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Biopsychosocial Aspects of HPAAxis Dysfunction
Objectives
Define and explain the HPAAxis
Identify the impact of trauma on the HPA Axis
Identify the impact of chronic stress/cumulative trauma on the HPAAxis
Identify symptoms of HPAAxis dysfunction
Identify interventions useful for this population
Based on
Posttraumatic stress disorder: the neurobiological impact of psychological trauma
Dialogues Clin Neurosci. 2011 Sep; 13(3): 263–278.
https://www.ncbi.nlm.nih.gov/pmc/arti...
Lifestyle Factors Contributing to HPAAxis 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
https://irispublishers.com/ann/pdf/AN...

What is the HPA Axis
HypothalamicPituitaryAdrenal 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 HPAAxis 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 HPAAxis dysregulation including
Noise
Stimulant use (caffeine, nicotine, ADHD medications)
Insufficient quality sleep
Media exposure

Consequences of HPAAxis Dysfunction
More than 50% of Americans suffer from one or more chronic conditions associated with disturbances of the HPAAxis 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 HPAAxis Function
When exposed to a physical, environmental or social stressor, the HPAAxis 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 HPAAxis 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 antiinflammatory 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.