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Developmental Factors the Increase Vulnerabilty to
Post-Trauma Effects

The human capacity to adapt is the source of our survival, our well being, and much of our pain.  When the world is excessive in the stress it applies, our bodies tend to be excessive in their responses.  We survive, but at a price we may keep paying for a long time.  This page discusses a number of factors that may increase a service member’s vulnerability to substance use disorders, post-deployment stress effects, depression, and anxiety long before he or she enters the military.

Increased Vulnerability in Childhood:  Although Service Members’ SUDs and post-deployment stress effects do not begin in childhood, increased vulnerability to trauma in war—or in any other environment—may begin in childhood.  An understanding of the biological vulnerability that many people grow up with can bring a better understanding of the vulnerability that many people carry into the theater of war.

As earlier pages showed, the factors that best allow children to develop resilient stress response systems include consistent, “attuned” attachment and caregiving, a chance to burn up stress chemicals (e.g., adrenaline, norepinephrine, dopamine) through physical activity, and a chance to rest and “reset” between short, moderate periods of stress and threat (Schore, 2001).  But in the real world:

  • Most threats cannot be fought effectively with the resources that children possess
  • Many threats take place in situations in which children cannot burn off excess stress chemicals  with physical activity
  • Many stressful or threatening circumstances are long lived, recurrent, or chronic
  • Many children and adults are faced with multiple stressful or threatening circumstances
  • Many caregivers are unable to relate consistently in the ways needed to promote healthy development and regulation of children’s stress systems, often because of challenges to their own stress systems

Like the autonomic nervous system, children’s responses to extreme or chronic stress or threat also have two “arms”:

  • A sympathetic arm that leans toward anxiety, hyperactivity, and hyperarousal (the fight-or-flight response)
  • A parasympathetic arm that leans toward “shutting down,” numbing, and dissociation (compartmentalization of traumatic memory and experience)

When children’s experiences do not provide the safety and nurturing they need for development, a number of consequences can follow, to greater or lesser degrees:

  • Their sympathetic “fight or flight” chemicals (e.g., adrenaline, noradrenaline, dopamine) may be triggered too easily under stress (Schore, 2002;  Perry, 2001).  Growing up, they may be more vulnerable to levels of anxiety, and alcohol or drugs may seem like the only convenient “remedy”
  • Their parasympathetic “slow down,” numbing, “freeze” chemicals (e.g., cortisol and the chemicals used to stimulate its release) may be triggered too easily under stress (Weiss, Longhurst, and Mazure, 1999).  In adolescence, they may be drawn to substances that elevate their moods.
  • Throughout their lives, anxiety may drive them toward situations that are unsafe (because these situations are familiar, and when we are anxious, we seek that which is familiar) (van der Kolk, 1989).
  • Children’s bodies may develop patterns of responding to stress with high levels of pleasurable (e.g., dopamine) or numbing (e.g., endorphins) chemicals.  When stress subsides, withdrawal from these chemicals can leave them with urges to drink, use drugs, or re-enact stressful situations for their chemical effects (van der Kolk, 1989).
  • They may have less of the chemical (serotonin) that helps control moods and impulses—including the impulse to do things compulsively, drink, or use drugs (van der Kolk, 1994).
  • Some of these chemical reactions (e.g., having too much cortisol or too little serotonin) may weaken their immune systems and their resistance to illness.
  • Children may grow more vulnerable to anxiety disorders and PTSD later in life (Schore, 2002;  Perry, 1994).
  • They may be more vulnerable to diseases that run in their families, including substance dependence, depression, and other mental illnesses (Heim and Nemeroff, 2001;  Schore, 2002;  Perry, 1994).
  • Because of challenges to their orbitofrontal cortex and hippocampus, they may have difficulty thinking things through and remembering details of things that have happened (Schore, 2002;  Perry, 1997).
  • Children may have a harder time learning who they are in the world (Schore, 2002;  van der Kolk, 1989;  Herman, 1992), in part because of the “disconnect” between the amygdala’s powerful, unconscious memory fragments and the conscious context provided by the higher brain structures.

Possible Genetic Factors in Chemical Vulnerability:  The SUD treatment field is already well aware of the growing body of literature linking genetic factors with vulnerability to substance dependence (Nestler, 2000;  McClung and Nestler, 2003;  Comings et al., 1994).  Now researchers are also finding genetic factors that may make it more likely that children’s and adults’ bodies will respond to stress and trauma with some of the other chemical excesses and deficits described above.  Although much more information will be needed, there is evidence that:

  • Challenges to a number of genes that influence the transportation of serotonin (e.g., SERTPR, 5-HTTLPR, SLC6A4) may be involved in making serotonin less available, and so may make people more vulnerable to PTSD, depression, suicidal tendencies, and other psychiatric illnesses (Lee et al., 2005;  Zalsman et al., 2006;  Barr et al., 2004;  Gelernter, Pakstis, and Kidd, 1995).
  • Different variations in the stress-related gene FKBP5 may make people more or less vulnerable to severe PTSD symptoms by influencing the availability of cortisol (Binder et al., 2008).
  • A variation in the dopamine transporter gene SLC6A3 may make people more vulnerable to developing PTSD by increasing the availability of dopamine in response to stress (Segman et al., 2002).
  • A variation in the gene APOE may contribute to more difficult reexperiencing symptoms and memory problems in people exposed to trauma (Freeman et al., 2005).

Next: Common Sources of Stress in Childhood


The material on all of the Clinical Pages is taken directly from the draft version of Finding Balance After the War Zone:  Considerations in the Treatment of Post-Deployment Stress Effects, a manual under development for the Great Lakes Addiction Technology Transfer Center and Human Priorities.  This draft is copyright © 2008, Pamela Woll.  Reprint permission is universally granted, but attribution is requested.
Click here for References and Other Resources.
Click here to link to a PDF file of the current version of the clinician’s manual draft.
Click here to link to a PDF file of the accompanying booklet for veterans.

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