NYT
7-2-00
Childhood Abuse and Adult Stress
Women who were physically or
sexually abused in childhood show
exaggerated physiological responses
to stressful events, a new study has
found. And this abnormal stress response,
the researchers found, appears especially
pronounced in women who also have
symptoms of clinical depression.
When exposed to mild stress induced in
a laboratory setting, women in the study who
suffered from depression and had a history
of childhood abuse showed levels of ACTH, a
hormone secreted by the pituitary
gland in response to stress, six times
as high as those in women without
such histories. They also had higher
levels of cortisol, another stress hormone,
and higher heart rates than
women who had not been abused.
Women with a history of abuse who
were not depressed also showed
hypersensitivity to the stress, but to a
less extreme degree.
The study's findings offer further
confirmation that traumatic experiences
can have a profound effect on
brain chemistry, and in particular on
the brain's response to stress, and
they add to the growing body of evidence
that in exploring the origins of
psychiatric illness, nature and nurture
cannot be easily disentangled.
"Clearly, here is an environmental
event that causes changes in the
brain and must interact with genetic
vulnerability to influence whether or
not you get this syndrome of hypersensitivity,"
said Dr. Charles B. Nemeroff, chairman of
psychiatry and behavioral sciences at Emory
University School of Medicine and a co-author
of the study, which appears in
today's issue of The Journal of the
American Medical Association.
Dr. Nemeroff said the research
also underlined the importance of
addressing child abuse nationally.
More than three million cases of
child abuse are reported each year,
he said. "And if, indeed, this is a risk
factor for developing mood and anxiety
disorders," he continued, "this is
a very large public health problem."
Women were used in the study, he
said, because they are more likely to
suffer from depression than men and
are more frequently the victims of
sexual abuse. But he said there was
no inherent reason why men would
not exhibit the same response.
A history of childhood abuse, studies
have shown, puts people at higher
risk for developing depression, anxiety
disorders and other emotional
illnesses later in life. And abnormal
stress responses, Dr. Nemeroff and
his colleagues suggest, might to
some degree account for this increased risk.
Dr. Rachel Yehuda, professor of
psychiatry and director of the Traumatic Stress Studies Program at the
Mount Sinai School of Medicine, said
the new study's findings "support
observations that our group has
made over a 10-year period about the
exquisite responsiveness of stress
hormones in survivors who have sustained trauma in both childhood and
adulthood."
In a series of studies, Dr. Yehuda
and her colleagues have documented
abnormal stress responses in combat veterans, rape victims, survivors
of the Holocaust and others who have
endured traumatic experiences.
Evidence from animal studies also
suggests that extreme stress during
early development might lay the
groundwork for hypersensitivity to
stressful events later in life.
Adult rats separated from their
mothers for a few hours each day
soon after birth show exaggerated
cortisol secretion in response to
stress, researchers have found. And
similar abnormal responses have
been found in adult monkeys reared
by their mothers under stressful conditions.
For their study, Dr. Nemeroff and
his colleagues recruited 49 women
ages 18 to 45 as volunteers. Childhood
abuse was defined, for the purposes
of the study, as repeated, severe
abuse occurring at least once a
month for a period of at least one
year.
Independent verification that
abuse had occurred was obtained,
when possible, from court and medical records and the recollections of
friends and family members.
To induce mild stress, the participants in the study were asked to give
a speech and solve arithmetic problems in front of an audience.
Dr. Dennis Charney, chief of the
research program on mood and anxiety disorders at the National Institute of
Mental Health, said the new
study and others like it illustrated
"the proverbial gene-environment
interaction."
"You are born with a certain genetic constitution to handle many
things, including stress," Dr. Charney said. "But if the developing animal
or human is faced with an extraordinary amount of stress, those
systems are going to be changed in
how they develop."
