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1
Nature andor NurtureTrans-generational Transmission of Traumatic
Stress Chris Dunning PhD
Professor EmeritaUniversity of Wisconsin-Milwaukee
cdunninguwmedu414227-3399
PERSONALTRAUMA
PARENTrsquoSTRAUMA
FAMILYrsquoSTRAUMA
ANCESTORrsquoSTRAUMA
Whatrsquos in his backpack
2
Why examine Trans-generational Transmission of Trauma
Children Bring Their Whole Lives into the Classroom
bull Children spend 6-8 hours a day in school bull If the school is trauma-informed those could be hours in
which the children feel understood accepted and validated all of which might g help them recover from trauma
bull Teachers who function as secondary or alternative attachment figures could provide some protection against negative developmental outcomes
bull Education can help the children become part of society
3
Traumarsquos Legacies
YOUR STUDENT
PERSONALEXPERIENCES
PARENTALCAREGIVER
EXPERIENCES
FAMILYGRANDPARENTSrsquo
amp ANCESTORSrsquoEXPERIENCES
4
Letrsquos Talk About the Elephant in the Classroom
AFFECT ATTITUDE BEHAVIOR COGNITION
LEARNING
5
What Do You Have in the Classroom
bull Personal Traumasbull Familyrsquos Traumasbull Parentrsquos ChildhoodAdult Traumasbull CaregiverTeacherrsquosStaff Traumasbull Ancestorrsquos Traumasbull Community Traumas
NOT EVERY CHILD HAS THE SAME-SIZE ELEPHANT IN THEIR BACKPACK
6
Just Because a Person Has Been in a Traumatic Eventhellip
Doesnrsquot Mean They are TRAUMATIZED
7
STUDENTLEARNING
8
Letrsquos Take out Personal Experience and Look Only at InheritedTransmitted Trauma
STUDENT
GENETIC MAKEUPBIOLOGY
SCHEMASBELIEFSVALUES
LEARNEDMODELED
BEHAVIORS
9
What Makes Up a Student
BIOLOGY
SCHEMASBELIEFSVALUES
VulnerabilityTrust
IntentBlameGuilt
EmpathySelf-EsteemSelf-WorthFuturing
LEARNEDBEHAVIOR
Abused ChildgtAbusive ParentDomestic ViolencegtDomestic ldquoViolentorrdquo
VictimgtPerpetrator (Role Reversal)
10
Key Developmental Capacities Affected By Trauma
Ability to modulate tolerate or recover from extreme affect states
Regulation of bodily functions Capacity to know emotions or bodily states Capacity to describe emotions or bodily states Capacity to perceive threat including reading of safety
and danger cues Capacity for self-protection Capacity for self-soothing Ability to initiate or sustain goal-directed behavior Coherent self Identity sense of self-worth or esteem Capacity to regulate empathic arousal Capacity to trust
11
Domains Impacted by Trauma That Affect Learning
bull Behavioral Control
bull Cognition
bull Attachment
bull Dissociation
bull Affect Regulation
bull Physiological and Psychological State
bull Self Concept
12
Trans-generational Trauma
Attachment research shows a 75 correspondence between a motherrsquos attachment and that of her infant RESULTING INhellip
bull Repetition of disturbed interactions and patterns of relationships
bull Repetition of abuse and maltreatmentbull Issues for abused parents - anxiety
compensation and reparation envybull Re-enactment of unresolved attachment trauma
13
Transmission of Trauma from Parent to Child
bull ldquoDirect and specific transmission (a mental syndrome in the survivor parent leads directly to the same specific syndrome in the child)
bull Indirect and general transmission (a disorder in the parent makes the parent unable to function as a parent which indirectly leads to a general sense of deprivation in the child)
14
Trauma Symptoms that Impact Parenting PTSD Avoidant
D Negative alterations in cognitions and mood associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred) as evidenced by two or more of the following
1 Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia that is not due to head injury alcohol or drugs)
2 Persistent and exaggerated negative beliefs or expectations about oneself others or the world (eg ldquoI am badrdquo ldquoNo one can be trustedrdquo The world is completely dangerous) (Alternatively this might be expressed as eg ldquoIrsquove lost my soul foreverrdquo or ldquoMy whole nervous system is permanently ruinedrdquo)
3 Persistent distorted blame of self or others about the cause or consequences of the traumatic event(s)
4 Persistent negative emotional state (eg fear horror anger guilt or shame)
5 Markedly diminished interest or participation in significant activities6 Feelings of detachment or estrangement from others7 Persistent inability to experience positive emotions (eg unable to
have loving feelings psychic numbing)
15
Parentrsquos PTSD Arousal Symptoms
E Marked alterations in arousal and reactivity associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred as evidenced by two or more of the following
1 irritable or aggressive behavior2 reckless or self-destructive behavior (alcohol drug
eating self-harm high risk promiscuityhellip)3 hypervigilance4 exaggerated startle response5 problems with concentration6 sleep disturbance (eg difficulty falling or staying
asleep or restless sleep)
16
Empathic damage done to student by parent
1 Sense of Self-esteem2 Sense of Safety3 Affect Regulation Ability4 Fear of Abandonment5 Fear of Rejection6 Trust Level Questioned7 Fear of Betrayal8 Fear of Blame9 Sense of Control10 Loss of Sense of Self In Larger
PictureContext
17
Letrsquos Look at Traumatized FamiliesAdaptational Styles (Danieli)
bull General family types are associated with traumatic psychological responses ndash ldquoFamilies of fightersldquo
bull Children had to adopt a ldquoFighterHerordquo identity to saty in family and achieve parentsrsquo goals for recognition and redress
bull Contempt and intolerance for dependency weakness or failure
bull Outside world seen as oppositional so aggressive interaction the norm
bull Children programmed to seek validation for parentsrsquo suffering and to make their parentsrsquo whole
18
Adaptational Family Styles
ndash the Numb family bull Pervasive silence and depletion of all emotionsbull Parents capable of tolerating only minimal amount of
stimulationbull Childrenrsquos inner spontaneity and fantasy life severely
limitedbull Parents protect each other and children protect the
parentsbull Children adapt by numbing themselves or are
perpetually angrybull In attempt to please parents try to excel in social
standard of achievementsbull Children frequently accept outside role models over
parents to know how to live
19
Adaptational Family Styles
ndash ldquoThose who made itldquo families bull Motivated by magical fantasies during traumabull Desire to ldquomake it bigrdquo regain power and control
ndash ldquoVictim familiesrdquobull Pervasive depression fear worry and distrust of
outside worldbull Symbiotic clinging within the familybull Catastrophic reactions to everyday problems and
situationsbull Guilt used as a form of control
20
Two new categories to add to Danielis typologyndash
5 ldquoLife goes on families Conspiracy of SilenceAdvocacy for present and future gainsChildren expected to achieve
6 ldquoSplit families ndash Ready acceptance of new members (ldquoauntiesrdquo
ldquounclesrdquo ldquodaddiesrdquo ldquosiblingsrdquohellip) ndash Fluid membership-transfer between familiesndash Toleration of independence parentificationndash Creation of ldquonew familiesrdquo (eg affiliation with gangs
cults groups social institutions [churches]hellipndash Little parental oversight
21
Holocaust Link Jewish and Native American
Holocaust
Survivorsrsquo child complex Disenfranchised grief Transposition
bull Fixation to trauma bull attempts to resolve past
1 Effectsbull Nightmaresbull Perceived
obligation to ancestors
2 Coping strategiesbull Memory Candles
(Living testaments)
bull Loss cannot be openly mourned
1 Individualbull Inhibited with
shame
2 Societybull Loss of ancestral
tradition
bullLiving in the Past amp Present
1 1st GenerationbullPost Traumatic Stress Disorder
2 Subsequent GenerationsbullHistorical Unresolved Trauma
22
Neurobiology of Trans-generational Transmission of Trauma
Caveat The genetic model of transmission may evoke resistance because of its similarity with the Nazi ideology of purifying the gene pool of the German race it provides a clear theoretical basis for future research
ndash Parental traumatization may be transmitted in the same manner as some hereditary diseases are passed on from one generation to another
ndash Genetic memory code of a traumatized parent may thus be transmitted to the child through some electro-chemical processes in the brain
23
Genetic transmissionThe neural organization of various memory systems in
the parent (eg hyperalertness) would lead to a similar organization and constitution in the child
Since psychic trauma is assumed to have long-term effects on the neurochemical responses to stress in traumatized parents it may also lead to the same enduring characterological deficiencies and to a kind of biological vulnerability in the child
24
Gene Environment Interaction
bull New research helps answer the puzzling question of why post-traumatic stress doesnt happen to everyone who endures horrible trauma
bull Researchers found that survivors of child abuse were particularly likely to have symptoms of post-traumatic stress as adults if they also had specific variations in a stress-related gene
25
We are concerned with the gene for stress hormone systems
bullNorepinephrine ndash ldquorevving uprdquo hormone
bullCortisol ndash ldquoquieting downrdquo hormone
Both hormones are released in response to stress They are normally in balance
26
Stress Response
bull Designed to help mobilize ourselves to cope with danger by responding in one or more of the following behaviorsWithdrawal ndashFLIGHTImmobility-FREEZINGAggression-FIGHTAppeasement-SUBMISSIONTypically our first reaction to danger is to freeze to stop
all movement
27
A Threat Occurs Human Stress Response
Fightfleefreeze1048710 State of high alert hypervigilance1048710 Action not thought1048710 Decreased ability to think clearly or completely1048710 Extremist thinking1048710 Attention to threat ndash tagged for mental priority1048710 Increased aggression ndash loss of impulse control1048710 Dissociation buffers CNS but fragments mental functioning1048710 Speechless terror ndash loss of words1048710 Action is successful or not=helplessness
28
The Culprit-FKBP5The FKBP5 gene is active in the biochemical
make-up of the bodys stress-response system
bull Early-life abuse can result in particularly potent changes to this system as it develops mdash depending partly on whether or not the variations are present in the gene
bull The combination of the gene variations and past child abuse were the key ingredients for the doubled PTSD symptoms when a subsequent trauma occurred
bull This finding suggests a genechildhood environment interaction for adult PTSD
bull Inherited variations in multiple genes which have yet to be identified are estimated to account for 30 to 40 percent of the risk of developing PTSD
29
Research on Ancestral PTSD
bull Found that low cortisol levels were significantly associated with both PTSD in parents and lifetime PTSD in offspring whereas having a current psychiatric diagnosis other than PTSD was relatively but non-significantly associated with higher cortisol levelsndash ldquoAncestral PTSD a putative risk factor for PTSD appears to
be associated with low cortisol level in offspring even in the absence of lifetime PTSD in the offspring The findings suggest that low cortisol levels in PTSD may constitute a vulnerability marker related to parental PTSD as well as a state-related characteristic associated with acute or chronic PTSD symptomsrdquo
30
PHYSIOLOGIC DIFFERENCEDepression Stress or Trauma
CRF Gluco Corticoid Receptors
-----HYPOTHALMUS
PITUATARY
ADRENAL Gluco Corticoid Receptors ++++
31
Research Findings-FKBP5bull Research examines polymorphisms (variants of a
gene among a population) of a gene called FKBP5 ndash Protein in this gene encodes is involved in mediating the
actions of the glucocorticoid receptor which upon activation moves into the nucleus of the cell and regulates gene expression
bull Researchers discovered polymorphisms of FKBP5 were correlated with increased rates of PTSD in adults who experienced traumatic stress but only in subjects who had experienced trauma previously or who had inherited the morphism of their FKBP5 gene
32
FKBP5 Gene
bull On its own FKBP5 polymporphism was not correlated with adult PTSD-Mutation only happens in early childhood under traumatic circumstances
FOR EXAMPLEA Normal FKBP5 parent traumatized while serving in Iraq=no
mutationB Parent abused repeatedly in first 5 years of life= possibility of
FKPB5 mutation which could then be passed on
A Child inherits mutated FKBP5 gene and never experiences a trauma=no PTSD (may have some symptoms)
B Child inherits mutated FKBP5 gene and experiences a trauma=substantially greater possibility of PTSD if no buffering factors
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
2
Why examine Trans-generational Transmission of Trauma
Children Bring Their Whole Lives into the Classroom
bull Children spend 6-8 hours a day in school bull If the school is trauma-informed those could be hours in
which the children feel understood accepted and validated all of which might g help them recover from trauma
bull Teachers who function as secondary or alternative attachment figures could provide some protection against negative developmental outcomes
bull Education can help the children become part of society
3
Traumarsquos Legacies
YOUR STUDENT
PERSONALEXPERIENCES
PARENTALCAREGIVER
EXPERIENCES
FAMILYGRANDPARENTSrsquo
amp ANCESTORSrsquoEXPERIENCES
4
Letrsquos Talk About the Elephant in the Classroom
AFFECT ATTITUDE BEHAVIOR COGNITION
LEARNING
5
What Do You Have in the Classroom
bull Personal Traumasbull Familyrsquos Traumasbull Parentrsquos ChildhoodAdult Traumasbull CaregiverTeacherrsquosStaff Traumasbull Ancestorrsquos Traumasbull Community Traumas
NOT EVERY CHILD HAS THE SAME-SIZE ELEPHANT IN THEIR BACKPACK
6
Just Because a Person Has Been in a Traumatic Eventhellip
Doesnrsquot Mean They are TRAUMATIZED
7
STUDENTLEARNING
8
Letrsquos Take out Personal Experience and Look Only at InheritedTransmitted Trauma
STUDENT
GENETIC MAKEUPBIOLOGY
SCHEMASBELIEFSVALUES
LEARNEDMODELED
BEHAVIORS
9
What Makes Up a Student
BIOLOGY
SCHEMASBELIEFSVALUES
VulnerabilityTrust
IntentBlameGuilt
EmpathySelf-EsteemSelf-WorthFuturing
LEARNEDBEHAVIOR
Abused ChildgtAbusive ParentDomestic ViolencegtDomestic ldquoViolentorrdquo
VictimgtPerpetrator (Role Reversal)
10
Key Developmental Capacities Affected By Trauma
Ability to modulate tolerate or recover from extreme affect states
Regulation of bodily functions Capacity to know emotions or bodily states Capacity to describe emotions or bodily states Capacity to perceive threat including reading of safety
and danger cues Capacity for self-protection Capacity for self-soothing Ability to initiate or sustain goal-directed behavior Coherent self Identity sense of self-worth or esteem Capacity to regulate empathic arousal Capacity to trust
11
Domains Impacted by Trauma That Affect Learning
bull Behavioral Control
bull Cognition
bull Attachment
bull Dissociation
bull Affect Regulation
bull Physiological and Psychological State
bull Self Concept
12
Trans-generational Trauma
Attachment research shows a 75 correspondence between a motherrsquos attachment and that of her infant RESULTING INhellip
bull Repetition of disturbed interactions and patterns of relationships
bull Repetition of abuse and maltreatmentbull Issues for abused parents - anxiety
compensation and reparation envybull Re-enactment of unresolved attachment trauma
13
Transmission of Trauma from Parent to Child
bull ldquoDirect and specific transmission (a mental syndrome in the survivor parent leads directly to the same specific syndrome in the child)
bull Indirect and general transmission (a disorder in the parent makes the parent unable to function as a parent which indirectly leads to a general sense of deprivation in the child)
14
Trauma Symptoms that Impact Parenting PTSD Avoidant
D Negative alterations in cognitions and mood associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred) as evidenced by two or more of the following
1 Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia that is not due to head injury alcohol or drugs)
2 Persistent and exaggerated negative beliefs or expectations about oneself others or the world (eg ldquoI am badrdquo ldquoNo one can be trustedrdquo The world is completely dangerous) (Alternatively this might be expressed as eg ldquoIrsquove lost my soul foreverrdquo or ldquoMy whole nervous system is permanently ruinedrdquo)
3 Persistent distorted blame of self or others about the cause or consequences of the traumatic event(s)
4 Persistent negative emotional state (eg fear horror anger guilt or shame)
5 Markedly diminished interest or participation in significant activities6 Feelings of detachment or estrangement from others7 Persistent inability to experience positive emotions (eg unable to
have loving feelings psychic numbing)
15
Parentrsquos PTSD Arousal Symptoms
E Marked alterations in arousal and reactivity associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred as evidenced by two or more of the following
1 irritable or aggressive behavior2 reckless or self-destructive behavior (alcohol drug
eating self-harm high risk promiscuityhellip)3 hypervigilance4 exaggerated startle response5 problems with concentration6 sleep disturbance (eg difficulty falling or staying
asleep or restless sleep)
16
Empathic damage done to student by parent
1 Sense of Self-esteem2 Sense of Safety3 Affect Regulation Ability4 Fear of Abandonment5 Fear of Rejection6 Trust Level Questioned7 Fear of Betrayal8 Fear of Blame9 Sense of Control10 Loss of Sense of Self In Larger
PictureContext
17
Letrsquos Look at Traumatized FamiliesAdaptational Styles (Danieli)
bull General family types are associated with traumatic psychological responses ndash ldquoFamilies of fightersldquo
bull Children had to adopt a ldquoFighterHerordquo identity to saty in family and achieve parentsrsquo goals for recognition and redress
bull Contempt and intolerance for dependency weakness or failure
bull Outside world seen as oppositional so aggressive interaction the norm
bull Children programmed to seek validation for parentsrsquo suffering and to make their parentsrsquo whole
18
Adaptational Family Styles
ndash the Numb family bull Pervasive silence and depletion of all emotionsbull Parents capable of tolerating only minimal amount of
stimulationbull Childrenrsquos inner spontaneity and fantasy life severely
limitedbull Parents protect each other and children protect the
parentsbull Children adapt by numbing themselves or are
perpetually angrybull In attempt to please parents try to excel in social
standard of achievementsbull Children frequently accept outside role models over
parents to know how to live
19
Adaptational Family Styles
ndash ldquoThose who made itldquo families bull Motivated by magical fantasies during traumabull Desire to ldquomake it bigrdquo regain power and control
ndash ldquoVictim familiesrdquobull Pervasive depression fear worry and distrust of
outside worldbull Symbiotic clinging within the familybull Catastrophic reactions to everyday problems and
situationsbull Guilt used as a form of control
20
Two new categories to add to Danielis typologyndash
5 ldquoLife goes on families Conspiracy of SilenceAdvocacy for present and future gainsChildren expected to achieve
6 ldquoSplit families ndash Ready acceptance of new members (ldquoauntiesrdquo
ldquounclesrdquo ldquodaddiesrdquo ldquosiblingsrdquohellip) ndash Fluid membership-transfer between familiesndash Toleration of independence parentificationndash Creation of ldquonew familiesrdquo (eg affiliation with gangs
cults groups social institutions [churches]hellipndash Little parental oversight
21
Holocaust Link Jewish and Native American
Holocaust
Survivorsrsquo child complex Disenfranchised grief Transposition
bull Fixation to trauma bull attempts to resolve past
1 Effectsbull Nightmaresbull Perceived
obligation to ancestors
2 Coping strategiesbull Memory Candles
(Living testaments)
bull Loss cannot be openly mourned
1 Individualbull Inhibited with
shame
2 Societybull Loss of ancestral
tradition
bullLiving in the Past amp Present
1 1st GenerationbullPost Traumatic Stress Disorder
2 Subsequent GenerationsbullHistorical Unresolved Trauma
22
Neurobiology of Trans-generational Transmission of Trauma
Caveat The genetic model of transmission may evoke resistance because of its similarity with the Nazi ideology of purifying the gene pool of the German race it provides a clear theoretical basis for future research
ndash Parental traumatization may be transmitted in the same manner as some hereditary diseases are passed on from one generation to another
ndash Genetic memory code of a traumatized parent may thus be transmitted to the child through some electro-chemical processes in the brain
23
Genetic transmissionThe neural organization of various memory systems in
the parent (eg hyperalertness) would lead to a similar organization and constitution in the child
Since psychic trauma is assumed to have long-term effects on the neurochemical responses to stress in traumatized parents it may also lead to the same enduring characterological deficiencies and to a kind of biological vulnerability in the child
24
Gene Environment Interaction
bull New research helps answer the puzzling question of why post-traumatic stress doesnt happen to everyone who endures horrible trauma
bull Researchers found that survivors of child abuse were particularly likely to have symptoms of post-traumatic stress as adults if they also had specific variations in a stress-related gene
25
We are concerned with the gene for stress hormone systems
bullNorepinephrine ndash ldquorevving uprdquo hormone
bullCortisol ndash ldquoquieting downrdquo hormone
Both hormones are released in response to stress They are normally in balance
26
Stress Response
bull Designed to help mobilize ourselves to cope with danger by responding in one or more of the following behaviorsWithdrawal ndashFLIGHTImmobility-FREEZINGAggression-FIGHTAppeasement-SUBMISSIONTypically our first reaction to danger is to freeze to stop
all movement
27
A Threat Occurs Human Stress Response
Fightfleefreeze1048710 State of high alert hypervigilance1048710 Action not thought1048710 Decreased ability to think clearly or completely1048710 Extremist thinking1048710 Attention to threat ndash tagged for mental priority1048710 Increased aggression ndash loss of impulse control1048710 Dissociation buffers CNS but fragments mental functioning1048710 Speechless terror ndash loss of words1048710 Action is successful or not=helplessness
28
The Culprit-FKBP5The FKBP5 gene is active in the biochemical
make-up of the bodys stress-response system
bull Early-life abuse can result in particularly potent changes to this system as it develops mdash depending partly on whether or not the variations are present in the gene
bull The combination of the gene variations and past child abuse were the key ingredients for the doubled PTSD symptoms when a subsequent trauma occurred
bull This finding suggests a genechildhood environment interaction for adult PTSD
bull Inherited variations in multiple genes which have yet to be identified are estimated to account for 30 to 40 percent of the risk of developing PTSD
29
Research on Ancestral PTSD
bull Found that low cortisol levels were significantly associated with both PTSD in parents and lifetime PTSD in offspring whereas having a current psychiatric diagnosis other than PTSD was relatively but non-significantly associated with higher cortisol levelsndash ldquoAncestral PTSD a putative risk factor for PTSD appears to
be associated with low cortisol level in offspring even in the absence of lifetime PTSD in the offspring The findings suggest that low cortisol levels in PTSD may constitute a vulnerability marker related to parental PTSD as well as a state-related characteristic associated with acute or chronic PTSD symptomsrdquo
30
PHYSIOLOGIC DIFFERENCEDepression Stress or Trauma
CRF Gluco Corticoid Receptors
-----HYPOTHALMUS
PITUATARY
ADRENAL Gluco Corticoid Receptors ++++
31
Research Findings-FKBP5bull Research examines polymorphisms (variants of a
gene among a population) of a gene called FKBP5 ndash Protein in this gene encodes is involved in mediating the
actions of the glucocorticoid receptor which upon activation moves into the nucleus of the cell and regulates gene expression
bull Researchers discovered polymorphisms of FKBP5 were correlated with increased rates of PTSD in adults who experienced traumatic stress but only in subjects who had experienced trauma previously or who had inherited the morphism of their FKBP5 gene
32
FKBP5 Gene
bull On its own FKBP5 polymporphism was not correlated with adult PTSD-Mutation only happens in early childhood under traumatic circumstances
FOR EXAMPLEA Normal FKBP5 parent traumatized while serving in Iraq=no
mutationB Parent abused repeatedly in first 5 years of life= possibility of
FKPB5 mutation which could then be passed on
A Child inherits mutated FKBP5 gene and never experiences a trauma=no PTSD (may have some symptoms)
B Child inherits mutated FKBP5 gene and experiences a trauma=substantially greater possibility of PTSD if no buffering factors
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
3
Traumarsquos Legacies
YOUR STUDENT
PERSONALEXPERIENCES
PARENTALCAREGIVER
EXPERIENCES
FAMILYGRANDPARENTSrsquo
amp ANCESTORSrsquoEXPERIENCES
4
Letrsquos Talk About the Elephant in the Classroom
AFFECT ATTITUDE BEHAVIOR COGNITION
LEARNING
5
What Do You Have in the Classroom
bull Personal Traumasbull Familyrsquos Traumasbull Parentrsquos ChildhoodAdult Traumasbull CaregiverTeacherrsquosStaff Traumasbull Ancestorrsquos Traumasbull Community Traumas
NOT EVERY CHILD HAS THE SAME-SIZE ELEPHANT IN THEIR BACKPACK
6
Just Because a Person Has Been in a Traumatic Eventhellip
Doesnrsquot Mean They are TRAUMATIZED
7
STUDENTLEARNING
8
Letrsquos Take out Personal Experience and Look Only at InheritedTransmitted Trauma
STUDENT
GENETIC MAKEUPBIOLOGY
SCHEMASBELIEFSVALUES
LEARNEDMODELED
BEHAVIORS
9
What Makes Up a Student
BIOLOGY
SCHEMASBELIEFSVALUES
VulnerabilityTrust
IntentBlameGuilt
EmpathySelf-EsteemSelf-WorthFuturing
LEARNEDBEHAVIOR
Abused ChildgtAbusive ParentDomestic ViolencegtDomestic ldquoViolentorrdquo
VictimgtPerpetrator (Role Reversal)
10
Key Developmental Capacities Affected By Trauma
Ability to modulate tolerate or recover from extreme affect states
Regulation of bodily functions Capacity to know emotions or bodily states Capacity to describe emotions or bodily states Capacity to perceive threat including reading of safety
and danger cues Capacity for self-protection Capacity for self-soothing Ability to initiate or sustain goal-directed behavior Coherent self Identity sense of self-worth or esteem Capacity to regulate empathic arousal Capacity to trust
11
Domains Impacted by Trauma That Affect Learning
bull Behavioral Control
bull Cognition
bull Attachment
bull Dissociation
bull Affect Regulation
bull Physiological and Psychological State
bull Self Concept
12
Trans-generational Trauma
Attachment research shows a 75 correspondence between a motherrsquos attachment and that of her infant RESULTING INhellip
bull Repetition of disturbed interactions and patterns of relationships
bull Repetition of abuse and maltreatmentbull Issues for abused parents - anxiety
compensation and reparation envybull Re-enactment of unresolved attachment trauma
13
Transmission of Trauma from Parent to Child
bull ldquoDirect and specific transmission (a mental syndrome in the survivor parent leads directly to the same specific syndrome in the child)
bull Indirect and general transmission (a disorder in the parent makes the parent unable to function as a parent which indirectly leads to a general sense of deprivation in the child)
14
Trauma Symptoms that Impact Parenting PTSD Avoidant
D Negative alterations in cognitions and mood associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred) as evidenced by two or more of the following
1 Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia that is not due to head injury alcohol or drugs)
2 Persistent and exaggerated negative beliefs or expectations about oneself others or the world (eg ldquoI am badrdquo ldquoNo one can be trustedrdquo The world is completely dangerous) (Alternatively this might be expressed as eg ldquoIrsquove lost my soul foreverrdquo or ldquoMy whole nervous system is permanently ruinedrdquo)
3 Persistent distorted blame of self or others about the cause or consequences of the traumatic event(s)
4 Persistent negative emotional state (eg fear horror anger guilt or shame)
5 Markedly diminished interest or participation in significant activities6 Feelings of detachment or estrangement from others7 Persistent inability to experience positive emotions (eg unable to
have loving feelings psychic numbing)
15
Parentrsquos PTSD Arousal Symptoms
E Marked alterations in arousal and reactivity associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred as evidenced by two or more of the following
1 irritable or aggressive behavior2 reckless or self-destructive behavior (alcohol drug
eating self-harm high risk promiscuityhellip)3 hypervigilance4 exaggerated startle response5 problems with concentration6 sleep disturbance (eg difficulty falling or staying
asleep or restless sleep)
16
Empathic damage done to student by parent
1 Sense of Self-esteem2 Sense of Safety3 Affect Regulation Ability4 Fear of Abandonment5 Fear of Rejection6 Trust Level Questioned7 Fear of Betrayal8 Fear of Blame9 Sense of Control10 Loss of Sense of Self In Larger
PictureContext
17
Letrsquos Look at Traumatized FamiliesAdaptational Styles (Danieli)
bull General family types are associated with traumatic psychological responses ndash ldquoFamilies of fightersldquo
bull Children had to adopt a ldquoFighterHerordquo identity to saty in family and achieve parentsrsquo goals for recognition and redress
bull Contempt and intolerance for dependency weakness or failure
bull Outside world seen as oppositional so aggressive interaction the norm
bull Children programmed to seek validation for parentsrsquo suffering and to make their parentsrsquo whole
18
Adaptational Family Styles
ndash the Numb family bull Pervasive silence and depletion of all emotionsbull Parents capable of tolerating only minimal amount of
stimulationbull Childrenrsquos inner spontaneity and fantasy life severely
limitedbull Parents protect each other and children protect the
parentsbull Children adapt by numbing themselves or are
perpetually angrybull In attempt to please parents try to excel in social
standard of achievementsbull Children frequently accept outside role models over
parents to know how to live
19
Adaptational Family Styles
ndash ldquoThose who made itldquo families bull Motivated by magical fantasies during traumabull Desire to ldquomake it bigrdquo regain power and control
ndash ldquoVictim familiesrdquobull Pervasive depression fear worry and distrust of
outside worldbull Symbiotic clinging within the familybull Catastrophic reactions to everyday problems and
situationsbull Guilt used as a form of control
20
Two new categories to add to Danielis typologyndash
5 ldquoLife goes on families Conspiracy of SilenceAdvocacy for present and future gainsChildren expected to achieve
6 ldquoSplit families ndash Ready acceptance of new members (ldquoauntiesrdquo
ldquounclesrdquo ldquodaddiesrdquo ldquosiblingsrdquohellip) ndash Fluid membership-transfer between familiesndash Toleration of independence parentificationndash Creation of ldquonew familiesrdquo (eg affiliation with gangs
cults groups social institutions [churches]hellipndash Little parental oversight
21
Holocaust Link Jewish and Native American
Holocaust
Survivorsrsquo child complex Disenfranchised grief Transposition
bull Fixation to trauma bull attempts to resolve past
1 Effectsbull Nightmaresbull Perceived
obligation to ancestors
2 Coping strategiesbull Memory Candles
(Living testaments)
bull Loss cannot be openly mourned
1 Individualbull Inhibited with
shame
2 Societybull Loss of ancestral
tradition
bullLiving in the Past amp Present
1 1st GenerationbullPost Traumatic Stress Disorder
2 Subsequent GenerationsbullHistorical Unresolved Trauma
22
Neurobiology of Trans-generational Transmission of Trauma
Caveat The genetic model of transmission may evoke resistance because of its similarity with the Nazi ideology of purifying the gene pool of the German race it provides a clear theoretical basis for future research
ndash Parental traumatization may be transmitted in the same manner as some hereditary diseases are passed on from one generation to another
ndash Genetic memory code of a traumatized parent may thus be transmitted to the child through some electro-chemical processes in the brain
23
Genetic transmissionThe neural organization of various memory systems in
the parent (eg hyperalertness) would lead to a similar organization and constitution in the child
Since psychic trauma is assumed to have long-term effects on the neurochemical responses to stress in traumatized parents it may also lead to the same enduring characterological deficiencies and to a kind of biological vulnerability in the child
24
Gene Environment Interaction
bull New research helps answer the puzzling question of why post-traumatic stress doesnt happen to everyone who endures horrible trauma
bull Researchers found that survivors of child abuse were particularly likely to have symptoms of post-traumatic stress as adults if they also had specific variations in a stress-related gene
25
We are concerned with the gene for stress hormone systems
bullNorepinephrine ndash ldquorevving uprdquo hormone
bullCortisol ndash ldquoquieting downrdquo hormone
Both hormones are released in response to stress They are normally in balance
26
Stress Response
bull Designed to help mobilize ourselves to cope with danger by responding in one or more of the following behaviorsWithdrawal ndashFLIGHTImmobility-FREEZINGAggression-FIGHTAppeasement-SUBMISSIONTypically our first reaction to danger is to freeze to stop
all movement
27
A Threat Occurs Human Stress Response
Fightfleefreeze1048710 State of high alert hypervigilance1048710 Action not thought1048710 Decreased ability to think clearly or completely1048710 Extremist thinking1048710 Attention to threat ndash tagged for mental priority1048710 Increased aggression ndash loss of impulse control1048710 Dissociation buffers CNS but fragments mental functioning1048710 Speechless terror ndash loss of words1048710 Action is successful or not=helplessness
28
The Culprit-FKBP5The FKBP5 gene is active in the biochemical
make-up of the bodys stress-response system
bull Early-life abuse can result in particularly potent changes to this system as it develops mdash depending partly on whether or not the variations are present in the gene
bull The combination of the gene variations and past child abuse were the key ingredients for the doubled PTSD symptoms when a subsequent trauma occurred
bull This finding suggests a genechildhood environment interaction for adult PTSD
bull Inherited variations in multiple genes which have yet to be identified are estimated to account for 30 to 40 percent of the risk of developing PTSD
29
Research on Ancestral PTSD
bull Found that low cortisol levels were significantly associated with both PTSD in parents and lifetime PTSD in offspring whereas having a current psychiatric diagnosis other than PTSD was relatively but non-significantly associated with higher cortisol levelsndash ldquoAncestral PTSD a putative risk factor for PTSD appears to
be associated with low cortisol level in offspring even in the absence of lifetime PTSD in the offspring The findings suggest that low cortisol levels in PTSD may constitute a vulnerability marker related to parental PTSD as well as a state-related characteristic associated with acute or chronic PTSD symptomsrdquo
30
PHYSIOLOGIC DIFFERENCEDepression Stress or Trauma
CRF Gluco Corticoid Receptors
-----HYPOTHALMUS
PITUATARY
ADRENAL Gluco Corticoid Receptors ++++
31
Research Findings-FKBP5bull Research examines polymorphisms (variants of a
gene among a population) of a gene called FKBP5 ndash Protein in this gene encodes is involved in mediating the
actions of the glucocorticoid receptor which upon activation moves into the nucleus of the cell and regulates gene expression
bull Researchers discovered polymorphisms of FKBP5 were correlated with increased rates of PTSD in adults who experienced traumatic stress but only in subjects who had experienced trauma previously or who had inherited the morphism of their FKBP5 gene
32
FKBP5 Gene
bull On its own FKBP5 polymporphism was not correlated with adult PTSD-Mutation only happens in early childhood under traumatic circumstances
FOR EXAMPLEA Normal FKBP5 parent traumatized while serving in Iraq=no
mutationB Parent abused repeatedly in first 5 years of life= possibility of
FKPB5 mutation which could then be passed on
A Child inherits mutated FKBP5 gene and never experiences a trauma=no PTSD (may have some symptoms)
B Child inherits mutated FKBP5 gene and experiences a trauma=substantially greater possibility of PTSD if no buffering factors
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
4
Letrsquos Talk About the Elephant in the Classroom
AFFECT ATTITUDE BEHAVIOR COGNITION
LEARNING
5
What Do You Have in the Classroom
bull Personal Traumasbull Familyrsquos Traumasbull Parentrsquos ChildhoodAdult Traumasbull CaregiverTeacherrsquosStaff Traumasbull Ancestorrsquos Traumasbull Community Traumas
NOT EVERY CHILD HAS THE SAME-SIZE ELEPHANT IN THEIR BACKPACK
6
Just Because a Person Has Been in a Traumatic Eventhellip
Doesnrsquot Mean They are TRAUMATIZED
7
STUDENTLEARNING
8
Letrsquos Take out Personal Experience and Look Only at InheritedTransmitted Trauma
STUDENT
GENETIC MAKEUPBIOLOGY
SCHEMASBELIEFSVALUES
LEARNEDMODELED
BEHAVIORS
9
What Makes Up a Student
BIOLOGY
SCHEMASBELIEFSVALUES
VulnerabilityTrust
IntentBlameGuilt
EmpathySelf-EsteemSelf-WorthFuturing
LEARNEDBEHAVIOR
Abused ChildgtAbusive ParentDomestic ViolencegtDomestic ldquoViolentorrdquo
VictimgtPerpetrator (Role Reversal)
10
Key Developmental Capacities Affected By Trauma
Ability to modulate tolerate or recover from extreme affect states
Regulation of bodily functions Capacity to know emotions or bodily states Capacity to describe emotions or bodily states Capacity to perceive threat including reading of safety
and danger cues Capacity for self-protection Capacity for self-soothing Ability to initiate or sustain goal-directed behavior Coherent self Identity sense of self-worth or esteem Capacity to regulate empathic arousal Capacity to trust
11
Domains Impacted by Trauma That Affect Learning
bull Behavioral Control
bull Cognition
bull Attachment
bull Dissociation
bull Affect Regulation
bull Physiological and Psychological State
bull Self Concept
12
Trans-generational Trauma
Attachment research shows a 75 correspondence between a motherrsquos attachment and that of her infant RESULTING INhellip
bull Repetition of disturbed interactions and patterns of relationships
bull Repetition of abuse and maltreatmentbull Issues for abused parents - anxiety
compensation and reparation envybull Re-enactment of unresolved attachment trauma
13
Transmission of Trauma from Parent to Child
bull ldquoDirect and specific transmission (a mental syndrome in the survivor parent leads directly to the same specific syndrome in the child)
bull Indirect and general transmission (a disorder in the parent makes the parent unable to function as a parent which indirectly leads to a general sense of deprivation in the child)
14
Trauma Symptoms that Impact Parenting PTSD Avoidant
D Negative alterations in cognitions and mood associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred) as evidenced by two or more of the following
1 Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia that is not due to head injury alcohol or drugs)
2 Persistent and exaggerated negative beliefs or expectations about oneself others or the world (eg ldquoI am badrdquo ldquoNo one can be trustedrdquo The world is completely dangerous) (Alternatively this might be expressed as eg ldquoIrsquove lost my soul foreverrdquo or ldquoMy whole nervous system is permanently ruinedrdquo)
3 Persistent distorted blame of self or others about the cause or consequences of the traumatic event(s)
4 Persistent negative emotional state (eg fear horror anger guilt or shame)
5 Markedly diminished interest or participation in significant activities6 Feelings of detachment or estrangement from others7 Persistent inability to experience positive emotions (eg unable to
have loving feelings psychic numbing)
15
Parentrsquos PTSD Arousal Symptoms
E Marked alterations in arousal and reactivity associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred as evidenced by two or more of the following
1 irritable or aggressive behavior2 reckless or self-destructive behavior (alcohol drug
eating self-harm high risk promiscuityhellip)3 hypervigilance4 exaggerated startle response5 problems with concentration6 sleep disturbance (eg difficulty falling or staying
asleep or restless sleep)
16
Empathic damage done to student by parent
1 Sense of Self-esteem2 Sense of Safety3 Affect Regulation Ability4 Fear of Abandonment5 Fear of Rejection6 Trust Level Questioned7 Fear of Betrayal8 Fear of Blame9 Sense of Control10 Loss of Sense of Self In Larger
PictureContext
17
Letrsquos Look at Traumatized FamiliesAdaptational Styles (Danieli)
bull General family types are associated with traumatic psychological responses ndash ldquoFamilies of fightersldquo
bull Children had to adopt a ldquoFighterHerordquo identity to saty in family and achieve parentsrsquo goals for recognition and redress
bull Contempt and intolerance for dependency weakness or failure
bull Outside world seen as oppositional so aggressive interaction the norm
bull Children programmed to seek validation for parentsrsquo suffering and to make their parentsrsquo whole
18
Adaptational Family Styles
ndash the Numb family bull Pervasive silence and depletion of all emotionsbull Parents capable of tolerating only minimal amount of
stimulationbull Childrenrsquos inner spontaneity and fantasy life severely
limitedbull Parents protect each other and children protect the
parentsbull Children adapt by numbing themselves or are
perpetually angrybull In attempt to please parents try to excel in social
standard of achievementsbull Children frequently accept outside role models over
parents to know how to live
19
Adaptational Family Styles
ndash ldquoThose who made itldquo families bull Motivated by magical fantasies during traumabull Desire to ldquomake it bigrdquo regain power and control
ndash ldquoVictim familiesrdquobull Pervasive depression fear worry and distrust of
outside worldbull Symbiotic clinging within the familybull Catastrophic reactions to everyday problems and
situationsbull Guilt used as a form of control
20
Two new categories to add to Danielis typologyndash
5 ldquoLife goes on families Conspiracy of SilenceAdvocacy for present and future gainsChildren expected to achieve
6 ldquoSplit families ndash Ready acceptance of new members (ldquoauntiesrdquo
ldquounclesrdquo ldquodaddiesrdquo ldquosiblingsrdquohellip) ndash Fluid membership-transfer between familiesndash Toleration of independence parentificationndash Creation of ldquonew familiesrdquo (eg affiliation with gangs
cults groups social institutions [churches]hellipndash Little parental oversight
21
Holocaust Link Jewish and Native American
Holocaust
Survivorsrsquo child complex Disenfranchised grief Transposition
bull Fixation to trauma bull attempts to resolve past
1 Effectsbull Nightmaresbull Perceived
obligation to ancestors
2 Coping strategiesbull Memory Candles
(Living testaments)
bull Loss cannot be openly mourned
1 Individualbull Inhibited with
shame
2 Societybull Loss of ancestral
tradition
bullLiving in the Past amp Present
1 1st GenerationbullPost Traumatic Stress Disorder
2 Subsequent GenerationsbullHistorical Unresolved Trauma
22
Neurobiology of Trans-generational Transmission of Trauma
Caveat The genetic model of transmission may evoke resistance because of its similarity with the Nazi ideology of purifying the gene pool of the German race it provides a clear theoretical basis for future research
ndash Parental traumatization may be transmitted in the same manner as some hereditary diseases are passed on from one generation to another
ndash Genetic memory code of a traumatized parent may thus be transmitted to the child through some electro-chemical processes in the brain
23
Genetic transmissionThe neural organization of various memory systems in
the parent (eg hyperalertness) would lead to a similar organization and constitution in the child
Since psychic trauma is assumed to have long-term effects on the neurochemical responses to stress in traumatized parents it may also lead to the same enduring characterological deficiencies and to a kind of biological vulnerability in the child
24
Gene Environment Interaction
bull New research helps answer the puzzling question of why post-traumatic stress doesnt happen to everyone who endures horrible trauma
bull Researchers found that survivors of child abuse were particularly likely to have symptoms of post-traumatic stress as adults if they also had specific variations in a stress-related gene
25
We are concerned with the gene for stress hormone systems
bullNorepinephrine ndash ldquorevving uprdquo hormone
bullCortisol ndash ldquoquieting downrdquo hormone
Both hormones are released in response to stress They are normally in balance
26
Stress Response
bull Designed to help mobilize ourselves to cope with danger by responding in one or more of the following behaviorsWithdrawal ndashFLIGHTImmobility-FREEZINGAggression-FIGHTAppeasement-SUBMISSIONTypically our first reaction to danger is to freeze to stop
all movement
27
A Threat Occurs Human Stress Response
Fightfleefreeze1048710 State of high alert hypervigilance1048710 Action not thought1048710 Decreased ability to think clearly or completely1048710 Extremist thinking1048710 Attention to threat ndash tagged for mental priority1048710 Increased aggression ndash loss of impulse control1048710 Dissociation buffers CNS but fragments mental functioning1048710 Speechless terror ndash loss of words1048710 Action is successful or not=helplessness
28
The Culprit-FKBP5The FKBP5 gene is active in the biochemical
make-up of the bodys stress-response system
bull Early-life abuse can result in particularly potent changes to this system as it develops mdash depending partly on whether or not the variations are present in the gene
bull The combination of the gene variations and past child abuse were the key ingredients for the doubled PTSD symptoms when a subsequent trauma occurred
bull This finding suggests a genechildhood environment interaction for adult PTSD
bull Inherited variations in multiple genes which have yet to be identified are estimated to account for 30 to 40 percent of the risk of developing PTSD
29
Research on Ancestral PTSD
bull Found that low cortisol levels were significantly associated with both PTSD in parents and lifetime PTSD in offspring whereas having a current psychiatric diagnosis other than PTSD was relatively but non-significantly associated with higher cortisol levelsndash ldquoAncestral PTSD a putative risk factor for PTSD appears to
be associated with low cortisol level in offspring even in the absence of lifetime PTSD in the offspring The findings suggest that low cortisol levels in PTSD may constitute a vulnerability marker related to parental PTSD as well as a state-related characteristic associated with acute or chronic PTSD symptomsrdquo
30
PHYSIOLOGIC DIFFERENCEDepression Stress or Trauma
CRF Gluco Corticoid Receptors
-----HYPOTHALMUS
PITUATARY
ADRENAL Gluco Corticoid Receptors ++++
31
Research Findings-FKBP5bull Research examines polymorphisms (variants of a
gene among a population) of a gene called FKBP5 ndash Protein in this gene encodes is involved in mediating the
actions of the glucocorticoid receptor which upon activation moves into the nucleus of the cell and regulates gene expression
bull Researchers discovered polymorphisms of FKBP5 were correlated with increased rates of PTSD in adults who experienced traumatic stress but only in subjects who had experienced trauma previously or who had inherited the morphism of their FKBP5 gene
32
FKBP5 Gene
bull On its own FKBP5 polymporphism was not correlated with adult PTSD-Mutation only happens in early childhood under traumatic circumstances
FOR EXAMPLEA Normal FKBP5 parent traumatized while serving in Iraq=no
mutationB Parent abused repeatedly in first 5 years of life= possibility of
FKPB5 mutation which could then be passed on
A Child inherits mutated FKBP5 gene and never experiences a trauma=no PTSD (may have some symptoms)
B Child inherits mutated FKBP5 gene and experiences a trauma=substantially greater possibility of PTSD if no buffering factors
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
5
What Do You Have in the Classroom
bull Personal Traumasbull Familyrsquos Traumasbull Parentrsquos ChildhoodAdult Traumasbull CaregiverTeacherrsquosStaff Traumasbull Ancestorrsquos Traumasbull Community Traumas
NOT EVERY CHILD HAS THE SAME-SIZE ELEPHANT IN THEIR BACKPACK
6
Just Because a Person Has Been in a Traumatic Eventhellip
Doesnrsquot Mean They are TRAUMATIZED
7
STUDENTLEARNING
8
Letrsquos Take out Personal Experience and Look Only at InheritedTransmitted Trauma
STUDENT
GENETIC MAKEUPBIOLOGY
SCHEMASBELIEFSVALUES
LEARNEDMODELED
BEHAVIORS
9
What Makes Up a Student
BIOLOGY
SCHEMASBELIEFSVALUES
VulnerabilityTrust
IntentBlameGuilt
EmpathySelf-EsteemSelf-WorthFuturing
LEARNEDBEHAVIOR
Abused ChildgtAbusive ParentDomestic ViolencegtDomestic ldquoViolentorrdquo
VictimgtPerpetrator (Role Reversal)
10
Key Developmental Capacities Affected By Trauma
Ability to modulate tolerate or recover from extreme affect states
Regulation of bodily functions Capacity to know emotions or bodily states Capacity to describe emotions or bodily states Capacity to perceive threat including reading of safety
and danger cues Capacity for self-protection Capacity for self-soothing Ability to initiate or sustain goal-directed behavior Coherent self Identity sense of self-worth or esteem Capacity to regulate empathic arousal Capacity to trust
11
Domains Impacted by Trauma That Affect Learning
bull Behavioral Control
bull Cognition
bull Attachment
bull Dissociation
bull Affect Regulation
bull Physiological and Psychological State
bull Self Concept
12
Trans-generational Trauma
Attachment research shows a 75 correspondence between a motherrsquos attachment and that of her infant RESULTING INhellip
bull Repetition of disturbed interactions and patterns of relationships
bull Repetition of abuse and maltreatmentbull Issues for abused parents - anxiety
compensation and reparation envybull Re-enactment of unresolved attachment trauma
13
Transmission of Trauma from Parent to Child
bull ldquoDirect and specific transmission (a mental syndrome in the survivor parent leads directly to the same specific syndrome in the child)
bull Indirect and general transmission (a disorder in the parent makes the parent unable to function as a parent which indirectly leads to a general sense of deprivation in the child)
14
Trauma Symptoms that Impact Parenting PTSD Avoidant
D Negative alterations in cognitions and mood associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred) as evidenced by two or more of the following
1 Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia that is not due to head injury alcohol or drugs)
2 Persistent and exaggerated negative beliefs or expectations about oneself others or the world (eg ldquoI am badrdquo ldquoNo one can be trustedrdquo The world is completely dangerous) (Alternatively this might be expressed as eg ldquoIrsquove lost my soul foreverrdquo or ldquoMy whole nervous system is permanently ruinedrdquo)
3 Persistent distorted blame of self or others about the cause or consequences of the traumatic event(s)
4 Persistent negative emotional state (eg fear horror anger guilt or shame)
5 Markedly diminished interest or participation in significant activities6 Feelings of detachment or estrangement from others7 Persistent inability to experience positive emotions (eg unable to
have loving feelings psychic numbing)
15
Parentrsquos PTSD Arousal Symptoms
E Marked alterations in arousal and reactivity associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred as evidenced by two or more of the following
1 irritable or aggressive behavior2 reckless or self-destructive behavior (alcohol drug
eating self-harm high risk promiscuityhellip)3 hypervigilance4 exaggerated startle response5 problems with concentration6 sleep disturbance (eg difficulty falling or staying
asleep or restless sleep)
16
Empathic damage done to student by parent
1 Sense of Self-esteem2 Sense of Safety3 Affect Regulation Ability4 Fear of Abandonment5 Fear of Rejection6 Trust Level Questioned7 Fear of Betrayal8 Fear of Blame9 Sense of Control10 Loss of Sense of Self In Larger
PictureContext
17
Letrsquos Look at Traumatized FamiliesAdaptational Styles (Danieli)
bull General family types are associated with traumatic psychological responses ndash ldquoFamilies of fightersldquo
bull Children had to adopt a ldquoFighterHerordquo identity to saty in family and achieve parentsrsquo goals for recognition and redress
bull Contempt and intolerance for dependency weakness or failure
bull Outside world seen as oppositional so aggressive interaction the norm
bull Children programmed to seek validation for parentsrsquo suffering and to make their parentsrsquo whole
18
Adaptational Family Styles
ndash the Numb family bull Pervasive silence and depletion of all emotionsbull Parents capable of tolerating only minimal amount of
stimulationbull Childrenrsquos inner spontaneity and fantasy life severely
limitedbull Parents protect each other and children protect the
parentsbull Children adapt by numbing themselves or are
perpetually angrybull In attempt to please parents try to excel in social
standard of achievementsbull Children frequently accept outside role models over
parents to know how to live
19
Adaptational Family Styles
ndash ldquoThose who made itldquo families bull Motivated by magical fantasies during traumabull Desire to ldquomake it bigrdquo regain power and control
ndash ldquoVictim familiesrdquobull Pervasive depression fear worry and distrust of
outside worldbull Symbiotic clinging within the familybull Catastrophic reactions to everyday problems and
situationsbull Guilt used as a form of control
20
Two new categories to add to Danielis typologyndash
5 ldquoLife goes on families Conspiracy of SilenceAdvocacy for present and future gainsChildren expected to achieve
6 ldquoSplit families ndash Ready acceptance of new members (ldquoauntiesrdquo
ldquounclesrdquo ldquodaddiesrdquo ldquosiblingsrdquohellip) ndash Fluid membership-transfer between familiesndash Toleration of independence parentificationndash Creation of ldquonew familiesrdquo (eg affiliation with gangs
cults groups social institutions [churches]hellipndash Little parental oversight
21
Holocaust Link Jewish and Native American
Holocaust
Survivorsrsquo child complex Disenfranchised grief Transposition
bull Fixation to trauma bull attempts to resolve past
1 Effectsbull Nightmaresbull Perceived
obligation to ancestors
2 Coping strategiesbull Memory Candles
(Living testaments)
bull Loss cannot be openly mourned
1 Individualbull Inhibited with
shame
2 Societybull Loss of ancestral
tradition
bullLiving in the Past amp Present
1 1st GenerationbullPost Traumatic Stress Disorder
2 Subsequent GenerationsbullHistorical Unresolved Trauma
22
Neurobiology of Trans-generational Transmission of Trauma
Caveat The genetic model of transmission may evoke resistance because of its similarity with the Nazi ideology of purifying the gene pool of the German race it provides a clear theoretical basis for future research
ndash Parental traumatization may be transmitted in the same manner as some hereditary diseases are passed on from one generation to another
ndash Genetic memory code of a traumatized parent may thus be transmitted to the child through some electro-chemical processes in the brain
23
Genetic transmissionThe neural organization of various memory systems in
the parent (eg hyperalertness) would lead to a similar organization and constitution in the child
Since psychic trauma is assumed to have long-term effects on the neurochemical responses to stress in traumatized parents it may also lead to the same enduring characterological deficiencies and to a kind of biological vulnerability in the child
24
Gene Environment Interaction
bull New research helps answer the puzzling question of why post-traumatic stress doesnt happen to everyone who endures horrible trauma
bull Researchers found that survivors of child abuse were particularly likely to have symptoms of post-traumatic stress as adults if they also had specific variations in a stress-related gene
25
We are concerned with the gene for stress hormone systems
bullNorepinephrine ndash ldquorevving uprdquo hormone
bullCortisol ndash ldquoquieting downrdquo hormone
Both hormones are released in response to stress They are normally in balance
26
Stress Response
bull Designed to help mobilize ourselves to cope with danger by responding in one or more of the following behaviorsWithdrawal ndashFLIGHTImmobility-FREEZINGAggression-FIGHTAppeasement-SUBMISSIONTypically our first reaction to danger is to freeze to stop
all movement
27
A Threat Occurs Human Stress Response
Fightfleefreeze1048710 State of high alert hypervigilance1048710 Action not thought1048710 Decreased ability to think clearly or completely1048710 Extremist thinking1048710 Attention to threat ndash tagged for mental priority1048710 Increased aggression ndash loss of impulse control1048710 Dissociation buffers CNS but fragments mental functioning1048710 Speechless terror ndash loss of words1048710 Action is successful or not=helplessness
28
The Culprit-FKBP5The FKBP5 gene is active in the biochemical
make-up of the bodys stress-response system
bull Early-life abuse can result in particularly potent changes to this system as it develops mdash depending partly on whether or not the variations are present in the gene
bull The combination of the gene variations and past child abuse were the key ingredients for the doubled PTSD symptoms when a subsequent trauma occurred
bull This finding suggests a genechildhood environment interaction for adult PTSD
bull Inherited variations in multiple genes which have yet to be identified are estimated to account for 30 to 40 percent of the risk of developing PTSD
29
Research on Ancestral PTSD
bull Found that low cortisol levels were significantly associated with both PTSD in parents and lifetime PTSD in offspring whereas having a current psychiatric diagnosis other than PTSD was relatively but non-significantly associated with higher cortisol levelsndash ldquoAncestral PTSD a putative risk factor for PTSD appears to
be associated with low cortisol level in offspring even in the absence of lifetime PTSD in the offspring The findings suggest that low cortisol levels in PTSD may constitute a vulnerability marker related to parental PTSD as well as a state-related characteristic associated with acute or chronic PTSD symptomsrdquo
30
PHYSIOLOGIC DIFFERENCEDepression Stress or Trauma
CRF Gluco Corticoid Receptors
-----HYPOTHALMUS
PITUATARY
ADRENAL Gluco Corticoid Receptors ++++
31
Research Findings-FKBP5bull Research examines polymorphisms (variants of a
gene among a population) of a gene called FKBP5 ndash Protein in this gene encodes is involved in mediating the
actions of the glucocorticoid receptor which upon activation moves into the nucleus of the cell and regulates gene expression
bull Researchers discovered polymorphisms of FKBP5 were correlated with increased rates of PTSD in adults who experienced traumatic stress but only in subjects who had experienced trauma previously or who had inherited the morphism of their FKBP5 gene
32
FKBP5 Gene
bull On its own FKBP5 polymporphism was not correlated with adult PTSD-Mutation only happens in early childhood under traumatic circumstances
FOR EXAMPLEA Normal FKBP5 parent traumatized while serving in Iraq=no
mutationB Parent abused repeatedly in first 5 years of life= possibility of
FKPB5 mutation which could then be passed on
A Child inherits mutated FKBP5 gene and never experiences a trauma=no PTSD (may have some symptoms)
B Child inherits mutated FKBP5 gene and experiences a trauma=substantially greater possibility of PTSD if no buffering factors
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
6
Just Because a Person Has Been in a Traumatic Eventhellip
Doesnrsquot Mean They are TRAUMATIZED
7
STUDENTLEARNING
8
Letrsquos Take out Personal Experience and Look Only at InheritedTransmitted Trauma
STUDENT
GENETIC MAKEUPBIOLOGY
SCHEMASBELIEFSVALUES
LEARNEDMODELED
BEHAVIORS
9
What Makes Up a Student
BIOLOGY
SCHEMASBELIEFSVALUES
VulnerabilityTrust
IntentBlameGuilt
EmpathySelf-EsteemSelf-WorthFuturing
LEARNEDBEHAVIOR
Abused ChildgtAbusive ParentDomestic ViolencegtDomestic ldquoViolentorrdquo
VictimgtPerpetrator (Role Reversal)
10
Key Developmental Capacities Affected By Trauma
Ability to modulate tolerate or recover from extreme affect states
Regulation of bodily functions Capacity to know emotions or bodily states Capacity to describe emotions or bodily states Capacity to perceive threat including reading of safety
and danger cues Capacity for self-protection Capacity for self-soothing Ability to initiate or sustain goal-directed behavior Coherent self Identity sense of self-worth or esteem Capacity to regulate empathic arousal Capacity to trust
11
Domains Impacted by Trauma That Affect Learning
bull Behavioral Control
bull Cognition
bull Attachment
bull Dissociation
bull Affect Regulation
bull Physiological and Psychological State
bull Self Concept
12
Trans-generational Trauma
Attachment research shows a 75 correspondence between a motherrsquos attachment and that of her infant RESULTING INhellip
bull Repetition of disturbed interactions and patterns of relationships
bull Repetition of abuse and maltreatmentbull Issues for abused parents - anxiety
compensation and reparation envybull Re-enactment of unresolved attachment trauma
13
Transmission of Trauma from Parent to Child
bull ldquoDirect and specific transmission (a mental syndrome in the survivor parent leads directly to the same specific syndrome in the child)
bull Indirect and general transmission (a disorder in the parent makes the parent unable to function as a parent which indirectly leads to a general sense of deprivation in the child)
14
Trauma Symptoms that Impact Parenting PTSD Avoidant
D Negative alterations in cognitions and mood associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred) as evidenced by two or more of the following
1 Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia that is not due to head injury alcohol or drugs)
2 Persistent and exaggerated negative beliefs or expectations about oneself others or the world (eg ldquoI am badrdquo ldquoNo one can be trustedrdquo The world is completely dangerous) (Alternatively this might be expressed as eg ldquoIrsquove lost my soul foreverrdquo or ldquoMy whole nervous system is permanently ruinedrdquo)
3 Persistent distorted blame of self or others about the cause or consequences of the traumatic event(s)
4 Persistent negative emotional state (eg fear horror anger guilt or shame)
5 Markedly diminished interest or participation in significant activities6 Feelings of detachment or estrangement from others7 Persistent inability to experience positive emotions (eg unable to
have loving feelings psychic numbing)
15
Parentrsquos PTSD Arousal Symptoms
E Marked alterations in arousal and reactivity associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred as evidenced by two or more of the following
1 irritable or aggressive behavior2 reckless or self-destructive behavior (alcohol drug
eating self-harm high risk promiscuityhellip)3 hypervigilance4 exaggerated startle response5 problems with concentration6 sleep disturbance (eg difficulty falling or staying
asleep or restless sleep)
16
Empathic damage done to student by parent
1 Sense of Self-esteem2 Sense of Safety3 Affect Regulation Ability4 Fear of Abandonment5 Fear of Rejection6 Trust Level Questioned7 Fear of Betrayal8 Fear of Blame9 Sense of Control10 Loss of Sense of Self In Larger
PictureContext
17
Letrsquos Look at Traumatized FamiliesAdaptational Styles (Danieli)
bull General family types are associated with traumatic psychological responses ndash ldquoFamilies of fightersldquo
bull Children had to adopt a ldquoFighterHerordquo identity to saty in family and achieve parentsrsquo goals for recognition and redress
bull Contempt and intolerance for dependency weakness or failure
bull Outside world seen as oppositional so aggressive interaction the norm
bull Children programmed to seek validation for parentsrsquo suffering and to make their parentsrsquo whole
18
Adaptational Family Styles
ndash the Numb family bull Pervasive silence and depletion of all emotionsbull Parents capable of tolerating only minimal amount of
stimulationbull Childrenrsquos inner spontaneity and fantasy life severely
limitedbull Parents protect each other and children protect the
parentsbull Children adapt by numbing themselves or are
perpetually angrybull In attempt to please parents try to excel in social
standard of achievementsbull Children frequently accept outside role models over
parents to know how to live
19
Adaptational Family Styles
ndash ldquoThose who made itldquo families bull Motivated by magical fantasies during traumabull Desire to ldquomake it bigrdquo regain power and control
ndash ldquoVictim familiesrdquobull Pervasive depression fear worry and distrust of
outside worldbull Symbiotic clinging within the familybull Catastrophic reactions to everyday problems and
situationsbull Guilt used as a form of control
20
Two new categories to add to Danielis typologyndash
5 ldquoLife goes on families Conspiracy of SilenceAdvocacy for present and future gainsChildren expected to achieve
6 ldquoSplit families ndash Ready acceptance of new members (ldquoauntiesrdquo
ldquounclesrdquo ldquodaddiesrdquo ldquosiblingsrdquohellip) ndash Fluid membership-transfer between familiesndash Toleration of independence parentificationndash Creation of ldquonew familiesrdquo (eg affiliation with gangs
cults groups social institutions [churches]hellipndash Little parental oversight
21
Holocaust Link Jewish and Native American
Holocaust
Survivorsrsquo child complex Disenfranchised grief Transposition
bull Fixation to trauma bull attempts to resolve past
1 Effectsbull Nightmaresbull Perceived
obligation to ancestors
2 Coping strategiesbull Memory Candles
(Living testaments)
bull Loss cannot be openly mourned
1 Individualbull Inhibited with
shame
2 Societybull Loss of ancestral
tradition
bullLiving in the Past amp Present
1 1st GenerationbullPost Traumatic Stress Disorder
2 Subsequent GenerationsbullHistorical Unresolved Trauma
22
Neurobiology of Trans-generational Transmission of Trauma
Caveat The genetic model of transmission may evoke resistance because of its similarity with the Nazi ideology of purifying the gene pool of the German race it provides a clear theoretical basis for future research
ndash Parental traumatization may be transmitted in the same manner as some hereditary diseases are passed on from one generation to another
ndash Genetic memory code of a traumatized parent may thus be transmitted to the child through some electro-chemical processes in the brain
23
Genetic transmissionThe neural organization of various memory systems in
the parent (eg hyperalertness) would lead to a similar organization and constitution in the child
Since psychic trauma is assumed to have long-term effects on the neurochemical responses to stress in traumatized parents it may also lead to the same enduring characterological deficiencies and to a kind of biological vulnerability in the child
24
Gene Environment Interaction
bull New research helps answer the puzzling question of why post-traumatic stress doesnt happen to everyone who endures horrible trauma
bull Researchers found that survivors of child abuse were particularly likely to have symptoms of post-traumatic stress as adults if they also had specific variations in a stress-related gene
25
We are concerned with the gene for stress hormone systems
bullNorepinephrine ndash ldquorevving uprdquo hormone
bullCortisol ndash ldquoquieting downrdquo hormone
Both hormones are released in response to stress They are normally in balance
26
Stress Response
bull Designed to help mobilize ourselves to cope with danger by responding in one or more of the following behaviorsWithdrawal ndashFLIGHTImmobility-FREEZINGAggression-FIGHTAppeasement-SUBMISSIONTypically our first reaction to danger is to freeze to stop
all movement
27
A Threat Occurs Human Stress Response
Fightfleefreeze1048710 State of high alert hypervigilance1048710 Action not thought1048710 Decreased ability to think clearly or completely1048710 Extremist thinking1048710 Attention to threat ndash tagged for mental priority1048710 Increased aggression ndash loss of impulse control1048710 Dissociation buffers CNS but fragments mental functioning1048710 Speechless terror ndash loss of words1048710 Action is successful or not=helplessness
28
The Culprit-FKBP5The FKBP5 gene is active in the biochemical
make-up of the bodys stress-response system
bull Early-life abuse can result in particularly potent changes to this system as it develops mdash depending partly on whether or not the variations are present in the gene
bull The combination of the gene variations and past child abuse were the key ingredients for the doubled PTSD symptoms when a subsequent trauma occurred
bull This finding suggests a genechildhood environment interaction for adult PTSD
bull Inherited variations in multiple genes which have yet to be identified are estimated to account for 30 to 40 percent of the risk of developing PTSD
29
Research on Ancestral PTSD
bull Found that low cortisol levels were significantly associated with both PTSD in parents and lifetime PTSD in offspring whereas having a current psychiatric diagnosis other than PTSD was relatively but non-significantly associated with higher cortisol levelsndash ldquoAncestral PTSD a putative risk factor for PTSD appears to
be associated with low cortisol level in offspring even in the absence of lifetime PTSD in the offspring The findings suggest that low cortisol levels in PTSD may constitute a vulnerability marker related to parental PTSD as well as a state-related characteristic associated with acute or chronic PTSD symptomsrdquo
30
PHYSIOLOGIC DIFFERENCEDepression Stress or Trauma
CRF Gluco Corticoid Receptors
-----HYPOTHALMUS
PITUATARY
ADRENAL Gluco Corticoid Receptors ++++
31
Research Findings-FKBP5bull Research examines polymorphisms (variants of a
gene among a population) of a gene called FKBP5 ndash Protein in this gene encodes is involved in mediating the
actions of the glucocorticoid receptor which upon activation moves into the nucleus of the cell and regulates gene expression
bull Researchers discovered polymorphisms of FKBP5 were correlated with increased rates of PTSD in adults who experienced traumatic stress but only in subjects who had experienced trauma previously or who had inherited the morphism of their FKBP5 gene
32
FKBP5 Gene
bull On its own FKBP5 polymporphism was not correlated with adult PTSD-Mutation only happens in early childhood under traumatic circumstances
FOR EXAMPLEA Normal FKBP5 parent traumatized while serving in Iraq=no
mutationB Parent abused repeatedly in first 5 years of life= possibility of
FKPB5 mutation which could then be passed on
A Child inherits mutated FKBP5 gene and never experiences a trauma=no PTSD (may have some symptoms)
B Child inherits mutated FKBP5 gene and experiences a trauma=substantially greater possibility of PTSD if no buffering factors
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
7
STUDENTLEARNING
8
Letrsquos Take out Personal Experience and Look Only at InheritedTransmitted Trauma
STUDENT
GENETIC MAKEUPBIOLOGY
SCHEMASBELIEFSVALUES
LEARNEDMODELED
BEHAVIORS
9
What Makes Up a Student
BIOLOGY
SCHEMASBELIEFSVALUES
VulnerabilityTrust
IntentBlameGuilt
EmpathySelf-EsteemSelf-WorthFuturing
LEARNEDBEHAVIOR
Abused ChildgtAbusive ParentDomestic ViolencegtDomestic ldquoViolentorrdquo
VictimgtPerpetrator (Role Reversal)
10
Key Developmental Capacities Affected By Trauma
Ability to modulate tolerate or recover from extreme affect states
Regulation of bodily functions Capacity to know emotions or bodily states Capacity to describe emotions or bodily states Capacity to perceive threat including reading of safety
and danger cues Capacity for self-protection Capacity for self-soothing Ability to initiate or sustain goal-directed behavior Coherent self Identity sense of self-worth or esteem Capacity to regulate empathic arousal Capacity to trust
11
Domains Impacted by Trauma That Affect Learning
bull Behavioral Control
bull Cognition
bull Attachment
bull Dissociation
bull Affect Regulation
bull Physiological and Psychological State
bull Self Concept
12
Trans-generational Trauma
Attachment research shows a 75 correspondence between a motherrsquos attachment and that of her infant RESULTING INhellip
bull Repetition of disturbed interactions and patterns of relationships
bull Repetition of abuse and maltreatmentbull Issues for abused parents - anxiety
compensation and reparation envybull Re-enactment of unresolved attachment trauma
13
Transmission of Trauma from Parent to Child
bull ldquoDirect and specific transmission (a mental syndrome in the survivor parent leads directly to the same specific syndrome in the child)
bull Indirect and general transmission (a disorder in the parent makes the parent unable to function as a parent which indirectly leads to a general sense of deprivation in the child)
14
Trauma Symptoms that Impact Parenting PTSD Avoidant
D Negative alterations in cognitions and mood associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred) as evidenced by two or more of the following
1 Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia that is not due to head injury alcohol or drugs)
2 Persistent and exaggerated negative beliefs or expectations about oneself others or the world (eg ldquoI am badrdquo ldquoNo one can be trustedrdquo The world is completely dangerous) (Alternatively this might be expressed as eg ldquoIrsquove lost my soul foreverrdquo or ldquoMy whole nervous system is permanently ruinedrdquo)
3 Persistent distorted blame of self or others about the cause or consequences of the traumatic event(s)
4 Persistent negative emotional state (eg fear horror anger guilt or shame)
5 Markedly diminished interest or participation in significant activities6 Feelings of detachment or estrangement from others7 Persistent inability to experience positive emotions (eg unable to
have loving feelings psychic numbing)
15
Parentrsquos PTSD Arousal Symptoms
E Marked alterations in arousal and reactivity associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred as evidenced by two or more of the following
1 irritable or aggressive behavior2 reckless or self-destructive behavior (alcohol drug
eating self-harm high risk promiscuityhellip)3 hypervigilance4 exaggerated startle response5 problems with concentration6 sleep disturbance (eg difficulty falling or staying
asleep or restless sleep)
16
Empathic damage done to student by parent
1 Sense of Self-esteem2 Sense of Safety3 Affect Regulation Ability4 Fear of Abandonment5 Fear of Rejection6 Trust Level Questioned7 Fear of Betrayal8 Fear of Blame9 Sense of Control10 Loss of Sense of Self In Larger
PictureContext
17
Letrsquos Look at Traumatized FamiliesAdaptational Styles (Danieli)
bull General family types are associated with traumatic psychological responses ndash ldquoFamilies of fightersldquo
bull Children had to adopt a ldquoFighterHerordquo identity to saty in family and achieve parentsrsquo goals for recognition and redress
bull Contempt and intolerance for dependency weakness or failure
bull Outside world seen as oppositional so aggressive interaction the norm
bull Children programmed to seek validation for parentsrsquo suffering and to make their parentsrsquo whole
18
Adaptational Family Styles
ndash the Numb family bull Pervasive silence and depletion of all emotionsbull Parents capable of tolerating only minimal amount of
stimulationbull Childrenrsquos inner spontaneity and fantasy life severely
limitedbull Parents protect each other and children protect the
parentsbull Children adapt by numbing themselves or are
perpetually angrybull In attempt to please parents try to excel in social
standard of achievementsbull Children frequently accept outside role models over
parents to know how to live
19
Adaptational Family Styles
ndash ldquoThose who made itldquo families bull Motivated by magical fantasies during traumabull Desire to ldquomake it bigrdquo regain power and control
ndash ldquoVictim familiesrdquobull Pervasive depression fear worry and distrust of
outside worldbull Symbiotic clinging within the familybull Catastrophic reactions to everyday problems and
situationsbull Guilt used as a form of control
20
Two new categories to add to Danielis typologyndash
5 ldquoLife goes on families Conspiracy of SilenceAdvocacy for present and future gainsChildren expected to achieve
6 ldquoSplit families ndash Ready acceptance of new members (ldquoauntiesrdquo
ldquounclesrdquo ldquodaddiesrdquo ldquosiblingsrdquohellip) ndash Fluid membership-transfer between familiesndash Toleration of independence parentificationndash Creation of ldquonew familiesrdquo (eg affiliation with gangs
cults groups social institutions [churches]hellipndash Little parental oversight
21
Holocaust Link Jewish and Native American
Holocaust
Survivorsrsquo child complex Disenfranchised grief Transposition
bull Fixation to trauma bull attempts to resolve past
1 Effectsbull Nightmaresbull Perceived
obligation to ancestors
2 Coping strategiesbull Memory Candles
(Living testaments)
bull Loss cannot be openly mourned
1 Individualbull Inhibited with
shame
2 Societybull Loss of ancestral
tradition
bullLiving in the Past amp Present
1 1st GenerationbullPost Traumatic Stress Disorder
2 Subsequent GenerationsbullHistorical Unresolved Trauma
22
Neurobiology of Trans-generational Transmission of Trauma
Caveat The genetic model of transmission may evoke resistance because of its similarity with the Nazi ideology of purifying the gene pool of the German race it provides a clear theoretical basis for future research
ndash Parental traumatization may be transmitted in the same manner as some hereditary diseases are passed on from one generation to another
ndash Genetic memory code of a traumatized parent may thus be transmitted to the child through some electro-chemical processes in the brain
23
Genetic transmissionThe neural organization of various memory systems in
the parent (eg hyperalertness) would lead to a similar organization and constitution in the child
Since psychic trauma is assumed to have long-term effects on the neurochemical responses to stress in traumatized parents it may also lead to the same enduring characterological deficiencies and to a kind of biological vulnerability in the child
24
Gene Environment Interaction
bull New research helps answer the puzzling question of why post-traumatic stress doesnt happen to everyone who endures horrible trauma
bull Researchers found that survivors of child abuse were particularly likely to have symptoms of post-traumatic stress as adults if they also had specific variations in a stress-related gene
25
We are concerned with the gene for stress hormone systems
bullNorepinephrine ndash ldquorevving uprdquo hormone
bullCortisol ndash ldquoquieting downrdquo hormone
Both hormones are released in response to stress They are normally in balance
26
Stress Response
bull Designed to help mobilize ourselves to cope with danger by responding in one or more of the following behaviorsWithdrawal ndashFLIGHTImmobility-FREEZINGAggression-FIGHTAppeasement-SUBMISSIONTypically our first reaction to danger is to freeze to stop
all movement
27
A Threat Occurs Human Stress Response
Fightfleefreeze1048710 State of high alert hypervigilance1048710 Action not thought1048710 Decreased ability to think clearly or completely1048710 Extremist thinking1048710 Attention to threat ndash tagged for mental priority1048710 Increased aggression ndash loss of impulse control1048710 Dissociation buffers CNS but fragments mental functioning1048710 Speechless terror ndash loss of words1048710 Action is successful or not=helplessness
28
The Culprit-FKBP5The FKBP5 gene is active in the biochemical
make-up of the bodys stress-response system
bull Early-life abuse can result in particularly potent changes to this system as it develops mdash depending partly on whether or not the variations are present in the gene
bull The combination of the gene variations and past child abuse were the key ingredients for the doubled PTSD symptoms when a subsequent trauma occurred
bull This finding suggests a genechildhood environment interaction for adult PTSD
bull Inherited variations in multiple genes which have yet to be identified are estimated to account for 30 to 40 percent of the risk of developing PTSD
29
Research on Ancestral PTSD
bull Found that low cortisol levels were significantly associated with both PTSD in parents and lifetime PTSD in offspring whereas having a current psychiatric diagnosis other than PTSD was relatively but non-significantly associated with higher cortisol levelsndash ldquoAncestral PTSD a putative risk factor for PTSD appears to
be associated with low cortisol level in offspring even in the absence of lifetime PTSD in the offspring The findings suggest that low cortisol levels in PTSD may constitute a vulnerability marker related to parental PTSD as well as a state-related characteristic associated with acute or chronic PTSD symptomsrdquo
30
PHYSIOLOGIC DIFFERENCEDepression Stress or Trauma
CRF Gluco Corticoid Receptors
-----HYPOTHALMUS
PITUATARY
ADRENAL Gluco Corticoid Receptors ++++
31
Research Findings-FKBP5bull Research examines polymorphisms (variants of a
gene among a population) of a gene called FKBP5 ndash Protein in this gene encodes is involved in mediating the
actions of the glucocorticoid receptor which upon activation moves into the nucleus of the cell and regulates gene expression
bull Researchers discovered polymorphisms of FKBP5 were correlated with increased rates of PTSD in adults who experienced traumatic stress but only in subjects who had experienced trauma previously or who had inherited the morphism of their FKBP5 gene
32
FKBP5 Gene
bull On its own FKBP5 polymporphism was not correlated with adult PTSD-Mutation only happens in early childhood under traumatic circumstances
FOR EXAMPLEA Normal FKBP5 parent traumatized while serving in Iraq=no
mutationB Parent abused repeatedly in first 5 years of life= possibility of
FKPB5 mutation which could then be passed on
A Child inherits mutated FKBP5 gene and never experiences a trauma=no PTSD (may have some symptoms)
B Child inherits mutated FKBP5 gene and experiences a trauma=substantially greater possibility of PTSD if no buffering factors
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
8
Letrsquos Take out Personal Experience and Look Only at InheritedTransmitted Trauma
STUDENT
GENETIC MAKEUPBIOLOGY
SCHEMASBELIEFSVALUES
LEARNEDMODELED
BEHAVIORS
9
What Makes Up a Student
BIOLOGY
SCHEMASBELIEFSVALUES
VulnerabilityTrust
IntentBlameGuilt
EmpathySelf-EsteemSelf-WorthFuturing
LEARNEDBEHAVIOR
Abused ChildgtAbusive ParentDomestic ViolencegtDomestic ldquoViolentorrdquo
VictimgtPerpetrator (Role Reversal)
10
Key Developmental Capacities Affected By Trauma
Ability to modulate tolerate or recover from extreme affect states
Regulation of bodily functions Capacity to know emotions or bodily states Capacity to describe emotions or bodily states Capacity to perceive threat including reading of safety
and danger cues Capacity for self-protection Capacity for self-soothing Ability to initiate or sustain goal-directed behavior Coherent self Identity sense of self-worth or esteem Capacity to regulate empathic arousal Capacity to trust
11
Domains Impacted by Trauma That Affect Learning
bull Behavioral Control
bull Cognition
bull Attachment
bull Dissociation
bull Affect Regulation
bull Physiological and Psychological State
bull Self Concept
12
Trans-generational Trauma
Attachment research shows a 75 correspondence between a motherrsquos attachment and that of her infant RESULTING INhellip
bull Repetition of disturbed interactions and patterns of relationships
bull Repetition of abuse and maltreatmentbull Issues for abused parents - anxiety
compensation and reparation envybull Re-enactment of unresolved attachment trauma
13
Transmission of Trauma from Parent to Child
bull ldquoDirect and specific transmission (a mental syndrome in the survivor parent leads directly to the same specific syndrome in the child)
bull Indirect and general transmission (a disorder in the parent makes the parent unable to function as a parent which indirectly leads to a general sense of deprivation in the child)
14
Trauma Symptoms that Impact Parenting PTSD Avoidant
D Negative alterations in cognitions and mood associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred) as evidenced by two or more of the following
1 Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia that is not due to head injury alcohol or drugs)
2 Persistent and exaggerated negative beliefs or expectations about oneself others or the world (eg ldquoI am badrdquo ldquoNo one can be trustedrdquo The world is completely dangerous) (Alternatively this might be expressed as eg ldquoIrsquove lost my soul foreverrdquo or ldquoMy whole nervous system is permanently ruinedrdquo)
3 Persistent distorted blame of self or others about the cause or consequences of the traumatic event(s)
4 Persistent negative emotional state (eg fear horror anger guilt or shame)
5 Markedly diminished interest or participation in significant activities6 Feelings of detachment or estrangement from others7 Persistent inability to experience positive emotions (eg unable to
have loving feelings psychic numbing)
15
Parentrsquos PTSD Arousal Symptoms
E Marked alterations in arousal and reactivity associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred as evidenced by two or more of the following
1 irritable or aggressive behavior2 reckless or self-destructive behavior (alcohol drug
eating self-harm high risk promiscuityhellip)3 hypervigilance4 exaggerated startle response5 problems with concentration6 sleep disturbance (eg difficulty falling or staying
asleep or restless sleep)
16
Empathic damage done to student by parent
1 Sense of Self-esteem2 Sense of Safety3 Affect Regulation Ability4 Fear of Abandonment5 Fear of Rejection6 Trust Level Questioned7 Fear of Betrayal8 Fear of Blame9 Sense of Control10 Loss of Sense of Self In Larger
PictureContext
17
Letrsquos Look at Traumatized FamiliesAdaptational Styles (Danieli)
bull General family types are associated with traumatic psychological responses ndash ldquoFamilies of fightersldquo
bull Children had to adopt a ldquoFighterHerordquo identity to saty in family and achieve parentsrsquo goals for recognition and redress
bull Contempt and intolerance for dependency weakness or failure
bull Outside world seen as oppositional so aggressive interaction the norm
bull Children programmed to seek validation for parentsrsquo suffering and to make their parentsrsquo whole
18
Adaptational Family Styles
ndash the Numb family bull Pervasive silence and depletion of all emotionsbull Parents capable of tolerating only minimal amount of
stimulationbull Childrenrsquos inner spontaneity and fantasy life severely
limitedbull Parents protect each other and children protect the
parentsbull Children adapt by numbing themselves or are
perpetually angrybull In attempt to please parents try to excel in social
standard of achievementsbull Children frequently accept outside role models over
parents to know how to live
19
Adaptational Family Styles
ndash ldquoThose who made itldquo families bull Motivated by magical fantasies during traumabull Desire to ldquomake it bigrdquo regain power and control
ndash ldquoVictim familiesrdquobull Pervasive depression fear worry and distrust of
outside worldbull Symbiotic clinging within the familybull Catastrophic reactions to everyday problems and
situationsbull Guilt used as a form of control
20
Two new categories to add to Danielis typologyndash
5 ldquoLife goes on families Conspiracy of SilenceAdvocacy for present and future gainsChildren expected to achieve
6 ldquoSplit families ndash Ready acceptance of new members (ldquoauntiesrdquo
ldquounclesrdquo ldquodaddiesrdquo ldquosiblingsrdquohellip) ndash Fluid membership-transfer between familiesndash Toleration of independence parentificationndash Creation of ldquonew familiesrdquo (eg affiliation with gangs
cults groups social institutions [churches]hellipndash Little parental oversight
21
Holocaust Link Jewish and Native American
Holocaust
Survivorsrsquo child complex Disenfranchised grief Transposition
bull Fixation to trauma bull attempts to resolve past
1 Effectsbull Nightmaresbull Perceived
obligation to ancestors
2 Coping strategiesbull Memory Candles
(Living testaments)
bull Loss cannot be openly mourned
1 Individualbull Inhibited with
shame
2 Societybull Loss of ancestral
tradition
bullLiving in the Past amp Present
1 1st GenerationbullPost Traumatic Stress Disorder
2 Subsequent GenerationsbullHistorical Unresolved Trauma
22
Neurobiology of Trans-generational Transmission of Trauma
Caveat The genetic model of transmission may evoke resistance because of its similarity with the Nazi ideology of purifying the gene pool of the German race it provides a clear theoretical basis for future research
ndash Parental traumatization may be transmitted in the same manner as some hereditary diseases are passed on from one generation to another
ndash Genetic memory code of a traumatized parent may thus be transmitted to the child through some electro-chemical processes in the brain
23
Genetic transmissionThe neural organization of various memory systems in
the parent (eg hyperalertness) would lead to a similar organization and constitution in the child
Since psychic trauma is assumed to have long-term effects on the neurochemical responses to stress in traumatized parents it may also lead to the same enduring characterological deficiencies and to a kind of biological vulnerability in the child
24
Gene Environment Interaction
bull New research helps answer the puzzling question of why post-traumatic stress doesnt happen to everyone who endures horrible trauma
bull Researchers found that survivors of child abuse were particularly likely to have symptoms of post-traumatic stress as adults if they also had specific variations in a stress-related gene
25
We are concerned with the gene for stress hormone systems
bullNorepinephrine ndash ldquorevving uprdquo hormone
bullCortisol ndash ldquoquieting downrdquo hormone
Both hormones are released in response to stress They are normally in balance
26
Stress Response
bull Designed to help mobilize ourselves to cope with danger by responding in one or more of the following behaviorsWithdrawal ndashFLIGHTImmobility-FREEZINGAggression-FIGHTAppeasement-SUBMISSIONTypically our first reaction to danger is to freeze to stop
all movement
27
A Threat Occurs Human Stress Response
Fightfleefreeze1048710 State of high alert hypervigilance1048710 Action not thought1048710 Decreased ability to think clearly or completely1048710 Extremist thinking1048710 Attention to threat ndash tagged for mental priority1048710 Increased aggression ndash loss of impulse control1048710 Dissociation buffers CNS but fragments mental functioning1048710 Speechless terror ndash loss of words1048710 Action is successful or not=helplessness
28
The Culprit-FKBP5The FKBP5 gene is active in the biochemical
make-up of the bodys stress-response system
bull Early-life abuse can result in particularly potent changes to this system as it develops mdash depending partly on whether or not the variations are present in the gene
bull The combination of the gene variations and past child abuse were the key ingredients for the doubled PTSD symptoms when a subsequent trauma occurred
bull This finding suggests a genechildhood environment interaction for adult PTSD
bull Inherited variations in multiple genes which have yet to be identified are estimated to account for 30 to 40 percent of the risk of developing PTSD
29
Research on Ancestral PTSD
bull Found that low cortisol levels were significantly associated with both PTSD in parents and lifetime PTSD in offspring whereas having a current psychiatric diagnosis other than PTSD was relatively but non-significantly associated with higher cortisol levelsndash ldquoAncestral PTSD a putative risk factor for PTSD appears to
be associated with low cortisol level in offspring even in the absence of lifetime PTSD in the offspring The findings suggest that low cortisol levels in PTSD may constitute a vulnerability marker related to parental PTSD as well as a state-related characteristic associated with acute or chronic PTSD symptomsrdquo
30
PHYSIOLOGIC DIFFERENCEDepression Stress or Trauma
CRF Gluco Corticoid Receptors
-----HYPOTHALMUS
PITUATARY
ADRENAL Gluco Corticoid Receptors ++++
31
Research Findings-FKBP5bull Research examines polymorphisms (variants of a
gene among a population) of a gene called FKBP5 ndash Protein in this gene encodes is involved in mediating the
actions of the glucocorticoid receptor which upon activation moves into the nucleus of the cell and regulates gene expression
bull Researchers discovered polymorphisms of FKBP5 were correlated with increased rates of PTSD in adults who experienced traumatic stress but only in subjects who had experienced trauma previously or who had inherited the morphism of their FKBP5 gene
32
FKBP5 Gene
bull On its own FKBP5 polymporphism was not correlated with adult PTSD-Mutation only happens in early childhood under traumatic circumstances
FOR EXAMPLEA Normal FKBP5 parent traumatized while serving in Iraq=no
mutationB Parent abused repeatedly in first 5 years of life= possibility of
FKPB5 mutation which could then be passed on
A Child inherits mutated FKBP5 gene and never experiences a trauma=no PTSD (may have some symptoms)
B Child inherits mutated FKBP5 gene and experiences a trauma=substantially greater possibility of PTSD if no buffering factors
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
9
What Makes Up a Student
BIOLOGY
SCHEMASBELIEFSVALUES
VulnerabilityTrust
IntentBlameGuilt
EmpathySelf-EsteemSelf-WorthFuturing
LEARNEDBEHAVIOR
Abused ChildgtAbusive ParentDomestic ViolencegtDomestic ldquoViolentorrdquo
VictimgtPerpetrator (Role Reversal)
10
Key Developmental Capacities Affected By Trauma
Ability to modulate tolerate or recover from extreme affect states
Regulation of bodily functions Capacity to know emotions or bodily states Capacity to describe emotions or bodily states Capacity to perceive threat including reading of safety
and danger cues Capacity for self-protection Capacity for self-soothing Ability to initiate or sustain goal-directed behavior Coherent self Identity sense of self-worth or esteem Capacity to regulate empathic arousal Capacity to trust
11
Domains Impacted by Trauma That Affect Learning
bull Behavioral Control
bull Cognition
bull Attachment
bull Dissociation
bull Affect Regulation
bull Physiological and Psychological State
bull Self Concept
12
Trans-generational Trauma
Attachment research shows a 75 correspondence between a motherrsquos attachment and that of her infant RESULTING INhellip
bull Repetition of disturbed interactions and patterns of relationships
bull Repetition of abuse and maltreatmentbull Issues for abused parents - anxiety
compensation and reparation envybull Re-enactment of unresolved attachment trauma
13
Transmission of Trauma from Parent to Child
bull ldquoDirect and specific transmission (a mental syndrome in the survivor parent leads directly to the same specific syndrome in the child)
bull Indirect and general transmission (a disorder in the parent makes the parent unable to function as a parent which indirectly leads to a general sense of deprivation in the child)
14
Trauma Symptoms that Impact Parenting PTSD Avoidant
D Negative alterations in cognitions and mood associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred) as evidenced by two or more of the following
1 Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia that is not due to head injury alcohol or drugs)
2 Persistent and exaggerated negative beliefs or expectations about oneself others or the world (eg ldquoI am badrdquo ldquoNo one can be trustedrdquo The world is completely dangerous) (Alternatively this might be expressed as eg ldquoIrsquove lost my soul foreverrdquo or ldquoMy whole nervous system is permanently ruinedrdquo)
3 Persistent distorted blame of self or others about the cause or consequences of the traumatic event(s)
4 Persistent negative emotional state (eg fear horror anger guilt or shame)
5 Markedly diminished interest or participation in significant activities6 Feelings of detachment or estrangement from others7 Persistent inability to experience positive emotions (eg unable to
have loving feelings psychic numbing)
15
Parentrsquos PTSD Arousal Symptoms
E Marked alterations in arousal and reactivity associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred as evidenced by two or more of the following
1 irritable or aggressive behavior2 reckless or self-destructive behavior (alcohol drug
eating self-harm high risk promiscuityhellip)3 hypervigilance4 exaggerated startle response5 problems with concentration6 sleep disturbance (eg difficulty falling or staying
asleep or restless sleep)
16
Empathic damage done to student by parent
1 Sense of Self-esteem2 Sense of Safety3 Affect Regulation Ability4 Fear of Abandonment5 Fear of Rejection6 Trust Level Questioned7 Fear of Betrayal8 Fear of Blame9 Sense of Control10 Loss of Sense of Self In Larger
PictureContext
17
Letrsquos Look at Traumatized FamiliesAdaptational Styles (Danieli)
bull General family types are associated with traumatic psychological responses ndash ldquoFamilies of fightersldquo
bull Children had to adopt a ldquoFighterHerordquo identity to saty in family and achieve parentsrsquo goals for recognition and redress
bull Contempt and intolerance for dependency weakness or failure
bull Outside world seen as oppositional so aggressive interaction the norm
bull Children programmed to seek validation for parentsrsquo suffering and to make their parentsrsquo whole
18
Adaptational Family Styles
ndash the Numb family bull Pervasive silence and depletion of all emotionsbull Parents capable of tolerating only minimal amount of
stimulationbull Childrenrsquos inner spontaneity and fantasy life severely
limitedbull Parents protect each other and children protect the
parentsbull Children adapt by numbing themselves or are
perpetually angrybull In attempt to please parents try to excel in social
standard of achievementsbull Children frequently accept outside role models over
parents to know how to live
19
Adaptational Family Styles
ndash ldquoThose who made itldquo families bull Motivated by magical fantasies during traumabull Desire to ldquomake it bigrdquo regain power and control
ndash ldquoVictim familiesrdquobull Pervasive depression fear worry and distrust of
outside worldbull Symbiotic clinging within the familybull Catastrophic reactions to everyday problems and
situationsbull Guilt used as a form of control
20
Two new categories to add to Danielis typologyndash
5 ldquoLife goes on families Conspiracy of SilenceAdvocacy for present and future gainsChildren expected to achieve
6 ldquoSplit families ndash Ready acceptance of new members (ldquoauntiesrdquo
ldquounclesrdquo ldquodaddiesrdquo ldquosiblingsrdquohellip) ndash Fluid membership-transfer between familiesndash Toleration of independence parentificationndash Creation of ldquonew familiesrdquo (eg affiliation with gangs
cults groups social institutions [churches]hellipndash Little parental oversight
21
Holocaust Link Jewish and Native American
Holocaust
Survivorsrsquo child complex Disenfranchised grief Transposition
bull Fixation to trauma bull attempts to resolve past
1 Effectsbull Nightmaresbull Perceived
obligation to ancestors
2 Coping strategiesbull Memory Candles
(Living testaments)
bull Loss cannot be openly mourned
1 Individualbull Inhibited with
shame
2 Societybull Loss of ancestral
tradition
bullLiving in the Past amp Present
1 1st GenerationbullPost Traumatic Stress Disorder
2 Subsequent GenerationsbullHistorical Unresolved Trauma
22
Neurobiology of Trans-generational Transmission of Trauma
Caveat The genetic model of transmission may evoke resistance because of its similarity with the Nazi ideology of purifying the gene pool of the German race it provides a clear theoretical basis for future research
ndash Parental traumatization may be transmitted in the same manner as some hereditary diseases are passed on from one generation to another
ndash Genetic memory code of a traumatized parent may thus be transmitted to the child through some electro-chemical processes in the brain
23
Genetic transmissionThe neural organization of various memory systems in
the parent (eg hyperalertness) would lead to a similar organization and constitution in the child
Since psychic trauma is assumed to have long-term effects on the neurochemical responses to stress in traumatized parents it may also lead to the same enduring characterological deficiencies and to a kind of biological vulnerability in the child
24
Gene Environment Interaction
bull New research helps answer the puzzling question of why post-traumatic stress doesnt happen to everyone who endures horrible trauma
bull Researchers found that survivors of child abuse were particularly likely to have symptoms of post-traumatic stress as adults if they also had specific variations in a stress-related gene
25
We are concerned with the gene for stress hormone systems
bullNorepinephrine ndash ldquorevving uprdquo hormone
bullCortisol ndash ldquoquieting downrdquo hormone
Both hormones are released in response to stress They are normally in balance
26
Stress Response
bull Designed to help mobilize ourselves to cope with danger by responding in one or more of the following behaviorsWithdrawal ndashFLIGHTImmobility-FREEZINGAggression-FIGHTAppeasement-SUBMISSIONTypically our first reaction to danger is to freeze to stop
all movement
27
A Threat Occurs Human Stress Response
Fightfleefreeze1048710 State of high alert hypervigilance1048710 Action not thought1048710 Decreased ability to think clearly or completely1048710 Extremist thinking1048710 Attention to threat ndash tagged for mental priority1048710 Increased aggression ndash loss of impulse control1048710 Dissociation buffers CNS but fragments mental functioning1048710 Speechless terror ndash loss of words1048710 Action is successful or not=helplessness
28
The Culprit-FKBP5The FKBP5 gene is active in the biochemical
make-up of the bodys stress-response system
bull Early-life abuse can result in particularly potent changes to this system as it develops mdash depending partly on whether or not the variations are present in the gene
bull The combination of the gene variations and past child abuse were the key ingredients for the doubled PTSD symptoms when a subsequent trauma occurred
bull This finding suggests a genechildhood environment interaction for adult PTSD
bull Inherited variations in multiple genes which have yet to be identified are estimated to account for 30 to 40 percent of the risk of developing PTSD
29
Research on Ancestral PTSD
bull Found that low cortisol levels were significantly associated with both PTSD in parents and lifetime PTSD in offspring whereas having a current psychiatric diagnosis other than PTSD was relatively but non-significantly associated with higher cortisol levelsndash ldquoAncestral PTSD a putative risk factor for PTSD appears to
be associated with low cortisol level in offspring even in the absence of lifetime PTSD in the offspring The findings suggest that low cortisol levels in PTSD may constitute a vulnerability marker related to parental PTSD as well as a state-related characteristic associated with acute or chronic PTSD symptomsrdquo
30
PHYSIOLOGIC DIFFERENCEDepression Stress or Trauma
CRF Gluco Corticoid Receptors
-----HYPOTHALMUS
PITUATARY
ADRENAL Gluco Corticoid Receptors ++++
31
Research Findings-FKBP5bull Research examines polymorphisms (variants of a
gene among a population) of a gene called FKBP5 ndash Protein in this gene encodes is involved in mediating the
actions of the glucocorticoid receptor which upon activation moves into the nucleus of the cell and regulates gene expression
bull Researchers discovered polymorphisms of FKBP5 were correlated with increased rates of PTSD in adults who experienced traumatic stress but only in subjects who had experienced trauma previously or who had inherited the morphism of their FKBP5 gene
32
FKBP5 Gene
bull On its own FKBP5 polymporphism was not correlated with adult PTSD-Mutation only happens in early childhood under traumatic circumstances
FOR EXAMPLEA Normal FKBP5 parent traumatized while serving in Iraq=no
mutationB Parent abused repeatedly in first 5 years of life= possibility of
FKPB5 mutation which could then be passed on
A Child inherits mutated FKBP5 gene and never experiences a trauma=no PTSD (may have some symptoms)
B Child inherits mutated FKBP5 gene and experiences a trauma=substantially greater possibility of PTSD if no buffering factors
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
10
Key Developmental Capacities Affected By Trauma
Ability to modulate tolerate or recover from extreme affect states
Regulation of bodily functions Capacity to know emotions or bodily states Capacity to describe emotions or bodily states Capacity to perceive threat including reading of safety
and danger cues Capacity for self-protection Capacity for self-soothing Ability to initiate or sustain goal-directed behavior Coherent self Identity sense of self-worth or esteem Capacity to regulate empathic arousal Capacity to trust
11
Domains Impacted by Trauma That Affect Learning
bull Behavioral Control
bull Cognition
bull Attachment
bull Dissociation
bull Affect Regulation
bull Physiological and Psychological State
bull Self Concept
12
Trans-generational Trauma
Attachment research shows a 75 correspondence between a motherrsquos attachment and that of her infant RESULTING INhellip
bull Repetition of disturbed interactions and patterns of relationships
bull Repetition of abuse and maltreatmentbull Issues for abused parents - anxiety
compensation and reparation envybull Re-enactment of unresolved attachment trauma
13
Transmission of Trauma from Parent to Child
bull ldquoDirect and specific transmission (a mental syndrome in the survivor parent leads directly to the same specific syndrome in the child)
bull Indirect and general transmission (a disorder in the parent makes the parent unable to function as a parent which indirectly leads to a general sense of deprivation in the child)
14
Trauma Symptoms that Impact Parenting PTSD Avoidant
D Negative alterations in cognitions and mood associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred) as evidenced by two or more of the following
1 Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia that is not due to head injury alcohol or drugs)
2 Persistent and exaggerated negative beliefs or expectations about oneself others or the world (eg ldquoI am badrdquo ldquoNo one can be trustedrdquo The world is completely dangerous) (Alternatively this might be expressed as eg ldquoIrsquove lost my soul foreverrdquo or ldquoMy whole nervous system is permanently ruinedrdquo)
3 Persistent distorted blame of self or others about the cause or consequences of the traumatic event(s)
4 Persistent negative emotional state (eg fear horror anger guilt or shame)
5 Markedly diminished interest or participation in significant activities6 Feelings of detachment or estrangement from others7 Persistent inability to experience positive emotions (eg unable to
have loving feelings psychic numbing)
15
Parentrsquos PTSD Arousal Symptoms
E Marked alterations in arousal and reactivity associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred as evidenced by two or more of the following
1 irritable or aggressive behavior2 reckless or self-destructive behavior (alcohol drug
eating self-harm high risk promiscuityhellip)3 hypervigilance4 exaggerated startle response5 problems with concentration6 sleep disturbance (eg difficulty falling or staying
asleep or restless sleep)
16
Empathic damage done to student by parent
1 Sense of Self-esteem2 Sense of Safety3 Affect Regulation Ability4 Fear of Abandonment5 Fear of Rejection6 Trust Level Questioned7 Fear of Betrayal8 Fear of Blame9 Sense of Control10 Loss of Sense of Self In Larger
PictureContext
17
Letrsquos Look at Traumatized FamiliesAdaptational Styles (Danieli)
bull General family types are associated with traumatic psychological responses ndash ldquoFamilies of fightersldquo
bull Children had to adopt a ldquoFighterHerordquo identity to saty in family and achieve parentsrsquo goals for recognition and redress
bull Contempt and intolerance for dependency weakness or failure
bull Outside world seen as oppositional so aggressive interaction the norm
bull Children programmed to seek validation for parentsrsquo suffering and to make their parentsrsquo whole
18
Adaptational Family Styles
ndash the Numb family bull Pervasive silence and depletion of all emotionsbull Parents capable of tolerating only minimal amount of
stimulationbull Childrenrsquos inner spontaneity and fantasy life severely
limitedbull Parents protect each other and children protect the
parentsbull Children adapt by numbing themselves or are
perpetually angrybull In attempt to please parents try to excel in social
standard of achievementsbull Children frequently accept outside role models over
parents to know how to live
19
Adaptational Family Styles
ndash ldquoThose who made itldquo families bull Motivated by magical fantasies during traumabull Desire to ldquomake it bigrdquo regain power and control
ndash ldquoVictim familiesrdquobull Pervasive depression fear worry and distrust of
outside worldbull Symbiotic clinging within the familybull Catastrophic reactions to everyday problems and
situationsbull Guilt used as a form of control
20
Two new categories to add to Danielis typologyndash
5 ldquoLife goes on families Conspiracy of SilenceAdvocacy for present and future gainsChildren expected to achieve
6 ldquoSplit families ndash Ready acceptance of new members (ldquoauntiesrdquo
ldquounclesrdquo ldquodaddiesrdquo ldquosiblingsrdquohellip) ndash Fluid membership-transfer between familiesndash Toleration of independence parentificationndash Creation of ldquonew familiesrdquo (eg affiliation with gangs
cults groups social institutions [churches]hellipndash Little parental oversight
21
Holocaust Link Jewish and Native American
Holocaust
Survivorsrsquo child complex Disenfranchised grief Transposition
bull Fixation to trauma bull attempts to resolve past
1 Effectsbull Nightmaresbull Perceived
obligation to ancestors
2 Coping strategiesbull Memory Candles
(Living testaments)
bull Loss cannot be openly mourned
1 Individualbull Inhibited with
shame
2 Societybull Loss of ancestral
tradition
bullLiving in the Past amp Present
1 1st GenerationbullPost Traumatic Stress Disorder
2 Subsequent GenerationsbullHistorical Unresolved Trauma
22
Neurobiology of Trans-generational Transmission of Trauma
Caveat The genetic model of transmission may evoke resistance because of its similarity with the Nazi ideology of purifying the gene pool of the German race it provides a clear theoretical basis for future research
ndash Parental traumatization may be transmitted in the same manner as some hereditary diseases are passed on from one generation to another
ndash Genetic memory code of a traumatized parent may thus be transmitted to the child through some electro-chemical processes in the brain
23
Genetic transmissionThe neural organization of various memory systems in
the parent (eg hyperalertness) would lead to a similar organization and constitution in the child
Since psychic trauma is assumed to have long-term effects on the neurochemical responses to stress in traumatized parents it may also lead to the same enduring characterological deficiencies and to a kind of biological vulnerability in the child
24
Gene Environment Interaction
bull New research helps answer the puzzling question of why post-traumatic stress doesnt happen to everyone who endures horrible trauma
bull Researchers found that survivors of child abuse were particularly likely to have symptoms of post-traumatic stress as adults if they also had specific variations in a stress-related gene
25
We are concerned with the gene for stress hormone systems
bullNorepinephrine ndash ldquorevving uprdquo hormone
bullCortisol ndash ldquoquieting downrdquo hormone
Both hormones are released in response to stress They are normally in balance
26
Stress Response
bull Designed to help mobilize ourselves to cope with danger by responding in one or more of the following behaviorsWithdrawal ndashFLIGHTImmobility-FREEZINGAggression-FIGHTAppeasement-SUBMISSIONTypically our first reaction to danger is to freeze to stop
all movement
27
A Threat Occurs Human Stress Response
Fightfleefreeze1048710 State of high alert hypervigilance1048710 Action not thought1048710 Decreased ability to think clearly or completely1048710 Extremist thinking1048710 Attention to threat ndash tagged for mental priority1048710 Increased aggression ndash loss of impulse control1048710 Dissociation buffers CNS but fragments mental functioning1048710 Speechless terror ndash loss of words1048710 Action is successful or not=helplessness
28
The Culprit-FKBP5The FKBP5 gene is active in the biochemical
make-up of the bodys stress-response system
bull Early-life abuse can result in particularly potent changes to this system as it develops mdash depending partly on whether or not the variations are present in the gene
bull The combination of the gene variations and past child abuse were the key ingredients for the doubled PTSD symptoms when a subsequent trauma occurred
bull This finding suggests a genechildhood environment interaction for adult PTSD
bull Inherited variations in multiple genes which have yet to be identified are estimated to account for 30 to 40 percent of the risk of developing PTSD
29
Research on Ancestral PTSD
bull Found that low cortisol levels were significantly associated with both PTSD in parents and lifetime PTSD in offspring whereas having a current psychiatric diagnosis other than PTSD was relatively but non-significantly associated with higher cortisol levelsndash ldquoAncestral PTSD a putative risk factor for PTSD appears to
be associated with low cortisol level in offspring even in the absence of lifetime PTSD in the offspring The findings suggest that low cortisol levels in PTSD may constitute a vulnerability marker related to parental PTSD as well as a state-related characteristic associated with acute or chronic PTSD symptomsrdquo
30
PHYSIOLOGIC DIFFERENCEDepression Stress or Trauma
CRF Gluco Corticoid Receptors
-----HYPOTHALMUS
PITUATARY
ADRENAL Gluco Corticoid Receptors ++++
31
Research Findings-FKBP5bull Research examines polymorphisms (variants of a
gene among a population) of a gene called FKBP5 ndash Protein in this gene encodes is involved in mediating the
actions of the glucocorticoid receptor which upon activation moves into the nucleus of the cell and regulates gene expression
bull Researchers discovered polymorphisms of FKBP5 were correlated with increased rates of PTSD in adults who experienced traumatic stress but only in subjects who had experienced trauma previously or who had inherited the morphism of their FKBP5 gene
32
FKBP5 Gene
bull On its own FKBP5 polymporphism was not correlated with adult PTSD-Mutation only happens in early childhood under traumatic circumstances
FOR EXAMPLEA Normal FKBP5 parent traumatized while serving in Iraq=no
mutationB Parent abused repeatedly in first 5 years of life= possibility of
FKPB5 mutation which could then be passed on
A Child inherits mutated FKBP5 gene and never experiences a trauma=no PTSD (may have some symptoms)
B Child inherits mutated FKBP5 gene and experiences a trauma=substantially greater possibility of PTSD if no buffering factors
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
11
Domains Impacted by Trauma That Affect Learning
bull Behavioral Control
bull Cognition
bull Attachment
bull Dissociation
bull Affect Regulation
bull Physiological and Psychological State
bull Self Concept
12
Trans-generational Trauma
Attachment research shows a 75 correspondence between a motherrsquos attachment and that of her infant RESULTING INhellip
bull Repetition of disturbed interactions and patterns of relationships
bull Repetition of abuse and maltreatmentbull Issues for abused parents - anxiety
compensation and reparation envybull Re-enactment of unresolved attachment trauma
13
Transmission of Trauma from Parent to Child
bull ldquoDirect and specific transmission (a mental syndrome in the survivor parent leads directly to the same specific syndrome in the child)
bull Indirect and general transmission (a disorder in the parent makes the parent unable to function as a parent which indirectly leads to a general sense of deprivation in the child)
14
Trauma Symptoms that Impact Parenting PTSD Avoidant
D Negative alterations in cognitions and mood associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred) as evidenced by two or more of the following
1 Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia that is not due to head injury alcohol or drugs)
2 Persistent and exaggerated negative beliefs or expectations about oneself others or the world (eg ldquoI am badrdquo ldquoNo one can be trustedrdquo The world is completely dangerous) (Alternatively this might be expressed as eg ldquoIrsquove lost my soul foreverrdquo or ldquoMy whole nervous system is permanently ruinedrdquo)
3 Persistent distorted blame of self or others about the cause or consequences of the traumatic event(s)
4 Persistent negative emotional state (eg fear horror anger guilt or shame)
5 Markedly diminished interest or participation in significant activities6 Feelings of detachment or estrangement from others7 Persistent inability to experience positive emotions (eg unable to
have loving feelings psychic numbing)
15
Parentrsquos PTSD Arousal Symptoms
E Marked alterations in arousal and reactivity associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred as evidenced by two or more of the following
1 irritable or aggressive behavior2 reckless or self-destructive behavior (alcohol drug
eating self-harm high risk promiscuityhellip)3 hypervigilance4 exaggerated startle response5 problems with concentration6 sleep disturbance (eg difficulty falling or staying
asleep or restless sleep)
16
Empathic damage done to student by parent
1 Sense of Self-esteem2 Sense of Safety3 Affect Regulation Ability4 Fear of Abandonment5 Fear of Rejection6 Trust Level Questioned7 Fear of Betrayal8 Fear of Blame9 Sense of Control10 Loss of Sense of Self In Larger
PictureContext
17
Letrsquos Look at Traumatized FamiliesAdaptational Styles (Danieli)
bull General family types are associated with traumatic psychological responses ndash ldquoFamilies of fightersldquo
bull Children had to adopt a ldquoFighterHerordquo identity to saty in family and achieve parentsrsquo goals for recognition and redress
bull Contempt and intolerance for dependency weakness or failure
bull Outside world seen as oppositional so aggressive interaction the norm
bull Children programmed to seek validation for parentsrsquo suffering and to make their parentsrsquo whole
18
Adaptational Family Styles
ndash the Numb family bull Pervasive silence and depletion of all emotionsbull Parents capable of tolerating only minimal amount of
stimulationbull Childrenrsquos inner spontaneity and fantasy life severely
limitedbull Parents protect each other and children protect the
parentsbull Children adapt by numbing themselves or are
perpetually angrybull In attempt to please parents try to excel in social
standard of achievementsbull Children frequently accept outside role models over
parents to know how to live
19
Adaptational Family Styles
ndash ldquoThose who made itldquo families bull Motivated by magical fantasies during traumabull Desire to ldquomake it bigrdquo regain power and control
ndash ldquoVictim familiesrdquobull Pervasive depression fear worry and distrust of
outside worldbull Symbiotic clinging within the familybull Catastrophic reactions to everyday problems and
situationsbull Guilt used as a form of control
20
Two new categories to add to Danielis typologyndash
5 ldquoLife goes on families Conspiracy of SilenceAdvocacy for present and future gainsChildren expected to achieve
6 ldquoSplit families ndash Ready acceptance of new members (ldquoauntiesrdquo
ldquounclesrdquo ldquodaddiesrdquo ldquosiblingsrdquohellip) ndash Fluid membership-transfer between familiesndash Toleration of independence parentificationndash Creation of ldquonew familiesrdquo (eg affiliation with gangs
cults groups social institutions [churches]hellipndash Little parental oversight
21
Holocaust Link Jewish and Native American
Holocaust
Survivorsrsquo child complex Disenfranchised grief Transposition
bull Fixation to trauma bull attempts to resolve past
1 Effectsbull Nightmaresbull Perceived
obligation to ancestors
2 Coping strategiesbull Memory Candles
(Living testaments)
bull Loss cannot be openly mourned
1 Individualbull Inhibited with
shame
2 Societybull Loss of ancestral
tradition
bullLiving in the Past amp Present
1 1st GenerationbullPost Traumatic Stress Disorder
2 Subsequent GenerationsbullHistorical Unresolved Trauma
22
Neurobiology of Trans-generational Transmission of Trauma
Caveat The genetic model of transmission may evoke resistance because of its similarity with the Nazi ideology of purifying the gene pool of the German race it provides a clear theoretical basis for future research
ndash Parental traumatization may be transmitted in the same manner as some hereditary diseases are passed on from one generation to another
ndash Genetic memory code of a traumatized parent may thus be transmitted to the child through some electro-chemical processes in the brain
23
Genetic transmissionThe neural organization of various memory systems in
the parent (eg hyperalertness) would lead to a similar organization and constitution in the child
Since psychic trauma is assumed to have long-term effects on the neurochemical responses to stress in traumatized parents it may also lead to the same enduring characterological deficiencies and to a kind of biological vulnerability in the child
24
Gene Environment Interaction
bull New research helps answer the puzzling question of why post-traumatic stress doesnt happen to everyone who endures horrible trauma
bull Researchers found that survivors of child abuse were particularly likely to have symptoms of post-traumatic stress as adults if they also had specific variations in a stress-related gene
25
We are concerned with the gene for stress hormone systems
bullNorepinephrine ndash ldquorevving uprdquo hormone
bullCortisol ndash ldquoquieting downrdquo hormone
Both hormones are released in response to stress They are normally in balance
26
Stress Response
bull Designed to help mobilize ourselves to cope with danger by responding in one or more of the following behaviorsWithdrawal ndashFLIGHTImmobility-FREEZINGAggression-FIGHTAppeasement-SUBMISSIONTypically our first reaction to danger is to freeze to stop
all movement
27
A Threat Occurs Human Stress Response
Fightfleefreeze1048710 State of high alert hypervigilance1048710 Action not thought1048710 Decreased ability to think clearly or completely1048710 Extremist thinking1048710 Attention to threat ndash tagged for mental priority1048710 Increased aggression ndash loss of impulse control1048710 Dissociation buffers CNS but fragments mental functioning1048710 Speechless terror ndash loss of words1048710 Action is successful or not=helplessness
28
The Culprit-FKBP5The FKBP5 gene is active in the biochemical
make-up of the bodys stress-response system
bull Early-life abuse can result in particularly potent changes to this system as it develops mdash depending partly on whether or not the variations are present in the gene
bull The combination of the gene variations and past child abuse were the key ingredients for the doubled PTSD symptoms when a subsequent trauma occurred
bull This finding suggests a genechildhood environment interaction for adult PTSD
bull Inherited variations in multiple genes which have yet to be identified are estimated to account for 30 to 40 percent of the risk of developing PTSD
29
Research on Ancestral PTSD
bull Found that low cortisol levels were significantly associated with both PTSD in parents and lifetime PTSD in offspring whereas having a current psychiatric diagnosis other than PTSD was relatively but non-significantly associated with higher cortisol levelsndash ldquoAncestral PTSD a putative risk factor for PTSD appears to
be associated with low cortisol level in offspring even in the absence of lifetime PTSD in the offspring The findings suggest that low cortisol levels in PTSD may constitute a vulnerability marker related to parental PTSD as well as a state-related characteristic associated with acute or chronic PTSD symptomsrdquo
30
PHYSIOLOGIC DIFFERENCEDepression Stress or Trauma
CRF Gluco Corticoid Receptors
-----HYPOTHALMUS
PITUATARY
ADRENAL Gluco Corticoid Receptors ++++
31
Research Findings-FKBP5bull Research examines polymorphisms (variants of a
gene among a population) of a gene called FKBP5 ndash Protein in this gene encodes is involved in mediating the
actions of the glucocorticoid receptor which upon activation moves into the nucleus of the cell and regulates gene expression
bull Researchers discovered polymorphisms of FKBP5 were correlated with increased rates of PTSD in adults who experienced traumatic stress but only in subjects who had experienced trauma previously or who had inherited the morphism of their FKBP5 gene
32
FKBP5 Gene
bull On its own FKBP5 polymporphism was not correlated with adult PTSD-Mutation only happens in early childhood under traumatic circumstances
FOR EXAMPLEA Normal FKBP5 parent traumatized while serving in Iraq=no
mutationB Parent abused repeatedly in first 5 years of life= possibility of
FKPB5 mutation which could then be passed on
A Child inherits mutated FKBP5 gene and never experiences a trauma=no PTSD (may have some symptoms)
B Child inherits mutated FKBP5 gene and experiences a trauma=substantially greater possibility of PTSD if no buffering factors
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
12
Trans-generational Trauma
Attachment research shows a 75 correspondence between a motherrsquos attachment and that of her infant RESULTING INhellip
bull Repetition of disturbed interactions and patterns of relationships
bull Repetition of abuse and maltreatmentbull Issues for abused parents - anxiety
compensation and reparation envybull Re-enactment of unresolved attachment trauma
13
Transmission of Trauma from Parent to Child
bull ldquoDirect and specific transmission (a mental syndrome in the survivor parent leads directly to the same specific syndrome in the child)
bull Indirect and general transmission (a disorder in the parent makes the parent unable to function as a parent which indirectly leads to a general sense of deprivation in the child)
14
Trauma Symptoms that Impact Parenting PTSD Avoidant
D Negative alterations in cognitions and mood associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred) as evidenced by two or more of the following
1 Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia that is not due to head injury alcohol or drugs)
2 Persistent and exaggerated negative beliefs or expectations about oneself others or the world (eg ldquoI am badrdquo ldquoNo one can be trustedrdquo The world is completely dangerous) (Alternatively this might be expressed as eg ldquoIrsquove lost my soul foreverrdquo or ldquoMy whole nervous system is permanently ruinedrdquo)
3 Persistent distorted blame of self or others about the cause or consequences of the traumatic event(s)
4 Persistent negative emotional state (eg fear horror anger guilt or shame)
5 Markedly diminished interest or participation in significant activities6 Feelings of detachment or estrangement from others7 Persistent inability to experience positive emotions (eg unable to
have loving feelings psychic numbing)
15
Parentrsquos PTSD Arousal Symptoms
E Marked alterations in arousal and reactivity associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred as evidenced by two or more of the following
1 irritable or aggressive behavior2 reckless or self-destructive behavior (alcohol drug
eating self-harm high risk promiscuityhellip)3 hypervigilance4 exaggerated startle response5 problems with concentration6 sleep disturbance (eg difficulty falling or staying
asleep or restless sleep)
16
Empathic damage done to student by parent
1 Sense of Self-esteem2 Sense of Safety3 Affect Regulation Ability4 Fear of Abandonment5 Fear of Rejection6 Trust Level Questioned7 Fear of Betrayal8 Fear of Blame9 Sense of Control10 Loss of Sense of Self In Larger
PictureContext
17
Letrsquos Look at Traumatized FamiliesAdaptational Styles (Danieli)
bull General family types are associated with traumatic psychological responses ndash ldquoFamilies of fightersldquo
bull Children had to adopt a ldquoFighterHerordquo identity to saty in family and achieve parentsrsquo goals for recognition and redress
bull Contempt and intolerance for dependency weakness or failure
bull Outside world seen as oppositional so aggressive interaction the norm
bull Children programmed to seek validation for parentsrsquo suffering and to make their parentsrsquo whole
18
Adaptational Family Styles
ndash the Numb family bull Pervasive silence and depletion of all emotionsbull Parents capable of tolerating only minimal amount of
stimulationbull Childrenrsquos inner spontaneity and fantasy life severely
limitedbull Parents protect each other and children protect the
parentsbull Children adapt by numbing themselves or are
perpetually angrybull In attempt to please parents try to excel in social
standard of achievementsbull Children frequently accept outside role models over
parents to know how to live
19
Adaptational Family Styles
ndash ldquoThose who made itldquo families bull Motivated by magical fantasies during traumabull Desire to ldquomake it bigrdquo regain power and control
ndash ldquoVictim familiesrdquobull Pervasive depression fear worry and distrust of
outside worldbull Symbiotic clinging within the familybull Catastrophic reactions to everyday problems and
situationsbull Guilt used as a form of control
20
Two new categories to add to Danielis typologyndash
5 ldquoLife goes on families Conspiracy of SilenceAdvocacy for present and future gainsChildren expected to achieve
6 ldquoSplit families ndash Ready acceptance of new members (ldquoauntiesrdquo
ldquounclesrdquo ldquodaddiesrdquo ldquosiblingsrdquohellip) ndash Fluid membership-transfer between familiesndash Toleration of independence parentificationndash Creation of ldquonew familiesrdquo (eg affiliation with gangs
cults groups social institutions [churches]hellipndash Little parental oversight
21
Holocaust Link Jewish and Native American
Holocaust
Survivorsrsquo child complex Disenfranchised grief Transposition
bull Fixation to trauma bull attempts to resolve past
1 Effectsbull Nightmaresbull Perceived
obligation to ancestors
2 Coping strategiesbull Memory Candles
(Living testaments)
bull Loss cannot be openly mourned
1 Individualbull Inhibited with
shame
2 Societybull Loss of ancestral
tradition
bullLiving in the Past amp Present
1 1st GenerationbullPost Traumatic Stress Disorder
2 Subsequent GenerationsbullHistorical Unresolved Trauma
22
Neurobiology of Trans-generational Transmission of Trauma
Caveat The genetic model of transmission may evoke resistance because of its similarity with the Nazi ideology of purifying the gene pool of the German race it provides a clear theoretical basis for future research
ndash Parental traumatization may be transmitted in the same manner as some hereditary diseases are passed on from one generation to another
ndash Genetic memory code of a traumatized parent may thus be transmitted to the child through some electro-chemical processes in the brain
23
Genetic transmissionThe neural organization of various memory systems in
the parent (eg hyperalertness) would lead to a similar organization and constitution in the child
Since psychic trauma is assumed to have long-term effects on the neurochemical responses to stress in traumatized parents it may also lead to the same enduring characterological deficiencies and to a kind of biological vulnerability in the child
24
Gene Environment Interaction
bull New research helps answer the puzzling question of why post-traumatic stress doesnt happen to everyone who endures horrible trauma
bull Researchers found that survivors of child abuse were particularly likely to have symptoms of post-traumatic stress as adults if they also had specific variations in a stress-related gene
25
We are concerned with the gene for stress hormone systems
bullNorepinephrine ndash ldquorevving uprdquo hormone
bullCortisol ndash ldquoquieting downrdquo hormone
Both hormones are released in response to stress They are normally in balance
26
Stress Response
bull Designed to help mobilize ourselves to cope with danger by responding in one or more of the following behaviorsWithdrawal ndashFLIGHTImmobility-FREEZINGAggression-FIGHTAppeasement-SUBMISSIONTypically our first reaction to danger is to freeze to stop
all movement
27
A Threat Occurs Human Stress Response
Fightfleefreeze1048710 State of high alert hypervigilance1048710 Action not thought1048710 Decreased ability to think clearly or completely1048710 Extremist thinking1048710 Attention to threat ndash tagged for mental priority1048710 Increased aggression ndash loss of impulse control1048710 Dissociation buffers CNS but fragments mental functioning1048710 Speechless terror ndash loss of words1048710 Action is successful or not=helplessness
28
The Culprit-FKBP5The FKBP5 gene is active in the biochemical
make-up of the bodys stress-response system
bull Early-life abuse can result in particularly potent changes to this system as it develops mdash depending partly on whether or not the variations are present in the gene
bull The combination of the gene variations and past child abuse were the key ingredients for the doubled PTSD symptoms when a subsequent trauma occurred
bull This finding suggests a genechildhood environment interaction for adult PTSD
bull Inherited variations in multiple genes which have yet to be identified are estimated to account for 30 to 40 percent of the risk of developing PTSD
29
Research on Ancestral PTSD
bull Found that low cortisol levels were significantly associated with both PTSD in parents and lifetime PTSD in offspring whereas having a current psychiatric diagnosis other than PTSD was relatively but non-significantly associated with higher cortisol levelsndash ldquoAncestral PTSD a putative risk factor for PTSD appears to
be associated with low cortisol level in offspring even in the absence of lifetime PTSD in the offspring The findings suggest that low cortisol levels in PTSD may constitute a vulnerability marker related to parental PTSD as well as a state-related characteristic associated with acute or chronic PTSD symptomsrdquo
30
PHYSIOLOGIC DIFFERENCEDepression Stress or Trauma
CRF Gluco Corticoid Receptors
-----HYPOTHALMUS
PITUATARY
ADRENAL Gluco Corticoid Receptors ++++
31
Research Findings-FKBP5bull Research examines polymorphisms (variants of a
gene among a population) of a gene called FKBP5 ndash Protein in this gene encodes is involved in mediating the
actions of the glucocorticoid receptor which upon activation moves into the nucleus of the cell and regulates gene expression
bull Researchers discovered polymorphisms of FKBP5 were correlated with increased rates of PTSD in adults who experienced traumatic stress but only in subjects who had experienced trauma previously or who had inherited the morphism of their FKBP5 gene
32
FKBP5 Gene
bull On its own FKBP5 polymporphism was not correlated with adult PTSD-Mutation only happens in early childhood under traumatic circumstances
FOR EXAMPLEA Normal FKBP5 parent traumatized while serving in Iraq=no
mutationB Parent abused repeatedly in first 5 years of life= possibility of
FKPB5 mutation which could then be passed on
A Child inherits mutated FKBP5 gene and never experiences a trauma=no PTSD (may have some symptoms)
B Child inherits mutated FKBP5 gene and experiences a trauma=substantially greater possibility of PTSD if no buffering factors
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
13
Transmission of Trauma from Parent to Child
bull ldquoDirect and specific transmission (a mental syndrome in the survivor parent leads directly to the same specific syndrome in the child)
bull Indirect and general transmission (a disorder in the parent makes the parent unable to function as a parent which indirectly leads to a general sense of deprivation in the child)
14
Trauma Symptoms that Impact Parenting PTSD Avoidant
D Negative alterations in cognitions and mood associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred) as evidenced by two or more of the following
1 Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia that is not due to head injury alcohol or drugs)
2 Persistent and exaggerated negative beliefs or expectations about oneself others or the world (eg ldquoI am badrdquo ldquoNo one can be trustedrdquo The world is completely dangerous) (Alternatively this might be expressed as eg ldquoIrsquove lost my soul foreverrdquo or ldquoMy whole nervous system is permanently ruinedrdquo)
3 Persistent distorted blame of self or others about the cause or consequences of the traumatic event(s)
4 Persistent negative emotional state (eg fear horror anger guilt or shame)
5 Markedly diminished interest or participation in significant activities6 Feelings of detachment or estrangement from others7 Persistent inability to experience positive emotions (eg unable to
have loving feelings psychic numbing)
15
Parentrsquos PTSD Arousal Symptoms
E Marked alterations in arousal and reactivity associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred as evidenced by two or more of the following
1 irritable or aggressive behavior2 reckless or self-destructive behavior (alcohol drug
eating self-harm high risk promiscuityhellip)3 hypervigilance4 exaggerated startle response5 problems with concentration6 sleep disturbance (eg difficulty falling or staying
asleep or restless sleep)
16
Empathic damage done to student by parent
1 Sense of Self-esteem2 Sense of Safety3 Affect Regulation Ability4 Fear of Abandonment5 Fear of Rejection6 Trust Level Questioned7 Fear of Betrayal8 Fear of Blame9 Sense of Control10 Loss of Sense of Self In Larger
PictureContext
17
Letrsquos Look at Traumatized FamiliesAdaptational Styles (Danieli)
bull General family types are associated with traumatic psychological responses ndash ldquoFamilies of fightersldquo
bull Children had to adopt a ldquoFighterHerordquo identity to saty in family and achieve parentsrsquo goals for recognition and redress
bull Contempt and intolerance for dependency weakness or failure
bull Outside world seen as oppositional so aggressive interaction the norm
bull Children programmed to seek validation for parentsrsquo suffering and to make their parentsrsquo whole
18
Adaptational Family Styles
ndash the Numb family bull Pervasive silence and depletion of all emotionsbull Parents capable of tolerating only minimal amount of
stimulationbull Childrenrsquos inner spontaneity and fantasy life severely
limitedbull Parents protect each other and children protect the
parentsbull Children adapt by numbing themselves or are
perpetually angrybull In attempt to please parents try to excel in social
standard of achievementsbull Children frequently accept outside role models over
parents to know how to live
19
Adaptational Family Styles
ndash ldquoThose who made itldquo families bull Motivated by magical fantasies during traumabull Desire to ldquomake it bigrdquo regain power and control
ndash ldquoVictim familiesrdquobull Pervasive depression fear worry and distrust of
outside worldbull Symbiotic clinging within the familybull Catastrophic reactions to everyday problems and
situationsbull Guilt used as a form of control
20
Two new categories to add to Danielis typologyndash
5 ldquoLife goes on families Conspiracy of SilenceAdvocacy for present and future gainsChildren expected to achieve
6 ldquoSplit families ndash Ready acceptance of new members (ldquoauntiesrdquo
ldquounclesrdquo ldquodaddiesrdquo ldquosiblingsrdquohellip) ndash Fluid membership-transfer between familiesndash Toleration of independence parentificationndash Creation of ldquonew familiesrdquo (eg affiliation with gangs
cults groups social institutions [churches]hellipndash Little parental oversight
21
Holocaust Link Jewish and Native American
Holocaust
Survivorsrsquo child complex Disenfranchised grief Transposition
bull Fixation to trauma bull attempts to resolve past
1 Effectsbull Nightmaresbull Perceived
obligation to ancestors
2 Coping strategiesbull Memory Candles
(Living testaments)
bull Loss cannot be openly mourned
1 Individualbull Inhibited with
shame
2 Societybull Loss of ancestral
tradition
bullLiving in the Past amp Present
1 1st GenerationbullPost Traumatic Stress Disorder
2 Subsequent GenerationsbullHistorical Unresolved Trauma
22
Neurobiology of Trans-generational Transmission of Trauma
Caveat The genetic model of transmission may evoke resistance because of its similarity with the Nazi ideology of purifying the gene pool of the German race it provides a clear theoretical basis for future research
ndash Parental traumatization may be transmitted in the same manner as some hereditary diseases are passed on from one generation to another
ndash Genetic memory code of a traumatized parent may thus be transmitted to the child through some electro-chemical processes in the brain
23
Genetic transmissionThe neural organization of various memory systems in
the parent (eg hyperalertness) would lead to a similar organization and constitution in the child
Since psychic trauma is assumed to have long-term effects on the neurochemical responses to stress in traumatized parents it may also lead to the same enduring characterological deficiencies and to a kind of biological vulnerability in the child
24
Gene Environment Interaction
bull New research helps answer the puzzling question of why post-traumatic stress doesnt happen to everyone who endures horrible trauma
bull Researchers found that survivors of child abuse were particularly likely to have symptoms of post-traumatic stress as adults if they also had specific variations in a stress-related gene
25
We are concerned with the gene for stress hormone systems
bullNorepinephrine ndash ldquorevving uprdquo hormone
bullCortisol ndash ldquoquieting downrdquo hormone
Both hormones are released in response to stress They are normally in balance
26
Stress Response
bull Designed to help mobilize ourselves to cope with danger by responding in one or more of the following behaviorsWithdrawal ndashFLIGHTImmobility-FREEZINGAggression-FIGHTAppeasement-SUBMISSIONTypically our first reaction to danger is to freeze to stop
all movement
27
A Threat Occurs Human Stress Response
Fightfleefreeze1048710 State of high alert hypervigilance1048710 Action not thought1048710 Decreased ability to think clearly or completely1048710 Extremist thinking1048710 Attention to threat ndash tagged for mental priority1048710 Increased aggression ndash loss of impulse control1048710 Dissociation buffers CNS but fragments mental functioning1048710 Speechless terror ndash loss of words1048710 Action is successful or not=helplessness
28
The Culprit-FKBP5The FKBP5 gene is active in the biochemical
make-up of the bodys stress-response system
bull Early-life abuse can result in particularly potent changes to this system as it develops mdash depending partly on whether or not the variations are present in the gene
bull The combination of the gene variations and past child abuse were the key ingredients for the doubled PTSD symptoms when a subsequent trauma occurred
bull This finding suggests a genechildhood environment interaction for adult PTSD
bull Inherited variations in multiple genes which have yet to be identified are estimated to account for 30 to 40 percent of the risk of developing PTSD
29
Research on Ancestral PTSD
bull Found that low cortisol levels were significantly associated with both PTSD in parents and lifetime PTSD in offspring whereas having a current psychiatric diagnosis other than PTSD was relatively but non-significantly associated with higher cortisol levelsndash ldquoAncestral PTSD a putative risk factor for PTSD appears to
be associated with low cortisol level in offspring even in the absence of lifetime PTSD in the offspring The findings suggest that low cortisol levels in PTSD may constitute a vulnerability marker related to parental PTSD as well as a state-related characteristic associated with acute or chronic PTSD symptomsrdquo
30
PHYSIOLOGIC DIFFERENCEDepression Stress or Trauma
CRF Gluco Corticoid Receptors
-----HYPOTHALMUS
PITUATARY
ADRENAL Gluco Corticoid Receptors ++++
31
Research Findings-FKBP5bull Research examines polymorphisms (variants of a
gene among a population) of a gene called FKBP5 ndash Protein in this gene encodes is involved in mediating the
actions of the glucocorticoid receptor which upon activation moves into the nucleus of the cell and regulates gene expression
bull Researchers discovered polymorphisms of FKBP5 were correlated with increased rates of PTSD in adults who experienced traumatic stress but only in subjects who had experienced trauma previously or who had inherited the morphism of their FKBP5 gene
32
FKBP5 Gene
bull On its own FKBP5 polymporphism was not correlated with adult PTSD-Mutation only happens in early childhood under traumatic circumstances
FOR EXAMPLEA Normal FKBP5 parent traumatized while serving in Iraq=no
mutationB Parent abused repeatedly in first 5 years of life= possibility of
FKPB5 mutation which could then be passed on
A Child inherits mutated FKBP5 gene and never experiences a trauma=no PTSD (may have some symptoms)
B Child inherits mutated FKBP5 gene and experiences a trauma=substantially greater possibility of PTSD if no buffering factors
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
14
Trauma Symptoms that Impact Parenting PTSD Avoidant
D Negative alterations in cognitions and mood associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred) as evidenced by two or more of the following
1 Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia that is not due to head injury alcohol or drugs)
2 Persistent and exaggerated negative beliefs or expectations about oneself others or the world (eg ldquoI am badrdquo ldquoNo one can be trustedrdquo The world is completely dangerous) (Alternatively this might be expressed as eg ldquoIrsquove lost my soul foreverrdquo or ldquoMy whole nervous system is permanently ruinedrdquo)
3 Persistent distorted blame of self or others about the cause or consequences of the traumatic event(s)
4 Persistent negative emotional state (eg fear horror anger guilt or shame)
5 Markedly diminished interest or participation in significant activities6 Feelings of detachment or estrangement from others7 Persistent inability to experience positive emotions (eg unable to
have loving feelings psychic numbing)
15
Parentrsquos PTSD Arousal Symptoms
E Marked alterations in arousal and reactivity associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred as evidenced by two or more of the following
1 irritable or aggressive behavior2 reckless or self-destructive behavior (alcohol drug
eating self-harm high risk promiscuityhellip)3 hypervigilance4 exaggerated startle response5 problems with concentration6 sleep disturbance (eg difficulty falling or staying
asleep or restless sleep)
16
Empathic damage done to student by parent
1 Sense of Self-esteem2 Sense of Safety3 Affect Regulation Ability4 Fear of Abandonment5 Fear of Rejection6 Trust Level Questioned7 Fear of Betrayal8 Fear of Blame9 Sense of Control10 Loss of Sense of Self In Larger
PictureContext
17
Letrsquos Look at Traumatized FamiliesAdaptational Styles (Danieli)
bull General family types are associated with traumatic psychological responses ndash ldquoFamilies of fightersldquo
bull Children had to adopt a ldquoFighterHerordquo identity to saty in family and achieve parentsrsquo goals for recognition and redress
bull Contempt and intolerance for dependency weakness or failure
bull Outside world seen as oppositional so aggressive interaction the norm
bull Children programmed to seek validation for parentsrsquo suffering and to make their parentsrsquo whole
18
Adaptational Family Styles
ndash the Numb family bull Pervasive silence and depletion of all emotionsbull Parents capable of tolerating only minimal amount of
stimulationbull Childrenrsquos inner spontaneity and fantasy life severely
limitedbull Parents protect each other and children protect the
parentsbull Children adapt by numbing themselves or are
perpetually angrybull In attempt to please parents try to excel in social
standard of achievementsbull Children frequently accept outside role models over
parents to know how to live
19
Adaptational Family Styles
ndash ldquoThose who made itldquo families bull Motivated by magical fantasies during traumabull Desire to ldquomake it bigrdquo regain power and control
ndash ldquoVictim familiesrdquobull Pervasive depression fear worry and distrust of
outside worldbull Symbiotic clinging within the familybull Catastrophic reactions to everyday problems and
situationsbull Guilt used as a form of control
20
Two new categories to add to Danielis typologyndash
5 ldquoLife goes on families Conspiracy of SilenceAdvocacy for present and future gainsChildren expected to achieve
6 ldquoSplit families ndash Ready acceptance of new members (ldquoauntiesrdquo
ldquounclesrdquo ldquodaddiesrdquo ldquosiblingsrdquohellip) ndash Fluid membership-transfer between familiesndash Toleration of independence parentificationndash Creation of ldquonew familiesrdquo (eg affiliation with gangs
cults groups social institutions [churches]hellipndash Little parental oversight
21
Holocaust Link Jewish and Native American
Holocaust
Survivorsrsquo child complex Disenfranchised grief Transposition
bull Fixation to trauma bull attempts to resolve past
1 Effectsbull Nightmaresbull Perceived
obligation to ancestors
2 Coping strategiesbull Memory Candles
(Living testaments)
bull Loss cannot be openly mourned
1 Individualbull Inhibited with
shame
2 Societybull Loss of ancestral
tradition
bullLiving in the Past amp Present
1 1st GenerationbullPost Traumatic Stress Disorder
2 Subsequent GenerationsbullHistorical Unresolved Trauma
22
Neurobiology of Trans-generational Transmission of Trauma
Caveat The genetic model of transmission may evoke resistance because of its similarity with the Nazi ideology of purifying the gene pool of the German race it provides a clear theoretical basis for future research
ndash Parental traumatization may be transmitted in the same manner as some hereditary diseases are passed on from one generation to another
ndash Genetic memory code of a traumatized parent may thus be transmitted to the child through some electro-chemical processes in the brain
23
Genetic transmissionThe neural organization of various memory systems in
the parent (eg hyperalertness) would lead to a similar organization and constitution in the child
Since psychic trauma is assumed to have long-term effects on the neurochemical responses to stress in traumatized parents it may also lead to the same enduring characterological deficiencies and to a kind of biological vulnerability in the child
24
Gene Environment Interaction
bull New research helps answer the puzzling question of why post-traumatic stress doesnt happen to everyone who endures horrible trauma
bull Researchers found that survivors of child abuse were particularly likely to have symptoms of post-traumatic stress as adults if they also had specific variations in a stress-related gene
25
We are concerned with the gene for stress hormone systems
bullNorepinephrine ndash ldquorevving uprdquo hormone
bullCortisol ndash ldquoquieting downrdquo hormone
Both hormones are released in response to stress They are normally in balance
26
Stress Response
bull Designed to help mobilize ourselves to cope with danger by responding in one or more of the following behaviorsWithdrawal ndashFLIGHTImmobility-FREEZINGAggression-FIGHTAppeasement-SUBMISSIONTypically our first reaction to danger is to freeze to stop
all movement
27
A Threat Occurs Human Stress Response
Fightfleefreeze1048710 State of high alert hypervigilance1048710 Action not thought1048710 Decreased ability to think clearly or completely1048710 Extremist thinking1048710 Attention to threat ndash tagged for mental priority1048710 Increased aggression ndash loss of impulse control1048710 Dissociation buffers CNS but fragments mental functioning1048710 Speechless terror ndash loss of words1048710 Action is successful or not=helplessness
28
The Culprit-FKBP5The FKBP5 gene is active in the biochemical
make-up of the bodys stress-response system
bull Early-life abuse can result in particularly potent changes to this system as it develops mdash depending partly on whether or not the variations are present in the gene
bull The combination of the gene variations and past child abuse were the key ingredients for the doubled PTSD symptoms when a subsequent trauma occurred
bull This finding suggests a genechildhood environment interaction for adult PTSD
bull Inherited variations in multiple genes which have yet to be identified are estimated to account for 30 to 40 percent of the risk of developing PTSD
29
Research on Ancestral PTSD
bull Found that low cortisol levels were significantly associated with both PTSD in parents and lifetime PTSD in offspring whereas having a current psychiatric diagnosis other than PTSD was relatively but non-significantly associated with higher cortisol levelsndash ldquoAncestral PTSD a putative risk factor for PTSD appears to
be associated with low cortisol level in offspring even in the absence of lifetime PTSD in the offspring The findings suggest that low cortisol levels in PTSD may constitute a vulnerability marker related to parental PTSD as well as a state-related characteristic associated with acute or chronic PTSD symptomsrdquo
30
PHYSIOLOGIC DIFFERENCEDepression Stress or Trauma
CRF Gluco Corticoid Receptors
-----HYPOTHALMUS
PITUATARY
ADRENAL Gluco Corticoid Receptors ++++
31
Research Findings-FKBP5bull Research examines polymorphisms (variants of a
gene among a population) of a gene called FKBP5 ndash Protein in this gene encodes is involved in mediating the
actions of the glucocorticoid receptor which upon activation moves into the nucleus of the cell and regulates gene expression
bull Researchers discovered polymorphisms of FKBP5 were correlated with increased rates of PTSD in adults who experienced traumatic stress but only in subjects who had experienced trauma previously or who had inherited the morphism of their FKBP5 gene
32
FKBP5 Gene
bull On its own FKBP5 polymporphism was not correlated with adult PTSD-Mutation only happens in early childhood under traumatic circumstances
FOR EXAMPLEA Normal FKBP5 parent traumatized while serving in Iraq=no
mutationB Parent abused repeatedly in first 5 years of life= possibility of
FKPB5 mutation which could then be passed on
A Child inherits mutated FKBP5 gene and never experiences a trauma=no PTSD (may have some symptoms)
B Child inherits mutated FKBP5 gene and experiences a trauma=substantially greater possibility of PTSD if no buffering factors
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
15
Parentrsquos PTSD Arousal Symptoms
E Marked alterations in arousal and reactivity associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred as evidenced by two or more of the following
1 irritable or aggressive behavior2 reckless or self-destructive behavior (alcohol drug
eating self-harm high risk promiscuityhellip)3 hypervigilance4 exaggerated startle response5 problems with concentration6 sleep disturbance (eg difficulty falling or staying
asleep or restless sleep)
16
Empathic damage done to student by parent
1 Sense of Self-esteem2 Sense of Safety3 Affect Regulation Ability4 Fear of Abandonment5 Fear of Rejection6 Trust Level Questioned7 Fear of Betrayal8 Fear of Blame9 Sense of Control10 Loss of Sense of Self In Larger
PictureContext
17
Letrsquos Look at Traumatized FamiliesAdaptational Styles (Danieli)
bull General family types are associated with traumatic psychological responses ndash ldquoFamilies of fightersldquo
bull Children had to adopt a ldquoFighterHerordquo identity to saty in family and achieve parentsrsquo goals for recognition and redress
bull Contempt and intolerance for dependency weakness or failure
bull Outside world seen as oppositional so aggressive interaction the norm
bull Children programmed to seek validation for parentsrsquo suffering and to make their parentsrsquo whole
18
Adaptational Family Styles
ndash the Numb family bull Pervasive silence and depletion of all emotionsbull Parents capable of tolerating only minimal amount of
stimulationbull Childrenrsquos inner spontaneity and fantasy life severely
limitedbull Parents protect each other and children protect the
parentsbull Children adapt by numbing themselves or are
perpetually angrybull In attempt to please parents try to excel in social
standard of achievementsbull Children frequently accept outside role models over
parents to know how to live
19
Adaptational Family Styles
ndash ldquoThose who made itldquo families bull Motivated by magical fantasies during traumabull Desire to ldquomake it bigrdquo regain power and control
ndash ldquoVictim familiesrdquobull Pervasive depression fear worry and distrust of
outside worldbull Symbiotic clinging within the familybull Catastrophic reactions to everyday problems and
situationsbull Guilt used as a form of control
20
Two new categories to add to Danielis typologyndash
5 ldquoLife goes on families Conspiracy of SilenceAdvocacy for present and future gainsChildren expected to achieve
6 ldquoSplit families ndash Ready acceptance of new members (ldquoauntiesrdquo
ldquounclesrdquo ldquodaddiesrdquo ldquosiblingsrdquohellip) ndash Fluid membership-transfer between familiesndash Toleration of independence parentificationndash Creation of ldquonew familiesrdquo (eg affiliation with gangs
cults groups social institutions [churches]hellipndash Little parental oversight
21
Holocaust Link Jewish and Native American
Holocaust
Survivorsrsquo child complex Disenfranchised grief Transposition
bull Fixation to trauma bull attempts to resolve past
1 Effectsbull Nightmaresbull Perceived
obligation to ancestors
2 Coping strategiesbull Memory Candles
(Living testaments)
bull Loss cannot be openly mourned
1 Individualbull Inhibited with
shame
2 Societybull Loss of ancestral
tradition
bullLiving in the Past amp Present
1 1st GenerationbullPost Traumatic Stress Disorder
2 Subsequent GenerationsbullHistorical Unresolved Trauma
22
Neurobiology of Trans-generational Transmission of Trauma
Caveat The genetic model of transmission may evoke resistance because of its similarity with the Nazi ideology of purifying the gene pool of the German race it provides a clear theoretical basis for future research
ndash Parental traumatization may be transmitted in the same manner as some hereditary diseases are passed on from one generation to another
ndash Genetic memory code of a traumatized parent may thus be transmitted to the child through some electro-chemical processes in the brain
23
Genetic transmissionThe neural organization of various memory systems in
the parent (eg hyperalertness) would lead to a similar organization and constitution in the child
Since psychic trauma is assumed to have long-term effects on the neurochemical responses to stress in traumatized parents it may also lead to the same enduring characterological deficiencies and to a kind of biological vulnerability in the child
24
Gene Environment Interaction
bull New research helps answer the puzzling question of why post-traumatic stress doesnt happen to everyone who endures horrible trauma
bull Researchers found that survivors of child abuse were particularly likely to have symptoms of post-traumatic stress as adults if they also had specific variations in a stress-related gene
25
We are concerned with the gene for stress hormone systems
bullNorepinephrine ndash ldquorevving uprdquo hormone
bullCortisol ndash ldquoquieting downrdquo hormone
Both hormones are released in response to stress They are normally in balance
26
Stress Response
bull Designed to help mobilize ourselves to cope with danger by responding in one or more of the following behaviorsWithdrawal ndashFLIGHTImmobility-FREEZINGAggression-FIGHTAppeasement-SUBMISSIONTypically our first reaction to danger is to freeze to stop
all movement
27
A Threat Occurs Human Stress Response
Fightfleefreeze1048710 State of high alert hypervigilance1048710 Action not thought1048710 Decreased ability to think clearly or completely1048710 Extremist thinking1048710 Attention to threat ndash tagged for mental priority1048710 Increased aggression ndash loss of impulse control1048710 Dissociation buffers CNS but fragments mental functioning1048710 Speechless terror ndash loss of words1048710 Action is successful or not=helplessness
28
The Culprit-FKBP5The FKBP5 gene is active in the biochemical
make-up of the bodys stress-response system
bull Early-life abuse can result in particularly potent changes to this system as it develops mdash depending partly on whether or not the variations are present in the gene
bull The combination of the gene variations and past child abuse were the key ingredients for the doubled PTSD symptoms when a subsequent trauma occurred
bull This finding suggests a genechildhood environment interaction for adult PTSD
bull Inherited variations in multiple genes which have yet to be identified are estimated to account for 30 to 40 percent of the risk of developing PTSD
29
Research on Ancestral PTSD
bull Found that low cortisol levels were significantly associated with both PTSD in parents and lifetime PTSD in offspring whereas having a current psychiatric diagnosis other than PTSD was relatively but non-significantly associated with higher cortisol levelsndash ldquoAncestral PTSD a putative risk factor for PTSD appears to
be associated with low cortisol level in offspring even in the absence of lifetime PTSD in the offspring The findings suggest that low cortisol levels in PTSD may constitute a vulnerability marker related to parental PTSD as well as a state-related characteristic associated with acute or chronic PTSD symptomsrdquo
30
PHYSIOLOGIC DIFFERENCEDepression Stress or Trauma
CRF Gluco Corticoid Receptors
-----HYPOTHALMUS
PITUATARY
ADRENAL Gluco Corticoid Receptors ++++
31
Research Findings-FKBP5bull Research examines polymorphisms (variants of a
gene among a population) of a gene called FKBP5 ndash Protein in this gene encodes is involved in mediating the
actions of the glucocorticoid receptor which upon activation moves into the nucleus of the cell and regulates gene expression
bull Researchers discovered polymorphisms of FKBP5 were correlated with increased rates of PTSD in adults who experienced traumatic stress but only in subjects who had experienced trauma previously or who had inherited the morphism of their FKBP5 gene
32
FKBP5 Gene
bull On its own FKBP5 polymporphism was not correlated with adult PTSD-Mutation only happens in early childhood under traumatic circumstances
FOR EXAMPLEA Normal FKBP5 parent traumatized while serving in Iraq=no
mutationB Parent abused repeatedly in first 5 years of life= possibility of
FKPB5 mutation which could then be passed on
A Child inherits mutated FKBP5 gene and never experiences a trauma=no PTSD (may have some symptoms)
B Child inherits mutated FKBP5 gene and experiences a trauma=substantially greater possibility of PTSD if no buffering factors
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
16
Empathic damage done to student by parent
1 Sense of Self-esteem2 Sense of Safety3 Affect Regulation Ability4 Fear of Abandonment5 Fear of Rejection6 Trust Level Questioned7 Fear of Betrayal8 Fear of Blame9 Sense of Control10 Loss of Sense of Self In Larger
PictureContext
17
Letrsquos Look at Traumatized FamiliesAdaptational Styles (Danieli)
bull General family types are associated with traumatic psychological responses ndash ldquoFamilies of fightersldquo
bull Children had to adopt a ldquoFighterHerordquo identity to saty in family and achieve parentsrsquo goals for recognition and redress
bull Contempt and intolerance for dependency weakness or failure
bull Outside world seen as oppositional so aggressive interaction the norm
bull Children programmed to seek validation for parentsrsquo suffering and to make their parentsrsquo whole
18
Adaptational Family Styles
ndash the Numb family bull Pervasive silence and depletion of all emotionsbull Parents capable of tolerating only minimal amount of
stimulationbull Childrenrsquos inner spontaneity and fantasy life severely
limitedbull Parents protect each other and children protect the
parentsbull Children adapt by numbing themselves or are
perpetually angrybull In attempt to please parents try to excel in social
standard of achievementsbull Children frequently accept outside role models over
parents to know how to live
19
Adaptational Family Styles
ndash ldquoThose who made itldquo families bull Motivated by magical fantasies during traumabull Desire to ldquomake it bigrdquo regain power and control
ndash ldquoVictim familiesrdquobull Pervasive depression fear worry and distrust of
outside worldbull Symbiotic clinging within the familybull Catastrophic reactions to everyday problems and
situationsbull Guilt used as a form of control
20
Two new categories to add to Danielis typologyndash
5 ldquoLife goes on families Conspiracy of SilenceAdvocacy for present and future gainsChildren expected to achieve
6 ldquoSplit families ndash Ready acceptance of new members (ldquoauntiesrdquo
ldquounclesrdquo ldquodaddiesrdquo ldquosiblingsrdquohellip) ndash Fluid membership-transfer between familiesndash Toleration of independence parentificationndash Creation of ldquonew familiesrdquo (eg affiliation with gangs
cults groups social institutions [churches]hellipndash Little parental oversight
21
Holocaust Link Jewish and Native American
Holocaust
Survivorsrsquo child complex Disenfranchised grief Transposition
bull Fixation to trauma bull attempts to resolve past
1 Effectsbull Nightmaresbull Perceived
obligation to ancestors
2 Coping strategiesbull Memory Candles
(Living testaments)
bull Loss cannot be openly mourned
1 Individualbull Inhibited with
shame
2 Societybull Loss of ancestral
tradition
bullLiving in the Past amp Present
1 1st GenerationbullPost Traumatic Stress Disorder
2 Subsequent GenerationsbullHistorical Unresolved Trauma
22
Neurobiology of Trans-generational Transmission of Trauma
Caveat The genetic model of transmission may evoke resistance because of its similarity with the Nazi ideology of purifying the gene pool of the German race it provides a clear theoretical basis for future research
ndash Parental traumatization may be transmitted in the same manner as some hereditary diseases are passed on from one generation to another
ndash Genetic memory code of a traumatized parent may thus be transmitted to the child through some electro-chemical processes in the brain
23
Genetic transmissionThe neural organization of various memory systems in
the parent (eg hyperalertness) would lead to a similar organization and constitution in the child
Since psychic trauma is assumed to have long-term effects on the neurochemical responses to stress in traumatized parents it may also lead to the same enduring characterological deficiencies and to a kind of biological vulnerability in the child
24
Gene Environment Interaction
bull New research helps answer the puzzling question of why post-traumatic stress doesnt happen to everyone who endures horrible trauma
bull Researchers found that survivors of child abuse were particularly likely to have symptoms of post-traumatic stress as adults if they also had specific variations in a stress-related gene
25
We are concerned with the gene for stress hormone systems
bullNorepinephrine ndash ldquorevving uprdquo hormone
bullCortisol ndash ldquoquieting downrdquo hormone
Both hormones are released in response to stress They are normally in balance
26
Stress Response
bull Designed to help mobilize ourselves to cope with danger by responding in one or more of the following behaviorsWithdrawal ndashFLIGHTImmobility-FREEZINGAggression-FIGHTAppeasement-SUBMISSIONTypically our first reaction to danger is to freeze to stop
all movement
27
A Threat Occurs Human Stress Response
Fightfleefreeze1048710 State of high alert hypervigilance1048710 Action not thought1048710 Decreased ability to think clearly or completely1048710 Extremist thinking1048710 Attention to threat ndash tagged for mental priority1048710 Increased aggression ndash loss of impulse control1048710 Dissociation buffers CNS but fragments mental functioning1048710 Speechless terror ndash loss of words1048710 Action is successful or not=helplessness
28
The Culprit-FKBP5The FKBP5 gene is active in the biochemical
make-up of the bodys stress-response system
bull Early-life abuse can result in particularly potent changes to this system as it develops mdash depending partly on whether or not the variations are present in the gene
bull The combination of the gene variations and past child abuse were the key ingredients for the doubled PTSD symptoms when a subsequent trauma occurred
bull This finding suggests a genechildhood environment interaction for adult PTSD
bull Inherited variations in multiple genes which have yet to be identified are estimated to account for 30 to 40 percent of the risk of developing PTSD
29
Research on Ancestral PTSD
bull Found that low cortisol levels were significantly associated with both PTSD in parents and lifetime PTSD in offspring whereas having a current psychiatric diagnosis other than PTSD was relatively but non-significantly associated with higher cortisol levelsndash ldquoAncestral PTSD a putative risk factor for PTSD appears to
be associated with low cortisol level in offspring even in the absence of lifetime PTSD in the offspring The findings suggest that low cortisol levels in PTSD may constitute a vulnerability marker related to parental PTSD as well as a state-related characteristic associated with acute or chronic PTSD symptomsrdquo
30
PHYSIOLOGIC DIFFERENCEDepression Stress or Trauma
CRF Gluco Corticoid Receptors
-----HYPOTHALMUS
PITUATARY
ADRENAL Gluco Corticoid Receptors ++++
31
Research Findings-FKBP5bull Research examines polymorphisms (variants of a
gene among a population) of a gene called FKBP5 ndash Protein in this gene encodes is involved in mediating the
actions of the glucocorticoid receptor which upon activation moves into the nucleus of the cell and regulates gene expression
bull Researchers discovered polymorphisms of FKBP5 were correlated with increased rates of PTSD in adults who experienced traumatic stress but only in subjects who had experienced trauma previously or who had inherited the morphism of their FKBP5 gene
32
FKBP5 Gene
bull On its own FKBP5 polymporphism was not correlated with adult PTSD-Mutation only happens in early childhood under traumatic circumstances
FOR EXAMPLEA Normal FKBP5 parent traumatized while serving in Iraq=no
mutationB Parent abused repeatedly in first 5 years of life= possibility of
FKPB5 mutation which could then be passed on
A Child inherits mutated FKBP5 gene and never experiences a trauma=no PTSD (may have some symptoms)
B Child inherits mutated FKBP5 gene and experiences a trauma=substantially greater possibility of PTSD if no buffering factors
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
17
Letrsquos Look at Traumatized FamiliesAdaptational Styles (Danieli)
bull General family types are associated with traumatic psychological responses ndash ldquoFamilies of fightersldquo
bull Children had to adopt a ldquoFighterHerordquo identity to saty in family and achieve parentsrsquo goals for recognition and redress
bull Contempt and intolerance for dependency weakness or failure
bull Outside world seen as oppositional so aggressive interaction the norm
bull Children programmed to seek validation for parentsrsquo suffering and to make their parentsrsquo whole
18
Adaptational Family Styles
ndash the Numb family bull Pervasive silence and depletion of all emotionsbull Parents capable of tolerating only minimal amount of
stimulationbull Childrenrsquos inner spontaneity and fantasy life severely
limitedbull Parents protect each other and children protect the
parentsbull Children adapt by numbing themselves or are
perpetually angrybull In attempt to please parents try to excel in social
standard of achievementsbull Children frequently accept outside role models over
parents to know how to live
19
Adaptational Family Styles
ndash ldquoThose who made itldquo families bull Motivated by magical fantasies during traumabull Desire to ldquomake it bigrdquo regain power and control
ndash ldquoVictim familiesrdquobull Pervasive depression fear worry and distrust of
outside worldbull Symbiotic clinging within the familybull Catastrophic reactions to everyday problems and
situationsbull Guilt used as a form of control
20
Two new categories to add to Danielis typologyndash
5 ldquoLife goes on families Conspiracy of SilenceAdvocacy for present and future gainsChildren expected to achieve
6 ldquoSplit families ndash Ready acceptance of new members (ldquoauntiesrdquo
ldquounclesrdquo ldquodaddiesrdquo ldquosiblingsrdquohellip) ndash Fluid membership-transfer between familiesndash Toleration of independence parentificationndash Creation of ldquonew familiesrdquo (eg affiliation with gangs
cults groups social institutions [churches]hellipndash Little parental oversight
21
Holocaust Link Jewish and Native American
Holocaust
Survivorsrsquo child complex Disenfranchised grief Transposition
bull Fixation to trauma bull attempts to resolve past
1 Effectsbull Nightmaresbull Perceived
obligation to ancestors
2 Coping strategiesbull Memory Candles
(Living testaments)
bull Loss cannot be openly mourned
1 Individualbull Inhibited with
shame
2 Societybull Loss of ancestral
tradition
bullLiving in the Past amp Present
1 1st GenerationbullPost Traumatic Stress Disorder
2 Subsequent GenerationsbullHistorical Unresolved Trauma
22
Neurobiology of Trans-generational Transmission of Trauma
Caveat The genetic model of transmission may evoke resistance because of its similarity with the Nazi ideology of purifying the gene pool of the German race it provides a clear theoretical basis for future research
ndash Parental traumatization may be transmitted in the same manner as some hereditary diseases are passed on from one generation to another
ndash Genetic memory code of a traumatized parent may thus be transmitted to the child through some electro-chemical processes in the brain
23
Genetic transmissionThe neural organization of various memory systems in
the parent (eg hyperalertness) would lead to a similar organization and constitution in the child
Since psychic trauma is assumed to have long-term effects on the neurochemical responses to stress in traumatized parents it may also lead to the same enduring characterological deficiencies and to a kind of biological vulnerability in the child
24
Gene Environment Interaction
bull New research helps answer the puzzling question of why post-traumatic stress doesnt happen to everyone who endures horrible trauma
bull Researchers found that survivors of child abuse were particularly likely to have symptoms of post-traumatic stress as adults if they also had specific variations in a stress-related gene
25
We are concerned with the gene for stress hormone systems
bullNorepinephrine ndash ldquorevving uprdquo hormone
bullCortisol ndash ldquoquieting downrdquo hormone
Both hormones are released in response to stress They are normally in balance
26
Stress Response
bull Designed to help mobilize ourselves to cope with danger by responding in one or more of the following behaviorsWithdrawal ndashFLIGHTImmobility-FREEZINGAggression-FIGHTAppeasement-SUBMISSIONTypically our first reaction to danger is to freeze to stop
all movement
27
A Threat Occurs Human Stress Response
Fightfleefreeze1048710 State of high alert hypervigilance1048710 Action not thought1048710 Decreased ability to think clearly or completely1048710 Extremist thinking1048710 Attention to threat ndash tagged for mental priority1048710 Increased aggression ndash loss of impulse control1048710 Dissociation buffers CNS but fragments mental functioning1048710 Speechless terror ndash loss of words1048710 Action is successful or not=helplessness
28
The Culprit-FKBP5The FKBP5 gene is active in the biochemical
make-up of the bodys stress-response system
bull Early-life abuse can result in particularly potent changes to this system as it develops mdash depending partly on whether or not the variations are present in the gene
bull The combination of the gene variations and past child abuse were the key ingredients for the doubled PTSD symptoms when a subsequent trauma occurred
bull This finding suggests a genechildhood environment interaction for adult PTSD
bull Inherited variations in multiple genes which have yet to be identified are estimated to account for 30 to 40 percent of the risk of developing PTSD
29
Research on Ancestral PTSD
bull Found that low cortisol levels were significantly associated with both PTSD in parents and lifetime PTSD in offspring whereas having a current psychiatric diagnosis other than PTSD was relatively but non-significantly associated with higher cortisol levelsndash ldquoAncestral PTSD a putative risk factor for PTSD appears to
be associated with low cortisol level in offspring even in the absence of lifetime PTSD in the offspring The findings suggest that low cortisol levels in PTSD may constitute a vulnerability marker related to parental PTSD as well as a state-related characteristic associated with acute or chronic PTSD symptomsrdquo
30
PHYSIOLOGIC DIFFERENCEDepression Stress or Trauma
CRF Gluco Corticoid Receptors
-----HYPOTHALMUS
PITUATARY
ADRENAL Gluco Corticoid Receptors ++++
31
Research Findings-FKBP5bull Research examines polymorphisms (variants of a
gene among a population) of a gene called FKBP5 ndash Protein in this gene encodes is involved in mediating the
actions of the glucocorticoid receptor which upon activation moves into the nucleus of the cell and regulates gene expression
bull Researchers discovered polymorphisms of FKBP5 were correlated with increased rates of PTSD in adults who experienced traumatic stress but only in subjects who had experienced trauma previously or who had inherited the morphism of their FKBP5 gene
32
FKBP5 Gene
bull On its own FKBP5 polymporphism was not correlated with adult PTSD-Mutation only happens in early childhood under traumatic circumstances
FOR EXAMPLEA Normal FKBP5 parent traumatized while serving in Iraq=no
mutationB Parent abused repeatedly in first 5 years of life= possibility of
FKPB5 mutation which could then be passed on
A Child inherits mutated FKBP5 gene and never experiences a trauma=no PTSD (may have some symptoms)
B Child inherits mutated FKBP5 gene and experiences a trauma=substantially greater possibility of PTSD if no buffering factors
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
18
Adaptational Family Styles
ndash the Numb family bull Pervasive silence and depletion of all emotionsbull Parents capable of tolerating only minimal amount of
stimulationbull Childrenrsquos inner spontaneity and fantasy life severely
limitedbull Parents protect each other and children protect the
parentsbull Children adapt by numbing themselves or are
perpetually angrybull In attempt to please parents try to excel in social
standard of achievementsbull Children frequently accept outside role models over
parents to know how to live
19
Adaptational Family Styles
ndash ldquoThose who made itldquo families bull Motivated by magical fantasies during traumabull Desire to ldquomake it bigrdquo regain power and control
ndash ldquoVictim familiesrdquobull Pervasive depression fear worry and distrust of
outside worldbull Symbiotic clinging within the familybull Catastrophic reactions to everyday problems and
situationsbull Guilt used as a form of control
20
Two new categories to add to Danielis typologyndash
5 ldquoLife goes on families Conspiracy of SilenceAdvocacy for present and future gainsChildren expected to achieve
6 ldquoSplit families ndash Ready acceptance of new members (ldquoauntiesrdquo
ldquounclesrdquo ldquodaddiesrdquo ldquosiblingsrdquohellip) ndash Fluid membership-transfer between familiesndash Toleration of independence parentificationndash Creation of ldquonew familiesrdquo (eg affiliation with gangs
cults groups social institutions [churches]hellipndash Little parental oversight
21
Holocaust Link Jewish and Native American
Holocaust
Survivorsrsquo child complex Disenfranchised grief Transposition
bull Fixation to trauma bull attempts to resolve past
1 Effectsbull Nightmaresbull Perceived
obligation to ancestors
2 Coping strategiesbull Memory Candles
(Living testaments)
bull Loss cannot be openly mourned
1 Individualbull Inhibited with
shame
2 Societybull Loss of ancestral
tradition
bullLiving in the Past amp Present
1 1st GenerationbullPost Traumatic Stress Disorder
2 Subsequent GenerationsbullHistorical Unresolved Trauma
22
Neurobiology of Trans-generational Transmission of Trauma
Caveat The genetic model of transmission may evoke resistance because of its similarity with the Nazi ideology of purifying the gene pool of the German race it provides a clear theoretical basis for future research
ndash Parental traumatization may be transmitted in the same manner as some hereditary diseases are passed on from one generation to another
ndash Genetic memory code of a traumatized parent may thus be transmitted to the child through some electro-chemical processes in the brain
23
Genetic transmissionThe neural organization of various memory systems in
the parent (eg hyperalertness) would lead to a similar organization and constitution in the child
Since psychic trauma is assumed to have long-term effects on the neurochemical responses to stress in traumatized parents it may also lead to the same enduring characterological deficiencies and to a kind of biological vulnerability in the child
24
Gene Environment Interaction
bull New research helps answer the puzzling question of why post-traumatic stress doesnt happen to everyone who endures horrible trauma
bull Researchers found that survivors of child abuse were particularly likely to have symptoms of post-traumatic stress as adults if they also had specific variations in a stress-related gene
25
We are concerned with the gene for stress hormone systems
bullNorepinephrine ndash ldquorevving uprdquo hormone
bullCortisol ndash ldquoquieting downrdquo hormone
Both hormones are released in response to stress They are normally in balance
26
Stress Response
bull Designed to help mobilize ourselves to cope with danger by responding in one or more of the following behaviorsWithdrawal ndashFLIGHTImmobility-FREEZINGAggression-FIGHTAppeasement-SUBMISSIONTypically our first reaction to danger is to freeze to stop
all movement
27
A Threat Occurs Human Stress Response
Fightfleefreeze1048710 State of high alert hypervigilance1048710 Action not thought1048710 Decreased ability to think clearly or completely1048710 Extremist thinking1048710 Attention to threat ndash tagged for mental priority1048710 Increased aggression ndash loss of impulse control1048710 Dissociation buffers CNS but fragments mental functioning1048710 Speechless terror ndash loss of words1048710 Action is successful or not=helplessness
28
The Culprit-FKBP5The FKBP5 gene is active in the biochemical
make-up of the bodys stress-response system
bull Early-life abuse can result in particularly potent changes to this system as it develops mdash depending partly on whether or not the variations are present in the gene
bull The combination of the gene variations and past child abuse were the key ingredients for the doubled PTSD symptoms when a subsequent trauma occurred
bull This finding suggests a genechildhood environment interaction for adult PTSD
bull Inherited variations in multiple genes which have yet to be identified are estimated to account for 30 to 40 percent of the risk of developing PTSD
29
Research on Ancestral PTSD
bull Found that low cortisol levels were significantly associated with both PTSD in parents and lifetime PTSD in offspring whereas having a current psychiatric diagnosis other than PTSD was relatively but non-significantly associated with higher cortisol levelsndash ldquoAncestral PTSD a putative risk factor for PTSD appears to
be associated with low cortisol level in offspring even in the absence of lifetime PTSD in the offspring The findings suggest that low cortisol levels in PTSD may constitute a vulnerability marker related to parental PTSD as well as a state-related characteristic associated with acute or chronic PTSD symptomsrdquo
30
PHYSIOLOGIC DIFFERENCEDepression Stress or Trauma
CRF Gluco Corticoid Receptors
-----HYPOTHALMUS
PITUATARY
ADRENAL Gluco Corticoid Receptors ++++
31
Research Findings-FKBP5bull Research examines polymorphisms (variants of a
gene among a population) of a gene called FKBP5 ndash Protein in this gene encodes is involved in mediating the
actions of the glucocorticoid receptor which upon activation moves into the nucleus of the cell and regulates gene expression
bull Researchers discovered polymorphisms of FKBP5 were correlated with increased rates of PTSD in adults who experienced traumatic stress but only in subjects who had experienced trauma previously or who had inherited the morphism of their FKBP5 gene
32
FKBP5 Gene
bull On its own FKBP5 polymporphism was not correlated with adult PTSD-Mutation only happens in early childhood under traumatic circumstances
FOR EXAMPLEA Normal FKBP5 parent traumatized while serving in Iraq=no
mutationB Parent abused repeatedly in first 5 years of life= possibility of
FKPB5 mutation which could then be passed on
A Child inherits mutated FKBP5 gene and never experiences a trauma=no PTSD (may have some symptoms)
B Child inherits mutated FKBP5 gene and experiences a trauma=substantially greater possibility of PTSD if no buffering factors
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
19
Adaptational Family Styles
ndash ldquoThose who made itldquo families bull Motivated by magical fantasies during traumabull Desire to ldquomake it bigrdquo regain power and control
ndash ldquoVictim familiesrdquobull Pervasive depression fear worry and distrust of
outside worldbull Symbiotic clinging within the familybull Catastrophic reactions to everyday problems and
situationsbull Guilt used as a form of control
20
Two new categories to add to Danielis typologyndash
5 ldquoLife goes on families Conspiracy of SilenceAdvocacy for present and future gainsChildren expected to achieve
6 ldquoSplit families ndash Ready acceptance of new members (ldquoauntiesrdquo
ldquounclesrdquo ldquodaddiesrdquo ldquosiblingsrdquohellip) ndash Fluid membership-transfer between familiesndash Toleration of independence parentificationndash Creation of ldquonew familiesrdquo (eg affiliation with gangs
cults groups social institutions [churches]hellipndash Little parental oversight
21
Holocaust Link Jewish and Native American
Holocaust
Survivorsrsquo child complex Disenfranchised grief Transposition
bull Fixation to trauma bull attempts to resolve past
1 Effectsbull Nightmaresbull Perceived
obligation to ancestors
2 Coping strategiesbull Memory Candles
(Living testaments)
bull Loss cannot be openly mourned
1 Individualbull Inhibited with
shame
2 Societybull Loss of ancestral
tradition
bullLiving in the Past amp Present
1 1st GenerationbullPost Traumatic Stress Disorder
2 Subsequent GenerationsbullHistorical Unresolved Trauma
22
Neurobiology of Trans-generational Transmission of Trauma
Caveat The genetic model of transmission may evoke resistance because of its similarity with the Nazi ideology of purifying the gene pool of the German race it provides a clear theoretical basis for future research
ndash Parental traumatization may be transmitted in the same manner as some hereditary diseases are passed on from one generation to another
ndash Genetic memory code of a traumatized parent may thus be transmitted to the child through some electro-chemical processes in the brain
23
Genetic transmissionThe neural organization of various memory systems in
the parent (eg hyperalertness) would lead to a similar organization and constitution in the child
Since psychic trauma is assumed to have long-term effects on the neurochemical responses to stress in traumatized parents it may also lead to the same enduring characterological deficiencies and to a kind of biological vulnerability in the child
24
Gene Environment Interaction
bull New research helps answer the puzzling question of why post-traumatic stress doesnt happen to everyone who endures horrible trauma
bull Researchers found that survivors of child abuse were particularly likely to have symptoms of post-traumatic stress as adults if they also had specific variations in a stress-related gene
25
We are concerned with the gene for stress hormone systems
bullNorepinephrine ndash ldquorevving uprdquo hormone
bullCortisol ndash ldquoquieting downrdquo hormone
Both hormones are released in response to stress They are normally in balance
26
Stress Response
bull Designed to help mobilize ourselves to cope with danger by responding in one or more of the following behaviorsWithdrawal ndashFLIGHTImmobility-FREEZINGAggression-FIGHTAppeasement-SUBMISSIONTypically our first reaction to danger is to freeze to stop
all movement
27
A Threat Occurs Human Stress Response
Fightfleefreeze1048710 State of high alert hypervigilance1048710 Action not thought1048710 Decreased ability to think clearly or completely1048710 Extremist thinking1048710 Attention to threat ndash tagged for mental priority1048710 Increased aggression ndash loss of impulse control1048710 Dissociation buffers CNS but fragments mental functioning1048710 Speechless terror ndash loss of words1048710 Action is successful or not=helplessness
28
The Culprit-FKBP5The FKBP5 gene is active in the biochemical
make-up of the bodys stress-response system
bull Early-life abuse can result in particularly potent changes to this system as it develops mdash depending partly on whether or not the variations are present in the gene
bull The combination of the gene variations and past child abuse were the key ingredients for the doubled PTSD symptoms when a subsequent trauma occurred
bull This finding suggests a genechildhood environment interaction for adult PTSD
bull Inherited variations in multiple genes which have yet to be identified are estimated to account for 30 to 40 percent of the risk of developing PTSD
29
Research on Ancestral PTSD
bull Found that low cortisol levels were significantly associated with both PTSD in parents and lifetime PTSD in offspring whereas having a current psychiatric diagnosis other than PTSD was relatively but non-significantly associated with higher cortisol levelsndash ldquoAncestral PTSD a putative risk factor for PTSD appears to
be associated with low cortisol level in offspring even in the absence of lifetime PTSD in the offspring The findings suggest that low cortisol levels in PTSD may constitute a vulnerability marker related to parental PTSD as well as a state-related characteristic associated with acute or chronic PTSD symptomsrdquo
30
PHYSIOLOGIC DIFFERENCEDepression Stress or Trauma
CRF Gluco Corticoid Receptors
-----HYPOTHALMUS
PITUATARY
ADRENAL Gluco Corticoid Receptors ++++
31
Research Findings-FKBP5bull Research examines polymorphisms (variants of a
gene among a population) of a gene called FKBP5 ndash Protein in this gene encodes is involved in mediating the
actions of the glucocorticoid receptor which upon activation moves into the nucleus of the cell and regulates gene expression
bull Researchers discovered polymorphisms of FKBP5 were correlated with increased rates of PTSD in adults who experienced traumatic stress but only in subjects who had experienced trauma previously or who had inherited the morphism of their FKBP5 gene
32
FKBP5 Gene
bull On its own FKBP5 polymporphism was not correlated with adult PTSD-Mutation only happens in early childhood under traumatic circumstances
FOR EXAMPLEA Normal FKBP5 parent traumatized while serving in Iraq=no
mutationB Parent abused repeatedly in first 5 years of life= possibility of
FKPB5 mutation which could then be passed on
A Child inherits mutated FKBP5 gene and never experiences a trauma=no PTSD (may have some symptoms)
B Child inherits mutated FKBP5 gene and experiences a trauma=substantially greater possibility of PTSD if no buffering factors
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
20
Two new categories to add to Danielis typologyndash
5 ldquoLife goes on families Conspiracy of SilenceAdvocacy for present and future gainsChildren expected to achieve
6 ldquoSplit families ndash Ready acceptance of new members (ldquoauntiesrdquo
ldquounclesrdquo ldquodaddiesrdquo ldquosiblingsrdquohellip) ndash Fluid membership-transfer between familiesndash Toleration of independence parentificationndash Creation of ldquonew familiesrdquo (eg affiliation with gangs
cults groups social institutions [churches]hellipndash Little parental oversight
21
Holocaust Link Jewish and Native American
Holocaust
Survivorsrsquo child complex Disenfranchised grief Transposition
bull Fixation to trauma bull attempts to resolve past
1 Effectsbull Nightmaresbull Perceived
obligation to ancestors
2 Coping strategiesbull Memory Candles
(Living testaments)
bull Loss cannot be openly mourned
1 Individualbull Inhibited with
shame
2 Societybull Loss of ancestral
tradition
bullLiving in the Past amp Present
1 1st GenerationbullPost Traumatic Stress Disorder
2 Subsequent GenerationsbullHistorical Unresolved Trauma
22
Neurobiology of Trans-generational Transmission of Trauma
Caveat The genetic model of transmission may evoke resistance because of its similarity with the Nazi ideology of purifying the gene pool of the German race it provides a clear theoretical basis for future research
ndash Parental traumatization may be transmitted in the same manner as some hereditary diseases are passed on from one generation to another
ndash Genetic memory code of a traumatized parent may thus be transmitted to the child through some electro-chemical processes in the brain
23
Genetic transmissionThe neural organization of various memory systems in
the parent (eg hyperalertness) would lead to a similar organization and constitution in the child
Since psychic trauma is assumed to have long-term effects on the neurochemical responses to stress in traumatized parents it may also lead to the same enduring characterological deficiencies and to a kind of biological vulnerability in the child
24
Gene Environment Interaction
bull New research helps answer the puzzling question of why post-traumatic stress doesnt happen to everyone who endures horrible trauma
bull Researchers found that survivors of child abuse were particularly likely to have symptoms of post-traumatic stress as adults if they also had specific variations in a stress-related gene
25
We are concerned with the gene for stress hormone systems
bullNorepinephrine ndash ldquorevving uprdquo hormone
bullCortisol ndash ldquoquieting downrdquo hormone
Both hormones are released in response to stress They are normally in balance
26
Stress Response
bull Designed to help mobilize ourselves to cope with danger by responding in one or more of the following behaviorsWithdrawal ndashFLIGHTImmobility-FREEZINGAggression-FIGHTAppeasement-SUBMISSIONTypically our first reaction to danger is to freeze to stop
all movement
27
A Threat Occurs Human Stress Response
Fightfleefreeze1048710 State of high alert hypervigilance1048710 Action not thought1048710 Decreased ability to think clearly or completely1048710 Extremist thinking1048710 Attention to threat ndash tagged for mental priority1048710 Increased aggression ndash loss of impulse control1048710 Dissociation buffers CNS but fragments mental functioning1048710 Speechless terror ndash loss of words1048710 Action is successful or not=helplessness
28
The Culprit-FKBP5The FKBP5 gene is active in the biochemical
make-up of the bodys stress-response system
bull Early-life abuse can result in particularly potent changes to this system as it develops mdash depending partly on whether or not the variations are present in the gene
bull The combination of the gene variations and past child abuse were the key ingredients for the doubled PTSD symptoms when a subsequent trauma occurred
bull This finding suggests a genechildhood environment interaction for adult PTSD
bull Inherited variations in multiple genes which have yet to be identified are estimated to account for 30 to 40 percent of the risk of developing PTSD
29
Research on Ancestral PTSD
bull Found that low cortisol levels were significantly associated with both PTSD in parents and lifetime PTSD in offspring whereas having a current psychiatric diagnosis other than PTSD was relatively but non-significantly associated with higher cortisol levelsndash ldquoAncestral PTSD a putative risk factor for PTSD appears to
be associated with low cortisol level in offspring even in the absence of lifetime PTSD in the offspring The findings suggest that low cortisol levels in PTSD may constitute a vulnerability marker related to parental PTSD as well as a state-related characteristic associated with acute or chronic PTSD symptomsrdquo
30
PHYSIOLOGIC DIFFERENCEDepression Stress or Trauma
CRF Gluco Corticoid Receptors
-----HYPOTHALMUS
PITUATARY
ADRENAL Gluco Corticoid Receptors ++++
31
Research Findings-FKBP5bull Research examines polymorphisms (variants of a
gene among a population) of a gene called FKBP5 ndash Protein in this gene encodes is involved in mediating the
actions of the glucocorticoid receptor which upon activation moves into the nucleus of the cell and regulates gene expression
bull Researchers discovered polymorphisms of FKBP5 were correlated with increased rates of PTSD in adults who experienced traumatic stress but only in subjects who had experienced trauma previously or who had inherited the morphism of their FKBP5 gene
32
FKBP5 Gene
bull On its own FKBP5 polymporphism was not correlated with adult PTSD-Mutation only happens in early childhood under traumatic circumstances
FOR EXAMPLEA Normal FKBP5 parent traumatized while serving in Iraq=no
mutationB Parent abused repeatedly in first 5 years of life= possibility of
FKPB5 mutation which could then be passed on
A Child inherits mutated FKBP5 gene and never experiences a trauma=no PTSD (may have some symptoms)
B Child inherits mutated FKBP5 gene and experiences a trauma=substantially greater possibility of PTSD if no buffering factors
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
21
Holocaust Link Jewish and Native American
Holocaust
Survivorsrsquo child complex Disenfranchised grief Transposition
bull Fixation to trauma bull attempts to resolve past
1 Effectsbull Nightmaresbull Perceived
obligation to ancestors
2 Coping strategiesbull Memory Candles
(Living testaments)
bull Loss cannot be openly mourned
1 Individualbull Inhibited with
shame
2 Societybull Loss of ancestral
tradition
bullLiving in the Past amp Present
1 1st GenerationbullPost Traumatic Stress Disorder
2 Subsequent GenerationsbullHistorical Unresolved Trauma
22
Neurobiology of Trans-generational Transmission of Trauma
Caveat The genetic model of transmission may evoke resistance because of its similarity with the Nazi ideology of purifying the gene pool of the German race it provides a clear theoretical basis for future research
ndash Parental traumatization may be transmitted in the same manner as some hereditary diseases are passed on from one generation to another
ndash Genetic memory code of a traumatized parent may thus be transmitted to the child through some electro-chemical processes in the brain
23
Genetic transmissionThe neural organization of various memory systems in
the parent (eg hyperalertness) would lead to a similar organization and constitution in the child
Since psychic trauma is assumed to have long-term effects on the neurochemical responses to stress in traumatized parents it may also lead to the same enduring characterological deficiencies and to a kind of biological vulnerability in the child
24
Gene Environment Interaction
bull New research helps answer the puzzling question of why post-traumatic stress doesnt happen to everyone who endures horrible trauma
bull Researchers found that survivors of child abuse were particularly likely to have symptoms of post-traumatic stress as adults if they also had specific variations in a stress-related gene
25
We are concerned with the gene for stress hormone systems
bullNorepinephrine ndash ldquorevving uprdquo hormone
bullCortisol ndash ldquoquieting downrdquo hormone
Both hormones are released in response to stress They are normally in balance
26
Stress Response
bull Designed to help mobilize ourselves to cope with danger by responding in one or more of the following behaviorsWithdrawal ndashFLIGHTImmobility-FREEZINGAggression-FIGHTAppeasement-SUBMISSIONTypically our first reaction to danger is to freeze to stop
all movement
27
A Threat Occurs Human Stress Response
Fightfleefreeze1048710 State of high alert hypervigilance1048710 Action not thought1048710 Decreased ability to think clearly or completely1048710 Extremist thinking1048710 Attention to threat ndash tagged for mental priority1048710 Increased aggression ndash loss of impulse control1048710 Dissociation buffers CNS but fragments mental functioning1048710 Speechless terror ndash loss of words1048710 Action is successful or not=helplessness
28
The Culprit-FKBP5The FKBP5 gene is active in the biochemical
make-up of the bodys stress-response system
bull Early-life abuse can result in particularly potent changes to this system as it develops mdash depending partly on whether or not the variations are present in the gene
bull The combination of the gene variations and past child abuse were the key ingredients for the doubled PTSD symptoms when a subsequent trauma occurred
bull This finding suggests a genechildhood environment interaction for adult PTSD
bull Inherited variations in multiple genes which have yet to be identified are estimated to account for 30 to 40 percent of the risk of developing PTSD
29
Research on Ancestral PTSD
bull Found that low cortisol levels were significantly associated with both PTSD in parents and lifetime PTSD in offspring whereas having a current psychiatric diagnosis other than PTSD was relatively but non-significantly associated with higher cortisol levelsndash ldquoAncestral PTSD a putative risk factor for PTSD appears to
be associated with low cortisol level in offspring even in the absence of lifetime PTSD in the offspring The findings suggest that low cortisol levels in PTSD may constitute a vulnerability marker related to parental PTSD as well as a state-related characteristic associated with acute or chronic PTSD symptomsrdquo
30
PHYSIOLOGIC DIFFERENCEDepression Stress or Trauma
CRF Gluco Corticoid Receptors
-----HYPOTHALMUS
PITUATARY
ADRENAL Gluco Corticoid Receptors ++++
31
Research Findings-FKBP5bull Research examines polymorphisms (variants of a
gene among a population) of a gene called FKBP5 ndash Protein in this gene encodes is involved in mediating the
actions of the glucocorticoid receptor which upon activation moves into the nucleus of the cell and regulates gene expression
bull Researchers discovered polymorphisms of FKBP5 were correlated with increased rates of PTSD in adults who experienced traumatic stress but only in subjects who had experienced trauma previously or who had inherited the morphism of their FKBP5 gene
32
FKBP5 Gene
bull On its own FKBP5 polymporphism was not correlated with adult PTSD-Mutation only happens in early childhood under traumatic circumstances
FOR EXAMPLEA Normal FKBP5 parent traumatized while serving in Iraq=no
mutationB Parent abused repeatedly in first 5 years of life= possibility of
FKPB5 mutation which could then be passed on
A Child inherits mutated FKBP5 gene and never experiences a trauma=no PTSD (may have some symptoms)
B Child inherits mutated FKBP5 gene and experiences a trauma=substantially greater possibility of PTSD if no buffering factors
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
22
Neurobiology of Trans-generational Transmission of Trauma
Caveat The genetic model of transmission may evoke resistance because of its similarity with the Nazi ideology of purifying the gene pool of the German race it provides a clear theoretical basis for future research
ndash Parental traumatization may be transmitted in the same manner as some hereditary diseases are passed on from one generation to another
ndash Genetic memory code of a traumatized parent may thus be transmitted to the child through some electro-chemical processes in the brain
23
Genetic transmissionThe neural organization of various memory systems in
the parent (eg hyperalertness) would lead to a similar organization and constitution in the child
Since psychic trauma is assumed to have long-term effects on the neurochemical responses to stress in traumatized parents it may also lead to the same enduring characterological deficiencies and to a kind of biological vulnerability in the child
24
Gene Environment Interaction
bull New research helps answer the puzzling question of why post-traumatic stress doesnt happen to everyone who endures horrible trauma
bull Researchers found that survivors of child abuse were particularly likely to have symptoms of post-traumatic stress as adults if they also had specific variations in a stress-related gene
25
We are concerned with the gene for stress hormone systems
bullNorepinephrine ndash ldquorevving uprdquo hormone
bullCortisol ndash ldquoquieting downrdquo hormone
Both hormones are released in response to stress They are normally in balance
26
Stress Response
bull Designed to help mobilize ourselves to cope with danger by responding in one or more of the following behaviorsWithdrawal ndashFLIGHTImmobility-FREEZINGAggression-FIGHTAppeasement-SUBMISSIONTypically our first reaction to danger is to freeze to stop
all movement
27
A Threat Occurs Human Stress Response
Fightfleefreeze1048710 State of high alert hypervigilance1048710 Action not thought1048710 Decreased ability to think clearly or completely1048710 Extremist thinking1048710 Attention to threat ndash tagged for mental priority1048710 Increased aggression ndash loss of impulse control1048710 Dissociation buffers CNS but fragments mental functioning1048710 Speechless terror ndash loss of words1048710 Action is successful or not=helplessness
28
The Culprit-FKBP5The FKBP5 gene is active in the biochemical
make-up of the bodys stress-response system
bull Early-life abuse can result in particularly potent changes to this system as it develops mdash depending partly on whether or not the variations are present in the gene
bull The combination of the gene variations and past child abuse were the key ingredients for the doubled PTSD symptoms when a subsequent trauma occurred
bull This finding suggests a genechildhood environment interaction for adult PTSD
bull Inherited variations in multiple genes which have yet to be identified are estimated to account for 30 to 40 percent of the risk of developing PTSD
29
Research on Ancestral PTSD
bull Found that low cortisol levels were significantly associated with both PTSD in parents and lifetime PTSD in offspring whereas having a current psychiatric diagnosis other than PTSD was relatively but non-significantly associated with higher cortisol levelsndash ldquoAncestral PTSD a putative risk factor for PTSD appears to
be associated with low cortisol level in offspring even in the absence of lifetime PTSD in the offspring The findings suggest that low cortisol levels in PTSD may constitute a vulnerability marker related to parental PTSD as well as a state-related characteristic associated with acute or chronic PTSD symptomsrdquo
30
PHYSIOLOGIC DIFFERENCEDepression Stress or Trauma
CRF Gluco Corticoid Receptors
-----HYPOTHALMUS
PITUATARY
ADRENAL Gluco Corticoid Receptors ++++
31
Research Findings-FKBP5bull Research examines polymorphisms (variants of a
gene among a population) of a gene called FKBP5 ndash Protein in this gene encodes is involved in mediating the
actions of the glucocorticoid receptor which upon activation moves into the nucleus of the cell and regulates gene expression
bull Researchers discovered polymorphisms of FKBP5 were correlated with increased rates of PTSD in adults who experienced traumatic stress but only in subjects who had experienced trauma previously or who had inherited the morphism of their FKBP5 gene
32
FKBP5 Gene
bull On its own FKBP5 polymporphism was not correlated with adult PTSD-Mutation only happens in early childhood under traumatic circumstances
FOR EXAMPLEA Normal FKBP5 parent traumatized while serving in Iraq=no
mutationB Parent abused repeatedly in first 5 years of life= possibility of
FKPB5 mutation which could then be passed on
A Child inherits mutated FKBP5 gene and never experiences a trauma=no PTSD (may have some symptoms)
B Child inherits mutated FKBP5 gene and experiences a trauma=substantially greater possibility of PTSD if no buffering factors
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
23
Genetic transmissionThe neural organization of various memory systems in
the parent (eg hyperalertness) would lead to a similar organization and constitution in the child
Since psychic trauma is assumed to have long-term effects on the neurochemical responses to stress in traumatized parents it may also lead to the same enduring characterological deficiencies and to a kind of biological vulnerability in the child
24
Gene Environment Interaction
bull New research helps answer the puzzling question of why post-traumatic stress doesnt happen to everyone who endures horrible trauma
bull Researchers found that survivors of child abuse were particularly likely to have symptoms of post-traumatic stress as adults if they also had specific variations in a stress-related gene
25
We are concerned with the gene for stress hormone systems
bullNorepinephrine ndash ldquorevving uprdquo hormone
bullCortisol ndash ldquoquieting downrdquo hormone
Both hormones are released in response to stress They are normally in balance
26
Stress Response
bull Designed to help mobilize ourselves to cope with danger by responding in one or more of the following behaviorsWithdrawal ndashFLIGHTImmobility-FREEZINGAggression-FIGHTAppeasement-SUBMISSIONTypically our first reaction to danger is to freeze to stop
all movement
27
A Threat Occurs Human Stress Response
Fightfleefreeze1048710 State of high alert hypervigilance1048710 Action not thought1048710 Decreased ability to think clearly or completely1048710 Extremist thinking1048710 Attention to threat ndash tagged for mental priority1048710 Increased aggression ndash loss of impulse control1048710 Dissociation buffers CNS but fragments mental functioning1048710 Speechless terror ndash loss of words1048710 Action is successful or not=helplessness
28
The Culprit-FKBP5The FKBP5 gene is active in the biochemical
make-up of the bodys stress-response system
bull Early-life abuse can result in particularly potent changes to this system as it develops mdash depending partly on whether or not the variations are present in the gene
bull The combination of the gene variations and past child abuse were the key ingredients for the doubled PTSD symptoms when a subsequent trauma occurred
bull This finding suggests a genechildhood environment interaction for adult PTSD
bull Inherited variations in multiple genes which have yet to be identified are estimated to account for 30 to 40 percent of the risk of developing PTSD
29
Research on Ancestral PTSD
bull Found that low cortisol levels were significantly associated with both PTSD in parents and lifetime PTSD in offspring whereas having a current psychiatric diagnosis other than PTSD was relatively but non-significantly associated with higher cortisol levelsndash ldquoAncestral PTSD a putative risk factor for PTSD appears to
be associated with low cortisol level in offspring even in the absence of lifetime PTSD in the offspring The findings suggest that low cortisol levels in PTSD may constitute a vulnerability marker related to parental PTSD as well as a state-related characteristic associated with acute or chronic PTSD symptomsrdquo
30
PHYSIOLOGIC DIFFERENCEDepression Stress or Trauma
CRF Gluco Corticoid Receptors
-----HYPOTHALMUS
PITUATARY
ADRENAL Gluco Corticoid Receptors ++++
31
Research Findings-FKBP5bull Research examines polymorphisms (variants of a
gene among a population) of a gene called FKBP5 ndash Protein in this gene encodes is involved in mediating the
actions of the glucocorticoid receptor which upon activation moves into the nucleus of the cell and regulates gene expression
bull Researchers discovered polymorphisms of FKBP5 were correlated with increased rates of PTSD in adults who experienced traumatic stress but only in subjects who had experienced trauma previously or who had inherited the morphism of their FKBP5 gene
32
FKBP5 Gene
bull On its own FKBP5 polymporphism was not correlated with adult PTSD-Mutation only happens in early childhood under traumatic circumstances
FOR EXAMPLEA Normal FKBP5 parent traumatized while serving in Iraq=no
mutationB Parent abused repeatedly in first 5 years of life= possibility of
FKPB5 mutation which could then be passed on
A Child inherits mutated FKBP5 gene and never experiences a trauma=no PTSD (may have some symptoms)
B Child inherits mutated FKBP5 gene and experiences a trauma=substantially greater possibility of PTSD if no buffering factors
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
24
Gene Environment Interaction
bull New research helps answer the puzzling question of why post-traumatic stress doesnt happen to everyone who endures horrible trauma
bull Researchers found that survivors of child abuse were particularly likely to have symptoms of post-traumatic stress as adults if they also had specific variations in a stress-related gene
25
We are concerned with the gene for stress hormone systems
bullNorepinephrine ndash ldquorevving uprdquo hormone
bullCortisol ndash ldquoquieting downrdquo hormone
Both hormones are released in response to stress They are normally in balance
26
Stress Response
bull Designed to help mobilize ourselves to cope with danger by responding in one or more of the following behaviorsWithdrawal ndashFLIGHTImmobility-FREEZINGAggression-FIGHTAppeasement-SUBMISSIONTypically our first reaction to danger is to freeze to stop
all movement
27
A Threat Occurs Human Stress Response
Fightfleefreeze1048710 State of high alert hypervigilance1048710 Action not thought1048710 Decreased ability to think clearly or completely1048710 Extremist thinking1048710 Attention to threat ndash tagged for mental priority1048710 Increased aggression ndash loss of impulse control1048710 Dissociation buffers CNS but fragments mental functioning1048710 Speechless terror ndash loss of words1048710 Action is successful or not=helplessness
28
The Culprit-FKBP5The FKBP5 gene is active in the biochemical
make-up of the bodys stress-response system
bull Early-life abuse can result in particularly potent changes to this system as it develops mdash depending partly on whether or not the variations are present in the gene
bull The combination of the gene variations and past child abuse were the key ingredients for the doubled PTSD symptoms when a subsequent trauma occurred
bull This finding suggests a genechildhood environment interaction for adult PTSD
bull Inherited variations in multiple genes which have yet to be identified are estimated to account for 30 to 40 percent of the risk of developing PTSD
29
Research on Ancestral PTSD
bull Found that low cortisol levels were significantly associated with both PTSD in parents and lifetime PTSD in offspring whereas having a current psychiatric diagnosis other than PTSD was relatively but non-significantly associated with higher cortisol levelsndash ldquoAncestral PTSD a putative risk factor for PTSD appears to
be associated with low cortisol level in offspring even in the absence of lifetime PTSD in the offspring The findings suggest that low cortisol levels in PTSD may constitute a vulnerability marker related to parental PTSD as well as a state-related characteristic associated with acute or chronic PTSD symptomsrdquo
30
PHYSIOLOGIC DIFFERENCEDepression Stress or Trauma
CRF Gluco Corticoid Receptors
-----HYPOTHALMUS
PITUATARY
ADRENAL Gluco Corticoid Receptors ++++
31
Research Findings-FKBP5bull Research examines polymorphisms (variants of a
gene among a population) of a gene called FKBP5 ndash Protein in this gene encodes is involved in mediating the
actions of the glucocorticoid receptor which upon activation moves into the nucleus of the cell and regulates gene expression
bull Researchers discovered polymorphisms of FKBP5 were correlated with increased rates of PTSD in adults who experienced traumatic stress but only in subjects who had experienced trauma previously or who had inherited the morphism of their FKBP5 gene
32
FKBP5 Gene
bull On its own FKBP5 polymporphism was not correlated with adult PTSD-Mutation only happens in early childhood under traumatic circumstances
FOR EXAMPLEA Normal FKBP5 parent traumatized while serving in Iraq=no
mutationB Parent abused repeatedly in first 5 years of life= possibility of
FKPB5 mutation which could then be passed on
A Child inherits mutated FKBP5 gene and never experiences a trauma=no PTSD (may have some symptoms)
B Child inherits mutated FKBP5 gene and experiences a trauma=substantially greater possibility of PTSD if no buffering factors
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
25
We are concerned with the gene for stress hormone systems
bullNorepinephrine ndash ldquorevving uprdquo hormone
bullCortisol ndash ldquoquieting downrdquo hormone
Both hormones are released in response to stress They are normally in balance
26
Stress Response
bull Designed to help mobilize ourselves to cope with danger by responding in one or more of the following behaviorsWithdrawal ndashFLIGHTImmobility-FREEZINGAggression-FIGHTAppeasement-SUBMISSIONTypically our first reaction to danger is to freeze to stop
all movement
27
A Threat Occurs Human Stress Response
Fightfleefreeze1048710 State of high alert hypervigilance1048710 Action not thought1048710 Decreased ability to think clearly or completely1048710 Extremist thinking1048710 Attention to threat ndash tagged for mental priority1048710 Increased aggression ndash loss of impulse control1048710 Dissociation buffers CNS but fragments mental functioning1048710 Speechless terror ndash loss of words1048710 Action is successful or not=helplessness
28
The Culprit-FKBP5The FKBP5 gene is active in the biochemical
make-up of the bodys stress-response system
bull Early-life abuse can result in particularly potent changes to this system as it develops mdash depending partly on whether or not the variations are present in the gene
bull The combination of the gene variations and past child abuse were the key ingredients for the doubled PTSD symptoms when a subsequent trauma occurred
bull This finding suggests a genechildhood environment interaction for adult PTSD
bull Inherited variations in multiple genes which have yet to be identified are estimated to account for 30 to 40 percent of the risk of developing PTSD
29
Research on Ancestral PTSD
bull Found that low cortisol levels were significantly associated with both PTSD in parents and lifetime PTSD in offspring whereas having a current psychiatric diagnosis other than PTSD was relatively but non-significantly associated with higher cortisol levelsndash ldquoAncestral PTSD a putative risk factor for PTSD appears to
be associated with low cortisol level in offspring even in the absence of lifetime PTSD in the offspring The findings suggest that low cortisol levels in PTSD may constitute a vulnerability marker related to parental PTSD as well as a state-related characteristic associated with acute or chronic PTSD symptomsrdquo
30
PHYSIOLOGIC DIFFERENCEDepression Stress or Trauma
CRF Gluco Corticoid Receptors
-----HYPOTHALMUS
PITUATARY
ADRENAL Gluco Corticoid Receptors ++++
31
Research Findings-FKBP5bull Research examines polymorphisms (variants of a
gene among a population) of a gene called FKBP5 ndash Protein in this gene encodes is involved in mediating the
actions of the glucocorticoid receptor which upon activation moves into the nucleus of the cell and regulates gene expression
bull Researchers discovered polymorphisms of FKBP5 were correlated with increased rates of PTSD in adults who experienced traumatic stress but only in subjects who had experienced trauma previously or who had inherited the morphism of their FKBP5 gene
32
FKBP5 Gene
bull On its own FKBP5 polymporphism was not correlated with adult PTSD-Mutation only happens in early childhood under traumatic circumstances
FOR EXAMPLEA Normal FKBP5 parent traumatized while serving in Iraq=no
mutationB Parent abused repeatedly in first 5 years of life= possibility of
FKPB5 mutation which could then be passed on
A Child inherits mutated FKBP5 gene and never experiences a trauma=no PTSD (may have some symptoms)
B Child inherits mutated FKBP5 gene and experiences a trauma=substantially greater possibility of PTSD if no buffering factors
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
26
Stress Response
bull Designed to help mobilize ourselves to cope with danger by responding in one or more of the following behaviorsWithdrawal ndashFLIGHTImmobility-FREEZINGAggression-FIGHTAppeasement-SUBMISSIONTypically our first reaction to danger is to freeze to stop
all movement
27
A Threat Occurs Human Stress Response
Fightfleefreeze1048710 State of high alert hypervigilance1048710 Action not thought1048710 Decreased ability to think clearly or completely1048710 Extremist thinking1048710 Attention to threat ndash tagged for mental priority1048710 Increased aggression ndash loss of impulse control1048710 Dissociation buffers CNS but fragments mental functioning1048710 Speechless terror ndash loss of words1048710 Action is successful or not=helplessness
28
The Culprit-FKBP5The FKBP5 gene is active in the biochemical
make-up of the bodys stress-response system
bull Early-life abuse can result in particularly potent changes to this system as it develops mdash depending partly on whether or not the variations are present in the gene
bull The combination of the gene variations and past child abuse were the key ingredients for the doubled PTSD symptoms when a subsequent trauma occurred
bull This finding suggests a genechildhood environment interaction for adult PTSD
bull Inherited variations in multiple genes which have yet to be identified are estimated to account for 30 to 40 percent of the risk of developing PTSD
29
Research on Ancestral PTSD
bull Found that low cortisol levels were significantly associated with both PTSD in parents and lifetime PTSD in offspring whereas having a current psychiatric diagnosis other than PTSD was relatively but non-significantly associated with higher cortisol levelsndash ldquoAncestral PTSD a putative risk factor for PTSD appears to
be associated with low cortisol level in offspring even in the absence of lifetime PTSD in the offspring The findings suggest that low cortisol levels in PTSD may constitute a vulnerability marker related to parental PTSD as well as a state-related characteristic associated with acute or chronic PTSD symptomsrdquo
30
PHYSIOLOGIC DIFFERENCEDepression Stress or Trauma
CRF Gluco Corticoid Receptors
-----HYPOTHALMUS
PITUATARY
ADRENAL Gluco Corticoid Receptors ++++
31
Research Findings-FKBP5bull Research examines polymorphisms (variants of a
gene among a population) of a gene called FKBP5 ndash Protein in this gene encodes is involved in mediating the
actions of the glucocorticoid receptor which upon activation moves into the nucleus of the cell and regulates gene expression
bull Researchers discovered polymorphisms of FKBP5 were correlated with increased rates of PTSD in adults who experienced traumatic stress but only in subjects who had experienced trauma previously or who had inherited the morphism of their FKBP5 gene
32
FKBP5 Gene
bull On its own FKBP5 polymporphism was not correlated with adult PTSD-Mutation only happens in early childhood under traumatic circumstances
FOR EXAMPLEA Normal FKBP5 parent traumatized while serving in Iraq=no
mutationB Parent abused repeatedly in first 5 years of life= possibility of
FKPB5 mutation which could then be passed on
A Child inherits mutated FKBP5 gene and never experiences a trauma=no PTSD (may have some symptoms)
B Child inherits mutated FKBP5 gene and experiences a trauma=substantially greater possibility of PTSD if no buffering factors
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
27
A Threat Occurs Human Stress Response
Fightfleefreeze1048710 State of high alert hypervigilance1048710 Action not thought1048710 Decreased ability to think clearly or completely1048710 Extremist thinking1048710 Attention to threat ndash tagged for mental priority1048710 Increased aggression ndash loss of impulse control1048710 Dissociation buffers CNS but fragments mental functioning1048710 Speechless terror ndash loss of words1048710 Action is successful or not=helplessness
28
The Culprit-FKBP5The FKBP5 gene is active in the biochemical
make-up of the bodys stress-response system
bull Early-life abuse can result in particularly potent changes to this system as it develops mdash depending partly on whether or not the variations are present in the gene
bull The combination of the gene variations and past child abuse were the key ingredients for the doubled PTSD symptoms when a subsequent trauma occurred
bull This finding suggests a genechildhood environment interaction for adult PTSD
bull Inherited variations in multiple genes which have yet to be identified are estimated to account for 30 to 40 percent of the risk of developing PTSD
29
Research on Ancestral PTSD
bull Found that low cortisol levels were significantly associated with both PTSD in parents and lifetime PTSD in offspring whereas having a current psychiatric diagnosis other than PTSD was relatively but non-significantly associated with higher cortisol levelsndash ldquoAncestral PTSD a putative risk factor for PTSD appears to
be associated with low cortisol level in offspring even in the absence of lifetime PTSD in the offspring The findings suggest that low cortisol levels in PTSD may constitute a vulnerability marker related to parental PTSD as well as a state-related characteristic associated with acute or chronic PTSD symptomsrdquo
30
PHYSIOLOGIC DIFFERENCEDepression Stress or Trauma
CRF Gluco Corticoid Receptors
-----HYPOTHALMUS
PITUATARY
ADRENAL Gluco Corticoid Receptors ++++
31
Research Findings-FKBP5bull Research examines polymorphisms (variants of a
gene among a population) of a gene called FKBP5 ndash Protein in this gene encodes is involved in mediating the
actions of the glucocorticoid receptor which upon activation moves into the nucleus of the cell and regulates gene expression
bull Researchers discovered polymorphisms of FKBP5 were correlated with increased rates of PTSD in adults who experienced traumatic stress but only in subjects who had experienced trauma previously or who had inherited the morphism of their FKBP5 gene
32
FKBP5 Gene
bull On its own FKBP5 polymporphism was not correlated with adult PTSD-Mutation only happens in early childhood under traumatic circumstances
FOR EXAMPLEA Normal FKBP5 parent traumatized while serving in Iraq=no
mutationB Parent abused repeatedly in first 5 years of life= possibility of
FKPB5 mutation which could then be passed on
A Child inherits mutated FKBP5 gene and never experiences a trauma=no PTSD (may have some symptoms)
B Child inherits mutated FKBP5 gene and experiences a trauma=substantially greater possibility of PTSD if no buffering factors
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
28
The Culprit-FKBP5The FKBP5 gene is active in the biochemical
make-up of the bodys stress-response system
bull Early-life abuse can result in particularly potent changes to this system as it develops mdash depending partly on whether or not the variations are present in the gene
bull The combination of the gene variations and past child abuse were the key ingredients for the doubled PTSD symptoms when a subsequent trauma occurred
bull This finding suggests a genechildhood environment interaction for adult PTSD
bull Inherited variations in multiple genes which have yet to be identified are estimated to account for 30 to 40 percent of the risk of developing PTSD
29
Research on Ancestral PTSD
bull Found that low cortisol levels were significantly associated with both PTSD in parents and lifetime PTSD in offspring whereas having a current psychiatric diagnosis other than PTSD was relatively but non-significantly associated with higher cortisol levelsndash ldquoAncestral PTSD a putative risk factor for PTSD appears to
be associated with low cortisol level in offspring even in the absence of lifetime PTSD in the offspring The findings suggest that low cortisol levels in PTSD may constitute a vulnerability marker related to parental PTSD as well as a state-related characteristic associated with acute or chronic PTSD symptomsrdquo
30
PHYSIOLOGIC DIFFERENCEDepression Stress or Trauma
CRF Gluco Corticoid Receptors
-----HYPOTHALMUS
PITUATARY
ADRENAL Gluco Corticoid Receptors ++++
31
Research Findings-FKBP5bull Research examines polymorphisms (variants of a
gene among a population) of a gene called FKBP5 ndash Protein in this gene encodes is involved in mediating the
actions of the glucocorticoid receptor which upon activation moves into the nucleus of the cell and regulates gene expression
bull Researchers discovered polymorphisms of FKBP5 were correlated with increased rates of PTSD in adults who experienced traumatic stress but only in subjects who had experienced trauma previously or who had inherited the morphism of their FKBP5 gene
32
FKBP5 Gene
bull On its own FKBP5 polymporphism was not correlated with adult PTSD-Mutation only happens in early childhood under traumatic circumstances
FOR EXAMPLEA Normal FKBP5 parent traumatized while serving in Iraq=no
mutationB Parent abused repeatedly in first 5 years of life= possibility of
FKPB5 mutation which could then be passed on
A Child inherits mutated FKBP5 gene and never experiences a trauma=no PTSD (may have some symptoms)
B Child inherits mutated FKBP5 gene and experiences a trauma=substantially greater possibility of PTSD if no buffering factors
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
29
Research on Ancestral PTSD
bull Found that low cortisol levels were significantly associated with both PTSD in parents and lifetime PTSD in offspring whereas having a current psychiatric diagnosis other than PTSD was relatively but non-significantly associated with higher cortisol levelsndash ldquoAncestral PTSD a putative risk factor for PTSD appears to
be associated with low cortisol level in offspring even in the absence of lifetime PTSD in the offspring The findings suggest that low cortisol levels in PTSD may constitute a vulnerability marker related to parental PTSD as well as a state-related characteristic associated with acute or chronic PTSD symptomsrdquo
30
PHYSIOLOGIC DIFFERENCEDepression Stress or Trauma
CRF Gluco Corticoid Receptors
-----HYPOTHALMUS
PITUATARY
ADRENAL Gluco Corticoid Receptors ++++
31
Research Findings-FKBP5bull Research examines polymorphisms (variants of a
gene among a population) of a gene called FKBP5 ndash Protein in this gene encodes is involved in mediating the
actions of the glucocorticoid receptor which upon activation moves into the nucleus of the cell and regulates gene expression
bull Researchers discovered polymorphisms of FKBP5 were correlated with increased rates of PTSD in adults who experienced traumatic stress but only in subjects who had experienced trauma previously or who had inherited the morphism of their FKBP5 gene
32
FKBP5 Gene
bull On its own FKBP5 polymporphism was not correlated with adult PTSD-Mutation only happens in early childhood under traumatic circumstances
FOR EXAMPLEA Normal FKBP5 parent traumatized while serving in Iraq=no
mutationB Parent abused repeatedly in first 5 years of life= possibility of
FKPB5 mutation which could then be passed on
A Child inherits mutated FKBP5 gene and never experiences a trauma=no PTSD (may have some symptoms)
B Child inherits mutated FKBP5 gene and experiences a trauma=substantially greater possibility of PTSD if no buffering factors
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
30
PHYSIOLOGIC DIFFERENCEDepression Stress or Trauma
CRF Gluco Corticoid Receptors
-----HYPOTHALMUS
PITUATARY
ADRENAL Gluco Corticoid Receptors ++++
31
Research Findings-FKBP5bull Research examines polymorphisms (variants of a
gene among a population) of a gene called FKBP5 ndash Protein in this gene encodes is involved in mediating the
actions of the glucocorticoid receptor which upon activation moves into the nucleus of the cell and regulates gene expression
bull Researchers discovered polymorphisms of FKBP5 were correlated with increased rates of PTSD in adults who experienced traumatic stress but only in subjects who had experienced trauma previously or who had inherited the morphism of their FKBP5 gene
32
FKBP5 Gene
bull On its own FKBP5 polymporphism was not correlated with adult PTSD-Mutation only happens in early childhood under traumatic circumstances
FOR EXAMPLEA Normal FKBP5 parent traumatized while serving in Iraq=no
mutationB Parent abused repeatedly in first 5 years of life= possibility of
FKPB5 mutation which could then be passed on
A Child inherits mutated FKBP5 gene and never experiences a trauma=no PTSD (may have some symptoms)
B Child inherits mutated FKBP5 gene and experiences a trauma=substantially greater possibility of PTSD if no buffering factors
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
31
Research Findings-FKBP5bull Research examines polymorphisms (variants of a
gene among a population) of a gene called FKBP5 ndash Protein in this gene encodes is involved in mediating the
actions of the glucocorticoid receptor which upon activation moves into the nucleus of the cell and regulates gene expression
bull Researchers discovered polymorphisms of FKBP5 were correlated with increased rates of PTSD in adults who experienced traumatic stress but only in subjects who had experienced trauma previously or who had inherited the morphism of their FKBP5 gene
32
FKBP5 Gene
bull On its own FKBP5 polymporphism was not correlated with adult PTSD-Mutation only happens in early childhood under traumatic circumstances
FOR EXAMPLEA Normal FKBP5 parent traumatized while serving in Iraq=no
mutationB Parent abused repeatedly in first 5 years of life= possibility of
FKPB5 mutation which could then be passed on
A Child inherits mutated FKBP5 gene and never experiences a trauma=no PTSD (may have some symptoms)
B Child inherits mutated FKBP5 gene and experiences a trauma=substantially greater possibility of PTSD if no buffering factors
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
32
FKBP5 Gene
bull On its own FKBP5 polymporphism was not correlated with adult PTSD-Mutation only happens in early childhood under traumatic circumstances
FOR EXAMPLEA Normal FKBP5 parent traumatized while serving in Iraq=no
mutationB Parent abused repeatedly in first 5 years of life= possibility of
FKPB5 mutation which could then be passed on
A Child inherits mutated FKBP5 gene and never experiences a trauma=no PTSD (may have some symptoms)
B Child inherits mutated FKBP5 gene and experiences a trauma=substantially greater possibility of PTSD if no buffering factors
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
33
FKBP5 and HPA axis
bull Identified genes were generally involved in hypothalamic-pituitary-adrenal (HPA) axis signal transduction or brain and immune cell function ndash FKBP5 a modulator of glucocorticoid receptor (GR)
sensitivity showed reduced expression in PTSD consistent with enhanced GR responsiveness
ndash FKBP5 expression was predicted by cortisol when entered with PTSD severity in regression
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
34
HPA Axis Alterations
PTSD Major Depression
Cortisol levels Low High
Glucocorticoid receptors Increased Decreased
Negative feedback Stronger Weaker
CSF CRF levels Increased Increased
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
35
What does this biological state do to the studentrsquos body
CRH
ACTHcortisol
Short-term effect of cortisolGlucose release from liver and
muscles
Long-term effectsImmune changes
Loss of muscle and bone massLoss of insulin sensitivity
Hippocampus neuronal death
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
36
STRESS
Targets for Cortisolbull Acute - enhances immunebull Memory energy replenishmentbull Cardiovascular functionbull Chronic suppresses immunebull impairs memory and attention via
effects on hippocampus and PFC bull Heightens fear via altering
amygdalabull Promotes bone amp mineral
loss induces metabolicsyndrome
bull Stress induced cortisol release causes declarative memory impairment
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
37
Hippocampal Volume Reduction in PTSD
NORMAL PTSDMRI scan of the hippocampus in a normal control and patient with PTSD secondary to childhood abuse The
hippocampus outlined in blue is visibly smaller in PTSD Overall there was a 12 reduction in volume in PTSD
Bremner et al Am J Psychiatry 1995 152973-981 Bremner et al Biol Psychiatry 1997 4123-32
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
38
Effects of Increased Cortisol
Effect on Childrsquos Brain
Loss of neurons- pruning
Decreased myelination- as neurons are fired they strengthen the myelin by using proteins hence the brain is stronger
Decreased neurogenesis- growth of new brain cells
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
39
STAT5B
bull Also less expressed in PTSD were STAT5B a direct inhibitor of GR (glucocorticoid receptor) and major histocompatibility complex (MHC) Class II
bull The Major Histocompatibility Complex (MHC) is a set of molecules displayed on cell surfaces that are responsible for lymphocyte recognition and antigen presentation The MHC molecules control the immune response through recognition of self and non-self
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
40
Early Stress and StressReactivity Gene Environment
Interactionbull Disrupt pre-programmed gene transcription related to stress reactivity during critical developmental periodndash Disrupts developmental stress circuit integrationndash Permanent behavioral and neurobiologic changesbull Gene variants can make individual more susceptible to impact of traumandash Polymorphisms of monoamine oxidase A and alcoholismndash Polymorphisms of serotonin transporter and depressionndash Increased risk for psychiatric disorder
Caspi et al 2003 Ducci et al 2008
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
41
Implications for Educators
bull Safe successful learning must maintain stress hormone levels low enough to keep the hippocampus functioning
bull Thats why its so crucial for both student and teacher to know how to apply the brakes in class - to keep the hippocampus in commission and return it to action as promptly as possible when the system goes on overload
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
42
The last thing we want to happen is that we as educators add to that backpack
QUESTIONS
