for example dogs). The mouth dries as saliva and gastric juice production decreases, as does blood flow to the digestive system.
The HPA system works very well to survive threats, and has worked this way for many hundreds of thousands of years. But it’s not foolproof. Sometimes the threat is not real, but the system switches on just the same. If a person (or another mammal) experiences a severe trauma, the system may not turn off at all. Because the body cannot return to its unstressed or homeostatic state, the long-term effects of the flight/fight/freeze response begin to take their toll.
Medically speaking, stress results when an organism fails to return to homeostasis. Homeostasis refers to the normal state of the organism before the threat. While our hunter-gatherer ancestors faced threats from predators on a daily basis, and most of us face nothing more threatening than a bad driver, the system that helped them survive remains largely unchanged. While occasional stress may actually be beneficial as it allows us to perform, or to push ourselves to reach goals, provided that stress is short term, the body can return to it’s normal state. For our ancestors, once the threat was dealt with, they could return to the homeostatic or pre-stressed state. Short-term stress is not damaging, however long term or chronic stress is a significant problem.
Chronic stress has deleterious consequences and harmful effects. This is due to how the system works, what it has evolved to do, and why it is a short-term adaptive process. When activated long term, even at relatively low levels, the results are often a compromised immune function, weight gain, developmental impairment, cardiovascular disease, dyslipidemia and insomnia. Chronic stress has also been associated with Metabolic Syndrome and Arteriosclerosis.
Chronic Stress and your Organ Systems
Long-term stress affects the body in several ways, and more than a few medical conditions can be traced to overstressed organ systems. Chronic stress can cause major skin problems including acne, psoriasis, eczema, and dermatitis. It can also make your skin more sensitive and more reactive to sunlight. A person suffering from chronic stress will often experience migraines or cluster headaches due to the build up of tension in the neck and shoulders. Chronic stress can cause anxiety and depression, and new evidence links stress to some forms of dementia and memory loss. Because stress increases blood pressure, there is a long-established link between long-term stress and heart disease. Prolonged stress also reeks havoc in maintaining blood sugar levels which can have direct implications in how the heart functions. Stress can also result in heart arrhythmias, and stress has long been known to cause inflammatory responses in a number of organ systems. Stressed directly affects how well our gut functions. When stressed our stomachs stop processing nutrients as effectively and decreased nutrient absorption and oxygenation can decrease by 75% in the intestines resulting in significantly reduced metabolism and decreased enzymatic output.
Immune and Metabolic Impact of Stress
During the stress response, the pancreas produces more than the required amount of insulin to allow the muscles to convert all available glucose to energy. However, when consistently elevated as in the case of chronic stress, the increased insulin begins to cause damage to arteries and other organs. The immune system is severely impacted by the stress response, and chronic stress greatly impacts the immune system’s ability to defend against foreign bodies like bacteria, viruses, or cancer cells. The elevation of corticosteroids released during stress negatively affects the immune system by impacting the number of leukocytes available in the blood, making us far more susceptible to infections. New research is currently being done which may show a link between long-term chronic stress and inflammatory diseases such as multiple sclerosis, type-1 diabetes, rheumatoid arthritis, lupus, Crohn’s kidney disease, chronic fatigue syndrome, kidney disease, ulcerative colitis fibromyalgia, and a host of other inflammatory response disorders. Chronic stress is also involved in the neurobiology of mood disorders and functional illnesses, including anxiety disorder, bipolar disorder, insomnia, posttraumatic stress disorder, borderline personality disorder, ADHD, major depressive disorder, and emotional burnout. There is also new research into the long-term effects of PTSD from child abuse.
PTSD, Child Abuse, and Chronic Stress
Memories instilled in children, particularly around physical, psychological, or sexual abuse, are often multi-schematic, meaning they are stored in different parts of the brain as emotional stimuli, visual stimuli, physical stimuli, and auditory stimuli. For this reason, a smell, a picture, anything that stimulates the sensory system may trigger the fight/flight/freeze response, and one reason why childhood memories are lasting. While physical injuries may heal over time, at least in some degree, psychological scars do not. Psychological trauma from child abuse is at epidemic levels in the United States, according to the Centers for Disease Control and Prevention (CDC). In 2012 alone, nearly 700,000 children were victims of abuse, and the National Children’s Alliance reported that abuse was suspected in an additional 3.8 million incidents involving children under the age of 18 years. Perhaps most shocking is that children between birth and one year of age suffered the highest rate of abuse. According to the CDC, the direct and indirect costs of treating child abuse in the United States are nearly $125 billion annually.
Often the results of child abuse, whether it is physical, emotional, or sexual abuse may not manifest for years. A group of researchers investigated whether or not a history of assault and childhood could be associated with chronic health conditions in later years. The team used data from a large study that involved over 6000 middle-aged Americans, finding a significant association between abuse in childhood and the diagnosis of hypertension. The team concluded that, although the abuse had taken place decades earlier, the negative impacts on psychological and physiological health remained long after the event or events. Perhaps it is not surprising that psychological disorders were also found among the same child abuse survivors including depression and anxiety. However it is hypertension that has been termed the silent killer, but the real culprit is stress. While there are often few symptoms of hypertension if accompanied by other conditions, like dyslipidemia, cardiovascular disease, and atherosclerosis, the resulting cluster of conditions called Metabolic Syndrome. In this study, several of the preconditions of Metabolic Syndrome were found to be associated with a history of posttraumatic stress in childhood at least within these study participants.