Figure 2.

The Stress Phenotyping Framework and the potential for identifying stress phenotypes. (A) Commonly used stress response cluster model. Stress reactivity clusters are often simplified to reactive or blunted and focus on ANS and HPA axis reactivity. This model can be very helpful in the clinical encounter to quickly describe complex processes to clients and patients. However, people likely differ in their stress reactivity across systems and may need a broader assessment and treatment strategy. (B) The Stress Phenotyping Framework. Within each of the stress-related systems described in this narrative review, an individual could have a reactive (↑), blunted (↓), disorganized (bi-directional arrow), or well-regulated (~) stress response. We suggest that clinicians can provide more targeted interventions by identifying individual differences across different stress-related systems. In addition, we hypothesize that future research can identify clinically distinct stress-response clusters or “stress phenotypes” that could further predict health behaviors and disease risks and provide an opportunity to advance therapeutic interventions. (C) Potential patterns of cortisol reactivity to acute stress (adapted from McEwen, 2000a, 2000b, 2006). This graph depicts an example of differential regulation of HPA-axis reactivity. Mapping the patterns of dysregulation for all stress-related systems following ELA and chronic stress may better inform classification of common stress phenotypes and targeted therapeutic interventions.