Early Trauma as the Origin of Chronic Inflammation: A Psychoneuroimmunological Perspective

267 Pages·2023·3.879 MB·English

by  Rainer H. Straub

Early Trauma as
the Origin of Chronic
Inflammation
A Psychoneuroimmunological
Perspective
Rainer H. Straub
123
Early Trauma as the Origin of Chronic
Inflammation
Rainer H. Straub
Early Trauma as the Origin
of Chronic Inflammation
A Psychoneuroimmunological Perspective
Rainer H. Straub
Division of Rheumatology
Department of Internal Medicine
University Hospital
Regensburg, Germany
ISBN 978-3-662-66750-7 ISBN 978-3-662-66751-4 (eBook)
https://doi.org/10.1007/978-3-662-66751-4
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Dedicated to my doctoral students and pupils
Foreword
Life events in childhood and adolescence have a lasting impact on a person's personal-
ity development, both in a positive and a negative sense. These functional connections
are not only postulated by the various psychological schools and psychotherapeutic
approaches from psychoanalysis to cognitive behavioral therapy, but are now also con-
firmed by many empirical studies.
As an experimental behavioral scientist and clinically active behavioral thera-
pist, even after more than 30 years of therapeutic work, I am always impressed by the
close connections between the current psychological problems my patients report and
the described experiences and events from their childhood and adolescence. It is not
always only traumatic experiences such as sexual abuse, physical abuse or emotional
neglect that are related to the acute psychological complaints such as anxiety, depressive
symptoms or somatoform dysfunctions. Often, divorce of the parents and the resulting
insecurity or high performance expectations of the parents cause the development of
psychological problems in later adult life. These stressful childhood experiences affect
not only mental health, but also physical processes. Since its beginnings, psychosomatic
medicine has postulated the connections between traumatic childhood experiences and
the development of physical illnesses such as chronic inflammatory processes. For a long
time, however, only speculation was possible about these connections, since too little
was known about the functions of the immune system and the corresponding connections
with the nervous and hormonal systems.
Through the new academic and research field of psychoneuroimmunology, the interac-
tions between systems have become known in increasing detail in recent years, and the
interplay between systems appears to be much closer and more complex than previously
thought. For example, a recent high-profile publication in the journal Cell showed that
information from a subsided inflammatory response in the gut is stored in a special brain
area called the insular cortex. When the neurons in the insular cortex are reactivated in
the mice using chemogenetic methods, a renewed inflammatory response in the intestinal
tissue occurs in the animals (Koren et al. 2022, Cell, 184 5902).
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viii Foreword
As a physician and one of the internationally recognized protagonists of psychoneuro-
immunology, Professor Rainer H. Straub has contributed groundbreaking basic scientific
findings on bidirectional communications between the nervous, endocrine, and immune
systems, which have significantly contributed to a better understanding of these interac-
tions between the systems for the development and course of immunologically related
diseases. In this book, Rainer H. Straub uses his profound knowledge accumulated over
many years to provide an excellent summary of previous knowledge and empirical find-
ings on the functional connections between traumatic experiences in childhood and ado-
lescence and the development of chronic inflammatory diseases in later adulthood.
Rainer H. Straub describes the psychological foundations just as competently as the
historical development, the evolutionary-biological background, the genetic-epigenetic
and, of course, the endocrinological and immunological correlations that prove to be
responsible for chronic inflammatory diseases after early traumas. The author does not
merely loosely string together individual empirical findings; rather, he understands how
to bring these sometimes complex interrelationships to the reader in an understandable
way in an entertaining narrative style.
Overall, this is an impressive book that presents this exciting topic in a unique way,
and I wish it a wide range of readers.
Essen Manfred Schedlowski
25 February 2022
Preface
The population on this earth is growing and growing, and this is the cause of many prob-
lems. New large populations are joining the globalized work force. Resources are being
consumed, the environment is being increasingly polluted and the world of work is being
seriously changed. The family with two working parents is the norm. This brings an
increase in stressful life situations, especially in families with precarious circumstances.
In addition, there are mental illnesses as a result of stress and environmental influences.
The migration of people seeking protection and the confrontation with the local popu-
lation is another stress factor. The difficulties cannot all be listed here in detail, but the
major victims are often the children and young people. The Corona pandemic also shows
this.
The famous American dancer Isadora Duncan (1877–1927) once wrote: “As long as
little children are allowed to suffer, there is no true love in this world.” Karl Menninger
(1893–1990), American psychiatrist, added: “What’s done to children, they will do to
society.”
Already around conception, during the time in utero, through childhood and in ado-
lescence, people are exposed to more and more stress factors. These stressful situa-
tions influence individual development in different time windows, which can be linked
to problems in adulthood. Throughout life, these stress factors accumulate, and this can
lead to lasting psychological and physical problems in later stages of life.
My goal in writing this book was, first, to raise public awareness of the important
long-term physical and psychological effects of early trauma in children and adoles-
cents. While this is a central task of psychotraumatologists, it also concerns the inter-
ested immunologist, as you will see in the next paragraph. It is not a question of “What
is wrong with this child?” but a question of “What happened to this child?” And another
question is, “Why can there be such long-term problems that extend into adulthood?”
My second goal as a psycho-neuro-endocrine oriented immunologist was, on the
other hand, to shed light on the often detectable increased inflammatory state after
early traumas. This chronic immune activation is shown by increased inflammation lev-
els in the blood. It may lead to an increased incidence of autoimmune diseases such as
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x Preface
rheumatoid arthritis (the most common form of chronic joint inflammation) later in life,
and this concerns the rheumatologist. However, it is not yet well understood why an
early traumatic event or stressful situation should cause a higher inflammatory situation
in the long run. There must be some kind of programming that originates in the brain and
subsequently affects the body periphery in the form of increased inflammation.
The reader is introduced to the topic of trauma through examples in the first chapter.
In the second chapter, the different trauma situations, the time of occurrence and the fre-
quencies of childhood adversities in the population are pointed out. Furthermore, those
factors that can protect against long-term consequences are mentioned. Indeed, it is by
no means just a “one-way street from trauma to late problems,” as there are many pro-
tective elements (the subject of resilience research, among others). This attitude reflects
the view of those affected who put the trauma behind them and yet look positively to the
future. This part is concluded by an evolutionary medical view.
In Chap. 3, I deal with the consequential problems found in the brain and body
periphery. Pathophysiological pathways are outlined, and this requires some medical
depth. This discussion transitions into the presentation of the elevated inflammatory
situation, with a focus on the chronic situation, also known as autoimmune disease.
Epidemiological studies show a clear link between childhood/adolescent trauma and
later onset of these autoaggressive diseases.
The fourth chapter now explains step by step how a problem in the brain can affect
the body periphery to cause chronic inflammation there. The brain and immune system
are intertwined via “connectors,” and these contribute to chronic immune activation. The
Chap. 5 looks into the future. On the basis of energy considerations, a hypothesis is put
forward which reads: Mild inflammation exists, but it does not decisively stimulate the
late problems. This last statement may be surprising for one or the other reader, because
he understands inflammation as the supporting pillar of all subsequent problems, particu-
larly in the periphery. This mild inflammation is for me only a concomitant phenomenon
in the context of the energy regulation of the body, a support of the immune system for
an overactive brain.
This book is intended for researchers already studying psychological trauma and late
effects, as well as those who wish to engage in this growing area of research, includ-
ing students, and individuals who wish to improve the lives of vulnerable children.
Professionals in medicine, psychology, psychiatry, social work, education, sociology,
nursing, pediatrics, public health, applied economics, humanitarian aid, and disaster
planning may find useful ideas and background for their work. A basic understanding of
medicine is beneficial for reading.
As in my previous books, I do not make any suggestions for therapy, because that is
presumptuous, because there are specialists in psychotraumatology for that. If you read
the book carefully, you can see approaches to therapy in abundance. Often these therapy
options consist of preventing the bad and stimulating the good.
Preface xi
A book like this is never created single-handedly, so a few very helpful people have
given good advice here. The book was critically read by my wife Verena Straub. Another
big thank you goes to Dr. Volker von Baehr, IMD Institute for Medical Diagnostics,
Berlin, who supported the printing of the book. From the Springer-Verlag, valuable help
came from Dr. Christine Lerche. If inclined readers provide further tips, I am grateful.
Improvements will be collected and added to a later edition.
Regensburg Rainer H. Straub
Summer 2022