Age of trauma onset and HPA axis dysregulation among trauma-exposed youth
Open accessAbstract
The hypothalamic–pituitary–adrenal axis (HPA axis) is a pathway through which childhood trauma may increase risk for negative health outcomes. The HPA axis is sensitive to stress throughout development; however, few studies have examined whether timing of exposure to childhood trauma is related to differences in later HPA axis functioning. Therefore, we examined the association between age of first trauma and HPA axis functioning among adolescents, and whether these associations varied by sex. Parents of 97 youth (aged 9–16 years) completed the Early Trauma Inventory (ETI), and youth completed the Socially‐Evaluated Cold‐Pressor Task (SECPT). We measured salivary cortisol response to the SECPT, the cortisol awakening response, and diurnal regulation at home across 2 consecutive weekdays. Exposure to trauma during infancy related to delayed cortisol recovery from peak responses to acute stress, d = 0.23 to 0.42. Timing of trauma exposure related to diverging patterns of diurnal cortisol regulation for males, d = 0.55, and females, d = 0.57. Therefore, the HPA axis may be susceptible to developing acute stress dysregulation when exposed to trauma during infancy, whereas the consequences within circadian cortisol regulation may occur in the context of later trauma exposure and vary by sex. Further investigations are warranted to characterize HPA axis sensitivity to exposure to childhood trauma across child development.
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Physical abuse is associated with faster reactivity to acute stress in adolescents.
““Physical abuse” (e.g., being injured to the point of bruising) was associated with faster reactivity to acute stress.”
From Childhood Trauma, the HPA Axis and Psychiatric Illnesses: A Targeted Literature Synthesis (2022) · cites this paper as [143]
The Methods (Measures; page unavailable) define physical abuse to include being hit to the point of bruising. But the Results (page unavailable) report that more traumatic experiences were not associated with differences in cortisol activation to peak; the association found was slower recovery after acute stress, not faster reactivity. (LLM, conf=0.78)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredELS/CT exposure in the first 2 years of life is associated with prolonged cortisol reactivity to acute social stressors among adolescents.
“Studies from Kuhlman et al. (94, 113) confirmed that ELS/CT exposure in the first 2 years in life is associated with prolonged cortisol reactivity to acute social stressors among adolescents.”
From Developmental Trajectories of Early Life Stress and Trauma: A Narrative Review on Neurobiological Aspects Beyond Stress System Dysregulation (2019) · cites this paper as [113]
The Discussion reports that first trauma exposure before age 1 was associated with delayed cortisol recovery after acute stress in youth aged 9–16; the Method identifies the stressor as the Socially-Evaluated Cold-Pressor Task. The claim extends the timing to the first 2 years and calls the finding prolonged reactivity, whereas the paper distinguishes slower recovery from reactivity. (LLM, conf=0.88)
Experimental — accuracy not yet measuredSexual maturation, in interaction with sex and environmental cues, represents a new major confounder of HPA axis reprogramming.
“On the other hand, it is rather sexual maturation, in interaction with sex and environmental cues, which represents a new major confounder of HPA axis reprogramming (113).”
From Developmental Trajectories of Early Life Stress and Trauma: A Narrative Review on Neurobiological Aspects Beyond Stress System Dysregulation (2019) · cites this paper as [113]
The Discussion (page unavailable) says pubertal status may account for differences in diurnal HPA-axis regulation between males and females and notes that pubertal status was not collected. It does not establish sexual maturation interacting with environmental cues as a new major confounder of HPA-axis reprogramming. (LLM, conf=0.84)
Experimental — accuracy not yet measuredHPA axis functioning can be perceived as specific to trauma subtypes rather than inconsistent across studies.
“The authors suggest that HPA axis functioning can be perceived as specific to trauma subtypes rather than inconsistent across studies; however, more research to establish a concrete connection between reactivity and subtype in adolescents.”
From Childhood Trauma, the HPA Axis and Psychiatric Illnesses: A Targeted Literature Synthesis (2022) · cites this paper as [143]
The Results (page not provided) say that trauma type and timing were independent contributors to later HPA-axis functioning in this sample, supporting the subtype-specific part of the claim. The paper does not explicitly interpret inconsistent findings across studies as subtype-specific effects. Its call for further research concerns HPA-axis sensitivity across development, not specifically the connection between reactivity and trauma subtype in adolescents. (LLM, conf=0.81)
Experimental — accuracy not yet measuredExposure to non-intentional trauma is associated with normal diurnal regulation but elevated cortisol at bedtime in adolescents.
“Results indicated that exposure to “non-intentional trauma” (e.g., witnessing an accident or experiencing a natural disaster) was associated with normal diurnal regulation but elevated cortisol at bedtime.”
From Childhood Trauma, the HPA Axis and Psychiatric Illnesses: A Targeted Literature Synthesis (2022) · cites this paper as [143]
The Discussion reports elevated evening cortisol in males whose first trauma occurred later, compared with infancy exposure. It does not report that non-intentional trauma specifically was associated with normal diurnal regulation and elevated bedtime cortisol; it says only that 77% of the sample experienced non-intentional trauma first. The Results instead describe diurnal patterns that vary by age of first trauma and sex (page numbers unavailable in our copy). (LLM, conf=0.85)
Experimental — accuracy not yet measured
Emotional abuse is associated with delayed recovery following acute stress in adolescents.
““Emotional abuse” (e.g., persistently being ridiculed or insulted by a caregiver) was associated with delayed recovery following acute stress.”
From Childhood Trauma, the HPA Axis and Psychiatric Illnesses: A Targeted Literature Synthesis (2022) · cites this paper as [143]
The Methods (Measures; page unavailable) define emotional abuse to include being persistently insulted by a caregiver. The Results and Discussion report slower cortisol recovery after acute stress with greater total trauma exposure and earlier first trauma, but do not establish that emotional abuse specifically was associated with delayed recovery. (LLM, conf=0.86)
Experimental — accuracy not yet measured
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- Authors
- Kuhlman, K. R., Vargas, I., Geiss, E. G., & Lopez‐Duran, N. L.
- Affiliations
- University of California, Los Angeles (US)
- Department of Psychology University of Michigan Ann Arbor Michigan USA
- University of Michigan (US)
- Corresponding author
- Kuhlman, Kate Ryan
- Venue
- Journal of Traumatic Stress
- Publisher
- Wiley
- Published
- 2015-11-10
- Volume
- 28
- Issue
- 6
- Pages
- 572-579
- ISSN
- 0894-9867 (ISSN-L)
- 1573-6598
- PMC
- PMC5403247
- OpenAlex
- W2128902233
- Semantic Scholar
- c5ad2bfb8c794caa1754783d038a2cda45cebfb3
- Cited by
- 75
- References
- 36
- Citations by year
- 2026: 8 · 2025: 6 · 2024: 3 · 2023: 8 · 2022: 7 · 2021: 9 · 2020: 5 · 2019: 10 · 2018: 8 · 2017: 8 · 2016: 3
- FWCI
- 3.28
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Traumatic Stress (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (T32MH015750)
- Topics
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Keywords
- childhood trauma, HPA axis dysregulation, salivary cortisol, cortisol awakening response, diurnal cortisol rhythm, cold pressor task, sex differences, adolescents, stress response
- MeSH terms
- Psychological Trauma, Adolescent, Child, Cross-Sectional Studies, Female, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Life Change Events, Male, Pituitary-Adrenal System, Saliva, Stress Disorders, Post-Traumatic, Time, Age of Onset, Sex Distribution
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