The Power of Cortisol as The Silent Player in Your Trauma Narrative
- Brainz Magazine
- 3 hours ago
- 12 min read
Written by Sam Mishra, The Medical Massage Lady
Sam Mishra (The Medical Massage Lady) is a multi-award winning massage therapist, aromatherapist, accredited course tutor, oncology and lymphatic practitioner, trauma practitioner, breathwork facilitator, reiki and intuitive energy healer, transformational and spiritual coach, and hypnotherapist.
Everywhere you turn on social media, people are talking about cortisol, and it seems to have become the cause of all of our problems. But cortisol isn’t all bad, so how much do we actually understand about it? We have long recognised the connection between cortisol and trauma, but does experiencing trauma inevitably lead to elevated cortisol levels?
What is cortisol?
Cortisol is a glucocorticoid, or steroid hormone, produced and secreted by the adrenal gland. It helps regulate inflammation, immunosuppression, and metabolic processes, including blood glucose regulation. They play a major role in stress responses, blood pressure regulation, maintaining homeostasis, and sleep cycles. When cortisol levels drop or rise, your health can be negatively impacted.
Cortisol is often referred to as the stress hormone, but spikes in cortisol levels will vary according to whether the stress is acute, such as a threat to one’s safety for a short period of time, or chronic, such as having a long-term health issue. Generally, after the cortisol levels peak, they will return to baseline, but sometimes, due to factors beyond your control, cortisol levels may remain abnormally high or low. This article will examine the relationship between trauma and cortisol levels.
How does cortisol affect the body?
Because most tissues contain glucocorticoid receptors, cortisol levels will affect most body systems.
The musculoskeletal system
Cortisol is a contributing factor to bone health, muscle mass, and strength, with high levels potentially resulting in loss of bone formation and density due to calcium absorption being affected and increased bone resorption. Osteoporosis has been linked with high cortisol levels in those with Cushing's syndrome.
Cortisol also increases the breakdown of muscle proteins and amino acids, leading to atrophy of the muscle tissue and consequently reduced muscle strength. The effect of increased cortisol on the metabolism of carbohydrates through glucogenesis will lead to further weakness in the muscles.
Cortisol raises blood sugar by releasing stored glucose, counterbalancing the effect of insulin, which lowers glucose levels. High cortisol levels can therefore lead to consistent hyperglycaemia and type 2 diabetes.
Inflammation resulting from high cortisol levels can not only increase joint pain but also increase muscle tension when cortisol peaks through stress, contributing to conditions such as fibromyalgia.
The immune system
Increased secretion of pro-inflammatory cytokines, which fight infection and temporarily raise cortisol levels, can temporarily enhance immune function. In the long term, however, high cortisol will result in chronic inflammation and weaken the immune system, usually due to prolonged stress. Long-term stress can also inhibit lymphocyte production, which reduces the body’s ability to fight infections, and alter the distribution of immune cells in the body.
The reproductive system
Cortisol can impact the reproductive system as a result of both immunosuppression, which can interfere with conception, and disruption of the hypothalamic-pituitary-adrenal axis, which regulates hormone synthesis and inhibits oestrogen. When stress and high cortisol disrupt hormone levels, this can lead to menstrual irregularities, egg quality and ovulation issues, and implantation issues due to changes in the endometrium. High cortisol can also reduce testosterone and sperm motility and quality, thus also impacting male fertility.
The respiratory system
Cortisol has a minimal effect on the respiratory system, but when stress is also an issue, high cortisol levels can result in shallow, rapid breathing, reducing oxygen intake and increasing breathlessness. Not only will such elevated levels exacerbate any anxiety, but it may also affect airway tone, potentially increasing the frequency of asthma attacks, even though cortisol is thought to potentially improve airflow in asthmatics. Increased inflammation due to high levels of cortisol combined with weakened immune function will certainly worsen conditions such as COPD, asthma, and bronchiectasis, increasing susceptibility to respiratory infections.
The cardiovascular system
Raised cortisol levels, usually a result of prolonged stress, can increase blood pressure, constrict arteries, thus reducing blood flow, affect platelet activation and vascular contractility, which potentially lead to thrombosis, and promote arterial plaque accumulation, all of which are contributing factors to heart disease. Plus, cortisol can impact cholesterol and blood glucose levels, which are also risk factors for strokes and heart attacks.
The integumentary system
As mentioned, high cortisol due to being stuck in the stress response promotes inflammation, and this explains why our skin is often affected when we’re stressed; redness, itching, and inflammatory skin conditions such as eczema, rosacea, and psoriasis will get worse. High cortisol will have additional effects on the skin, as the breakdown of collagen and elastin fibres will cause thinning and damage the infection barrier, which, when combined with a suppressed immune system, increases the risk of infection, bruising, and premature ageing. Hyaluronic acid inhibition and difficulty in retaining moisture will further dehydrate the skin and accelerate ageing. A compromised skin barrier can also cause hypersensitivity, problematic scar formation, and delayed wound healing.
However, high cortisol can also overstimulate the sebaceous glands, meaning that acne outbreaks may be triggered due to excess oil production.
The nervous system
Perhaps the most significant effect of raised cortisol in terms of the discussion in this article is that on the nervous system and the sleep cycle.
Cortisol, a primary stress hormone, plays a significant role in nervous system regulation, as it activates the sympathetic nervous system to initiate the "fight or flight" response and then promotes relaxation via the parasympathetic nervous system to help the body rebalance. When the sympathetic nervous system is activated, cortisol, adrenaline and norepinephrine increase alertness by raising blood pressure and heart rate. Cortisol also increases blood glucose levels to produce the energy needed to respond to stress, taking resources from non-essential functions like digestion and reproduction.
However, if we are exposed to long-term stress, the high cortisol levels can dysregulate the nervous system further and lead to health issues, such as anxiety and impaired cognitive function, that we see in PTSD.
The sleep cycle
Cortisol levels should follow a natural circadian rhythm where they are high in the morning to help us wake up, gradually decreasing through the day so that by the evening, they are low to promote sleep. If cortisol levels are high in the evening, sleep will be disrupted, as sympathetic nervous system activation will cause our heart rate and blood pressure to rise, and melatonin, which also promotes sleep, will be inhibited.
How does the body regulate cortisol levels?
The HPA axis (hypothalamic-pituitary-adrenal) is the regulatory system for cortisol in the body, and each of these three glands must be functioning well to achieve a healthy cortisol balance. The hypothalamus and pituitary glands regulate cortisol synthesis in the adrenal glands, and when factors such as illness or prolonged stress disrupt this balance, if cortisol levels drop, CRH (corticotropin-releasing hormone) secretion from the hypothalamus prompts ACTH (adrenocorticotropic hormone) synthesis in the pituitary, which promotes more cortisol release from the adrenal glands.
Prolonged hypercortisolism is usually a result of Cushing's syndrome, but other factors include corticosteroid medication or tumours of the pituitary or adrenal glands, which cause overproduction of ACTH or cortisol. The excess production can lead to weight gain, hyperglycaemia, hypertension, muscle weakness, osteoporosis, purple stretch marks, and hirsutism.
Hypocortisolism, or adrenal insufficiency, is often due to Addison's disease, where the immune system attacks the adrenal glands, or sometimes adrenal haemorrhage or infection. It may also occur with an underactive pituitary, tumour, or withdrawal of corticosteroid medication, causing poor appetite, weight loss, fatigue, and low blood pressure.
Aside from these medical issues, the main factor in cortisol dysregulation is stress and trauma.
Cortisol and stress
When we are subjected to stress, whether physical or psychological, activation of the sympathetic nervous system initiates the fight or flight response and triggers cortisol release, meaning that we become more alert, ready to defend ourselves against a threat. In the process, our blood glucose level, blood pressure, and heart rate all increase. If, for whatever reason, the parasympathetic nervous system doesn’t fully reactivate and we don’t return to baseline, we will continue to secrete cortisol, and because this is a hormone that activates the amygdala and hippocampus of the brain, our memories and processing of emotions will be affected. These events can trigger prolonged episodes of anxiety and depression. Cortisol will also interfere with the transmission of dopamine and serotonin, which help regulate our mood and promote further instability. Mood can be further affected in women because cortisol levels will correlate with fluctuating oestrogen and progesterone levels. This scenario creates a vicious cycle where stress increases cortisol levels, which can then impact brain function and perpetuate negative emotions.
Cortisol is not bad, it promotes our survival, but when the situation becomes chronic and adrenaline and norepinephrine are also repeatedly being secreted, we develop more health problems, for example, diabetes, heart disease, obesity, kidney damage, and blindness. Research has also shown that if we have hypercortisolism when we are pregnant, our children will grow up with suppressed immune systems and altered metabolisms due to increased hormone levels.
PTSD and high cortisol
The hormone response to stress and trauma is complex and doesn’t involve only cortisol. As already noted in this article, other hormones such as ACTH, progesterone, and oestrogen also play roles, but we should also consider adrenaline, which is secreted by the kidneys as part of the stress response. Both cortisol and adrenaline affect brain function during trauma, but they work in different ways. Cortisol inhibits hippocampus function, meaning that cortisol receptors can’t integrate traumatic memories, while adrenaline activates the amygdala, thus encouraging certain types of memories. Long-term, this implies the establishment of more emotional memories, while cortisol intensifies brain dysfunction.
Research has shown a 60% increase in cortisol in those who experienced childhood trauma and as a result have PTSD, and when there is an additional stress factor involved, the levels double again. It has been shown through brain scans that those with PTSD actually exhibit changes in the brain, and memory function is often affected. The change is thought to be due to the effect of raised cortisol on the hippocampus, which is the memory centre of the brain. In the long term, this can cause depression and anxiety if it is not already a factor.
The connection between cortisol and stress is apparent since our infancy, when stress in the form of hunger or fear causes a rush of cortisol, which activates a crying response. This is the fight-or-flight response in infancy, and if we have caregivers who are attentive to our emotional needs, our brain is taught to return to baseline, and the brain closes the stress pathway off. Where there is early childhood trauma, however, the nervous system doesn’t develop as it should, and we don’t develop the capacity to return to baseline. Cortisol levels will subsequently become imbalanced, creating dysfunctional stress regulation, immune function and nervous system function, and this can contribute to inflammatory and cardiovascular illnesses. These epigenetic changes will still be present in adulthood. Also, studies have shown that different epigenetic changes take place according to the type of adverse childhood experience, with raised cortisol levels being seen in those who experienced emotional abuse, rather than neglect.
Cortisol, trauma, stress & memory
Cortisol's effect on memory depends on the receptor type and how much it is activated. This explains why some of our traumatic memories are remembered very clearly, and some are fragmented or completely lacking. If either both types of receptors are fully activated by the cortisol or if there isn’t sufficient cortisol to activate enough receptors, then some of our memory will be impaired. More cortisol is needed to impair the memory than to enhance it, because when we enter the stress response and go into survival mode, the body naturally tries to conserve energy. Cortisol will bind to the easiest receptor type first, then activate the other types. If cortisol levels balance out when these other receptors are partially activated, the memory will be enhanced. There has to be sufficient cortisol to activate the first receptors before we can establish memories; therefore, our memory of a traumatic event is not determined by the severity of the trauma but by the level of cortisol being produced, which is affected by the natural levels that occur at certain times of the day. Cortisol levels are naturally higher in the morning to help us wake up, so if a traumatic event happens in the morning and increases the cortisol level more than usual, this means that the cortisol will activate more of the additional receptors, thus impairing the memory. In the evening, when we need to relax to promote sleep, our cortisol levels naturally drop, so if extra cortisol were to be secreted, the additional receptors would only be partially activated; hence, the memory would be enhanced.
Sleep patterns and cortisol in PTSD
Cortisol is known to naturally rise early in the morning to prepare us for waking up, but in those with PTSD, this cycle can often result in waking at around 3 am. For those with regulated cortisol, the rise in levels is gradual, meaning that they have unbroken sleep and wake up slowly at whatever time is normal for them. When PTSD is a factor, however, the cortisol levels are already higher, which means that when the levels naturally rise at around 3 am, the heart rate and blood pressure increase due to sympathetic nervous system activation, so we wake up too early. This sympathetic activation may also be triggered by nightmares or flashbacks and result in broken sleep, which increases fatigue, irritability and anxiety. Impairing general functioning has a ripple effect on all facets of life.
Low cortisol and CPTSD
While cortisol levels tend to be raised in those with PTSD, when the disorder becomes complex PTSD over a long period of time, the cortisol levels drop. A single trauma will cause levels to rise in response to the fight or flight response, but then eventually the levels return to baseline, but when exposure to trauma is prolonged, the cortisol levels may remain at a lower level because the body isn’t designed to function under consistently high levels of stress hormones. Hormone regulation systems in the body will therefore reduce cortisol production when levels are high for an extended period of time. When cortisol levels drop, it then becomes difficult to remember things because there is not enough cortisol to bind to the receptors that help with memory.
Low cortisol levels are often demonstrated in those with early childhood trauma, which could be due to the immature nervous system being programmed a different way and certain receptors being altered, rather than insufficient hippocampus-pituitary-adrenal function. This adaptation could also explain why those with trauma in early childhood exhibit an increased amount of cortisol in the liver and kidneys without much impact. The hepatic and renal cortisol assist with essential functions such as salt retention and energy output, while the lower levels in the circulation avoid the harmful effects on the muscles and brain, although there may be increased susceptibility to stress.
Reducing cortisol levels
Understanding the role that cortisol plays in the sleep cycle and PTSD is the starting point in managing it, but there are various means by which we can help to regulate our cortisol levels, and establishing healthy sleep patterns is possibly the most important. Using a weighted blanket, which will offer a small amount of compression, may help to regulate the nervous system, while creating a pre-bed routine with minimal stimulation can also help, for example, no technology in the hour before bed, and maybe participating in some mindfulness or breathwork. Writing in a journal, doing yoga, and progressive muscle relaxation can also help to manage cortisol levels by reducing heart rate and sympathetic activity.
Regular exercise can also promote sleep by reducing stress, although intensive or prolonged exercise may increase cortisol levels, so for someone who has PTSD, walking out in nature or yoga may be preferable to strength training, which could contribute to heightened stress levels.
Dietary changes may also help: replacing comfort eating with an activity to promote relaxation and reducing sugar, caffeine, alcohol, and recreational drugs, which may disrupt cortisol levels. Staying hydrated will also help to avoid raised cortisol levels.
If these methods aren’t working, perhaps trauma-focused therapy in the form of EMDR (eye movement desensitisation and reprocessing) or CBT (cognitive behavioural therapy) may be useful, or talking to your GP about any medication that may help with cortisol regulation. Reprogramming your thought patterns can help us recognise toxic relationships that we often fall into after trauma, and if we can reduce co-dependency in our connections with others, we can potentially bring more laughter and fun into our lives, which in turn will reduce our stress levels.
Read more from Sam Mishra
Sam Mishra, The Medical Massage Lady
Sam Mishra (The Medical Massage Lady), is a multi-award winning massage therapist, aromatherapist, accredited course tutor, oncology and lymphatic practitioner, trauma practitioner, breathwork facilitator, reiki and intuitive energy healer, transformational and spiritual coach and hypnotherapist. Her medical background as a nurse and a midwife, combined with her own experiences of childhood disability and abuse, have resulted in a diverse and specialised service, but she is mostly known for her trauma work. She is motivated by the adversity she has faced, using it as a driving force in her charity work and in offering the vulnerable a means of support. Her aim is to educate about medical conditions using easily understood language, to avoid inappropriate treatments being carried out, and for health promotion purposes in the general public. She is also becoming known for challenging the stigmas in our society and pushing through the boundaries that have been set by such stigmas within the massage industry.
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