Sexual abuse and complex PTSD: the effects of chronic traumatic stress on the immune system. Intervention strategies

Journal title RIVISTA DI SESSUOLOGIA CLINICA
Author/s Rebecca Eibenstein, Adele Fabrizi
Publishing Year 2021 Issue 2021/1
Language Italian Pages 21 P. 23-43 File size 225 KB
DOI 10.3280/RSC2021-001002
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This paper shows the main features of complex PTSD in the context of sexual abuse and the impact that this disease, with the consequent chronic stress condi-tion, may have on the traumatized patient, in particular on the immune system. The immune system has the ability to react in different ways to different stimuli. Moreover, learning and memory ability are demonstrated, showing how this sys-tem is intrinsecally connected to the environment. There is a growing evidence that the different response patterns of the immune system do not depend only on the type of stimulus (for example, virus, bacteria), but also on the microenvironment and on the general condition of the whole physiology, and therefore on the psy-chological stress too. Thus, it is clear how the immune system is able to interact with the nervous system and consequently with mental and relational phenomena. The chronic psychological stress observed in those who have suffered by cumula-tive interpersonal trauma may be considered an important factor with a negative effect on the immune system function and may lead to a dysregulation of the immune response that is the basis of many pathologies in which the immune sys-tem has a key role. Furthermore, a shift in the autonomic nervous system of vic-tims exposed to sexual abuse has been detected, so that they have an hyperac-tivated visceral system that sends a continuous threatening feedback. This condi-tion also has severe consequences on interactive and social capabilities, with a se-vere impact on the psychophysical well-being of the person. For this reason, it is necessary to develop interventions based on a multidisciplinary and biopsychoso-cial approach that could help the traumatized people both to retune autonomic state to enable spontaneus social engagement and trust, and to heal the emotional and somatic components of the traumatic experience.

Keywords: complex PTSD, chronic stress, sexual abuse, immunity, immune dis-function, inflammation.

  1. Gill J., Saligan L., Woods S., Page G. (2009). PTSD is associated with an excess of inflammatory immune activities. Perspectives in Psychiatric Care, 45(4): 262-277.
  2. APA (American Psychiatric Association) (2014). DSM-5: Manuale diagnostico e statistico dei disturbi mentali. Milano: Raffaello Cortina.
  3. Altemus M., Cloitre M., Dhabar F.S. (2003). Enhanced cellular immune response in women with PTSD related to childhood abuse. American Journal of Psychiatry, 160: 1705-1707.
  4. Antonovsky A. (1996). The salutogenic model as a theory to guide health promotion. Health Promotion International, 11(1): 11-18.
  5. Ayaydin H., Osman A., Akdeniz N.O., Kok B.E., Gunes A., Yildirim A., Deniz G. (2016). Immune system changes after sexual abuse in adolescents. Pediatrics International, 58: 105-112.
  6. Boscarino J.A., Hoffman S.N. (2007). Consistent association between mixed lateral preference and PTSD: Confirmation among a national study of 2490 US army Vietnam veterans. Psychosomatic medicine, 69: 365-369.
  7. Bottaccioli A.G., Bottaccioli F., Di Palma M., Minelli A. (2019). Malattie psichiatriche. Le interazioni fra stress e network psico-neuro-endocrino-immunitario. Annals of the New York Academy of Science, 1437(1): 31-42.
  8. Cloitre M., Stolbach B.C., Herman J.L., van der Kolk B., Pynoos R., Wang J., Petkova E. (2009). A developmental approach to complex PTSD: Childhood and adult cumulative trauma as predictors of symptom complexity. Journal of Traumatic Stress, 22(5): 399-408.
  9. Cohen S., Williamson G.M. (1991). Stress and infectious disease in humans. Psychological Bulletin, 109(1): 5-24.
  10. Cozolino L. (2019). Oltre il tempo. La formula naturale per la salute e la longevità. Milano: Raffaello Cortina.
  11. De Kloet C.S., Vermetten E., Bikker A., Meulman E., Geuze E., Kavelaars A., Heijnen C.J. (2007). Leukocyte glucorticoid receptor expression and immunoregulation in veterans with and without post-traumatic stress disorder. Molecular Psychiatry, 12(5): 443-453.
  12. De Kloet E.R., Vreugdenhil E., Oitzl M.S., Joels A. (1998). Brain corticosteroid receptor balance in health and disease. Endocrine Reviews, 19: 269-301.
  13. Farley M., Patsalides B.M. (2001). Physical symptoms, Posttraumatic Stress Disorder and healthcare utilization of women with and without childhood physical and sexual abuse. Psychological Reports, 89 (3): 5959-606.
  14. Feldman C.H., Malspeis S., Leatherwood C., Kubzansky L., Costenbader K.H., Roberts A.L. (2019). Association of childhood abuse with incident systemic lupus erythematosus in adulthood in a longitudinal cohort of women. The Journal of Rheumatology, 46(12): 1589-1596.
  15. Felitti V.J., Anda R.F., Nordenberg D., Williamson D.F., Spitz A.M., Edwards V., Koss M.P., Marks J.S. (1998). Relationships of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14: 245-258.
  16. Giannantonio M. (2009). Psicotraumatologia. Fondamenti e strumenti operativi. Torino: Centro Scientifico.
  17. Giannantonio M. (2014). Memorie traumatiche. EMDR e strategie avanzate in psicoterapia e psicotraumatologia. Milano: Mimesis.
  18. Glaser R., Kiecolt Glaser J.K. (2005). Stress-induced immune dysfunction: Implications for health. Perspectives, 5(3): 243-251.
  19. Gokce N., Keaney J.F., Hunter L.Z., Watkins M.T., Menzoian J.O., Vita J.A. (2002). Risk stratification for postoperative cardiovascular events via noninvasive assessment of endothelial function: A prospective study. Circulation, 105: 1567-1572.
  20. Grandi S., Rafanelli C., Fava G.A. (2011). Manuale di psicosomatica. Roma: Il Pensiero Scientifico.
  21. Jeter P.E., Slutsky J., Singh N., Khalsa S.B.S. (2015). Yoga as a therapeutic intervention: A bibliometric analysis of published research studies from 1967 to 2013. Journal of Alternative and Complementary Medicine, 21(10): 586-592.
  22. Kiyimba N. (2016). Developmental trauma and the role of epigenetics. Healthcare Counselling & Psychoterapy Journal, 16(4): 18-21.
  23. Kohrt B.A., Worthman C.M., Adhikari R.P., Luitel N.P., Arevalo J.M.G., Ma J., Mc Creath H., Seeman T.E., Crimmins E.M., Cole S.V. (2016). Psychological resilience and the gene regulatory impact of posttraumatic stress in Nepali child soldiers. Proceedings of the National Academy of Science of the USA, 113: 8156-8161.
  24. Lazzari D., Bottaccioli, F. Stress e sistema immunitario: la psiconeuroendocrinoimmunologia (2012). In Compare A., Grossi E. (2012). Stress e disturbi da somatizzazione. Evidence-based practice in psicologia clinica. Milano: Springer.
  25. Lee S.W., Mancuso C.A., Charlson M.E. (2004). Prospective study of new partecipants in a community-based mind-body training program. Journal of General Internal Medicine, 19(7): 760-765.
  26. Lester P., Wong S.W., Hendren R.L. (2003). The neurobiological effects of trauma. Adolescent Psychiatry, 27: 259-282.
  27. Li S., Borninger J.C., Yamaguchi H., Hèdou J., Gaudilliere B., De Lecea L. (2020). Hypothalamic circuitry underlying stress-induced insomnia and peripheral immunosuppression. Science Advances, 6: 1-13. DOI: 10.1101/2020.04.29.06939
  28. Lilly M.M., Valdez C.E. (2012). Interpersonal trauma and PTSD: The roles of gender and a lifespan perspective in predicting risk. Psychological Trauma: Theory, Research, Practice and Policy, 4(1): 140-144.
  29. Lohr J.B., Palmer B.W., Eidt C.A., Aailaboyina S., Mausbach B.T., Wokowitz O.M., Thorp S.R., Jeste D.V. (2015). Is post-traumatic stress disorder associated with premature senescence? A review of the literature. American Journal of Geriatric Psychiatry, 23(7): 709-725.
  30. Maier S.F., Watkins L.R. (2000). The Immune System as a Sensory System: Implications for psychology. Current Directions in Psychological Science, 9(3): 98-102.
  31. Masho S.W., Ahmed G. (2007). Age at sexual assault and Posttraumatic Stress Disorder among women: Prevalence, correlates and implications for prevention. Journal of Women’s Health, 16: 262-271.
  32. Mcleay S. C., Harvey W.M., Romaniuk M., Crawford D., Colquhoun D.M., Young R., Dwyer M., Gibson J.M., O’sullivan R.A., Cooksley G., Strakosh C.R., Thomson R.M., Voisey J., Lawford B.R. (2017). Phisycal comorbidities of post-traumatic stress disorder in Australian Vietnam War veterans. Research, 6: 251-257.
  33. Merenlender Wagner A., Dikshtein Y., Yadid G. (2009). The β-Endorphine role in stress-related psychiatric disorders. Current Drug Targets, 10: 1096-1108.
  34. Oflaz F., Hatipoglu S., Aydin H. (2007). Effectiveness of psychoeducation intervention on post-traumatic stress disorder and coping style on earthquake survivors. Journal of Clinical Nursing, 17(5): 677-687.
  35. Ogden P., Minton K. (2000). Sensorimotor Psychoterapy: One method for processing traumatic memory. Traumatology, 3(3): 149-173. DOI: 10.1177/15347656000060030
  36. Ogden P., Pain C., Fisher J. (2006). A sensorimotor approach to the treatment of trauma and dissociation. Psychiatric Clinics of North America, 29: 263-279.
  37. Pennebaker J.W., Beall S.K. (1986). Confronting a traumatic event: Toward an understanding of inhibition and disease. Journal of Abnormal Psycholgy, 95(3): 274-281.
  38. Pennebaker J.W., Kiecolt-Glaser J.K., Glaser R. (1988). Disclosure of traumas and immune function: Health implications for psychotherapy. Journal of Consulting and Clinical Psychology, 56: 239-245. DOI: 10.1037/0022-006X.56.2.23
  39. Porges S. (2011). La teoria polivagale. Fondamenti neurofisiologici delle emozioni, dell’attaccamento, della comunicazione e dell’autoregolazione. Roma: Giovanni Fioriti.
  40. Ramo Fernandez L., Schneider A., Wilker S., Kolassa I.T. (2015). Epigenetic alterations associated with war trauma and childhood maltreatment. Behavioral Science & Law, 33(5): 701-721.
  41. Roth S., Newman E., Pelcovitz D., van der Kolk B., Mandel F.S. (1997). Complex PTSD in victims exposed to sexual and physical abuse: Results from the DSM-IV field trial for Posttraumatic Stress Disorder. Journal of Traumatic Stress, 10(4): 539-555.
  42. Siegel D.J. (2014). Mappe per la mente. Guida alla neurobiologia interpersonale. Milano: Raffaello Cortina.
  43. Silverthorn D.U. (2009). Fisiologia. Un approccio integrato. Roma: Casa Editrice Ambrosiana.
  44. Solano L. (2013). Tra mente e corpo. Milano: Raffaello Cortina.
  45. Somvanshi P.R., Mellon S.H., Flory J.D., Abu-Amara D., Wolkowitz O.M., Yehuda R., Jett M., Hood L., Marmar C., Doyle F.J. (2019). Mechanistic inferences on metabolyc dysfunction in posttraumatic stress disorder from an integrated model and multiomic analysis: Role of glucocorticoid receptor sensitivity. American Journal of Physiology-Endocrinology and Metabolism, 317: E879-E898.
  46. Song H., Fang F., Tomasson G., Arnberg F.K., Mataix Cols D., Fernàndez De La Cruz L., Almqvist C., Fall K., Vladimarsdottir U.A. (2018). Association of stress-related disorders with subsequent autoimmune disease. American Medical Association, 319(23): 2388-2400.
  47. Swaims-Kohlmeier A., Haddad L.B., Tiger Li Z-R., Brookmeyer K.A., Baker J.M., Spatz Widom, Lamousin J.C., Chi K-H., Chen C.Y., Kersh E.N., Johnson J.A., Herbst-Kralovetz M.M., Hogben M., Ofotokun I., Kohlmeier J.E. (2019). Chronic immune barrier dysregulation among women with a history of violence victimization. JCI Insight, 4(10): e126097.
  48. Tagliavini G. (2011). Modulazione dell’arousal, memoria procedurale ed elaborazione del trauma: il contributo clinico del modello polivagale e della psicoterapia sensomotoria. Cognitivismo Clinico, 8(1): 60-72.
  49. Trickett P.K., Noll J.G., Susman E.J., Shenk C.E., Putnam F.W. (2010). Attenuation of cortisol across development for victims of sexual abuse. Development and Psychopathology, 22(1): 165-175. DOI: 10.1017/S095457940999033
  50. van der Kolk B.A. (2015). Il corpo accusa il colpo. Mente, corpo e cervello nell’elaborazione delle memorie traumatiche. Milano: Raffaello Cortina.
  51. van der Kolk B.A., Mcfarlane A.C., Weisaeth L. (2004). Stress traumatico. Gli effetti sulla mente, sul corpo e sulla società delle esperienze intollerabili. Roma: Edizioni Scientifiche Ma.Gi.
  52. van der Kolk B.A., Stone L., West J., Rhodes A., Emerson D., Suvak M., Spinazzola J. (2014). Yoga as an adjunctive treatment for Posttraumatic Stress Disorder: A randomized control trial. The Journal of Clinical Psychiatry, 75(6): 559-565.
  53. Vargas Nunes S.O., Ehara Watanabe M.A., Morimoto H.K., Moriya R., Vissoci Reiche E.M. (2010). Impact of childhood sexual abuse on activation of immunological and neuroendocrine response. Aggression and Violent Behavior, 15(6): 440-445.
  54. Wang Z., Young M.R.I. (2016). PTSD, a disorder with an immunological component. Frontiers in Immunology, 7: 219.
  55. Weiss S. (2007). Neurobiological alterations associated with traumatic stress. Perspectives in Psychiatric Care, 43(3): 114-122.
  56. Williams R. (2009). Trauma e relazioni. le prospettive scientifiche e cliniche contemporanee. Milano: Raffaello Cortina.
  57. Yehuda R., Giller E.L., Southwick S.M., Lowy M.T., Masson J.W. (1991). Hypothalamic- pituitary- adrenal dysfunction in posttraumatic stress disorder. Biological Psychiatry, 30: 1031-1048.
  58. Yehuda R., Southwick S.M., Krystal J.H., Bremner D., Charney D.S., Masson J.W. (1993). Enhanced suppression of cortisol following dexamethasone administration in posttraumatic stress disorders. American Journal of Psychiatry, 150: 83-86.
  59. Zachariae R. (2009). Psychoneuroimmunology: A bio-psycho-social approach to health and disease. Scandinavian Journal of Psychology, 50(6): 645-651.
  60. Zohu J., Nagarkatti P., Zhong Y., Ginsberg J.P., Singh N.P., Zhang J., Nagarkatti M. (2014). Disregulation in microRNA expression is associated with alterations in immune functions in combat veterans with post-traumatic stress disorder. PLoS ONE, 9(4): e94075.

Rebecca Eibenstein, Adele Fabrizi, Abuso sessuale e PTSD complesso: gli effetti dello stress traumatico cronico sul sistema immunitario. Strategie d’intervento in "RIVISTA DI SESSUOLOGIA CLINICA" 1/2021, pp 23-43, DOI: 10.3280/RSC2021-001002