Brain Story Certification: Module 12
Module 12: ACEs, Part C – The Impact of Adverse
Childhood Experiences on PTSD & Depression
Excerpt from “The Aftermath of Adverse Childhood Experiences: Posttraumatic Stress Disorder & Beyond”
Ruth Lanius, MD, PhD
University of Western Ontario
- Core symptoms
- Exposure to a traumatic event
- Re-experiencing
- Avoidance/numbing (the individual is detached from emotions)
- Hyperarousal (increased startle response)
- Symptoms that pose a functional impairment
- Toxic life stress have much more complex systems – not well captured within the DSM
- Complex PTSD (Disorders of extreme stress not otherwise specified)
- Difficulty regulating affective arousal
- Alteration in consciousness and attention
- Somatization – a lot of unexplained medical problems – no organic cause found. See the body keeps the score.
- chronic characterological changes – social learning within the individual’s environment/context
- Attachment may play a role in the regulation of emotions – it allows a child to learn how to calm the nervous system.
- Self-harm, under/over-eating, and other actions can become a means to try to regulate emotions.
- The nervous system finds a way to tolerate intolerable experiences – disassociation.
- There can be many co-morbid diagnoses that exist later in life when there is early life trauma.
- For PTSD there is a prevalence of 77% when there is childhood sexual abuse, 45% for physical abuse, and 85% for combined physical/sexual abuse survivors.
- In mental health settings the rates of childhood abuse range from 35% to 50%.
- Factors that increase PTSD vulnerability
- Gene-environment interactions
- Female gender
- History of psychiatric illness
- Prolonged/repeated trauma exposure
- Trauma during critical periods of development
- Poor social supports – supports are most-needed after trauma.
- A child’s early caregivers play a crucial role in buffering against stressful situations and can help build resilience against future experiences
- Secure attachments early on are a protective factor.
Excerpt from “The Aftermath of Adverse Childhood Experiences: Posttraumatic Stress Disorder & Beyond”
Ruth Lanius, MD, PhD
University of Western Ontario
- Neurobiology of PTSD & Emotional regulation/self-reflection
- Can be both over and under-modulation
- Under: re-experiencing and afflictive emotions around the trauma. (30% of the population – increased heart rate)
- Over: Restriction of unwanted emotional experiences (dissociation, numbing, analgesia, derealization). (70% of population – decreased heart rate)
- Hyperarousal are fragments of memories re-experienced.
- Flashback – decreased medial prefrontal cortex with increased amygdala response. Because the medial prefrontal cortex mediates the amygdala, the dampening of the amygdala does not occur as efficiently.
- Failed corticolimbic inhibition (emotional intermodulation)
- Decreased medial prefrontal activation may lead to inhibited limbic reactivity
- inhibited/failed limbic reactivity could be associated with intermodulation of emotions as observed in hyperarousal states in PTSD.
- Dissociative response
- disconnect self from the emotional content of memory.
- Increase in the activation of the medial prefrontal cortex, and decreased activation of the amygdala.
- This is conceptualized as emotional regulation.
- Manifests itself as a hyperemotional response.
- Patients can fluctuate between the two extremes – the goal is to bring them back to the centre.
Excerpt from “The Aftermath of Adverse Childhood Experiences: Posttraumatic Stress Disorder & Beyond”
Ruth Lanius, MD, PhD
University of Western Ontario
- Interpersonal dysfunction can emerge as a result of PTSD it includes:
- Social isolation
- sensitivity to criticism
- difficulty in standing up for oneself
- Revictimization (IPV, sexual assault, physical assault)
- Problems functioning in the workplace
- Difficulties in raising children
- Social Emotions: Elicited by social interactions and involve language, meaning, and social intentionality
- Nonsocial emotions: Emerge from stimuli that pose a direct physiological relevance (food, fight, flee)
- Differences between social and nonsocial emotions in the brain
- Superior temporal gyrus – understands complex social signals (eye gaze, body language)
- Right amygdala – responds to salient emotional properties that are social
- The dorsomedial prefrontal cortex – emotions within the context of interpersonal interactions.
- There is less activation of the dorsomedial prefrontal cortex of individuals with PTSD.
- How do we bring the dorsomedial prefrontal cortex back online?
- Oxytocin is vital in mediating interconnectedness and counteract stress and anxiety. Its decrease is associated with adverse childhood experiences – this needs to be examined further in conjunction with PTSD.
Excerpt from “Depression: Brain, Body & Beyond”
Glenda MacQueen, MD, PhD, FRCPC
University of Calgary
- Depression impacts all facets of the human experience.
- Influences are genetics, early experiences, and proximal stress.
- Stress-diathesis model – all of us have a genetic makeup that makes us resilient or vulnerable to depression. Pre Post-natal environments influence also influence outcomes.
- Depression is not genetically determined. Epigenetics can influence outcomes, however.
- Organizational influences of stress/depression:
- Poor direction/policies
- career/job ambiguity
- poor performance management
- poor communication up & down
- being unappreciated
Excerpt from “Depression: Brain, Body & Beyond”
Glenda MacQueen, MD, PhD, FRCPC
University of Calgary
- Depression’s impact on neurobiology – insular cortex, prefrontal cortex, hippocampus, amygdala, nucleus accumbens, anterior cingulate cortex, and thalamus
- Depression often impacts memory – little memory pieces carried out by the hippocampus. Memory is one of the top concerns of clients for its impacts on the client’s functioning.
- Hippocampus is changed by depression – the size/shape of the region is altered. 5-10% smaller in individuals with depression. It is easier to see shrinkage in instances of multiple reoccurrences of depressive episodes.
- Remission of depression is influenced by the structure of the hippocampus – smaller is associated with difficulty in reduction from depression. This may be useful to determine which treatments are most likely to produce results for the client.
Excerpt from “Depression: Brain, Body & Beyond”
Glenda MacQueen, MD, PhD, FRCPC
University of Calgary
- No health without mental health
- eg. Diabetes and stress influences on BG levels.
- Allostatic load is essential here.
- Depression and pain go together (Serotonin and norepinephrine are associated with depression).
- Relations between heart and depression – may impact blood vessels and heart.
- Often a relation between metabolic dysregulation.
- Hypertension, glucose dysregulation, dyslipidemia, and obesity are interconnected and possibly bi-directional with mental health.