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ETIOLOGY AND MECHANISMS OF DEVELOPMENT OF POST-TRAUMATIC
STRESS DISORDER
1
Nurshadov Jasur Qo‘chqor o‘g‘li
2
Safaraliyeva Shabnam Diyorjon qizi
3
Sharapova Dilfuza Nematillayevna
1-2
Student of group 505 of the Faculty Medical Pedagogy of Samarkand State Medical
University, Samarkand, Republic of Uzbekistan
3
Course of Psychiatry, Clinical ordenator, Samarkand State Medical University, Samarkand,
Republic of Uzbekistan.
https://doi.org/10.5281/zenodo.14926477
Abstract.
The etiology and mechanisms of development of post-traumatic stress disorder
(PTSD) are complex and involve biological, psychological, and social factors. This disorder can
arise as a result of severe psychological trauma, including experiences of violence, war, natural
disasters, car accidents, or other life-threatening situations. In the process of PTSD development,
neurobiological systems responsible for stress responses, such as the hypothalamic-pituitary-
adrenal (HPA) axis and the norepinephrine system, become significantly activated. Additionally,
genetic predisposition, pre-existing mental health conditions, and the level of social support can
influence the onset of PTSD. Understanding the mechanisms underlying this disorder is crucial
for developing effective treatment strategies.
Keywords:
etiology, mechanisms of development, post-traumatic stress disorder,
biological factors, psychological factors, social factors, psychological trauma.
Introduction.
Stress was first described in 1936 by the Canadian physiologist Hans Selye
as a general adaptation syndrome. Stress is a universal physiological response to any strong impact,
containing both protective and damaging elements, which ultimately leads to the activation of the
div's defense mechanisms. This means that stress occurs when the div is exposed to a powerful
stimulus. The intensity of this stimulus is such that the existing protective barriers are unable to
completely block its effects, resulting in a chain reaction within the div that has come to be
known as "stress."
The process of stress development involves a series of physiological and psychological
responses aimed at adapting to the challenging situation. Stress triggers the activation of the
hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system, leading to the
release of stress hormones such as cortisol and adrenaline.
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These biochemical changes prepare the div to respond to the stressor through the well-
known "fight or flight" reaction, enhancing alertness, increasing heart rate, and mobilizing energy
reserves [1-4].
According to Selye's model, stress develops in three distinct stages: Alarm Stage – This is
the div's initial reaction to a stressor. During this phase, the div perceives the threat and
activates the sympathetic nervous system. Stress hormones, primarily adrenaline and cortisol, are
released to prepare the div for a rapid response. Physiological changes include increased heart
rate, heightened alertness, and a surge of energy to cope with the perceived challenge [5].
Resistance Stage – If the stressor persists, the div enters a phase of adaptation. The
physiological responses initiated during the alarm stage continue, but the div attempts to return
to a balanced state (homeostasis). While stress hormones remain elevated, the div works to
maintain normal functioning. If the stressor is resolved, the div recovers. However, prolonged
stress can deplete resources and weaken the div's ability to cope [6-8].
Exhaustion Stage – If the stressor continues for an extended period and the div is unable
to adapt, it enters the exhaustion stage. At this point, the div's resources are depleted, leading to
decreased resistance to stress and increased vulnerability to illness, fatigue, anxiety, and other
physical and psychological health problems. Chronic stress can contribute to conditions such as
cardiovascular disease, weakened immune function, depression, and burnout [9-11].
Understanding the mechanisms of stress and its impact on the div is essential for
developing effective stress management strategies. By recognizing the different stages of stress
and their physiological effects, individuals can implement coping mechanisms such as relaxation
techniques, physical activity, social support, and cognitive-behavioral strategies to mitigate the
negative effects of prolonged stress.
Alarm Stage: The alarm stage is the initial phase of the stress response and begins
approximately six hours after exposure to a stressor, lasting up to 48 hours. During this stage, all
div systems experience heightened activation as they prepare to respond to the stressor. This
activation includes both psychological and physiological changes. Mentally, individuals may
experience increased emotional tension, heightened anxiety, and intensified cognitive focus.
Physically, the div undergoes significant physiological adjustments to prepare for action,
enhancing strength, endurance, and alertness [12-16].
From an evolutionary perspective, the alarm stage is a critical survival mechanism designed
to protect the organism from potential threats. It plays a crucial role in enabling both defensive and
aggressive responses necessary for survival.
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This phase is marked by the activation of two essential neurobiological systems: the
sympathoadrenal system and the hypothalamic-pituitary-adrenal (HPA) axis. These systems work
together to trigger the div's fight-or-flight response, ensuring an immediate and effective reaction
to stress [17-19].
The sympathoadrenal system, consisting of the sympathetic nervous system and the adrenal
medulla, is responsible for the rapid release of adrenaline (epinephrine) and noradrenaline
(norepinephrine). These hormones increase heart rate, blood pressure, and respiratory rate,
redirecting blood flow to essential organs such as the brain, muscles, and heart. This prepares the
div for quick action, whether to confront the stressor or escape from it.
Simultaneously, the HPA axis is activated, leading to the secretion of cortisol from the
adrenal cortex. Cortisol plays a vital role in maintaining energy levels by increasing glucose
availability, suppressing non-essential functions like digestion and immune responses, and
modulating brain activity to enhance alertness and decision-making [20-22].
Together, these two systems form the foundation of the div's immediate stress response.
Without their activation, the div's ability to cope with stress would be severely
compromised. The alarm stage represents a crucial adaptive response, allowing individuals to
quickly assess and react to challenging situations. However, if the stressor persists beyond this
phase, the div must transition to the next stage of stress response—the resistance stage—to
maintain long-term adaptation.
The Role of Catecholamines in the Stress Response: The effects of the sympathoadrenal
system are primarily mediated by three key neurotransmitters and hormones: dopamine,
norepinephrine (noradrenaline), and epinephrine (adrenaline). These chemical messengers belong
to a group known as catecholamines, which play a crucial role in regulating the div's response to
stress and preparing it for action. Each of these substances has specific physiological and
psychological functions that contribute to the div's adaptive mechanisms during stressful
situations [23-26].
Dopamine: Enhancing Mental and Physical Activity: Dopamine is a neurotransmitter
responsible for activating mental and physical processes, helping the div adapt to challenges by
enhancing focus, motivation, and motor function. It plays a critical role in reward and motivation,
influencing how individuals perceive and respond to stressors. Additionally, dopamine is
considered a key substance that determines the div's reserve capacity, often referred to as the
"safety margin." It helps regulate energy levels, ensuring that the div does not exhaust its
resources too quickly when responding to stress.
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High dopamine levels are associated with increased motivation, alertness, and cognitive
flexibility, which are essential for problem-solving and decision-making under pressure [27-29].
Norepinephrine: Boosting Mental Activity and Increasing Blood Pressure: Norepinephrine,
also known as noradrenaline, is another crucial catecholamine involved in the stress response. It
plays a primary role in enhancing cognitive function, increasing alertness, and maintaining
attention. One of its most significant effects is the induction of internal tension, which helps an
individual remain vigilant and ready to respond to potential threats.
Physiologically, norepinephrine causes vasoconstriction (narrowing of small blood
vessels), which leads to an increase in blood pressure. This process ensures that oxygen and
nutrients are rapidly delivered to essential organs, particularly the brain and muscles, allowing for
quick decision-making and physical readiness. Additionally, norepinephrine increases the
frequency and strength of heart contractions, helping to maintain adequate circulation during
stressful situations.
Epinephrine: Driving Physical Activity and the Fight-or-Flight Response: Epinephrine,
commonly known as adrenaline, is the primary hormone responsible for mobilizing the div for
physical activity during a stress response. It is released by the adrenal medulla in response to acute
stress and is a key driver of the fight-or-flight response [30-34].
When adrenaline is released, it causes several physiological changes, including: Increased
heart rate to pump more oxygenated blood to muscles and the brain. Dilation of airways to enhance
oxygen intake, improving physical endurance. Breakdown of glycogen into glucose, providing an
immediate energy source for muscle activity. Relaxation of certain blood vessels, redirecting blood
flow to large muscle groups needed for movement. These effects collectively ensure that the div
is physically prepared for rapid and intense activity, whether that means fighting off a threat or
escaping from danger [35-37].
The Role of the Hypothalamic-Pituitary-Adrenal (HPA) Axis in the Stress Response: The
hypothalamic-pituitary-adrenal (HPA) axis plays a crucial role in regulating the div's response
to stress. This system operates through a series of hormonal interactions, ultimately leading to the
release of corticosteroid hormones from the adrenal cortex. These hormones, particularly
mineralocorticoids and glucocorticoids, are essential for maintaining homeostasis and enabling the
div to adapt to stressful situations.
Effects of Epinephrine on Metabolism and Cardiovascular Function: Epinephrine
(adrenaline) is a key hormone released during stress, and its effects extend beyond increasing heart
rate and blood pressure.
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It also plays a critical role in metabolism by promoting: Breakdown of fats (lipolysis):
Adrenaline stimulates the breakdown of stored fat into free fatty acids, which serve as an energy
source for muscles during stressful situations [38-39].
Mobilization of glucose: It activates the release of glucose from glycogen stores in the liver
and muscles, ensuring that the div has a readily available energy supply for immediate physical
exertion.
Increase in emotional tension: The heightened energy availability and increased
cardiovascular activity contribute to the feeling of internal tension and readiness to respond to
threats.
The Hypothalamic-Pituitary-Adrenal (HPA) Axis and Hormonal Regulation: The HPA
axis is another essential system involved in the stress response. Its activation begins in the
hypothalamus, which signals the pituitary gland to release adrenocorticotropic hormone (ACTH).
ACTH, in turn, stimulates the adrenal cortex to produce and release corticosteroid
hormones, which play a critical role in adapting to stress.
These corticosteroids fall into two primary categories: These hormones help regulate fluid
balance and blood pressure by promoting the retention of sodium and water in the kidneys. By
maintaining the div's hydration status, mineralocorticoids ensure stable blood circulation during
stress. Increased fluid retention leads to higher blood pressure, which helps maintain adequate
blood flow to vital organs such as the brain, heart, and muscles [40-43].
Glucocorticoids play a crucial role in energy metabolism by enhancing glucose synthesis
(gluconeogenesis), ensuring that the div has enough energy to cope with stress. They help
regulate blood pressure, working in conjunction with the sympathoadrenal system to support
cardiovascular function. Glucocorticoids facilitate the conversion of norepinephrine
(noradrenaline) into epinephrine (adrenaline), thereby amplifying the effects of the fight-or-flight
response.
These hormones also have anti-inflammatory and immunosuppressive properties, helping
the div manage inflammation and prevent excessive immune activation that could be harmful
under prolonged stress.
The Stage of Increased Resistance (Stability Phase): The stage of increased resistance, also
known as the stability phase, represents the div's ability to maintain a new functional state in
response to a persistent stressor. At this stage, the div's adaptive systems have already been
activated, and the physiological and psychological mechanisms work to establish a state of
equilibrium.
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Unlike the initial alarm phase, where the response is immediate and intense, the resistance
phase is characterized by a more sustained and regulated reaction to stress. During this phase, the
div's functional systems operate in a fundamentally new mode, which allows an individual to
endure prolonged exposure to stress while maintaining relative stability. The activation of the
hypothalamic-pituitary-adrenal (HPA) axis continues, but instead of the sharp spikes in stress
hormone levels observed during the alarm phase, cortisol, adrenaline, and norepinephrine are now
regulated at a sustained level to support long-term adaptation [38-46].
The autonomic nervous system, particularly the sympathetic division, remains engaged to
ensure continued alertness and readiness to respond. However, to prevent excessive energy
depletion, certain compensatory mechanisms come into play:
Metabolic Adaptation: The div optimizes energy usage by increasing glucose production
while simultaneously conserving resources to prevent exhaustion.
Cardiovascular Adjustment: Blood pressure and heart rate remain elevated but are more
stable, ensuring an efficient supply of oxygen and nutrients to vital organs.
Immune System Modulation: The immune response may be suppressed to prevent
excessive inflammation, but at the same time, it remains active enough to defend against infections.
Cognitive and Emotional Regulation: Mental and emotional resilience develop, allowing
an individual to cope with stress more effectively without experiencing immediate breakdown or
overwhelming anxiety.
This phase can last for an extended period, depending on the intensity and duration of the
stressor. If the stressor is eliminated or reduced, the div can gradually return to a normal state.
However, if stress continues without relief, the div's adaptive capacity may become
exhausted, leading to the next phase—the exhaustion stage, where physiological and psychological
resources are depleted, increasing the risk of illness and burnout.
The Outcome Stage of Stress: The final stage of stress development is known as the
outcome stage, which determines how the div responds to prolonged stress exposure. This stage
can result in either a positive (adaptive) outcome or a negative (maladaptive) outcome, depending
on the individual's physiological and psychological resilience, as well as the nature of the stressor
[41-44].
Eustress – Positive (Beneficial) Stress: One possible outcome of stress is eustress, which
refers to a healthy and beneficial form of stress. In this case, the div successfully adapts to the
stressor, and as a result, functional reserves are strengthened.
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The physiological systems that were activated during the previous stages of stress become
more efficient, leading to enhanced endurance, cognitive performance, and emotional resilience
[45-47].
Eustress plays a crucial role in personal growth and development. It motivates individuals
to overcome challenges, enhances problem-solving abilities, and improves overall performance in
demanding situations. For example, athletes use controlled stress to build physical endurance,
while professionals experience performance-enhancing stress that drives productivity. Ultimately,
eustress leads to the elimination of stress itself, as the div becomes more capable of handling
similar situations in the future.
Distress – Negative (Harmful) Stress: On the other hand, if the stressor is excessive,
prolonged, or beyond the div's adaptive capacity, it can lead to distress, which is a harmful and
destructive form of stress. Distress occurs when the div's defense mechanisms become
overwhelmed, and physiological resources are depleted. This results in a state of exhaustion, where
the individual experiences chronic fatigue, emotional instability, and a weakened immune system
[48-52].
During distress, the div's ability to maintain homeostasis is significantly impaired,
leading to various negative health consequences, including:
Mental Health Disorders: Anxiety, depression, and post-traumatic stress disorder (PTSD)
can develop as a result of chronic distress.
Cardiovascular Problems: Persistent stress can contribute to hypertension, heart disease,
and increased risk of stroke.
Weakened Immune Function: Prolonged distress suppresses the immune system, making
the div more susceptible to infections and illnesses.
Gastrointestinal Issues: Conditions such as ulcers, irritable bowel syndrome (IBS), and
digestive disorders may arise due to chronic stress.
The manifestation of distress may vary among individuals. Some may experience physical
symptoms like headaches, muscle tension, and fatigue, while others may struggle with emotional
symptoms such as irritability, sadness, or feelings of helplessness. In extreme cases, distress can
lead to burnout syndrome, a state of complete mental and physical exhaustion that severely impacts
daily functioning [52-55].
Conclusion:
Stress is a fundamental physiological response that helps the div adapt to
external challenges. The Alarm Stage represents the div's initial response to a stressor, activating
the sympathoadrenal system and the HPA axis, leading to the release of adrenaline, noradrenaline,
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and cortisol. These hormones prepare the div for action by increasing heart rate, blood pressure,
and energy availability. The Resistance Stage occurs if the stressor persists, during which the div
attempts to maintain homeostasis. Physiological and psychological adjustments enable temporary
adaptation, but prolonged exposure can lead to resource depletion.
The Exhaustion Stage arises when the div's adaptive capacity is overwhelmed, resulting
in physical, emotional, and cognitive breakdown. Chronic stress can lead to mental health
disorders (anxiety, depression, PTSD), cardiovascular diseases, weakened immunity, and burnout.
The outcome of stress depends on its intensity and duration. Short-term, manageable stress
(eustress) enhances performance and resilience, promoting growth and adaptation. However,
excessive, prolonged stress (distress) has detrimental effects on physical and mental health,
increasing vulnerability to diseases and impairing daily functioning.
To mitigate the harmful effects of chronic stress, individuals should adopt effective stress
management strategies, such as relaxation techniques, regular physical activity, social support, and
cognitive-behavioral approaches. Recognizing and addressing stress early can help maintain well-
being and improve overall quality of life.
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