Chapter Two: The Systems of the Body

The Brain ( Source: Lankford, 1979, p. 232)

Brain- Structure Cortex: Interpret Threat Mid Brain: “mammalian” Frontal Lobe: Modulates, Plans, Decides Role of Trauma: bypass cortex, irrational Mid Brain: “mammalian” Hypothalamus: Primitive Stress Response Limbic System: “Emotional Center” Amygdala: anxiety; threat sensitive Hippocampus: memory consolidation

Case of Trauma Annie suffers from PTSD after watching her best friend die from a severe anaphylactic shock at school. She developed avoidance of anything resembling school and would have intense panic attacks at the sight of medics. Stress Response is irrational, by-passes the thinking brain, imprinted in lower areas of brain. Side note on PTSD: Most individuals facing life-threatening stressors never develop PTSD.

How does the body handle stress? Brain : “The Master Gland” Interprets threat in the Cortex: “Rational” Reflexive/Reactive Fear: “Irrational” Hypothalamus: The 4 Fs (fight, flight, fear, sex) Responds to frontal lobe signal or to trauma stimuli Pituitary: Releases hormones to start the stress response in the rest of the body

Figure 2.1 - The Components of the Nervous System

Stress Pathway Hypothalamus: Corticotropin Releasing Factor (CRF) Pituitary: Vasopressin (Cardiac Response) Endorphins : Dulls Pain Perception Why is this adaptive? Adrenals: Epinephrine (Adrenaline) Increases Blood Pressure Dilates Pupils and Constricts Blood Vessels Mobilizes Muscles to react

Acute Stress Response Sympathetic Nervous System: Inhibits salivation Accelerate heartbeat Inhibits digestion Stimulates epinephrine (adrenaline) Stimulates arousal and orgasm Reproductive Hormones Suppressed Growth Hormones Suppressed Insulin Suppressed

Figure 2.3 - The Endocrine System

How does stress make us sick? The Stressed Body How does stress make us sick?

Cardiovascular Disease Main Idea: Heart Overused Wears Out Increasing the force of fluid through vessels harm arteries: tears, scars, pits Atherosclerosis: fat deposits accumulate in the pits and tears Animal Studies: Stressed monkeys given betablockers, no plaques formed

Heart Disease Continued Angina Pain: Stress constricts not dilate blood vessels Damaged Cardiovascular system becomes over responsive to acute stressors Sudden Cardiac Death: Fibrillation/over- reactive heart is heart attack prone

Stress and Metabolism Huge Meal -> (normal response) Insulin Pours out of pancreas to blood -> Purpose to store storage of energy Fatty Acids go into fat cells -> Stimulate Glycogen and Protein Synthesis -> (Glycogen: strings of glucose)

Stress and Metabolism cont Stress -> Triggers Sympathetic NS Sympathetic NS -> Secrete Glucocorticoids Glucocorticoids blocks energy storage Leaves Glucose in blood available for energy Energy available for quick response: brain and muscles

Stress and Metabolism cont Sustained Stress -> Expend excessive energy Fatigue (muscles do not repair) Diabetes Type II: Glucose builds up in blood vessels, Insulin not effective in storing glucose Glucose plaque in arteries:chronic pain/heart disease Necrosis in tissue: amputation danger Kidney damage (dialysis prone) Eye damage (danger of blindness)

Stress and Metabolism Chronic Stress: Glucocorticoids and Epinephrine: creates insulin ineffectiveness and instability Diabetes: Body incapable of properly using insulin Type I Diabetes: Autoimmune; Genetic/viral Type II Diabetes: Disease of Lifestyle

Stress and GI Disease Conditions to consider: Ulcer, Colitis, IBS Stress -> Shuts down digestion – Normal Stomach Response? Case of Ulcer: Chronic Stress stomach lining not rebuilt -> walls of stomach thin out Prostaglandins rebuild lining but inhibited by stress -> H-Pylori Bacteria cause infections in the small holes in stomach walls

Stress and GI Disorders Stress diverts energy away from digestion to brain and muscles: Large intestines empties and small intestines stop the absorption IBS: “spastic colon” too sensitive to stress Intestines stop and start erratically Constipation: small intestines stop erratically Diarrhea: large intestines empty erratically

Stress and Appetite CRF (Corticotropin Factor) hypothalamus Suppresses Appetite: short stressful events Responding to acute demands of body Stimulates Appetite: Glucocorticoids released during chronic stress after acute stressor resolves

Stress and Growth Growth Hormones (Testosterone/Estrogen) Suppressed during Stress Estrogen facilitates new bone growth Testosterone facilitates new bone growth and muscle development Side note: Excess Testosterone can speed up fusing of bones as well

Stress and Growth Neglect, Abuse, Insufficient Nurturance Overactive sympathetic system Dwarfism in children Recover if stress removed before Puberty; Stress during Puberty reduces bone growth Case Example: http://www.dailymail.co.uk/news/article- 1306794/The-little-boy-neglected-badly-mother- DWARF.html?ito=email_share_mobile-top

Stress and Bone Mass Adulthood: Bone mass decreases normally with age Growth hormones repair cells Glucocorticoids block calcium Aging with Stress: Excessive Glucocorticoids & Reduced growth hormones Accelerates Bone loss Greater risk for Bone Fracture, Hip Fractures, Fatal complications; Fractures not healing

Stress and Memory Acute Stress: Increase STM storage Chronic Stress: Glucocorticoids Reduce concentration Increase forgetting Hippocampus shrinks (permanent damage) Children under Chronic Stress? Aging: Increased Glucocorticoids natural Severe stress and Aging: Speeds up aging and memory problems

Summary The Stress Response: Sacrifice long-term welfare for immediate physical survival Avoid physical threat or physical predators Dysregulates body systems: hyperactive sympathetic response (constant body stress) Stress response evolved early in our evolutionary development. What would a more modern stress response look like?

Disorders of Nervous System Epilepsy: seizures, stress link, medication managed Cerebral Palsy: child birth trauma, O2 loss to brain Parkinson’s Disease: Progressive degeneration of smooth muscle nerves Multiple Sclerosis: Degeneration of Myelin, motor then cognitive Huntington’s Chorea: Degeneration of Motor/Cogn Paraplegia/Quadriplegia: perm motor nerve damage Dementia: Progressive Cognitive Decline Short-term > longterm memory

Case Analysis “John” A 12-year-old has a history of physical abuse and neglect. He was removed from his biological parents who were heroine users and was found filthy, starving, and chronically truant from school at the age of 8. He was placed in foster care and group homes alternatively for the past four years. He is currently placed with a new foster parent who has two other foster children. He attends the 6th grade but physically appears frail and much younger than his age. He also suffers from irritable bowels and has had accidents at school. The teacher mentions that he has trouble retaining any information. What are important considerations in this case. What might be important interventions? What is John’s prognosis?

Case Analysis “Cindy” A 30-year-old female share with you that she was recently involved in a car accident. Since then, she has had recurrent nightmares, avoids driving, and experiences severe panic attacks at the sound of cars skidding or braking. She also mentions that her appetite has increased significantly and finds herself snacking far more than typical. She is otherwise high functioning and currently works as an executive secretary to a company CEO. She tells you that she is finding it very difficult to reconcile her anxious behavior with her very rational self. What do you tell her? How do you help her understand her anxiety?