If Stress Is Bad For Your Health, Trauma Is Really Bad

Here’s the abstract from an article, “Psychological Trauma and Physical Health: A Psychoneuroimmunology Approach to Etiology of Negative Health Effects and Possible Interventions” (2009) by Kathleen Kendall-Tackett published in Psychological Trauma: Theory, Research, and Policy. Quite a mouthful! What it means is: “Trauma Is Bad For Your Health”. You could also read it as “Stress Is Bad For Your Health” — keeping in mind that trauma is an extreme form of long-term stress. Sometimes an abstract (the short version of a scientific article) says so much. I’ve put some of the key points in bold, since I know you are busy.

People who have experienced traumatic events have higher rates than the general population of a wide range of serious and life-threatening illnesses including cardiovascular disease, diabetes, gastrointestinal disorders, and cancer. An important question, for both researchers and clinicians, is why this occurs. Researchers have discovered that traumatic events dysregulate the hypothalamic pituitary-adrenal axis and sympathetic nervous system. More recently, research from the field of psychoneuroimmunology (PNI) suggests that traumatic life events can lead to health problems through dysregulation of another key system: the inflammatory response. Prior trauma “primes” the inflammatory response system so that it reacts more rapidly to subsequent life stressors. Elevated inflammation has an etiologic role in many chronic illnesses. Recent PNI studies also suggest some interventions that can serve as adjuncts to traditional trauma treatment. These treatments include long-chain omega-3 fatty acids, exercise, and sleep interventions. Each of these interventions downregulates inflammation, which will likely halt the progression to chronic disease for some trauma survivors.

The take-home point, if you will, is not just that stress is bad, but the way that it is bad. We’ve known for some time that stress activates the adrenal system, and that leads to poor health outcomes. But aggravating the inflammatory response is a new wrinkle. As I understand it, the inflammatory response is a key player in the cause of both heart disease and cancer, and a lot of research is going into understanding what makes it tick. That said, if you can head the inflammatory response off at the pass, reduce its activity before it starts — that should reduce your risk of a whole range of health conditions. Exercise and diet can reduce your risk.

And if you have traumatic stress — then potentially you open yourself up to all kinds of health problems. The good news is that traumatic stress can be treated effectively.



Trauma Resource

I found this guide “Healing Emotional and Psychological Trauma” that might be useful for someone who suspects the root of their problem is related to trauma. It’s nicely laid out and covers a lot of material straightforwardly. Recommended.

Here’s the link to the article at helpguide.org.

10 Stories on DSM-V

Ken Pope’s listserv has been positively percolating with stories on the revision of DSM-V. It would be a full time job keeping up with the various controversies, but this list provides a bird’s-eye view of the range of concerns. The committee overseeing the revision of DSM-V is taking feedback up until this Friday, June 15, 2012:

1.   Revised Criteria For Mild Cognitive Impairment May Compromise the Diagnosis of Alzheimer Disease Dementia. Article at the Archives of Neurology.

Briefly quoted: “The original diagnosis of MCI6 – 7 was limited to individuals with cognitive impairment in a single domain (memory), thus distinguishing MCI from dementia, but more recently its differentiation from dementia has come to rest solely on the preservation of functional activities.8 – 9 The revised criteria for MCI,2 however, allow considerable latitude as to what represents functional independence and thus blur the categorical distinction between MCI and dementia.”

2.   Researchers Voice Concern Over Proposed Addiction Guideline Changes. From a press release at the University of Connecticut.

Briefly quoted: “Psychiatric epidemiologist Thomas F. Babor, head of the Department of Community Medicine and regional editor of the international journal Addiction, and Dr. Yifrah Kaminer, professor of psychiatry and pediatrics in the Department of Psychiatry and Alcohol Research Center, are concerned that pending changes to the definition of addiction in the Diagnostic and Statistical Manual (DSM) could represent a step backward in diagnosing and treating substance use disorders – and could have major economic and social consequences…. Babor’s reservations about the proposed changes concern the broadening of language defining addiction and the lowering of the threshold of what counts as a substance use disorder. The revisions would expand the number of symptoms of addiction, reduce the number required for a diagnosis and introduce a “behavioral addiction” category – all of which could lead to millions more people being categorized as addicts when they in fact are simply unhealthy users. This could put a strain on already-limited resources in schools, prisons and hospitals, he says.”

3.   A Closer Look at Pending Changes to the Future of Psychiatric Diagnosis. From a news release at the Journal of Nervous and Mental Disease. The special section notes several articles regarding proposed DSM changes.

Briefly quoted: “Many articles within the section present criticisms of DSM-5 proposals. Specifically, several authors worry that the new DSM-5 standards may open up more opportunities for false-positives – a doctor diagnosing a condition when it is not present, or providing medication when it is not needed.” 

Subsection titles include: “Behavioral Addiction V Quo Vadis”, “Hebephilia and the Construction of a Fictitious Diagnosis”, “Should Prolonged Grief Be Reclassified as a Mental Disorder in DSM-5? Reconsidering the Empirical and Conceptual Arguments for Complicated Grief Disorder”,  “Psychotropic Marketing Practices and Problems: Implication for DSM-5”, and “A Critique of the DSM-5 Field Trials.”

4.   Premenstrual Dysphoric Disorder: Why it Doesn’t Belong in DSM-5. Available as a brief podcast.

5.   International Dyslexia Association Requests Reinstatement of the Term “Dyslexia” in American Psychiatric Association’s DSM-5. A news release from the International Dyslexia Association.

Briefly quoted: “However, many view this latest round of revisions — which now omits the term dyslexia — as a significant step backward and worry that this omission will perpetuate lack of recognition and understanding of dyslexia and contribute to delays in diagnosis and treatment.”

6.   Changes to Name, Definition of Mental Retardation Raise Concerns. An article at Education Week.

In the case of the definition of mental retardation, the American Association on Intellectual and Developmental Disabilities said that plans to change mental retardation to “intellectual development disorder” doesn’t match shifts in the United States and abroad to use the term “intellectual disability.

7.   The psychiatric oligarchs who medicalise normality. From a letter to the editor at the British Medical Journal, responding to the article of that title.

8.   Tradition versus empiricism in the current DSM-5 proposal for revising the classification of personality disorders. From an editorial at Criminal Behaviour and Mental Health.

From the abstract: “The DSM-5 proposal is for a confusing, complex and inconsistent system that lacks credibility. A broad overview of the study of personality disorders suggests that the field is having difficulty integrating traditional concepts and modes of practice with empirical findings. The basic theoretical models and concepts underpinning contemporary ideas about classification, aetiology and treatment are largely based on clinical observations. Although these observations often yielded remarkable insights, they were relatively unsystematic and based on small, unrepresentative samples. Evidence and methods are available to construct an innovative and empirically informed classification with high clinical utility that could advance our understanding of the nature and origins of personality disorder. But to implement such a system, one needs the courage and ability both to move beyond traditional assumptions and presuppositions and to ignore political considerations.”

9.   The American Family Therapy Academy released a policy statement about DSM-5. AFTA finds APA non-responsive to feedback.

“AFTA has joined over fifty organizations and thousands of practitioners and researchers worldwide, in writing to the DSM Task Force and the American Psychiatric Association to express these concerns. The response from the American Psychiatric Association has been minimal, at best. None of the organizations or individuals have been invited to participate in the decision making process. We find that the current revision of the DSM continues a long history of ignoring research and excluding vital contributions of non-psychiatric mental health disciplines resulting in invalid diagnostic categories and treatment protocols.”

10.  Criticism Continues to Dog Psychiatric Manual as Deadline Approaches by Greg Miller at the Journal Science. 

“When planning for DSM-5 first began in 1999, its leaders hoped to tap advances in neuroscience and genetics to create a taxonomy of mental illness that better carved nature at its joints (Science, 31 October 2003, p. 808). That didn’t happen to the extent they had hoped. We could not construct a diagnostic classification on the basis of neuroscience findings at this point,” acknowledges David Kupfer, a psychiatrist at the University of Pittsburgh School of Medicine in Pennsylvania and the chair of the DSM-5 committee overseeing the revisions.”

Do You Co-Device?

You may well ask what that is.

Two friends in their early twenties pause after sharing a meal and conversation. They hesitate, almost imperceptibly, then look discretely into their laps where they set to work on their smart phones. It’s no secret what they’re doing. They’ve tacitly agreed that this is an acceptable juncture to tend to their devices, respectfully. To be alone together.

Another restaurant, another duo, most likely a couple, sit blandly staring at their screens after having ordered their meal. They have not spoken since they arrived at the restaurant. Their silence seems more one of boredom, possibly it’s sullen, maybe angry. But I don’t know any of these people.

Yet another couple, in their early sixties. I do know them. They talk throughout the day — have a loving relationship. Yet when I come upon them in the early evening, they too are glued to their devices. This is a silence of comfort, habit.

Do you spend time being alone with a friend, partner, spouse, family — and your smart phone, tablet, or other device? (“co-devicing” — if you will). What is the quality of that time spent together? How does it reflect upon your relationship? Are there rules of engagement — when it’s okay and not okay to use your smart phone within your relationship? Are these talked about? Do you ever find yourself having device regret?

An interesting book, Too Much Magic: Pulling the Plug on the Cult of Tech by Jason Benlevi addresses a broad range of issues related to technology and our relationship with it and ourselves. It’s not hard to see where he stands on the issue, but he raises a lot of interesting points. More thoughts to come, as I finish the book.

The Self-Tracking Advantage

A curious article in last week’s New York Times Magazine, The Data-Driven Life, examined the somewhat geeky, but increasing phenomenon of tracking quantifiable aspects of one’s life, chiefly by means of computers. Things tracked ranged from coffee consumption, time spent doing roommate’s dishes, time spent sleeping, tracking cognitive performance — one man claims to have a record of every thought he has had since 1984. While some of these pursuits seem a tad trifling, many have practical applications — exercise logs, increasing awareness of drinking patterns, a mood chart for depressives — yet charges of navel-gazing self-absorption are difficult to fend off.

I think an important point emerges, however. The data that these people are collecting is their data. In an age where “evidence based treatments” are increasingly touted, this is not a small point. Such treatments carry weight with insurance companies precisely because they claim to measure the outcomes of their treatment. And they do, in a way. But what research deals in is generalities. Generalities. Just because, say, DBT, works quite well for many women with a certain diagnosis is no guarantee whatsoever that it will work for you. What people are doing is essentially research on what works for themselves, invaluable information if you think about it.

Self-experiments like Barbier’s and Roberts’s are not clinical trials. The goal isn’t to figure out something about human beings generally but to discover something about yourself. Their validity may be narrow, but it is beautifully relevant. Generally, when we try to change, we simply thrash about: we improvise, guess, forget our results or change the conditions without even noticing the results. Errors are possible in self-tracking and self-experiment, of course. It is easy to mistake a transient effect for a permanent one, or miss some hidden factor that is influencing your data and confounding your conclusions. But once you start gathering data, recording the dates, toggling the conditions back and forth while keeping careful records of the outcome, you gain a tremendous advantage over the normal human practice of making no valid effort whatsoever.

“Generally, when we try to change, we simply thrash about.” How often does psychotherapy resemble this statement? Don’t psychotherapists, in some sense, track data — the personal data of our clients’ fantasies, idiosyncrasies, miseries? Might we not incorporate some more quantifiable methods of tracking some of these data?

Good psychotherapy is exquisitely tailored to the individual. And how that tailoring occurs is in the give-and-take within the therapeutic relationship. Standard treatment, in some sense, fail from the outset. This last excerpt speaks to the potential cold comfort of standardized treatment, and how it is not in any way tailored to the individual:

“Here’s what they told me was the normal surgical course of treatment,” Adler explained. “First they were going to cut out my tonsils, and if that didn’t work, they would break my jaw and reset it to reposition my tongue, and finally they would cut out the roof of my mouth. I had one question: What if my case is different? They said, ‘Let’s try the standard course of treatment first, and if that doesn’t work, then we’ll know your case is different.’ ” Adler recognized what this proposal meant: it meant that his doctors had no cure for different. They wanted to see him as a standard case, because they have treatments for the standard cases. Before Adler underwent surgery, he wanted some evidence that he was a standard case. Some of us aren’t standard, after all; perhaps many of us aren’t.

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DSM-V and Some New Diagnoses

Just a little piece on the DSM-V update at the Los Angeles Times. Written by Christopher Lane, author of the fascinating Shyness: How Normal Behavior Became a Sickness. Lane has done extensive research into the processes involved in the creation of the DSM. Many of them were quite arbitrary. Here’s a quote from the Times article:

Not only do mental health professionals use it routinely when treating patients, but the DSM is also a bible of sorts for insurance companies deciding what disorders to cover, as well as for clinicians, courts, prisons, pharmaceutical companies and agencies that regulate drugs. Because large numbers of countries, including the United States, treat the DSM as gospel, it’s no exaggeration to say that minor changes and additions have powerful ripple effects on mental health diagnoses around the world.

Behind the dispute about transparency is the question of whether the vague, open-ended terms being discussed even come close to describing real psychiatric disorders. To large numbers of experts, apathy, compulsive shopping and parental alienation are symptoms of psychological conflict rather than full-scale mental illnesses in their own right. Also, because so many participants in the process of defining new disorders have ties to pharmaceutical companies, some critics argue that the addition of new disorders to the manual is little more than a pretext for prescribing profitable drugs.

Pharmaceutical Sales 2007: Antipsychotics For Sale

Out of the $663 billion sales of pharmaceuticals in 2007, the sale of psychotropic medications was not that high: 3 percent for antipsychotics, 3 percent for antidepressants. Yet if you look at the top ten best-selling drugs, three of them are antipsychotics. The source is IMS health, who describe themselves:

IMS is the one global source for pharmaceutical market intelligence, providing critical information, analysis and services that drive decisions and shape strategies.

Clinical Psychology and Psychiatry: A Closer Look quotes the IMS statistics and adds these observations:

Antipsychotics were the sixth best selling class of medications globally in 2007, according to IMS Health. They raked in a cool $20.7 billion, an increase of 10.7% from 2006. Thank God we are doing a better job of overrecognizing, er, appropriately treating bipolar disorder. Antidepressants were #7, at $19.7 billion, down nearly seven percent. This does not appear to be due to declining prescriptions. Blame generics, not decreased prescriptions for the lower numbers. With Cymbalta, Lilly has shown that new antidepressants don’t have to be anything special, so it would behoove other companies to release other run of the mill antidepressants, attach a comical, er, highly educational marketing campaign such as Depression Hurts, then watch the money roll in. Just some free advice.

It was the author of that website (Clinical Psych) that proposed a National Bipolar Unawareness Week. An humorous take on the overdiagnosis of manic depression.