Working in an intensive outpatient facility, I often encounter presenting symptoms of depression, anxiety, and different presentations of personality disorders at a severe level. One contributing factor that comes up often with my patients is the role trauma plays within their mental health challenges. Trauma is a word that is being used frequently in society; often, when a word is used so often in the discussion, the meaning of the word can become easily misunderstood. Trauma can have negative connotations in many instances. What really helps “spell out” what trauma is is explaining some of the biological underpinnings of this psychiatric disorder. I find this information provides a level of empowerment to my patients who struggle to understand how trauma worsens the symptoms of their primary psychiatric diagnosis.
Teaching psychoeducation on what is occurring at the molecular level when trauma is found in a patient is one of my favorite skill groups I teach. For the fear of complicating the picture too much, I want to share some highlights of this skill group in this blog. In the end, I will do my best to summarize some of the main points I wrote about in this blog.
The development of new system-wide techniques, i.e., genomic, epigenomic, transcriptomic, proteomic, and metabolomic profiling, has permitted a greater examination of potential drivers or stress-related dysregulation, advancing the unbiased discovery of novel biomarkers implicated in someone who has experienced trauma (Daskalakis et al., 2021). Profiling is another way to describe how a person’s DNA “shows up” in real life. Trauma alters adrenal production of Glucocorticoids (GC’s). GC, stress hormone, is produced after the hypothalamic-pituitary-adrenal gland (HPA-axis) is stimulated by psychological arousing stimuli, i.e., trauma. by the outer zone (cortex) of the adrenal gland. GC suppresses inflammation and converts amino acids from protein breakdown into glucose, thus raising blood sugar levels. Their effect is thus antagonistic to that of insulin. More reports also further suggest that trauma may also contribute to an increase in basal cortisol levels. Trauma, in its many presentations, also alters tissue sensitivity that is connected with the production of GC. So, trauma can negatively affect GC production which helps manage inflammation that stems from trauma. A person who experiences too much inflammation may experience physiological responses, e.g., thyroid issues.
In addition, lipopolysaccharide (LPS)-induced cytokine production from leukocytes, a measure of monocyte responsiveness, has been reported to be more sensitive to dexamethasone, i.e., a steroid to decrease inflammation cells, in samples collected from PTSD patients compared to samples collected from controls (Daskalakis et al., 2021). One major takeaway from these observations and studies that were done at the molecular level is that certain features of trauma increase GC sensitivity in others or even that there are pathways within the same cell type with enhanced GC sensitivity and other pathways with reduced GC sensitivity. So, often, trauma can increase the chance that a person develops behaviors that result in addiction, i.e., abusing substances like cocaine and cannabis (Yansong et al., 2014). In other words, stress that often comes about when someone faces a trauma trigger may pursue behaviors that may lead to an addiction.
Lastly, trauma may produce genetic variants and epigenetic differences within the NR3CI gene encoding the GC receptor (GR). Trauma can cause your DNA to be altered. Functional genetic and epigenetic differences have been described also for genes encoding GR-chaperone proteins such as FK506-binding protein 5 (FKBP5), a GR-binding inhibitor, and spindle and kinetochore-associated protein 2 (SKA2), which is involved in GR-translocation to the nucleus. Interestedly, some of the observed traumatic stress-induced epigenetic effects could be transferred among family generations. So, in certain cases, a person’s genetic background and early-life events and experiences can influence trauma and PTSD risk. So, traumatic events may not always lead to someone being traumatized. A combination of genetic, biological, and life experiences factor in what contributes to experiencing trauma.
Here are some of the main practical mental concepts that you can take away from this discussion about the topic of trauma and its relationship to biology:
- Trauma causes stress levels to lose their stability, giving way to issues like chronic stress, thyroid issues, and chronic inflammation.
- Specific factors further contribute to a person experiencing trauma: genetics, environmental, life experiences, and family transmission.
- Addiction and trauma possess a relationship – addiction is not a moral failure, contrary to popular belief.
- Empowerment is a key trait to possess as you heal from trauma.
- Trauma is not linear nor is it only a psychiatric disorder.
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Clinical Complex Trauma Specialist (CCTS-1),
Certified Dialectical Behavioral Therapist (C-DBT),
Certified Alcohol & Drug Abuse Counseling (CADC)
