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Biopsychosocial Aspects of HPA-Axis Dysfunction
– Define and explain the HPA-Axis
– Identify the impact of trauma on the HPA Axis
– Identify the impact of chronic stress/cumulative trauma on the HPA-Axis
– Identify symptoms of HPA-Axis dysfunction
– Identify interventions useful for this population
Based on
– Post-traumatic stress disorder: the neurobiological impact of psychological trauma
Dialogues Clin Neurosci. 2011 Sep; 13(3): 263–278.
– Lifestyle Factors Contributing to HPA-Axis Activation and Chronic Illness in Americans
Archives of Neurology and Neuroscience. 2019 Oct.; 5(2) ANN.MS.ID.000608. DOI:10.33552/ANN.2019.05.000608

What is the HPA Axis
– Hypothalamic-Pituitary-Adrenal Axis
– Controls reactions to stress and regulates digestion, the immune system, mood and emotions, sexuality, and energy storage and expenditure
– The signs and symptoms of HPA-Axis dysfunction reflect a persistent, abnormal adaptation of neurobiological systems to trauma or chronic stress.
– In addition to trauma, multiple lifestyle factors have been associated with HPA-Axis dysregulation including
– Noise
– Stimulant use (caffeine, nicotine, ADHD medications)
– Insufficient quality sleep
– Media exposure

Consequences of HPA-Axis Dysfunction
– More than 50% of Americans suffer from one or more chronic conditions associated with disturbances of the HPA-Axis with an estimated cost of $3.3 trillion annually including:
– Major depressive disorder (20%)
– Generalized anxiety disorder (18.1%)
– Sex hormone imbalances (25%)
– Diabetes (9.2%)
– Autoimmune disorders (23%)
– Chronic pain
– Metabolic syndrome (30%)
– Cardiovascular disease (44%)
– Hypothyroid (4.6%)
– IBS symptoms such as constipation and diarrhea
– Reduced tolerance to physical and mental stresses (including pain)

Overview of Healthy HPA-Axis Function
– When exposed to a physical, environmental or social stressor, the HPA-Axis is activated and prompts the “fight or flight” reaction.
– Glutamate and Norepinephrine are released
– The hypothalamus releases corticotropin releasing factor (CRF) and arginine vasopressin (AVP) to stimulate the anterior pituitary to produce and secrete adrenocorticotropic hormone (ACTH).
– ACTH causes glucocorticoid (cortisol) synthesis and release from the adrenal glands

Overview of Healthy HPA-Axis Function
– Cortisol’s primary function is to
– Increase blood glucose and modify fat and protein metabolism to fuel the fight or flight reaction
– Modulate immune and brain function to effectively manage stressors.
– Cortisol initially causes a potent anti-inflammatory response which allows the organism to react to the stressor without being pain or fatigue.
– Glucocorticoids interfere with the retrieval of traumatic memories
– As cues of the threat wane, the body increases inflammation by releasing proinflammatory cytokines to accelerate wound healing
Stress Response
– The response of an individual to stress depends not only on stressor characteristics, but also on factors specific to the individual.
– Perception of stressor
– Proximity to safe zones
– Similarity to victim
– Degree of helplessness
– Prior traumatic experiences
– Amount of stress in the preceding months
– Current mental health or addiction issues
– Availability of social support
– Compared to positive events, negative events, or “stress” causes greater awareness and recall of event details leading to stronger encoding of negative or stressful events.