Marble

the problem with looking for this function of the endocrine system in the scientific literature is that PTSD and CPTSD still arent reliably clinically separated even though they have very different symptomology, and people with one-time-incident PTSD don't tend to show the endocrine damage. so studies on "people with PTSD and their cortisol levels" show inconsistent results.

this study from 2018 notes that the cortisol in female subjects and subjects who had PTSD from sexual and domestic assaul--two groups whose PTSD is almost always C-PTSD rather than short term, like natural disaster or combat trauma--was significantly lower than in combat veterans, illustrating my point without apparently knowing or speculating on the reason behind it.

this is an extremely useful adaptation because it restores stress hormone homeostasis (balance) to a person who is trapped in a nightmare situation. the problem is that it also causes you to start feeling "worse" as soon as you are no longer in a crisis. this can cause malfunctions of your "gut check" processes because sometimes, for some people, you feel better when you're actively in danger, a thing thats been observed by researchers and emergency workers who work with domestic violence situations and adult victims of childhood trauma for a century, and makes a lot of the "trust your body" type advice actively counterproductive.

minor effects include reinforcing the ADHD tendency to leave everything until the last minute because you know and have learned you literally cannot do it unless it's an emergency, but it also creates people like my aunt who very observably creates emergencies for herself through various little choices like intentionally ignoring her check engine light because she has been so dysfunctional for so long that she can't operate at all unless she's trying to outrun falling dominoes.

anyway I think low dose corticosteroid treatment will probably be officially discovered as a treatment for C-PTSD within the next five years and be clinically applied at some point after that. one of the discouraging things about this process is that the endocrine system doesn't seem to adapt to relative safety very quickly or at all for many people, including myself. either it's impossible for the affected person to achieve the level of security required to actually readjust and small stressors keep signaling to the body to maintain the incorrect stress responses (common for people who are stuck in poverty by disability or mental illness), or theyre like my aunt and either consciously or unconsciously maintain their own emergencies to stay on an even keel.

For example, one study showed decreased cortisol predicted PTSD symptom severity at 6 weeks and 6 months post trauma (Mouthaan et al., 2014). Conversely, Walsh and colleagues found elevated cortisol measured within 72 h of rape correlated with increased PTSD symptoms at a 6 week follow up, but only in those without a prior history of assault (Walsh et al., 2013). It is important to note that those with a prior history of assault had lower cortisol at the 72-h mark when compared to those without a history of prior assault (Walsh et al., 2013). Thus, many studies on cortisol in PTSD have conflicting results.

so as a good illustration of the problems happening in research with this issue right now, the researchers are aware that "PTSD" as a blanket diagnosis is an issue but still don't seem to be separating patient groups into "people who got PTSD from a single incident of trauma or a limited traumatic exposure to unusual circumstances (regular PTSD, like combat or natural disaster survivors)" vs "people who got PTSD from twenty years of consistent abuse in a dysfunctional household or were in an abusive relationship for long enough that it became normalized (C-PTSD)". the phrase I emphasized in the quoted passage notes that a history of trauma predicts lower cortisol levels in the patients. it was observed that most people who had been traumatized before responded with low cortisol to new trauma, in other words. people who were having their first traumatic experience had high cortisol. this makes sense if you think of the body responding to trauma as either "what the fuck is going on" vs "ah lads not again".

but even though this paper came out in 2024 it doesn't use the term "C-PTSD". even though researchers in general are aware of C-PTSD, it doesn't seem to have become formally accepted into research frameworks yet so you have a million papers going "a lot of these trauma victims have low cortisol but others have high cortisol, what gives", which is very frustrating, but I'm not a researcher and I know there are various institutional processes and rules that make stuff like this happen. all patients with post traumatic syndromes are still being treated as if combat trauma in military personnel and a domestic violence survivor should have exactly the same symptoms and exactly the same response to treatment, which isn't the case. eventually this will get figured out but right now it is confusing the issue whenever you try to look up research about it.

anyway this is yet another reason all the Tiktok wellness shit about "decreasing cortisol" and using "stress hormones" as a bogeyman is complete bullshit. many, maybe most people who are trying to recover from trauma need MORE "stress hormones", not less

me personally, I have found that just becoming aware that this was happening to me was very helpful. if I know I am enjoying a crisis situation and feel healthier specifically because something is going wrong in my brain, and not because it is objectively good to be in crisis, or objectively good and correct to be abused or exploited, that's a useful calibration for me. it allows me to explain my seemingly contradictory feelings and also to understand that the usual "trust your body" advice is completely useless to me and can be safely ignored. actually I did listen to my body, and my body is telling me to run into the nearest burning building so I can feel normal for once.