G3.8: Severe child trauma may lead to Dissociative Identity Disorder (DID) or PTSD.

Dissociative Identity Disorder (DID) is a mental health disorder that can result when there was severe child abuse and/or neglect. Colin A. Ross, M.D. is a specialist in the treatment of DID, see his book Dissociative Identity Disorder: Diagnosis, Clinical Features, and Treatment of Multiple Personality for more information. (G3.32)

The author provides an example script he developed for patients to describe what cognitive therapy is and how it might help them. The script begins with lines that suggest that our feelings are sometimes affected by what we think and that if that is true then changing how we think may be the best way to change how we feel. He describes cognitive therapy as a method for helping the patient to learn what not to do rather than focusing on teaching them what to do.(p 339, G3.32)

Incorrect beliefs can develop during childhood that may have been helpful to the child at the time but may cause problems later in life. The author discusses false assumptions commonly believed by DID patients and he describes a few cognitive therapy techniques which he found helpful for challenging the old beliefs and guiding the patients to new beliefs. Counseling strategies and false assumptions are discussed within the section titled Cognitive Restructuring Techniques. (pp 338-345, G3.32)

G3.9: Cognitive Restructuring Techniques for “false assumptions.”

The false assumptions are discussed in the book Dissociative Identity Disorder: Diagnosis, Clinical Features, and Treatment of Multiple Personality within the section titled Cognitive Restructuring Techniques  (pp 338-345, G3.32) I found the ideas helpful and combined the false beliefs into a list, with notes summarized from my understanding of the text, words in italics are quotes from the text:

  1. “Different parts of the self are separate selves.” – Which can lead to the false belief that different parts of the self (alters) actually have different bodies and cognitive therapy may address the risk of one alter causing physical harm to the host (primary personality) by tackling the alters’ false belief that there are two or more separate bodies.
  2. “The victim is responsible for the abuse.”  This false belief may occur during developmental stages in early childhood when the child believes that what happens in the world is caused by the child’s actions. Cognitive therapy  can challenge the underlying belief that “I must be bad.”
  3. The abuse happened because I am bad.” Children can’t just leave their caregivers and the need to love and feel love is also strong so it can be a common false assumption that whatever is happening is right and the child is wrong or deserving of the mistreatment. Cognitive therapy can discuss the differences between a child’s and an adult’s responsibilities in life and whether traumatic events are something other children could cause to occur or that they deserve instead of normal love and affection.
  4. It is wrong to show anger.” Cognitive therapy can help teach what healthy anger is and how to control it. Underlying false beliefs can be challenged by asking: “Who says anger is bad? How do you know that?”
  5. The primary personality can’t handle the memories.” Cognitive therapy can help the DID patient to recognize that as an adult the primary personality is older and may have more ability to cope with painful memories. (paraphrased from the book Dissociative Identity Disorder: Diagnosis, Clinical Features, and Treatment of Multiple Personality: Cognitive Restructuring Techniques, (pp 338-345, G3.32))
  • The first and last of the assumptions listed above are more specific to DID in that amnesia is involved; the memory of the trauma is blocked from the primary personality. However a child in a trauma situation might also develop the last assumption about other people in their lives. They might feel a need to protect family or others from information that the child might fear is too disturbing in some way or had been told by someone else to keep secret.
  • Less severe cases of childhood trauma may result in the child growing up believing false assumptions similar to those listed in number 2, 3, and 4 without the child also developing amnesiac memory blocks or feeling like there are parts of the self that are separate from each other.

Dissociation can be a normal coping strategy but in DID it can become disruptive for the adult even though it may have helped the child survive traumatic events. Cognitive therapy strategies can help the patient recognize that the beliefs they had developed as a child are not necessarily true at all or they are not true now that the child is really an adult. Initial recognition of false assumptions can help change old beliefs and related behaviors quickly, but it can also take months or years repeating the new beliefs to replace the old childhood beliefs.

G3.10: Therapy for Dissociative Disorders can be Effective & Cost Effective.

Information from the book Dissociative Identity Disorder: Diagnosis, Clinical Features, and Treatment of Multiple Personality regarding the cost effectiveness of therapy for DID found it to be very cost effective and could save years of ineffective therapy. Clinicians have reported stable integration in children with DID in as few as 5 to 10 office visits. The shortest reported integration for a child patient occurred in just one session and the longest treatment reportedly took 30 sessions over five months. The point is made however, that it wouldn’t be ethical to treat a child with DID while they are still experiencing abuse because the therapy would be taking away the child’s coping strategies. (p256, G3.32)

Adults with DID have been reported to have spent as long as twenty years in ineffective therapy before the diagnosis of DID was made. Twenty years of therapy can cost $500,000. Research that examined the treatment of fifteen women found that it took an average of 8.1 years in therapy before a diagnosis of DID was even made, at an average cost of $166,786.97 each. In comparison the average length of treatment once a diagnosis of DID was given was 2.6 years. (p257, G3.32) Two to five years of therapy before reaching integration is typical for patients with DID. (p257, G3.32)

The diagnosis of DID became controversial in the past as some practitioners over diagnosed and may have led some patients to false memories during sessions. However it is a real condition that is not very common.

  • A narrative “dramatized” description of a patient with DID and her therapy is available in the book Jennifer and Her Selves. written by the patient’s psychotherapist: (G3.33)
  • A patient with the condition shared her own story and “survival tips” for others with Dissociative Identity Disorder. At the time she wrote her book the condition was still called Multiple Personality Disorder. The next section includes more of Sandra J. Hocking and Company’s story in their book, Living With Your Selves: A Survival Manual for People With Multiple Personalities, (G3.34) . Sandra wrote the book along with some of her “alters“, the other sides of her personality that were formed at different stages of her childhood or adult life.  More about her story and the difference between DID and schizophrenia will be included in the next post.

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

References:

 

G3.7: Work Burnout is a type of Dissociative Disorder called Depersonalization Disorder.

A more frequent problem than is recognized is a milder form of a dissociative condition called Depersonalization/Derealization Disorder, commonly known as “work burnout,” than the more well-known but rare “Multiple Personality Disorder.” That name has been changed to Dissociative Identity Disorder (DID).  Symptoms may include depersonalization and/or derealization without the presence of other psychosis or memory and identity disturbances. It is one of the Dissociative Disorders which also include Dissociative Amnesia  and Dissociative Fugue and Dissociative Disorder Not Otherwise Specified, in addition to the more severe DID, Dissociative Identity Disorder. The disorders may be underdiagnosed or misdiagnosed even though symptoms consistent the Dissociative Disorders are often reported by people with psychiatric illness who also have a history of having experienced trauma. (G3.30)

  • Read more: Stress and Trauma: Psychotherapy and Pharmacotherapy for Depersonalization/Derealization Disorder. (G3.30)

Techniques that help patients reach a deeply relaxed state can help reach the nonverbal emotions and memories from early childhood that may not have been stored as “words.” Art therapy, journaling or poetry, music and movement and meditation can all help access or nonverbal memories. EMDR therapy incorporates rapid eye movement or hearing a sound that switches from the right to the left side of the brain rapidly. The stimulation in a rhythmic pattern helps reach a relaxed meditative state that is not as deep as hypnosis but might be somewhat similar. The therapist then guides the patient with some questions about a traumatic event or memory in order to try to reframe the issue from an adult’s perspective, in order to help the little child within the patient understand the issue from a more adult perspective. Forgiveness for parents who didn’t know better might be part of reviewing a traumatic childhood from the viewpoint of an adult. Parents may have just been young and foolish once too.

  • Eye Movement Desensitization and Reprocessing, EMDR Therapy: Using EMDR to Find Your ‘Safe Place’ in Trauma Recovery. (G3.31)

/Disclosure: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes./

References:

  • G3.30: Stress and Trauma: Psychotherapy and Pharmacotherapy for Depersonalization/Derealization Disorder, by J.P. Gentile, M. Snyder, P. M. Gillig, Innov Clin Neurosci. 2014 Jul-Aug; 11(7-8): 37–41. (G3.30)
  • G3.31: Using EMDR to Find Your ‘Safe Place’ in Trauma Recovery. By Camille Larsen, Aug.15, 2016, (G3.31.goodtherapy.org)

G3.6.1.8: If magnesium deficiency is cause of a diabetic patient’s pain, why give opioids instead?

Evidence based clinical research from 2009 could have helped save many lives lost to the opioid epidemic if patients were being told and treated with the discovery. (G3.101) Patients with diabetes and chronic pain often don’t experience much if any relief from the use of opioid medications, however that is the standard pain medication that is provided for chronic pain so it is often prescribed to diabetic patients anyway, just a prescription pad after all not a patient (not true). The research study provided magnesium to the diabetic patients as a pretreatment before providing the opioid or along with an IV drip of the medication, and not only was the pain reduced for patients who received magnesium, but the pain level was reduced for several days for the fortunate patients. And some trials of the experimental treatment didn’t provide the opioid medication and yet pain relief was felt by the diabetic patients.

Well that is exciting and it leads me to say – why even bother giving an opioid medication then, if it won’t help to relieve pain that is actually being caused by a magnesium deficiency? Because there is profit to be made by prescribing opioid medications but there isn’t profit to be made writing a magnesium prescription? Pondering is a waste of time for someone in pain.

The research discussion seemed to focus on using 30 mg of magnesium with IVs of morphine or other opioid medication for better pain control, but didn’t address or stress the fact that the 300 mg dose of magnesium had reduced pain levels for patients on its own, without any opioid medication having been given along with the nutrient. Pain control without needing an addictive drug that can cause death if overdosed?

Common sense can be inexpensive – consider the benefits of resolving a problem instead of treating symptoms and ignoring the underlying cause. (Magnesium can also be deadly in overdoses, but that really isn’t as common a cause of death as opioid overdoses.)

  • Read more: Magnesium ions and opioid agonists in vincristine-induced neuropathy, (G3.101).

Trying to replace a natural function with a patented medication is using patient’s pain for the purposes of profit.

Calcium channel blocker medications (PPIs for example) are trying to close the gates and keep the calcium out – and magnesium would be delighted to do that as nature intended if enough of the mineral were being absorbed from the intestines. However many issues with our modern food supply and the contaminants it may contain, may be leading to poor absorption of magnesium and increased loss of magnesium by the kidneys, (too much active hormone D3 can cause increased calcium absorption and loss of magnesium). Note the frequent use of the word “may” – more research is needed, in the meantime an Epsom salt bath or foot soak or use of a topical magnesium chloride product could bypass poor intestinal absorption problems. The magnesium sulfate used in Epsom salt would also provide sulfate which may also be beneficial due to possible contaminants in our modern food supply.

Talking about doing things “traditionally” is nice but our children are not growing up in the same chemical environment that we did, and we didn’t get to experience the food supply that our grandparents enjoyed.

Calcium channel blocker medications make a large profit for the pharmaceutical company – magnesium cannot be patented.

Now that it is clear that emotions and environmental triggers can cause inflammation, which at the same time is a cause of feeling “pain,” it is easy to see why childhood trauma or severe traumatic experiences or ongoing trauma can lead to developing inflammatory conditions such as inflammatory bowel conditions or fibromyalgia and migraine pain. The next section moves into psychological conditions that can be due to emotional trauma but may cause physical symptoms as well as mental symptoms.

See a healthcare provider for medical advice, diagnosis or treatment.

  • Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

The Academy of Nutrition and Dietetics has a service for locating a nutrition counselor near you at the website eatright.org: (eatright.org/find-an-expert)

References:

Only one? – yes, it is an important one:

G3.6.1.7: TRPV channels – the comfort of vanilla, the heat of capsaicin.

Before leaving the topic of “getting to know your TRP channels,” I’d like to introduce the vanilloid family. They were among the first TRP channels to be identified with lab techniques. This is all very tiny stuff, difficult to work with compared to a craft or construction project in the full size world we can see without a microscope. It is easy, however, to see when someone is scratching or wincing from pain, so the lab technicians and research scientists are to be commended for their fine eye for microscopic detail.

Vanillin or vanilloid receptors can have a calming effect on the body – baked goods with vanilla have a little extra besides love soothing the body. However some types of TRVP channels can also be stimulated by hot pepper due to its capsaicin content. (G3.99) Capsaicin is the active phytochemical that causes a feeling of “hot” when hot peppers are eaten – because it activated a TRPV channel which activates a nerve to send a signal to the brain that is most likely to be interpreted as “hot” although some people learn to enjoy the feeling, or may be genetically different and experiencing slightly differently than other people who couldn’t imagine eating very hot, hot peppers (G3.100)

The aroma of vanilla can lead to an emotional feeling of comfort even without eating a food containing the phytochemical that can activate the TRPV channels. “Aroma” does involve nerves being activated in response to a chemical in the air that enters the nostrils. Tiny amounts of “vanilla” aroma are entering the nose and physically activating TRPV channels which physically activate nerve signals that tell the brain “something” happened. This time it wouldn’t be as obviously “hot” as the capsaicin though, the vanilla is activating a different TRP channel which would activate a different nerve. If hot peppers had been experienced before the memory of them would be strong enough to remember not to eat them or touch them again. Making “noxious” chemicals, irritants or toxins, is a plant defense mechanism to encourage animals to not eat the plant unless it is ready for the seeds to be spread. A delicious fruit smells delicious when it is ripe and the seeds are ready to be “planted” somewhere other than right where the plant is growing. Some plants make seed pods that catch the wind or have burrs and attach to animal fur as animals walk by, and other plants make delicious fruit or other nutritious seeds to encourage animals to eat them, and carry the seeds elsewhere to be “planted” later (whenever the animal defecates). Nature is amazing.

Vanilla is a delicious smelling seed pod so the plant must want its seeds to be eaten. For delicious history and recipe information see Primer: Vanilla Part One and Two, by Jasmine, a culinary blogger.  (G3.102, G3.103)

We learn from previous experiences when to avoid something and when to reach for a second helping. If the brain had experienced home baked cookies in the past, then the scent of them baking any time in the future might set off an expectation of delicious food and activate saliva glands in addition to causing a calm or pleasant emotional response to the aroma of vanilla or a comforting memory from childhood. Aromas can also be tied to emotional responses that were learned in childhood or at any time in a trauma situation. Positive memories associated with an aroma may be triggered by re-experiencing the favorite fragrance or negative memories might also be triggered by a reminder of something associated with the trauma.

Cancer treatments can be so nauseating that patients are counseled to avoid favorite foods during the first few days after the treatment in order to prevent negative associations of nausea being linked to their favorite food.  When feeling “under the weather” there is a natural instinct to want to tempt the appetite with a comfort food – but if it is most likely going to be thrown up and the hope is that a few nutrients get absorbed before that happens then a bowl of oatmeal or a entree from an expensive restaurant would be equally unappealing on the way back up and the unusual meal might be more likely to cause memories of the experience. So – the common sense recommendation from dietetics eat the oatmeal while feeling sick or something neutral and save the favorites for later.

TRP channels – what were they again?

Physiology and Pharmacology of the Vanilloid Receptor, (G3.98) Excerpt: “In addition to the contribution of the vanilloid receptor as a target of the neurogenic inflammation underlying different diseases, TRPV1 is gaining interest for the treatment of neuropathic, postoperative and chronic pain and, recently, for the therapy of epithelial disorders [epithelial = skin or membrane]. Thus, for instance, topical capsaicin or resiniferotoxin have been used in postherpetic neuralgia, diabetic neuropathy, postmastectomy pain and arthritis [64,103]. Recently, TRPV1 has been clearly validated as a key target for management of chronic pain in bone cancer [42]. As a result, the development of specific TRPV1 antagonists is a central focus of current drug discovery.” (G3.98)

To review: magnesium is the ion that is needed inside of the cell to power the TRP or ion channel’s ability to stop some chemicals from entering the cell’s interior while allowing other chemicals to enter. Magnesium is the soldier at the gate with the energy to stand sentry all day and night – if present. If there is magnesium deficiency, the sentry with energy to keep the gate shut is gone and any chemical floating around in the fluid outside of the cell that is small enough to fit through the open ion channel is able to  flow through the unguarded gates. The capsaicin that can treat pain when used topically is over stimulating the receptors to the point where they are no longer sending any pain signals. When there is a magnesium deficiency then calcium itself can be a cause of pain.

Inside the interior of the cell calcium can activate the cell function and cause it to overwork to the point of cell death similarly to the “excitotoxins” such as glutamate or aspartic acid, both used in the food supply as flavorings – they also excite the tongue’s taste buds. MSG, aspartame and Neotame were included in the list of chemicals that might activate TRPA1 receptors which are associated with several chronic pain and chronic itch conditions.

 Calcium signals the cell to overwork, which leads to inflammation and signals of pain. Nerve signals are activated by inflammatory chemicals which are also “pain” signals as perceived by the brain – inflammation hurts because it is activating “pain” nerves. “Inflammation,” “oxidative stress,” and “pain” are all experienced as the same thing to the brain. So if someone at work is annoying you and you just can’t stop thinking about it – you might be physically hurting yourself, consider taking a walk in nature or buying a fern instead. Smelling vanilla scented essential oil products may also provide some comfort.

  • The research team suspect that “calcitonin gene related peptide (CGRP)” is involved in producing changes underlying the condition of “pain” and “inflammation” for the condition of arthritis at least. Inflammatory chemicals produced in one area of the body could travel and send nerve signals that led to inflammatory pain symptoms being felt in other areas of the body – so over-thinking can hurt? Read more: New Study Proves that Pain is Not a Symptom of Arthritis, Pain Causes Arthritis. Newsroom, University of Rochester Medical Center, urmc.rochester.edu, Sept. 29, 2008, (G3.109)

However CGRP has also been found to be involved in helping to suppress severity of symptoms in autoimmune diabetes. Providing CGRP therapy in an animal based research study helped reduce oxidative stress chemicals and the damage they can cause to pancreas cells that can eventually lead to developing autoimmune diabetes. (G3.114) Researchers working with human patients who have diabetes theorize that those people with a reduced response to stress are the people who seem to progress to diabetes most quickly. (page 19, G3.115) Chemicals similar to CGRP have also been tested therapeutically for heart disease patients and has been found to have some benefits for reducing hypertension, cardiac hypertrophy, and heart failure. (G3.116)

As a dietitian the question I next ask when I learn about a chemical in the body that seems to promote health is how do we make it for ourselves? How can we better assist patients to make it for themselves rather than being dependent on a daily medication? What does a person need to make CGRP ?

Drumroll – an answer does already exist in medical research – magnesium. Providing magnesium directly to an area of bone with a fracture in need of healing, was found to effectively promote increased bone healing – possibly due to a measured increase in levels of CGRP.  (G3.117G3.118)

So would you rather have a medical professional provide you a daily medication at a profit to the medical system – or be informed of ways to change your diet and lifestyle so that you could make the life saving chemical naturally the way healthy people do, everyday?

Like most things in life – too much CGRP isn’t good either. Genetic differences may be involved in risk for migraine as elevated levels of CGRP have been found in patients with migraines. Attempts to block the chemical Substance P were found to be ineffective but use of CGRP agonists/blockers were found to help patients with migraine. (G3.119)

And sugar is something that is a negative when eaten in excess. Too much sugar in the diet typically also means fewer nutrients are being consumed as refined sugar has no additional B vitamins or magnesium, while a piece of bread or fruit would provide some nutrients in addition to the naturally found sugars. Excess sugar in the bloodstream leads to an increased loss of magnesium by the kidneys because the mineral is necessary in order to remove the excess sugar from the blood and add it to the urinary waste stream. (G3.120) B vitamins are needed in order for the body to be able to break down the molecules of sugar so the stored energy is released. Smaller waste chemicals are produced from the larger sugar molecule that will also need to be excreted by the body as a normal part of metabolism (metabolism is roughly equal to all of the body’s many chemical, energy and digestive cycles). A diet with excess refined sugar has also been associated with heart disease risk. (G3.121)

See a healthcare provider for medical advice, diagnosis or treatment.

  • Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.
  • The Academy of Nutrition and Dietetics has a service for locating a nutrition counselor near you at the website eatright.org: (eatright.org/find-an-expert)

References: