The Biological Wounds of

Childhood Trauma: HPA-

axis Dysregulation &
Societal Implications
Elainna Simpson
Thesis
1. People with childhood trauma have biological differences
that effect the way that trauma may linger as a disorder.
2. Since the HPA-axis is dysregulated in those who have
experienced childhood trauma, it predominately affects
low-income and minority groups’ mental and physical
health.
Childhood Trauma
• Experiences during childhood: event, environment, or situation
• Trauma: has a strong and lasting psychological effect
• Impact on physical and psychological health.

• In November 2019, the CDC reported that 1 in 6 U.S. adults

experience four or more types of adverse childhood experiences
(ACEs). ACEs include violence, abuse, and growing up in a family with
mental health or substance use problems (CDC, 2019).
HPA-axis
• Hypothalamic-pituitary-
adrenal axis
• Important to stress (corticotrophin-releasing factor)
response
• Once blood concentration
of cortisol is right, cortisol
initiates the negative
feedback and homeostasis
returns. (adrenocorticotropic
• Repeated exposure to stress hormone)

= habituation and sustained

HPA-axis activation (cortisol)
HPA-axis Dysregulation
• Increase in cortisol facilitates “fight or flight”
response because it provides energy from
glucose.
• Hyperactivation and Hypoactivation both
cause dysregulation.
• Hyperactivation: increased cortisol, impaired
negative feedback (Lu et al., 2016; Nikkheslat et al., 2020)
• Hypoactivation: reduced cortisol, enhanced
negative feedback (Menke et al. 2018; White et al., 2017; Yehuda
et al., 2010).

• Lead to mental health and physical health

issues.
 Epigenetics
• Epigenetics: environment can change the way your genes are expressed
• NR3C1 gene – makes the glucocorticoid receptors.
• Increased methylation = weakened cortisol responses causing sensitization
• Higher likelihood of initiating negative feedback
• Causes less stress control and higher likelihood of psychological disorders.
• Childhood trauma associated with greater methylation of the NR3C1 gene (Conradt et al.,
2015; Perroud et al., 2011; Tyrka et al.,2012)
• Severity of childhood abuse and neglect correlated with amount the NR3C1 gene was
methylated (Perroud et al., 2011)
• Epigenetic changes due to childhood trauma can create lasting effects on the function
of the HPA-axis, leading to disorders.
Inflammation
• Cortisol suppresses inflammation during stress (specifically
the glucocorticoid receptor)
• Once stress response is over then release of pro-
inflammatory cytokines to repair
• Childhood trauma associated with an increase in
inflammation
• TNF-α, IL-6, & C-reactive protein.
• Glucocorticoid receptor can regulate inflammation, but
inflammation can also effect glucocorticoid function.
• Long-lasting effect on inflammation into adulthood – may
be due to epigenetic changes.
• Creates physical and mental health issues.

(Baumeister, et al., 2016; Danese & Lewis, 2018; Menke et al., 2018; Wieck et al., 2014).
Connection to Clinical Psychology
• HPA-axis dysregulation causes disorders:
• Hyperactivation: depression, anxiety, OCD, anorexia, & panic disorder
• Hypoactivation: PTSD, atypical depression, & chronic fatigue syndrome
• People who have experienced childhood trauma tend to be less
responsive to treatments.
• Nikkheslat et al. (2020) severity of childhood trauma linked to
unresponsiveness to antidepressant medication.
• ACE Overcomers program: 12-week group program to improve
skills in emotional expression and processing, mindfulness,
resilience, and problem-solving techniques. (Cameron et al., 2018)
• Moderate to large improvements in those skills, mental health, and
physical health.
• Social and physical benefits were not as strong – program may not have
immediate effects.
Connection to Social Justice
• Childhood trauma is more likely to occur in low-income populations.
• Minority status also correlated to increased child abuse
• Due to the difference of income levels from minorities compared to white people. (Kim & Drake,
2018; Strompolis et al., 2019).

• The COVID-19 pandemic will likely show an increase in childhood trauma cases.
• Increased job loss and parental burnout from COVID-19 were found to be associated with
increased child maltreatment (physical and/or psychological). (Lawson, Piel, & Simon, 2020; Griffith, 2020)
• COVID-19 is disproportionately affecting specific populations: low-income and
minorities. (Fortuma, Tolou-Shams, Robles-Ramamurthy, & Porche, 2020)
• May only cause an increase in childhood trauma cases in low-income and minority-status
families.
Connection to Social Psychology
Racial Trauma
• Mexican American adolescents: interviewed about perceived
discrimination and then 3 day salivary cortisol levels were
measured. (Zeiders et al., 2012)
• Greater perceived discrimination was associated with greater overall
cortisol output.
• Perceived discrimination then activates our HPA-axis – chronic can lead to
dysregulation.
• African American and Latino college students: kept a diary over 3
weeks and wrote down microaggressions, salivary cortisol levels
• Increases in the number of microaggressions were predicted by greater
overall cortisol levels. (Zeiders et al., 2018)
• Microaggressions that specifically increase cortisol: assumptions of
inferiority and assumptions someone is a second-class citizen/criminal
 References
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analysis of peripheral C-reactive protein, interleukin-6 and tumour necrosis factor-α. Molecular psychiatry, 21(5), 642-649.
CDC. (2019, November 05). Adverse Childhood Experiences (ACEs). Retrieved October 25, 2020, from https://
www.cdc.gov/vitalsigns/aces/index.html
Conradt, E., Fei, M., LaGasse, L., Tronick, E., Guerin, D., Gorman, D., Marsit, C. J., & Lester, B. M. (2015). Prenatal predictors of infant self-
regulation: the contributions of placental DNA methylation of NR3C1 and neuroendocrine activity. Frontiers in Behavioral Neuroscience, 9, 130.
Fortuna, L. R., Tolou-Shams, M., Robles-Ramamurthy, B., & Porche, M. V. (2020). Inequity and the disproportionate impact of COVID-19 on
communities of color in the United States: The need for a trauma-informed social justice response. Psychological Trauma: Theory, Research,
Practice, and Policy.
Griffith, A. K. (2020). Parental burnout and child maltreatment during the COVID-19 pandemic. Journal of Family Violence, 1-7.
Kim, H., & Drake, B. (2018). Child maltreatment risk as a function of poverty and race/ethnicity in the USA. International Journal of
Epidemiology, 47(3), 780-787.
Lawson, M., Piel, M. H., & Simon, M. (2020). Child maltreatment during the CoViD-19 pandemic: consequences of parental job loss on
psychological and physical abuse towards children. Child Abuse & Neglect, 104709.
Lu, S., Gao, W., Huang, M., Li, L., & Xu, Y. (2016). In search of the HPA axis activity in unipolar depression patients with childhood trauma:
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 References (cont.)
Perroud, N., Paoloni-Giacobino, A., Prada, P., Olié, E., Salzmann, A., Nicastro, R., Guillaume, S., Mouthhon, D., Stouder, C., Dieben, K.,
Huguelet, P., Courtet, P., & Malafosse, A. (2011). Increased methylation of glucocorticoid receptor gene (NR3C1) in adults with a history of
childhood maltreatment: a link with the severity and type of trauma. Translational psychiatry, 1(12), e59-e59.
Schlosser, N., Wolf, O. T., Fernando, S. C., Riedesel, K., Otte, C., Muhtz, C., Beblo, T., Driessen, M., Löwe, B., & Wingenfeld, K. (2010). Effects of
acute cortisol administration on autobiographical memory in patients with major depression and healthy controls.
Psychoneuroendocrinology, 35(2), 316-320.
Strompolis, M., Tucker, W., Crouch, E., & Radcliff, E. (2019). The intersectionality of adverse childhood experiences, race/ethnicity, and
income: Implications for policy. Journal of Prevention & Intervention in the Community, 47(4), 310-324.
Tyrka, A. R., Price, L. H., Marsit, C., Walters, O. C., & Carpenter, L. L. (2012). Childhood adversity and epigenetic modulation of the leukocyte
glucocorticoid receptor: preliminary findings in healthy adults. PloS one, 7(1), e30148.
White, L. O., Ising, M., Klitzing, K., Sierau, S., Michel, A., Klein, A. M., Andreas, A., Keil, J., Quintero, L., Müller-Myhsok, B., Uhr, M., Gausche,
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Connection to Cognitive Psychology
• How does cortisol effect autobiographical
memory in MDD participants compared
to controls? (Schlosser et al., 2009)
• MDD: increased cortisol & reduced
negative feedback sensitivity.
• Glucocorticoid receptors in hippocampus
and prefrontal cortex.
• How might this be an issue for people
who have experienced childhood
trauma?