How can stress contribute to the development of an autoimmune disease such as Systemic Lupus Erythematosus, Rheumatoid Arthritis, Type 1 Diabetes, Hashimoto’s Thyroiditis, Psoriasis, or Crohn’s Disease? Claiming that the cause of autoimmune diseases solely lies in inherited genetic factors does not take into account a fundamental factor that can be key in their development: stress. On the other hand, in order to determine the triggers of stress, it is necessary to analyze the possible roots of this phenomenon that affects all of us at some point in our lives.
Insecure Attachment in Childhood and its Consequences in Adulthood
We cannot talk about stress without addressing personality structures that make individuals more vulnerable to stress. And to talk about these structures, we need to refer back to our childhood, where attachment relationships with our parents and other caregivers were formed, which were the cornerstone on which our character was built.
When attachment relationships between parents and children are not based on reciprocity, empathy, or emotional attunement (that is, a relationship in which the child’s emotional regulation needs and the parents’ responses are synchronized), we speak of „insecure attachment”. In insecure attachments, it is common for children to be exposed to more stressful situations, and it is also common for them to have more limited emotional regulation capacities compared to children with secure attachment.
In this sense, it is necessary to talk about the transition from heteroregulation (parents regulating their children’s emotions) to self-regulation (the child developing their own capacity for emotional and behavioral self-control). Parents attend to the emotional needs of their daughter or son when they cry, fall, are hungry, or have nightmares at night, and thanks to mirror neurons, the child unconsciously and automatically incorporates this capacity to regulate emotions in the same way they learn to walk, read, or write.
In other words, in the child’s brain, mirror neurons are activated when they observe a gesture or action from their parents, siblings…, gestures and actions that they simulate and interpret, deducing the intentions of the people around them and assimilating the meaning and concepts with which they can interact with their environment. This way, the transition from heteroregulation to self-regulation of emotions takes place.
In this transition, different studies have observed that children with insecure attachment tend to construct a compensatory character structure from which they disconnect from internal stress sensations in order to better adapt to family relationships that are not fully satisfying or do not evoke a habitual sense of fulfillment and calmness. This compensation is operationalized through certain defense mechanisms that allow children to temporarily appease or correct a feeling of distress in order to maintain balance in certain family relationships.
The problem arises when these defense mechanisms, such as denial (not acknowledging that something is happening), repression (being aware that something is happening but ignoring it), regression (retreating to past situations or states to avoid what is happening in the present), or projection (attributing what is happening to something external, rather than acknowledging it as one’s own), among others, become unconsciously internalized, generating autonomy and reversing or corrupting the relationship with oneself.
In other words, if the child used defense mechanisms to avoid feeling distress, now it is the defense mechanism itself that exposes the adult to very compromising situations without the person being aware that they need to protect themselves from themselves before the situations they are facing.
Consequences of Stress on the Immune System
In these types of insecure attachments, there is often a worse metabolization of stress, which often occurs unconsciously, as the sympathetic nervous system, which „activates” us in risky situations, is not prepared to think about relationship problems or how to pay a mortgage. The sympathetic nervous system is ancestrally prepared to fight or run away, as our ancestors did when a lion was chasing them. In today’s risk situations (relationship problems, economic issues…), among the multiple reactions that are triggered, the hypothalamic-pituitary-adrenal axis is activated, a hormonal system directly related to the stress response.
Thus, in response to stressful news, our cerebral hypothalamus initiates a cascade of hormonal events that stimulate the pituitary gland, which in turn reinforces the release of cortisol by the adrenal glands, which stimulates the secretion of adrenaline to either „fight” or „run away”. In short, in response to stressful news, a series of processes are triggered in our body to try to cope, culminating in an increase in cortisol and adrenaline.
The problem is that cortisol, which is popularly known as „the stress hormone”, has a catabolic effect on glutamine, which feeds the enterocytes of the intestinal epithelium. In other words, our intestines have a thin chain of cells called enterocytes, which are responsible for filtering the passage of microorganisms to the immune system. These enterocytes are nourished by an amino acid called glutamine, and excess cortisol degrades glutamine, thereby destroying the enterocytes.
As a result, small leaks form within the intestinal epithelium, and this is popularly known as „leaky gut”. That is why, whenever an autoimmune disease is diagnosed, it is necessary to consider irritable bowel, irritable colon, or intestinal permeability.
Once these leaks occur within the intestinal epithelium, both good and bad microorganisms reach the immune system without any screening. The immune system, in order to protect us, has to work indiscriminately by „killing flies with cannonballs”. As a result, the immune system becomes overwhelmed, and we experience a deficiency of lymphocytes called „T regulators”. The depletion of these lymphocytes leads to a phenomenon known as molecular mimicry. This means that, due to exhaustion, the immune system cannot distinguish between good and bad, and part of the immune system’s tissue begins to be attacked by the immune system itself, dying as a result of what is militarily known as „friendly fire”.
Stress, the Sympathetic Nervous System, and the Immune System
As mentioned above, the sympathetic nervous system is the one that „activates” us in risky situations. It is a self-regulation system in response to ancestral and unconscious stress, based on the „fight or flight” defense pattern. The first hominids who inhabited the planet 25 million years ago used this system to run away from predators while hunting in the jungle. And this system is designed for efficiency and energy saving. It’s simple, if you’re running away from a lion, why do we want you to have a good digestion? Or fertility? Or an immune system that protects you from a cold…
The sympathetic nervous system turns off digestion, immunity, or fertility so that the glucose these systems use can be redirected to the muscles and provide more energy for fighting or running. However, what happens when an adverse economic situation could result in the loss of our job? The fact is that phylogenetically, we are not adapted to encode messages like this. In other words, our biology and genetic load have not evolved enough, and we continue to react with the same pattern that determined the evolution of humans 25 million years ago: the „fight or flight” mechanism.
Today, we encounter different peaks of stress throughout the day, and if we do not have sufficient resources to metabolize it, the sympathetic nervous system will activate this energy-efficient pattern, which as a consequence will deactivate our immune system for approximately an hour. However, the worries we have about our work, money, children, or love life do not last just an hour, so our immune system will systematically activate and deactivate in the face of worries that exceed a certain threshold of distress that we are not prepared to metabolize.
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