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 Have you ever thought about the impact on one's nervous system after experiencing repeated trauma? While we typically anticipate an emotional reaction, it's important to recognize that both the body and mind are equally affected when we sense danger. Although, we can’t always control our reflexes, the function of our nervous systems and our physiological responses may continue to influence our behaviors even after the perceived threat is gone. In 1994, Dr. Stephen Porges proposed a theory called Polyvagal theory, in hopes of understanding the influence of our nervous system on social adaptiveness, expression of behavioral problems and psychiatric disorders. Polyvagal theory specifically describes how one’s automatic behavioral response is linked to perceived environmental cues. Ryland et al. (2022) further explained that Polyvagal theory emphasizes how one’s nervous system works in response to environmental factors that either activate one’s defensiveness or social engagement when appropriate. There are Three Pillars of Polyvagal Theory 3 Pathways Of Our Physiological Responses
Neuroception: Is described as the process of one’s nervous system to scan for cues that indicates safety, danger, or threats. Giving the nervous system the ability to react to those cues. After the scan is done, the Vagus nerve then transmits that information to the appropriate part of the body, serving as the main connection between the brain and the body. For example, when we touch some hot and immediately take our hands away, the vagus nerve sends distress signal to the brain and helps the body return back to a calmer state. With a normal nervous system, this process involves evaluating risk and finding appropriate channels of behavioral response. However, with individuals whose nervous system has been significantly compromised through repeated exposure to trauma, there is a mismatch in assessment of cues where their nervous system indicates constant danger even when the environment is safe. They may show reactions like fight, flight, freeze and even decrease social engagement behaviors (AMS Medicine, 2023)  The Impact of Regulating Our Nervous System
Coregulation: This happens when two or more nervous systems interact in a way that promotes mutual wellbeing and emotional connection. An example of this is seen in mothers and their infants. Oftentimes when the infants are in distress, they rely on the comfort and engagement of their caregivers to regulate their distress. Polyvagal Theory Plays a Role in Treatment Outcomes The Polyvagal theory was developed to help individuals dealing with trauma, stress, emotional dysregulation and other psychological disorders. Reestablishing emotional balance is ultimately necessary for the overall recovery and healing. The presence of trauma especially often dysregulates one’s nervous system. When this happens, we often see instances where people alternate between states of hyperarousal and complete depletion. Behaviors like exaggerated startle response, difficulty sleeping, constant feelings of being on edge or feelings of numbness, disconnect and emotional detachment becomes more apparent. The concept of coregulation often extends beyond parent and child relationships. A significant factor of improvement that was mentioned earlier is social engagement. When in distress, social engagement plays a vital role in fostering positive social interactions, sense of safety, trust and emotional resilience. However, co-regulation can be particularly challenging for people with PTSD or complex trauma. Individuals with PTSD often remain in a heightened state of alertness. This hypervigilance can make them highly sensitive to the emotional states of others, sometimes leading to increased anxiety or discomfort when trying to connect or co-regulate. In the context of development and therapeutic processes, co-regulation may also needed. In therapeutic settings, when there is co-regulation between therapist and clients, there is an increased sense of safety and support that foster healing and growth. People who have been through traumatic experiences that have altered their nervous system may need more positive social engagement with others. This enables people to be able to connect, understand, and support each other’s emotional and physiological well-being. With trauma care and treatment, this is especially helpful in reframing trauma behaviors. Therapeutic process further provides a way to repair ruptures in one’s ability to regulate their emotional capacity and relate to the world around them (Grassmann et al, 2023). The understanding of Polyvagal theory provides great insight into behaviors, choices and even distress patterns which facilitates better connections and positive treatment outcomes. Reference AMS Medicine (2023). Polyvagal Theory: Advancing the understanding of the autonomic nervous system in medicine. AMS Adult Medicine Specialists. https://amsmedicine.com/polyvagal-theory-advancing-the-understanding-of-the-autonomic-nervous-system-in-medicine/#comments Grassmann, H., Stupiggia, M., & Porges, S. W. (2023). The Science of Embodiment: Trauma, Body, and Relationship. International Body Psychotherapy Journal, 22(1), 149–158. Ryland, S., Johnson, L. N., & Bernards, J. C. (2022). Honoring Protective Responses: Reframing Resistance in Therapy Using Polyvagal Theory. Contemporary Family Therapy: An International Journal, 44(3), 267–275. https://doi.org/10.1007/s10591-021-09584-8
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Suicide is defined as death caused by injuring oneself with the intention of dying. Over the years suicide has become a more common trend among younger people especially. According to the Centers for Disease Control and Prevention, Suicide is the 2nd leading cause of death among people ages 10-24 years old. Research shows that this particular population is more vulnerable to mental health problems. Young people often experience various challenges navigating changes in life which could bring up emotions like fear, confusion, doubt, and shame.
Since the Covid-19 pandemic, people have experienced more disruption to their, life, work, and relationships putting more strain on their mental well-being. Suicide Prevention in Youth (2022) mentioned in their article that about 18% of youth in the US particularly seriously considered attempting suicide and 8.6% made suicide attempts within the past year in 2020. Suicide also among this population seems to be more prevalent in girls and among minority groups with limited access to mental health resources. Effects of suicide do not just have a physical impact on an individual, but they leave lasting effects in many areas of their lives like relationship, jobs, and their mental or emotional well-being. There are many factors that contribute to suicide or self-harming behaviors, some of them include; Mental health conditions: people who suffer from disorders like depression, anxiety, and other mood disorders may be more susceptible to suicide. People with depressive symptoms especially youths may have an increased sense of isolation and social alienation which increases the chances of self-harming behaviors (Freitage et al., 2022) Family History: Family systems and their environment can affect how a person is raised and how they identify in society. Family factors that contribute risk of suicide may include the history of suicide in the family, relationship conflict, presence of trauma or violence, neglect, parental divorce, and so on Alcohol and substance use- According to the American Addition Center’s article on substance abuse and suicide, suicide is the leading cause of death among people who misuse alcohol and drugs (2022). It’s common for people who experience suicidal thoughts to abuse alcohol and drugs in the hope of escaping the emotional pain. Unfortunately, alcohol/ drug use further intensifies depressive symptoms and increases the likelihood of impulsive behaviors. Previous Suicide Attempts- Not only does a prior suicide attempt increase the risk of suicide, but it also leaves both short and long-term effects on the individual. O’Brien et al (2022) suggested that with adolescents there are usually more reports of significant emotional distress and the overwhelming presence of negative emotions. Adding that adolescents who have previously attempted suicide are 60 times more likely to die from suicide than those who never attempted. Environmental Factors: other factors that may contribute to suicide may include socio-economic status, unemployment, discrimination, loss, access to means, criminal/legal problems, impulsivity or aggression tendencies, relationship problems, bullying, harassment, and identity crisis Warning Signs for Suicide There is a myth that talking about suicide increases the likelihood of suicide which is not true. Although, depression and suicide often coincide, it’s important to watch out for other signs of suicide. Awareness of the emotional and behavioral signs of suicide can be especially helpful for parents, teachers, and friends when assessing the risk of suicide. Talking about suicide creates a space for open communications and de-stigmatization of suicide; some warning signs include; · Recent fascination with death · Feelings of hopelessness and worthlessness · Feeling like a burden to others · Feelings of guilt, shame and anger · Saying goodbye to friends and family · Giving away prized possessions · Change in eating and sleeping patterns · Recklessness · Losing interest in personal hygiene or appearance · Withdrawn from friends, families and communities · Recent suicide attempt · Increase alcohol or substance use Treatment With collaborative efforts from family, teachers, and the engaging community suicide is always preventable. Losing someone to suicide is difficult and it comes with a lot of complicated emotions. Suicide does not only affect an individual, but it also affects the lives of the people around them. Assessing risk for suicide and treatment is possible with the help of everyone. The use comprehensive approach that assesses the level of risk and underlying problem causing suicidal thoughts or behaviors helps to enhance suicide care and rehabilitation. Ways to improve suicide care include; Psychotherapy- Seeking professional help like counseling can help with early interventions and effective assessment for suicide. Mental health and peer support especially in schools can help with providing strategies that can help individuals cope with issues regarding impulsivity, interpersonal conflict, sexual identity, trauma care, suicidal behaviors, self-esteem, social connectedness and so on which not only promotes mental wellness but improves access to appropriate mental health care. Medications- As discussed earlier one of the risk factors for suicides is the presence of other mental health disorders. Along with psychotherapy interventions, the use of antidepressants, anti-anxiety, antipsychotics, and other medications for mental illness can help better manage suicidal behaviors and thoughts Addiction treatment: Treatment for alcohol and substance dependency can help with addiction treatment and promote participation in social support groups that can help with rehabilitation Family support and Education: Involving family and friends in the treatment process can help provide a supportive environment for change. Family support and community engagement can foster better-coping skills, improve communication and more connectedness for the individual. Psychoeducation for individuals and families that center on de-stigmatization of mental health problems could promote positive treatment outcomes. Connecting with people you can trust can go a long way in seeking help and preventing suicide! Suicide Care Resource: Call a suicide hotline number
Amanda.Lautieri. (2022, September 15). The link between substance abuse & suicide in teens. American Addiction Centers. https://americanaddictioncenters.org/blog/link-between-substance-abuse-suicide-in-teens Centers for Disease Control and Prevention. (2023, May 9). Disparities in suicide. Centers for Disease Control and Prevention. https://www.cdc.gov/suicide/facts/disparities-in-suicide.html https://www.cdc.gov/suicide/facts/disparities-in-suicide.html Editorial: Suicide prevention in youth. (2022). Child & Adolescent Mental Health, 27(4), 325–327. https://doi.org/10.1111/camh.12604 Freitag, S., Bolstad, C. J., Nadorff, M. R., & Lamis, D. A. (2022). Social Functioning Mediates the Relation Between Symptoms of Depression, Anxiety, and Suicidal Ideation Among Youth. Journal of Child & Family Studies, 31(5), 1318–1327. https://doi.org/10.1007/s10826-021-02088-x O’Brien, K. H. M., Nicolopoulos, A., Almeida, J., Aguinaldo, L. D., & Rosen, R. K. (2021). Why adolescents attempt suicide: A qualitative study of the transition from ideation to action. Archives of Suicide Research, 25(2), 269–286. https://doi.org/10.1080/13811118.2019.1675561 Rumination syndrome (RS) is a feeding and eating disorder defined by repeated regurgitations of food material soon after eating, followed by re-swallowing, or spitting of the material (Murray, 2019). The first report of rumination was back in the 17th century when Edouard Brown Sequard, a physician, developed the learned behavior of regurgitations while experimenting with swallowing sponges to study gastric acid responses (Khan, 1998). Although the disorder was recognized and medicalized, few studies have been done since to study the disorder in detail. Therefore, the diagnosis of RS varies across different studies, often leading to it being misdiagnosed or undiagnosed. For instance, RS is often misdiagnosed for other conditions that cause vomiting, like gastroesophageal reflux disease and gastroparesis (Khan, 1998). The universal criterion for RS is repeated episodes of regurgitations that last more than a month and are not primarily caused by medical conditions or other eating disorders (Bryant‐Waugh, 2018).
The cause of RS is unknown, but several hypotheses have tried to explain the mechanisms behind the disorder. One hypothesis is that RS is a conditioned response to a specific stimulus. For instance, regurgitating after eating certain foods may trigger the same response when eating that same food. In other cases, individuals may feel a visceral sensation of pressure in the esophagus and abdomen, followed by a premonitory urge to regurgitate. After regurgitating, individuals are relieved of this urge and the abdominal wall contraction, which may positively reinforce the regurgitation behavior. Other hypotheses pose that the soothing sensation caused by regurgitation may serve as a coping mechanism to relieve psychological distress (Murray, 2019). Despite the lack of research on the disorder, proper and timely diagnosis and treatment of RS is necessary. Without proper diagnosis and treatment, RS can cause severe health problems, like dental damage, electrolyte imbalance, nausea, abdominal pain, heartburn, and nutrient deficiency (Murray, 2019; Khan. 1998). Currently, the first line of treatment is diaphragmatic breathing, which is a breathing exercise to strengthen the diaphragm. Such exercises have been shown to help contain the food material in the stomach. Other intervention methods, like relaxation, aversion training, distractions, or cognitive behavioral therapy can also enhance treatment. In some cases, medications like Baclofen or neuromodulators may help relieve the symptoms (Murray, 2019). However, more research is warranted to study the mechanisms behind the disorder and how to diagnose best and treat it. References Bryant‐Waugh, R., Micali, N., Cooke, L., Lawson, E. A., Eddy, K. T., & Thomas, J. J. (2018). Development of the PICA, Arfid, and rumination disorder interview, a multi‐informant, semi‐structured interview of feeding disorders across the lifespan: A pilot study for ages 10–22. International Journal of Eating Disorders, 52(4), 378–387. https://doi.org/10.1002/eat.22958 Khan, S., Hyman, P., & DiLorenzo, C. (1998). Rumination syndrome in adolescents. Journal of Pediatric Gastroenterology & Nutrition, 27(4), 479. https://doi.org/10.1097/00005176-199810000-00085 Murray, H. B., Juarascio, A. S., Di Lorenzo, C., Drossman, D. A., & Thomas, J. J. (2019). Diagnosis and treatment of rumination syndrome: A critical review. American Journal of Gastroenterology, 114(4), 562–578. https://doi.org/10.14309/ajg.0000000000000060 Vijayvargiya, P., Iturrino, J., Camilleri, M., Shin, A., Vazquez-Roque, M., Katzka, D. A., Snuggerud, J. R., & Seime, R. J. (2014). Novel association of rectal evacuation disorder and rumination syndrome: Diagnosis, comorbidities, and treatment. United European Gastroenterology Journal, 2(1), 38–46. https://doi.org/10.1177/2050640613518774 |