From Linda M. Rio, M.A., Marriage and Family Therapist and PWN contributor –This is not about politics but the potential psychological, emotional, relational, and physical toll that political and social events can have, especially on those whose bodies have already been compromised by a pituitary tumor or other disorder. It is difficult in a modern society to not be influenced by the media and current events. Even for those who try to limit exposure to hearing about events that may be stressful (wars, shootings, negative politics etc.) find it hard to not be affected. Sometimes things are just so permeated into our daily lives, discussions at home and work. Hearing shocking and sometimes very detailed and personal accounts is hard. For example, many who have served in the military and lived through the horrors of war know that the sound of a helicopter or backfire of a car can trigger an intense reaction even though they are have safely returned home. There is a particular need for those with pituitary disorders to understand potential ramifications that even overhearing disturbing accounts reported in the media may have on their bodies. Many people who have a diagnosis of a pituitary tumor, are going through the diagnostic process, and even post-surgery know that their bodies are likely to be hypersensitive to stress. The reasons for this are varied but patients are often told by their physicians to avoid stress. It is, of course, sometimes impossible to avoid stress, especially when it is all around. Because there is a specific population of those dealing with pituitary disorders who also may have a history of trauma it is important to provide information here that may be helpful.
Women and men who have a prior history of trauma are often unaware that they can be triggered into a trauma response and tend to move immediately from stimulus to response without often realizing what makes them so upset (van der Kolk, B, & McFarlane, 2007). Something as seemingly simple as watching the nightly news or reading a Tweet from a friend about current events can unwittingly put a trauma survivor’s body and mind into a high-alert status. And this alarm system is the endocrine system; that is its purpose. Those who have been traumatized often are unable to “know” what they feel and just become prone to an abundance of emotions and psychosomatic reactions without ever realizing a personal meaning for such and therefore unable to develop an more positive adaptive response (van der Kolk, B., Weisaeth, L., & van der Hart, O. 2007).
The media has recently talked a lot about PTSD but not long ago no one but mental health professionals knew much about this at all. Accurate and complete information, however, is often lacking. Of course, a thorough understanding of this complex psychological (and biological) process is not possible here but some of the essentials will be discussed with a focus on those with some form of pituitary and/or neuroendocrine disorder.
Post‐traumatic stress disorder (PTSD) is a mental health disorder precipitated by a stressful event(s) that produces fear or terror in the individual. Post‐traumatic stress disorder studies, particularly in cases of childhood sexual abuse, have been associated with neuroendocrine dysfunction, most notably the hypothalamic–pituitary–adrenal (HPA) axis. PTSD can occur at any age and symptoms usually begin within the first 3 months after the trauma but there may be a delay of months or even years after the trauma before criteria for the diagnosis are met (American Psychiatric Association, 2013). It is important to understand that trauma is only traumatic, or not, to the individual affected. Some events considered extremely traumatic to one person may not be experienced as traumatic to another since there are so many factors that can affect how it is perceived. For example, the age of a person can have a huge impact. If the person felt at the time they had the support of loved ones and they could talk to about what happened. Having comfort and the ability/safety to talk might mitigate the severity and intensity of the person’s response. If events are human-caused versus natural disasters frequently makes a difference in the response to the trauma. In general, harm caused by another human being is generally felt much more deeply. Most often people think of traumatic events as psychological but trauma can be physically caused and felt as well. Some medical procedures such as surgeries, emergency procedures and more are perceived as traumatic. Also, the traumatic event does not have to be intended to be harmful i.e. most doctors or nurses don’t intend to emotionally scar someone by their healing efforts but it can happen anyway. For example, I have worked with people who as a child had a medical procedure but years into adulthood had PTSD symptoms appear. Examples of reasons for this can be that the child may have been separated from their parents for the medical procedure, the child may not have understood what was happening as medical procedures can be scary and painful etc. and hospitals can just be intimidating even for adults.
Sexual abuse whether experienced as a child, adolescent or adult is considered traumatic. Victims often do not even think of themselves as such and for months, to years, to decades may deny or fail to remember painful events on a conscious level. Then, something, a “trigger” may happen that causes memories and feelings to rush-in causing a lot of confusion and turmoil. Some triggers can be identified as obvious such as seeing a perpetrator again after years of absence. Other triggers are more subtle like an aroma or color that was present during the initial incident, or a report on the news of an incident similar to one experienced personally.
Trauma, PTSD, and anxiety disorders have been linked to disturbances of the endocrine system (Blevins & Rio, 2014). Severe stress early in life is associated with persistent sensitization of the pituitary-adrenal and autonomic stress response, which, in turn, is likely related to an increased risk for adult psychopathological conditions (Heim et al., 2000). One small study consisted of 10 girls identified as sexual abuse victims matched with 10 control subjects. Morning saliva samples were collected from subjects and matched controls and found to be significantly lower in the sexually abused group as compared to their non‐abused counterparts (King, Mandusky, King, Fletcher, & Brewer, 2008). In addition to major depression, dysregulation of the stress system, including the HPA axis, is involved in the pathophysiology of post-traumatic stress disorder (Kassi, Kaltsas, & Chrousos, 2014). It has been reported that environmental factors might play a part in the etiology of pituitary-dependent pituitary tumors in cases of prolactinomas, Cushing’s, and non-functioning adenomas (Sobrinho, 2014). Animal studies also have shown negative effects of trauma on the H-P-A axis (Plotsky & Meaney, 1993; Nemeroff, 1994; Kassi, Kaltsas, & Chrousos, 2014). However, there is less research to date on the physical and psychological effects following a traumatic event(s) in humans. Finding a direct link to any subsequent event in human studies is not possible due to the enormous variability in people’s lives. There is no way to ethically subject human research subjects to severe trauma then observe them in a controlled environment over several years to see what may develop. Therefore, it is important to understand that at least at the present time there is no “cause” for pituitary disorders linked to sexual or physical trauma. This, however, does not mean there is no link or association.
Anyone who finds themselves recently experiencing unusual symptoms such as nightmares, recollections of traumatic or unusual events, avoidance of people, places, or things; difficulties with concentration; irritability or anger outbursts; feeling hypervigilant/on-edge; feeling easily startled and more should know these may be due to prior traumatic experience(s) that could have been triggered by current events. Some of these symptoms are also common to pituitary disorders so any treatment professional should be informed about not only physical but psychological/emotional history. There are many trauma-trained therapists who can gently guide patients through the healing process. Of course, there are also things that can be done right away by anyone who experiences an overabundant number of negative emotional reactions after being exposed to any current event. It may be difficult to consider limiting screen time but that is often quite helpful not just for children. Taking a walk, especially in nature may sound too simple but it is one of the most beneficial things to counter the effects of day-to-day stress. Other measures can include doing as many calming and pleasurable activities, including doing nothing, as possible. Asking family and friends to limit or avoid loud or contentious arguments about current affairs by telling them that it is just too much for you can help. If they don’t listen or abide by your wishes then allow frequent breaks to give the body time to calm itself. Viewing art, listening to pleasurable music, engage in sports, read…there are so many things can help rebalance the body’s alarm system. Even for those who have not experienced a trauma, these repair efforts are needed just to combat the stress of daily life.
References American Psychiatric Association. (2001). Diagnostic and Statistical Manual of Mental Disorders (DSM V) Washington, D.C.
Blevins, L., & Rio, L. (2014). Introduction. In L. Rio (Ed.), The hormone factor in mental health: Bridging the mind-body gap. London: Jessica Kingsley, 17-37.
Heim, C., Newport, J., Heit, S., Graham, Y.P., Wilcox, M., Bonsall, R. et al. (2000). Pituitary-adrenal and autonomic responses to stress in women after sexual and physical abuse in childhood. JAMA, vol.284,5, 592-597.
Kassi, E., Kaltsas, G., & Chrousos, G. (2014). Stress, trauma, and the impact on the pituitary. In L. Rio (Ed.), The hormone factor in mental health: Bridging the mind-body gap. London: Jessica Kingsley, 79-103). King, J.A., Mandasky, D., King, S., Fletcher, K.E., Brewer, J. (2001)..
King, J.A., Mandasky, D., King, S., & Fletcher, K.E. (2008). Early sexual abuse and low cortisol. Psychiatry and Clinical Neurosciences. Retrieved October 2, 2018, from https://onlinelibrary.wiley.com/doi/pdf/10.1046/j.1440-1819.2001.00787.x Psychiatry and Clinical Neurosciences,55, 71–74
Nemeroff CB. The preeminent role of early untoward experience on vulnerability to major psychiatric disorders: the nature-nurture controversy revisited and soon to be resolved. Mol Psychiatry.1999;4:106-108.
Plotsky PM, Meaney MJ. Early, postnatal experience alters hypothalamic corticotropin-releasing factor (CRF) mRNA, median eminence CRF content and stress-induced release in adult rats. Mol Brain Res.1993;18:195-200. 33.
Sobrinho, L. G. (2014). Psychological factors and pituitary disease: The chicken and the egg. In L. Rio (Ed.), The hormone factor in mental health: Bridging the mind-body gap. London: Jessica Kingsley, 105-118.
Van der Kolk, B., and McFarlane, A.C. (2007). The black hole of trauma. In B.A. van der Kolk, A.C. Mc Farlane, & L. Weisaeth (Eds) Traumatic stress: The effects of overwhelming experience on mind, body, and society. New York: Guilford Press. 3-25.
Van der Kolk, Weisaeth, L., & van der Hart, O. (2007). History of trauma in psychiatry.In B.A. van der Kolk, A.C. Mc Farlane, & L. Weisaeth (Eds) Traumatic stress: The effects of overwhelming experience on mind, body, and society. New York: Guilford Press. 47-74.
Our thanks to Linda M. Rio MA, for providing this critical information and contributing to our publication. Read Linda’s past articles on PWN here and learn more about Linda by going to her website at www.lindamrio.com .
LINDA’S BOOK: “THE HORMONE FACTOR IN MENTAL HEALTH” IS AVAILABLE THROUGH AMAZON.COM AND OTHER MAJOR BOOKSELLERS.
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