Childhood Trauma and PCOS
We need to talk about the link between childhood trauma/adversity and the manifestation of chronic conditions like PCOS. And yes, even if you’re scratching your head thinking “but my childhood wasn’t that bad”, I’m pleading with you to keep reading.
Childhood trauma leads to adulthood sickness, and…PCOS?
According to Dr. Nadine Burke Harris, Surgeon General of California, childhood trauma affects brain development, immune system, hormonal systems, cardiovascular and metabolic health. Wow…so effectively all bodily functions we know are impacted by PCOS, right? Childhood trauma even gets down to the level of our genetic material, influencing the way our DNA is interpreted and activated. The study of how our DNA is interpreted and activated is known as epigenetics. Read more here on how PCOS is a function of both genetics and epigenetics.
Trauma has a more widely encompassing definition than you may think
Now, we may think of the mainstream definition of trauma as a particular, horrible, disturbing event. However, acute trauma is actually the lasting emotional impact and response to that distressing event. Trauma from a particular event absolutely applies here, but what often gets overlooked is chronic trauma. This type of trauma stems from prolonged exposure to harmful situations and people. Unresolved trauma can promote a toxic stress response that primes our bodies for negative health outcomes.
What’s a toxic stress response?
The US National Academy of Sciences, Engineering and Medicine defines the toxic stress response as the “maladaptive and chronically dysregulated stress response that occurs in relation to prolonged or severe early life adversity”. A toxic stress response is enabled when a child experiences frequent and/or prolonged adversity without adequate adult support. Adversity can take on various shapes and forms, all the way from physical or emotional abuse, chronic neglect, caregiver substance abuse or mental illness, exposure to violence, economic hardship, racism, to bullying. It can have a direct effect on the HPA axis and cause dysregulation, disrupting the neuro-endocrine-immune system. Sounds a lot like what we know causes or exacerbates many of our PCOS symptoms, right?
What happens to us during our formative years can disrupt the architecture of our brain and how it develops. Childhood adversity can cause trouble with managing our relationships, how we process our emotions, and the way we view the world. It increases the risk for stress related disease and cognitive impairment well into adult years. A 2015 study found that children exposed to more psychological stress have higher cortisol levels even years after exposure to said stress.
All of these experiences, as Dr. Nadine Burke posits, are influencing the expression of our genetic material and the way our cells function and communicate with each other at a time when we are particularly malleable. So it would seem there is a strong likelihood that traumatic events, or prolonged stress responses, can activate the expression of PCOS-related symptoms.
But what happened to me also happened to my friend, or something worse happened to my friend and they don’t have PCOS
Here’s the thing - in the same way each of us has a unique tolerance for the food we put in our bodies, the exercise we enjoy, whether we can withstand high or low temperatures, the way we process stress, acute or chronic trauma is bioindividual. Your friend may also be able to eat mounds of melted cheese, and it may give you a horrendous stomach ache. We are all different, so our response to stressors will be different as well. Your friend may also not have an underlying genetic predisposition for PCOS.
There are also mediating effects when it comes to adverse experiences. Maybe you and your friend both grew up in a household with an abusive father. But maybe your mother stayed and your friend’s mother divorced her husband and won full custody. Maybe your friend saw a degree of control and agency, whereas you may have learned helplessness or inability to change your situation. Or, maybe your mother changed your environment, but she thought pretending the abuse did not happen would protect you from the pain of it. And maybe your friend’s mother took a different approach and helped emotionally coach her through her feelings. Maybe they went to therapy together. Don’t negate the lasting effects of what happened because you see other people handling the same situation differently. It’s possible your friend was able to complete the stress response cycle, but you didn’t have the resources to do so.
Completing the stress response cycle induced by repeated acute or chronic trauma can be your way out.
Let’s talk about the stress response cycle. When we experience any physical or psychological disruption to our steady state, it induces a stress response, where our physiological and behavioral responses alter. According to a review published by the National Institute of Health, the stress response is regulated by a complex interplay of nervous, endocrine and immune mechanisms. It involves the hypothalamus-pituitary-adrenal (HPA) axis, the sympathetic-adreno-medullar (SAM) axis, and the immune system. The stress response cycle goes like this:
1. ALARM
SAM Activation
The body’s immediate response to stress stems from activation of the SAM axis. It tells the adrenal glands to produce more norepinephrine and epinephrine (adrenaline). Together these two hormones and neurotransmitters cause rapid cellular responses to prepare us for fight or flight.
HPA Axis Activation
The activation of the HPA axis isn’t immediate, it’s slightly delayed and causes the release of corticotropin-releasing hormone from the hypothalamus. This signals the anterior pituitary gland in the brain to release ACTH, which triggers the adrenals to secrete glucocorticoid hormones like cortisol into the body.
The Overall Effect of SAM and HPA Axis Activation
The release of norepinephrine, adrenaline and glucocorticoid hormones like cortisol leads to increased blood glucose levels, heart rate, blood pressure, cardiac output, sodium retention, and breathing rate. It significantly reduces digestive efficiency, and leads to a change in behavior. We have heightened awareness, vigilance, and cognition.
2. RECOVERY
While the initial perceived threat may have ended, the body will prepare to return to homeostasis, but stay on alert. It will secrete less cortisol, reduce heart rate, blood pressure, and breathing will return to a more normal pace and depth. Only when our brain and body perceive the threat is no longer present will we return to homeostasis. Theoretically the cycle should end here. However, if we continue to perceive threat, we will get stuck in stress purgatory and develop general adaptation syndrome.
3. STRESS PURGATORY
When we’re trapped in this purgatory stage, it means our body could not get back to equilibrium or homeostasis. Chronic stress that results from a traumatic event, or repeated traumatic events means the body is forced to adapt to cope with the state of heightened anxiety, stress or panic. We continue to release more and more stress hormones, keeping us trapped in a vicious cycle where we repeatedly respond physiologically to the threatening stimuli even if they are not present. Now, if we learn this method of survival from a young age and repeat it through our formative years, it is going to become second nature to us. We may not even realize we’re trapped in it.
Signs of being trapped in this stage include:
Poor concentration
Irritability
Frustration
4. EXHAUSTION
Chronic stress and a chronic maladaptive stress response eventually wreaks havoc on the entire body if we cannot get back to homeostasis. The consistent presence of these stress hormones disrupts the chemical messaging systems throughout our bodies, throwing off the balance of hormones and neurotransmitters, upsetting the functioning of the endocrine, nervous and immune systems. When this happens during childhood, that means it is influencing our development and can lead to suboptimal functioning of our bodily systems. Psychological disorders will likely be present. Steady activation of elevated blood pressure and heart rate is a known cause of cardiovascular disease. Incessant stress diverts blood away from the digestive tract, causing digestive issues and malabsorption of nutrients. Indications you may have reached the exhaustion stage include:
A progressively weakening immune system
Burnout
Fatigue
Depression
Anxiety
Reduced stress tolerance
But guess what?
You can still complete the stress response cycle to bring our body back to a healthy equilibrium, and the way in which you do this will be unique to you.
Physical Activity
For some, physical activity will be the answer. That may look like going for a run, boxing, hiking, playing a sport you enjoy, doing yoga, swimming or lifting weights. You can choose to set an intention before your physical activity, that this allotted time represents a step in the direction of releasing stored stress hormones.
Create Something
Artistic expression can be a beautiful way to complete the stress response cycle. Once again, try setting an intention before your creative exploration. Tell yourself you will leave the pain on the page if you want to write, draw, or paint, or tell yourself you plan to transform your pain into something life-giving through gardening or cooking.
Express Yourself
Allow yourself to sit with your emotions. If this is scary for you, start by bringing awareness to what you are feeling. Identify where you feel it in your body and place a hand there. Write down what you feel. If you want to cry, cry. If you want to scream into a pillow, scream into a pillow. If you want to laugh, laugh. Releasing stored emotions does not have to be intimidating and can be done through a good belly laugh.
Connect
One of my favorite quotes is about relationships. “We are born in relationship, we are wounded in relationship, and we heal in relationship”. We think a lot about the first two, but very little about how relationships can heal us. The key is surrounding ourselves with people who love us and make us feel psychologically safe. Since we are often wounded by one or more of our caregivers, proving to ourselves that we can have relationships that do not wound us in the same way can reset our stress response. What did you wish you had from your caregivers or close loved ones? How can you create that in your relationships today?
Rest
If you’ve lived your life at heightened levels of stress and anxiety, your body is likely begging you to take a break. And I mean a real break. Don’t pack your schedule and free time with recreational activities. Those are great, too, but can sometimes leave you feeling more burnt out. Ask yourself what makes you feel the most relaxed and rested. Prioritize these activities while you recover.
Unsure if you had childhood experiences that caused a toxic stress response?
If you are unsure if you may have had childhood experiences that caused a maladaptive stress response, psychotherapist Kaytee Gillis noted certain behavioral indicators. These adult behaviors may allude to unresolved childhood trauma:
People-pleasing behaviors
Perfectionism
Constant comparison to others
Avoiding relationships or closeness to people in general
Jumping from relationship to relationship
Too rigid or too loose boundaries
Trying to fix others
Disordered eating
Self medicating with substances like alcohol, drugs or food
Feelings of depression, anxiety or anger that won’t go away
Additional Suggestions to Help Heal Unresolved Adverse Childhood Experiences
Validate what you went through
Write a letter to the person who hurt you. Destroy it in a ceremonious way to signify you are no longer letting that person, or the event, have a hold over you or define you.
Write a letter to yourself at the age you were when the event occurred. If it was prolonged stress, choose a younger age that resonates with you. What do you want to tell yourself?
Journal or reflect: What are you blaming yourself for? How can you release this?
Journal or reflect: What 5 things are you grateful to the trauma for? What 5 things do you want to let go?
Explore: How do you define yourself? Be as descriptive with your words as possible. Review these descriptions. Where do the words come from? You get to build your own life and identity. What words or descriptors can you release that are attached to what happened to you?
Visualization: Visualize your inner child standing in front of you. What do you want to tell yourself you wish you could have had when you were little? Visualize giving your inner child a hug, telling them you are grown and capable of creating what you need now.
Visualization: Visualize who hurt you. What do you want to say to them? Visualize their inner child standing in front of you. What did they go through? How did they develop the patterns they did? Can you note any compassion in yourself for them and move towards forgiveness?
Explore therapy modalities like EMDR or cognitive processing therapy.
All in all, this process is going to be heavy and likely will surface emotions you may have subconsciously been burying for a long, long time. Be kind to yourself throughout this healing journey and acknowledge that it requires patient. Take care of yourself, set boundaries, and prioritize time for your processing.
Next week, I’ll dive into some of my processing journey and some of the blockers I dealt with in acknowledging what I had been suppressing for years. Until then, take care of yourself today and every day.