Stan, Clarence, Barry, and the Health Chatter team chat with Dr. Ida Fonkoue, Assistant Professor in the Physical Therapy Division at the University of Minnesota, about the connections between trauma, stress, and PTSD in young women.Dr. Fonkoue serves as the director of the Neurobiology of Emotion, Sleep and Trauma (NEST) lab, where she and her team investigate how trauma affects neurocirculatory and hormonal systems, particularly as they relate to cardiovascular disease risk in women.Join us for an enlightening discussion about how trauma shapes women’s cardiovascular health.Join the conversation at healthchatterpodcast.comBrought to you in support of Hue-MAN, who is Creating Healthy Communities through Innovative Partnerships.More about their work can be found at https://www.huemanpartnershipalliance.org/
Chapter 1: What is PTSD and how does it affect young women?
Hello, everybody. Welcome to Health Chatter. Good morning. Good morning. Today, we have an interesting topic, and I'll profess, I really got educated just reading the research about this, and we'll hear more about it. We're going to be talking about post-traumatic stress disorder in young women with a special guest today. And so stay tuned on that. We have a great crew as always.
Maddie Levine-Wolfe, Aaron Collins, Deandra Howard, Matthew Campbell, Sheridan Nygaard are all our background crew that do excellent work with us. They've been here since day one on Health Shatter. And they are dear, dear colleagues. They do all the recording for us, the background research, production, marketing. The whole nine yards, and they're second to none. So thank you to you all.
And Maddie just turned 30, so happy birthday to you, Maddie. Also, Clarence. Clarence Jones. I'm here. Is here. And he'll be chiming in as my co-host, along with Dr. Barry Bain's
Chapter 2: What are the symptoms and diagnosis criteria for PTSD?
who will provide a little bit of a medical, maybe a little bit of a medical perspective on this subject today. Again, two great colleagues and friends. So thank you to you as well. Human Partnership is our sponsor for Health Chatter, wonderful community health organization. Check them out at humanpartnershipalliance.org. That's H-U-E-N. M-A-N, partnershipalliance.org.
And check us out at healthchatterpodcast.com for all the different shows that we've done. And we've done quite a few. And you can read the research and you can either read transcripts of the actual shows or listen to them. as an actual podcast. So thanks to everybody again. So today we're going to be talking about PTSD in young women. We have a wonderful guest from the University of Minnesota.
Dr. Ida Fonkwe is a tenure track assistant professor in the physical therapy division, Department of Family Medicine and Community Health. at the University of Minnesota, Director of the Neurobiology of Emotion, Sleep, and Trauma Lab, where she and her team study neurocirculatory and hormonal mechanisms linking trauma and cardiovascular risk in women.
That's a mouthful right there, but it's an interesting subject, and we're going to be talking about PTSD, and I've got some some maybe twists and turns as far as questions about this. But thank you for being with us, Ida. It's wonderful having you. Thank you for having me. And let's start out with, you know, for the listening audience, I think most of us have maybe just heard PTSD, okay?
But maybe we should clearly get a definition of what it really, really is. So let's start with that.
So post-traumatic stress disorder, and this is a disorder that was commonly described associated with the military before, but it's a psychological disorder that often develops after a traumatic event. We have a lot of symptoms that are usually associated with traumatic events, losing sleep, re-experiencing, avoidance of places or people that remind us of the trauma.
But the particularity of PTSD is that about 50% of those who experience those symptoms after trauma will actually go on to have the same symptoms four weeks later. So there's two important things that needs to be considered for the diagnosis of PTSD. The traumatic event, it's important. And second, the length of the symptoms.
So about four weeks minimum, because PTSD is in fact a diagnosis of extension, which means that Everybody will experience it, those symptoms after trauma, but just a handful, like I said, 50% of individuals will go on to after four weeks to continuously develop that. And one of the disclaimer I want to give here is that I am not a psychiatrist or a clinical psychologist.
I am a cardiovascular physiologist. So I don't diagnose people. a PTSD participant comes to me with a diagnosis, but my goal is to really show them it's not all in their head and see what's happening in their heart, blood vessels, and metabolism.
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Chapter 3: How can trauma impact cardiovascular health in women?
one way or the other. And then there might be others that are linked to the person that had the event. So for instance, what came to my mind when I was reading about this is, okay, there are wars going on around the world right now. And somebody in a family, for instance, might get injured or God forbid, killed. Okay, so if they're injured, they might experience PTSD after that.
But then what about a family member? Is there like kind of a complementary PTSD that can go within a family?
It's a good question you ask. And I like to use example.
Mm-hmm.
I had an example of a participant who came to us and had her own experience of trauma, and it was more of an interpersonal. I want to give a disclaimer here if I use some words that can be triggering for other people. So this was a sexual assault. that was the traumatic event for this young individual.
However, after she completed the survey, because although we don't diagnose, we have a survey that we give our participant to determine the severity of the different symptoms that I mentioned earlier, like hypervigilance, avoidance, hyperreactivity, sleep problems that usually come from it, which is part of the re-experiencing. Now, after she completed the survey, she asked me a question.
She said, well, can I complete another survey? And I said, why? She said, because I feel like I had two traumatic events in my life. I have what happened to me. And I had the trauma that I went through from listening to my mother share her own traumatic events. event while she was in the military.
So her mother was in the military and I'll probably touch on this later, which is one of the reasons why I study civilian women, civilian as opposed to military. But her mother was in the military and experienced trauma that was not related to war. It was within the military. And later on in her life, her mother felt like she was old enough for her to share this experience with her.
However, this ended up being very traumatic for her listening to her mother tell her own trauma. So, yes, it is. You don't have to. And that's why one of the questions that we ask in the questionnaire is, did it happen to you? Was it linked to a threat of death or not? Because Many people probably were traumatized by watching the video of George Floyd being murdered.
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Chapter 4: What role does community play in resilience against PTSD?
I can relate. You know, you're like Holocaust survivors, you know, and then they tell their story to their children and then their children kind of go through, I can imagine, can go through what you're talking about. Clarence, go ahead.
Dr. Ida, thank you for that. You started off with something that I wanted to dive into, which was about your journey into this topic. Yes. I think you had started just saying that. So could you just kind of share with us as much as you choose to about your journey into this topic?
Thank you very much. Well, I have a medical degree from Cameroon. And this is a story I don't usually, I haven't really shared. Growing up, I had a younger sister who had sickle cell disease. And anybody who knows anything about sickle cell will know these are patients that are in the hospital every month.
When I started medical school, even if you're a first year medical student, you become the doctor of the family. So I became this person who was responsible of my sister. And unfortunately, she has passed away now. But I was the one when I finally realized my father was tired to always carrying this burden of her being with her. I said, hey, I can take over. I can help.
So for the longest until I moved to the United States, because I'm originally from Cameroon, I was like my sister's caretaker. And I never, I could never sleep anytime she had one of her crises. So in hindsight now, and I think, I feel like my father had an undiagnosed case of PTSD.
Because never knowing if this child is going to make it out of the hospital this time is very traumatic for a parent. And that happens with parents with children with cancer or any type of chronic disease. So I moved to the UFs and I did a PhD in integrative physiology. And during my PhD, I decided to study stress. I just wanted to see the effect of stress on the heart and blood vessel.
I've always been interested in internal medicine. Working with Dr. Carter at Michigan Tech, I did my PhD at Michigan Tech. We looked at how acute stress through mental stressors using a serous obstruction, mental arithmetics.
So we basically had people do MAT acutely in the lab while they were hooked on many equipment, looking at their nerve, which is the fight or flight response, looking at their heart, their blood vessels, their breathing. So we were recording all of that while we stress them with mental MAT acutely, serious obstructions.
When I was done with my PhD, thinking again about the story of my father and my younger sister, because even though I had moved here, my sister was still back home and my father now had to, like the little break I gave him when I was there, now he was back being the one. Not sleeping, if I could say. So I decided to move and do a PhD here.
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Chapter 5: What interventions can help reduce PTSD symptoms?
I wanted to see what happened with chronic stress. I spoke to this physician who was at Emory during one of my conferences, and she said, well, I studied PTSD. And I said, well, can you tell me more about it? And I read more about it. And I thought, well, this is a disease of the military. I thought this is a disease of the military. Well, that doesn't really connect.
But as I started to learn more about it, I'm like, this is a chronic model of stress. So regardless of people in the military experiencing it at war, I really want to see what it does to the cardiovascular system. Fast forward three years after my postdoc at MRA, it was time for me to become an independent faculty. And I had been listening to the stories of women in the military.
What was striking to me was that the women in the military did not report witnessing war or being in combat. That's the reason why they were traumatized. For the men, it was the case. So we had a questionnaire called combat exposure questionnaire. Men were called high by women? No. And as I started to investigate more, I realized, and we were all aware of this, it's not a secret,
There's a lot of interpersonal abuse that used to happen and hopefully it's a little less now for women in the military. So there was a lot of abuse between rank and women not being able to express certain things.
So I thought, well, I think I really want to focus on women because whether women are in the military or outside of the military, they share this common interpersonal nature to their traumas. that's how I ended up where I am today, where I focus on PTSD, but mostly from interpersonal, from an interpersonal cause or origin.
So I hope I was able to like brush, these were nine years that I kind of trying to sum up in a few minutes here.
Yes. You did very, very well. Thank you for being willing to share that.
Yeah, it's an incredible story. As you were talking, my dog got stressed out because the recycling person is here.
Hey, we all have our causes.
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Chapter 6: How does PTSD correlate with hormonal changes in young women?
And in response to stress, they even had, these are all, by the way, these are what we call in the field cardiovascular risk factors. Having a high resting fight or flight, having a higher resting heart rate, and having a higher response to stress. In this case, we stress them using, again, math acutely. It's like using an acute stress on top of a chronic existing stress.
So what we saw was that this veteran with PTSD had about three or four, what we call independent risk factor for cardiovascular disease. High inflammation. Inflammation is supposed to be when you have a fever and inflammation. However, Low-grade inflammation, you're not necessarily having a high temperature, but your cells are feeling like under stress.
They feel that temperature even if you don't feel it. So we saw that high inflammation, high fight or flight response, blunted cardovagal baroreflex, which means your baroreflex is the ability of your nervous system to regulate your blood pressure. When it's high, your fight or flight should go down when blood pressure is high.
When it's low, your fight or flight should go up so that blood pressure can go up. So this was dysregulated in patients with PTSD. And then finally, what we saw in this individual with PTSD is that your rest and digest system, which is your parasympathetic nervous system, was not doing a good job at keeping heart rate down. So that was impaired as well.
So you have in just one group of individual, you have four different, and this is for what I can, we studied four different risk factors. So it's like a... I want to say double WAMI, but this is triple. I don't know what you say when it's quadruple WAMI. So you have four risk factors in one individual.
So moving forward, looking at women, one of the reasons why young women that I study, we call premenopausal women. These are women between the ages of 18 and 40 years old. One of the reasons why this group is very interesting is that As you will know, women before 40 years old or before menopause, if we use 40 as the age of menopause, for some women, it could be later.
Women before menopause are expected to be protected from all these cardiovascular diseases because of the hormone called oestrogen. I call oestrogen the happy hormone. Makes your blood vessels soft. calm down your fight or flight response, allow your rest and digest to be higher, and then close off inflammation, have a good control on cortisol. Everybody knows cortisol as that hormone of stress.
But, well, this is what people used to think. Now with PTSD, in my study, I'm seeing something different. I'm seeing that these young women almost have the physiology of women who have rich menopause, even though they're still young. And because we recruit women that are someone that are beside the diagnosis of PTSD and some comorbid depression, these are women who are healthy.
So it's like the question here now is what is PTSD doing to estrogen? What is the interaction between PTSD and estrogen? Is PTSD... rendering oestrogen, running the blood vessel and other organs less sensitive to oestrogen or is PTSD lowering the level of oestrogen, right? Which menopause is basically that lowering of the level of oestrogen.
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Chapter 7: What are the challenges in diagnosing PTSD in different populations?
So there's the normal comorbidity that we've seen in PTSD, particularly men or women a little bit older, but it's really scary. to see what's happening in young women that were thought to be protected from cardiovascular disease.
Wow, that's a really interesting finding. Barry, go ahead.
Yeah, this is really fascinating. And Ida, one of the questions I have is, Once someone develops post-traumatic stress disorder and they have these neurocirculatory and hormonal responses, all of us live lives where we're constantly exposed to at least many stresses, but it can become cumulative. So my question is, once someone...
has post-traumatic stress disorder, does the neurocirculatory and hormonal system like maladapt to a response? In other words, that the post-traumatic stress sort of primes their hormonal and neurocirculatory system to respond in a particular way. And then that becomes that even with little stresses, they become overloaded because the body learns that response.
And so I'm just wondering if that's something that you've seen, sort of following people, because it's pretty scary to think that young women um, you know, chronologically they're, you know, 18, you know, twenties, thirties, and yet physiologically they're, they're really showing up as being much older than that as a result of the stress response.
So I hope that, I hope that makes, I hope that makes sense.
It makes sense. Thank you Dr. Benz for that question. I think you said something there about physiologic, it's like your physiological age versus your real age. I think that's, a very, and I think we, that's the case for metabolic diseases too. They always talk about your physiological, your actual age.
The question you just asked right now, regarding young women that I'm studying at the moment, I would say stay tuned because I'm still analyzing that data in terms of how Because we have that acute stress that we do in the lab. And I'm trying to see how the fight or flight response and the blood pressure changes. I already see this high at rest, right? You always start higher.
But I want to see if once you're stressed, do you even have a higher response than your peers? And your peers here, we chose to recruit women who have been exposed to trauma but did not develop PTSD as a control group. So everybody who come to my lab have had exposure to trauma. Some did not develop PTSD, others did. And so our flyers do not mention PTSD actually. Our flyers mentioned trauma.
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Chapter 8: How can a multidisciplinary approach improve PTSD treatment?
You can change your family history. So what we saw is that in young men, contrary to what I thought, I thought that young black men with a family history of hypertension, that young black men with a family history of hypertension will have a higher MSNA response. MSNA is the fight or flight. But what we saw was actually the opposite of what we expected. as if there was a ceiling effect.
So at rest, this young black male had higher fight or flight response than the Caucasian age match counterpart. But after stress, we did not see that higher response that we expected. So we were wondering if there was some sort of a ceiling effect, as if it was so high that it couldn't go higher. But with the vascular response,
what we're seeing in young women here with this vasoconstriction so vessel getting tight you know what happened with vasoconstriction is that if your vessels are tighter which is what vasoconstriction is and they can really open up and be flexible and adapt to an influx of blood that is coming when you're stressed because when you're stressed you need more blood to go to your
muscle to go to your brain you have to think you have to run if you need to run so vasoconstriction is not what we want at that time because blood pressure is even going to go higher we want blood to be able blood vessel to be able to adapt to that flow of blood coming in.
So we're seeing in these young women already something that is not, something that is abnormal in the response of their blood vessel to stress. So I'm really interested to see what we'll see with the fight or flight. Are we going to see what we saw with black men, where there was like already a plateau effect, or are we going to see the trend that we're seeing with vascular function, which is
higher fight or flight in response to stress.
So my question is level of trauma. What kicks in to an actual diagnosis of PTSD? In other words, if somebody just witnesses something or if somebody is actually attacked or if somebody is hurt, what At what point, medically speaking, what events, I guess, have to indicate PTSD? I assume that some people are in that state, PTSD state, with a fairly minor trauma, where others...
kick into the diagnosis of PTSD with more major trauma. So how is it that when we diagnose this, we make that distinction?
That's a good question you're asking. And again, my disclaimer is that I'm not a clinical psychologist. But what I will say is that the gold standard for the diagnosis of PTSD is It's called the clinician-administered PTSD scale. Okay. Or called CAPS. The reason why it's a clinician-administered one is because it's not a survey. You're not given a survey that you answer. It's an interview.
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