CO096 | WHEN THE BODY SAYS ‘NO’: CHRONIC RELATIONAL STRESS AND IMMUNE THROMBOCYTOPENIA—TOWARD AN INTEGRATED PSYCHONEUROIMMUNOLOGICAL MODEL

G. Auteri¹, L. Ricci², B. Lovrencic³, A. Cuneo⁴, V. De Stefano⁵ | ¹Azienda Ospedaliero-Universitaria di Ferrara, Italy; ²Presidente dell’Associazione DOCEAT; ³Presidente dell’Associazione AIPIT; ⁴Università di Ferrara, Italy; ⁵Ospedale Policlinico Gemelli di Roma, Italy

Background. Immune thrombocytopenia (ITP) is an autoimmune disorder. These diseases have biological, environmental, and psychosocial factors interacting in shaping clinical expression. Chronic stress may act as a significant modulator of immune function, yet its role in ITP is insufficiently explored. Emerging evidence from psychoneuroendocrineimmunology (PNEI) suggests that unresolved relational trauma and chronic emotional dysregulation may leave measurable biological traces, contributing to immune imbalance.
Methods. “Living under the Sword of Damocles” is a psychosocial support program designed for ITP patients and caregivers. Core activities include online/in-person group sessions and individual psychotherapy if someone were to express the need. Within these settings, a qualitative analysis of patients’ narratives was conducted. An integrated theoretical framework combining PNEI and polyvagal theory was applied to explore, qualitatively, the connections between relational experiences, autonomic regulation, and immune function.
Results. Recurring patterns emerged across participants, including perceived inescapability within significant relationships, chronic suppression of assertive responses, and persistent emotional invalidation. These conditions were frequently rooted in early relational experiences and reinforced over time, contributing to maladaptive coping styles (hyper-responsibility, alexithymia, and over-control). From a neurophysiological perspective, these patterns are associated with sustained activation of the hypothalamic–pituitary–adrenal axis and dysregulation of the autonomic nervous system, particularly reduced ventral vagal tone and oscillations between sympathetic hyperarousal and dorsal vagal shutdown. Such alterations may promote increased production of pro-inflammatory cytokines and impairment of immune tolerance mechanisms, facilitating autoimmune responses. Notably, ITP onset was often temporally associated with critical relational events, periods of coping exhaustion, or phases following stress resolution (the “let-down effect”). Patients frequently described a sense of “embodied conflict,” where unexpressed emotions and inhibited defensive responses appeared to manifest somatically. Additionally, the disease itself may contribute to the maintenance of dysfunctional relational dynamics through secondary gain mechanisms, reinforcing patterns of inescapability and reduced assertiveness.
Conclusions. These findings suggest that chronic relational stress may represent a relevant cofactor in the modulation and clinical expression of ITP. We propose that rethinking the pathogenesis of immune-mediated diseases through a biopsychosocial lens constitutes not only an innovative perspective but also a potential strength in understanding disease variability and outcomes. In this model, immune dysregulation reflects not only biological vulnerability but also the cumulative impact of relational experiences on neurophysiological systems. We believe that medical management and structured psychological interventions are particularly valuable: while pharmacological treatment remains essential, the addition of interventions targeting autonomic regulation, emotional awareness, trauma processing, and assertiveness development may enhance overall disease management. This multidisciplinary collaboration between physicians and psychologists supports a more comprehensive and person-centered model of care.

GA/LR equally drafted the text.