Maria is a 21-year-old single mother. On the way to work, she drops off her 3-EEyear-old daughter at a community day care center and picks her up on the way home

Question

Because her income is low, Maria works at a second job from home in the evening and rarely goes out for social interaction. For the last several days, her daughter has been sick with influenza, so Maria has stayed awake throughout the night to care for her. One morning, while preparing her daughter's breakfast, Maria realized they had run out of milk and bread again. Maria sat down on the floor and began to cry.

One of the effects of chronic stress is an impaired immune response. What are the physiological mechanisms that will make Maria particularly prone to contracting her daughter's illness?

Assuming the stressors are the same, how is it that someone might react differently than Maria? From what you know of her history, what are some factors affecting Maria's ability to cope both physically and psychologically?

What are the signs and symptoms that would distinguish a person with posttraumatic stress disorder from an individual like Maria?

Answer 1

Psychological stress is a contributing factor to the development of physical illness. While the exact mechanisms are not known, immune suppression is a result of a series of endocrine-immunological interactions that include the following:
Hormone receptors on lymphocytes: suppression of lymphocyte activity occurs under the influence of a variety of CNS-controlled hormones.
Catecholamine release: the SNS innervates lymph nodes, thymus, and spleen. A synergistic relationship between epinephrine, CRF, and cortisol act to suppress the function of lymphatic structures.
Alteration of T-cell production: stress hormones stimulate the proliferation of particular subtypes of T-lymphocyte helper cells. This creates a physiologically altered immune response.

Conditioning factors contribute to an individual's response to a stressor. Some factors affecting Maria's ability to cope might include the following suggestions:
Time: students might identify the illness of her daughter, loss of sleep, and lack of food within a short length of time to be factors in Maria's adaptive abilities.
Age: it may be indicated by some students that she is a young mother and therefore less able to cope with daily stressors
Nutrition: there is indication that food security has been a problem in the household.
Sleep-wake cycles: decreased sleep disrupts both immunologic and psychological functioning.
Hardiness: while not addressed specifically in the case study, some students may suggest that Maria's sense of control of her life is limited by her circumstances.
Psychosocial factors: social support mechanisms and personal relationships are limited in this situation.

The individual with posttraumatic stress disorder presents with the following triad:
Intrusion: flashbacks and nightmares recounting the traumatic event
Avoidance: emotional numbing and withdrawal from relationships. There are also feelings of guilt and depression following the event.
Hyperarousal: There is increased emotional irritability, anxiety, decreased concentration, hypervigilance, and strong concern for safety. The patient will also demonstrate sleeping difficulties and an increased startle reflex.