Anticipatory Stress Response in PTSD

Article excerpt

Grogan and Murphy's (2010) literature review provides a synopsis of anticipatory stress response in children with posttraumatic stress disorder (PTSD) . The authors highlight the etiology of PTSD, risk and preventive factors, long-term health implications, and treatment options. The review spans prenatal development through adolescence.

Children who experience trauma and chronic anticipatory stress are at risk for irreparable damage to their developing brains, chronic illnesses (e.g., fibromyalgia, asthma), and emotional and behavioral disorders (e.g., depression, anxiety, substance abuse). The severity of PTSD seems to depend on a dose-response effeet; that is, the greater the severity of the trauma and number of types of traumas experienced, the greater a child's risk of experiencing more severe PTSD symptoms and health threats.

Anticipatory stress, different from thought- and language-based feelings of worry, is predominantly emotionand image-based (e.g., reexperiencing memories). Anticipatory stress occurs in the absence of an impending threat and results in intensified autonomic arousal. Fear conditioning can occur as a child reexperiences the memory of the trauma and experiences the physical and psychological responses of extreme fear, The process of sensitization and kindling can lead a child to experience an extreme response to small cues, which ultimately can result in a constant state of hypervigilance and hyperarousal as they work to avoid triggers to distressing emotions and become on the look-out for unpredictable threats. Hyperarousal is correlated with high levels of Cortisol and reduced volume of the hippocampus. Furthermore, allostatic overload results from stress responses that are elicited too often without sufficient time to return to a normal level, which produces neurochemical imbalance and damage to the structures involved in allostatic load (e.g., HPA axis, sympathetic nervous system) . Grogan and Murphy further review the impact of genetics, stress during prenatal development, and the multiple neurological and physiological systems that can be impacted by anticipatory stress.

The authors present nurses with numerous clinical practice applications, which have relevance for school psychologists and the field of school crisis intervention. During assessment, it is recommendedthat screeningfor trauma become routine. To ease the discomfort in reporting a traumatic event when screening adolescents, ask them to review a list of traumas and report only a single number that they've experienced. Identify the presence of somatic symptoms, developmental regression, stressors in the child's life, and emotional-behavioral and cognitive problems (e. …