Walking with parent at sunriseOver 17 million adults in the United States had at least one major depressive episode in 2017 (National Institute of Mental Health, 2019). Globally, more than 264 million people of all ages experience depression (World Health Organization, 2020).

In the United States, major depressive episodes are more common among adult women (8.7%) than adult men (5.3%). At 13.1%, young adults, aged 18-25, had the highest rate of major depressive episodes (National Institute of Mental Health, 2019).

As our understanding of mental health increases, we are beginning to look at how the environment of our parents and grandparents influences our own health and the health of our offspring. This knowledge is based on new research that investigates the epigenetic processes which regulate how the environment affects the expression of genes that relate to mental health generally and to depression in particular (Sun et al., 2013).

As our understanding of mental health increases, we are beginning to look at how the environment of our parents and grandparents influences our own health and the health of our offspring.

Environmental Impacts of Depression: Past and Present

Mental illness is incredibly complex and is influenced by a host of biological, chemical, and environmental factors. Depression, for example, is much more than low mood, negative thoughts, or a chemical imbalance in the brain. When we look at the biological component of depression, we see just how powerfully environment may determine our vulnerability to developing depression and how these environmental effects occur and accumulate over the generations.

We know childhood abuse and neglect can have lifelong impacts on the health and well-being of the child. But what about looking into the environment of our ancestors? We are beginning to understand how our parents’ and grandparents’ environment impacts our own and our children’s mental health.

Epigenetics, in its simplest meaning, refers to the stable changes in gene expression without modification of the DNA sequence. In the context of depression, these changes are often triggered by severe stress, and they can result in an increased vulnerability in the brain’s limbic regions (Nestler, 2014). The limbic regions of the brain are implicated in depression, as they are involved in emotion regulation, self-preservation, and the desire to procreate (Pandya et al., 2012). These changes in gene expression can be passed down from parents to offspring. However, the exact process of how this happens is still largely mysterious (Kaneshiro et al., 2019).

While the mechanism of transmission is not clear, the results of environmental exposure to risk factors for depression are measurable. We now know that the stress of our parents and grandparents can cause increased vulnerability to depression in ourselves and our children. The vulnerability to depression can be passed down through generations. This is true even though we may not have experienced early abuse, trauma, or neglect.

Change in Both Directions: How Environment Can Nurture

Epigenetic changes can also occur because of positive experiences such as supportive, healthy relationships and learning opportunities. Good physical health also influences gene expression in a positive way. Having access to nutritious food and a healthy lifestyle may also have a protective effect on mental health.

Even in adulthood, our brain continually changes with experience. For example, chronic anxiety resulting from early adverse childhood experiences can be improved by stress-reduction interventions (Hölzel et al., 2010). For adults, living in a healthy environment without prolonged exposure to severe stress can have a real impact on increasing resilience and reducing a person’s vulnerability to developing a mental health issue.

If we provide a healthy, nurturing environment with supportive relationships for our children, we can improve their resilience against developing depression. A healthy diet and exercise are included as part of an optimal environment for children. (According to researchers, a healthy diet, especially for growing infants and children, does not mean a fat-free diet. Fat is essential for neurological development and brain function (Milner & Allison, 1999).)

Therapy Can Improve Resilience

Part of moving toward a healthy lifestyle can include working with a therapist who incorporates cognitive behavioral therapy (CBT). CBT is an individualized process that has been shown to be effective for reducing stress, anxiety, and depression. CBT works on negative and unrealistic thought patterns and unhelpful behaviors. Additionally, therapy is a supportive relationship that allows for the healing of underlying issues that may be causing distress. Therapy and CBT can lead to improvements in mood and reduction in stress that will reduce anxiety and, over time, lead to improvements in brain areas associated with depression.

In summation, our environment, even the environment of our parents and grandparents, has an important impact on our mental health. It is important to understand that when you take care of yourself and your children, you are not only improving your own health—you may also be improving the lives and health of future generations who have not even been born yet.

References:

  1. Depression. (2020, January 30). World Health Organization (WHO). Retrieved from https://www.who.int/news-room/fact-sheets/detail/depression
  2. Hölzel, B. K., Carmody, J., Evans, K. C., Hoge, E. A., Dusek, J. A., Morgan, L., Pitman, R. K., & Lazar, S. W. (2010). Stress reduction correlates with structural changes in the amygdala. Social Cognitive and Affective Neuroscience, 5(1), 11-17. doi: 10.1093/scan/nsp034
  3. Kaneshiro, K. R., Rechtsteiner, A., & Strome, S. (2019, March 20). Sperm-inherited H3K27me3 impacts offspring transcription and development in C. elegans. Nature Communications, 10(1271). Retrieved from https://www.nature.com/articles/s41467-019-09141-w
  4. Major depression. (2019). National Institute of Mental Health (NIMH). Retrieved from https://www.nimh.nih.gov/health/statistics/major-depression.shtml
  5. Milner, J. A., & Allison, R. G. (1999). The role of dietary fat in child nutrition and development: Summary of an ASNS workshop. The Journal of Nutrition, 129(11), 2094-2105. doi: 10.1093/jn/129.11.2094
  6. Nestler, E. J. (2014). Epigenetic mechanisms of depression. JAMA Psychiatry, 71(4), 454-456. doi: 10.1001/jamapsychiatry.2013.4291
  7. Pandya, M., Altinay, M., Malone, D. A., & Anand, A. (2012). Where in the brain is depression?. Current Psychiatry Reports, 14(6), 634-642. doi: 10.1007/s11920-012-0322-7
  8. Sun, H., Kennedy, P. J., & Nestler, E. J. (2013). Epigenetics of the depressed brain: Role of histone acetylation and methylation. Neuropsychopharmacology, 38(1), 124-137. doi: 10.1038/npp.2012.73

Child standing by lockersEmotional incest, also known as covert incest, has nothing to do with incestuous sexual abuse. Rather, it is an unhealthy emotional relationship between a parent and a child that blurs boundaries in a way that elevates the child into an adult role. The parent looks to the child for emotional support. In some cases, the parent also seeks practical support from the child.

In an emotionally incestuous relationship, the child is expected to meet the needs of the parent rather than the parent meeting the needs of the child. This type of relationship, which is similar to enmeshment, is inappropriate and can be psychologically damaging for the child.

Emotional incest often occurs when the parent does not have their needs met by a romantic partner or when the family dynamic is broken. Substance abuse, infidelity, and mental health issues tend to increase the dependency of the parent.

Emotional incest occurs when the child believes they are responsible for their parent’s emotional well-being.

What Does Emotional Incest Look Like?

Emotional incest occurs when the child believes they are responsible for their parent’s emotional well-being. This can happen when the parent talks to the child as though the child were an adult. The parent may request advice from the child regarding adult issues and can even place the child in the role of therapist.

When the parent is sad or lonely, it’s up to the child to make them feel better, or at least feel their feelings with them. The boundaries are blurred and meshed. The child may lack any sense of emotional separation from the parent (Love, 2011).

Is Emotional Incest a Form of Neglect?

Elevating a child to the role of supporter and adult can lead to neglect and emotional abuse. A parent who is overly dependent on a child can also be critical and neglectful. Parents who have traversed or inverted parent-child roles can refuse or be unable to provide appropriate support for the child. This can result in a confusing mix of love and abuse (Hosier, 2015).

When a parent relies on the child, the child’s needs are not being met. Children who are placed in the role of adults often do not know how to ask for help. They understand that their parent is unable or uninterested in providing emotional support, so they deny their own needs.

Why Some Parents Look to Children for Support

It is thought that early emotional deprivation can lead some adults to regard their children as parental figures (Jurkovic, 2014). When divorce occurs, this can leave a vacuum that encourages a child to step in and do what they can to help the family (Freud, 1989).

Parents with narcissistic personality (NPD) may lack insight into how their behavior affects their child (Kriesberg, n.d.). They may also justify or deny their behavior and refuse to see that their child may be suffering.

Narcissistic parents and parents who engage in emotional incest often need praise from their child. Questions such as, “Am I a good mother?” or, “How much do you love me?” can place the child in a precarious position, as the child is not allowed to complain or express their own needs. Instead, the parent is the primary one who needs care. This unspoken understanding that the child’s needs are not as important as the needs of the parent can have lasting effects and can cause difficulties in adult relationships.

A parent with addiction may also develop an inappropriate reliance on their child. The child can assume the role of caretaker both when the parent is intoxicated and when the parent is sick and recovering from using substances or alcohol. Children of addicted parents often understand the parent is not capable of caring for them. As a result, they become the “strong one” in the family. The child may hide or deny their own needs even to themselves, as they know the parent is unavailable to provide care.

Emotional Incest: Child Outcomes

The impact of emotional incest on adult children can manifest in a variety of ways. They often have difficulties setting boundaries in relationships. They may also experience depression, shame, suicidal feelings, excessive guilt, anxiety, and social isolation.

Emotional incest can rob a child of the ability to develop at a normal pace, as they are forced into maturity at an early age and denied the opportunity to experience appropriate and supportive relationships. When they reach adulthood, they can experience dysfunctional adult relationships that perpetuate the cycle of unhealthy relationships.

Processing Emotional Incest: The Role of Therapy

Therapy allows you to understand and address the impacts of emotional incest. Underlying issues can be explored and healed in a nonjudgmental and safe environment. A therapist can provide guidance for building appropriate, healthy adult relationships as well as help with relationships with children.

Many adults who experienced emotional incest as a child do not want to repeat the pattern. Therapy can provide guidance and positive support for parents who want their own children to experience healthy parent-child relationships. Find a licensed, compassionate therapist here.

References:

  1. Freud, A. (1989). Normality and pathology in childhood: Assessments of development. London: Routledge.
  2. Hosier, D. (2015). Child-parent relationship too close for comfort? Emotional incest explained. Childhood Trauma Recovery. Retrieved from childhoodtraumarecovery.com/all-articles/child-parent-relationship-too-close-for-comfort-emotional-incest-explained
  3. Jurkovic, G. J. (2014). Lost childhoods: The plight of the parentified child. New York, NY: Routledge.
  4. Kriesberg, S. (n.d.). Women with narcissistic parent: Stuck in worry. Anxiety and Depression Association of America. Retrieved from adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/women-narcissistic-parents
  5. Love, P. (2011). The emotional incest syndrome: What to do when a parent’s love rules your life. New York, NY: Bantam.

Shadows of parents holding child's handMany might assume that the intergenerational transmission of trauma from parent to child occurs through abuse or neglect, but this is not always the case.

Trauma can also be passed on through changes in gene expression. This is known as the epigenetic transmission of trauma. Epigenetics is understood as changes in gene function that are heritable and not associated with changes in one’s DNA sequence (Dupont, Armant, & Brenner, 2009). It is thought that epigenetic changes can occur as a result of extreme stress, such as in the case of parents with histories of trauma.

Heritability of Trauma

Research with children of Holocaust survivors has indicated that children can inherit the traumatic memories of their parents. The evidence is so compelling that some have argued children can inherit the unconscious minds of their parents. Some children of Holocaust survivors have even been known to have genocide-themed nightmares. Although it can be argued the children receive Holocaust imagery through shared stories and narratives, it does not explain their increased vulnerability to stress-related diagnoses such as complex trauma (C-PTSD) and posttraumatic stress (PTSD).

While may be more difficult to prove the inheritance of traumatic memories, we do know that psychological stress can affect gene expression patterns via the nervous system.

While may be more difficult to prove the inheritance of traumatic memories, we do know that psychological stress can affect gene expression patterns via the nervous system. It may be that the disposition to develop PTSD and C-PTSD is passed down through an epigenetic route (Kellermann, 2013).

When Symptoms Occur Without a History of Trauma

It is important to understand that trauma can be inherited independently of difficult family circumstances. A child can develop anxiety, depression, or other stress-related issues such as PTSD as a result of an inherited vulnerability rather than direct trauma.

Research has shown that secure mother-child attachment is key for childhood development (Meins, Bureau, & Fernyhough, 2018). A recent study shows that “good-enough” parenting is adequate for a child to develop a secure attachment to its mother. What this means is that perfect parenting is not required for the child to grow up securely attached, a state that is associated with the best outcomes for mental health (Lehigh University, 2019).

The research has two sides. On one, the research shows us that we do not require perfect parenting and a stress-free environment to be secure and healthy. The flip side of this research is that some children will inherit trauma even with a gentle upbringing. In these cases, a child can inherit symptoms of trauma, including nightmares and anxiety, even without being exposed to trauma.

Can Epigenetic Changes Lead to Positive Outcomes?

While the news that trauma can be passed down despite good parenting may sound disheartening, epigenetics also creates changes in a positive way as well. When we have good nutrition and are raised in a nurturing and loving environment, over generations, epigenetic changes can also occur for the better. Researchers investigating epigenetics in animal models have found that rat pups with mothers who lick and groom them often are more likely to grow up to be calm, while pups who are not groomed frequently by their mothers may grow up to be anxious (Kirkpatrick, 2017).

What we know from epigenetic research as it relates to the intergenerational transmission of trauma is that we can have at least some influence on our children’s ability to be calm and resilient to stress. By providing a loving and nurturing environment for them, we can diminish the intensity of inherited trauma. Each succeeding generation can whittle away at the effects of trauma through consistent nurturing and loving parenting. Trauma does not have to continue from one generation to the next.

References:

  1. Dupont, C., Armant, D. R., & Brenner, C. A. (2009). Epigenetics: Definition, mechanisms and clinical perspective. Seminars in Reproductive Medicine, 27(5), 351-357. doi: 10.1055/s-0029-1237423
  2. Kellermann, N. P. (2013). Epigenetic transmission of Holocaust trauma: Can nightmares be inherited?. The Israel Journal of Psychiatry and Related Sciences, 50(1), 33-39. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24029109
  3. Kirkpatrick, B. (2017, December 12). Cuddling can leave positive epigenetic traces on your baby’s DNA. Retrieved from https://www.whatisepigenetics.com/cuddling-can-leave-positive-epigenetic-traces-babys-dna
  4. Lehigh University. (2019, May 8). ‘Good enough’ parenting is good enough, study finds. ScienceDaily. Retrieved from https://www.sciencedaily.com/releases/2019/05/190508134511.htm
  5. Meins, E., Bureau, J. F., & Fernyhough, C. (2018). Mother–child attachment from infancy to the preschool years: Predicting security and stability. Child Development, 89(3), 1,022-1,038. doi: 10.1111/cdev.12778

Woman looking into ornate, hand-help mirrorVery few people are one hundred percent happy with their physical appearance. Most of us have something about ourselves that we would like to change in some small way.

But for most of us, our perceived flaws do not interfere with our happiness or daily functioning. For those who have body dysmorphia, or body dysmorphic disorder (BDD), however, a small flaw—either real or imagined—can substantially reduce their quality of life. They may obsess and worry about the flaw for hours every day (Anxiety and Depression Association of America, n.d.). BDD is a serious mental health issue that can lead to suicidality and significant social and occupational dysfunction. Both men and women can experience BDD (Phillips & Castle, 2001).

People with BDD are often extremely preoccupied with their physical appearance and can become deeply upset over minor flaws that wouldn’t even be noticed by others. The person’s perception of the flaw, however unrealistic, often causes intense emotional distress and can trigger avoidance of social situations.

The preoccupation and obsession with flaws that comes with body dysmorphia can take away the ability to experience joy and healthy relationships. Some people with BDD undertake multiple cosmetic procedures to correct the flaw. Unfortunately, relief is likely to be short-lived at best. The root issue is not the flaw, which may be minor or even imagined. After the cosmetic procedures, the individual with BDD may simply focus on a different or “new” flaw.

The preoccupation and obsession with flaws that comes with body dysmorphia can take away the ability to experience joy and healthy relationships.

Emotional Neglect and Body Dysmorphia

Emotional neglect can be understood as a pattern in a parent-child relationship where the child’s needs are consistently ignored, disregarded, or devalued by the parent. Emotionally neglected parents often feel ambivalent towards their children’s emotional needs, particularly when they are distressed and crying (Didie et al., 2006). The parent may feel the child is impossible to please and—out of frustration—simply ignore and reject the child when they are upset. In this cycle, adults who were emotionally neglected as children tend to become emotionally neglectful as parents.

Emotional neglect is commonly found in both males and females diagnosed with BDD (Carey, Crocker, Elias, Feldman, & Coleman, 2009).

Emotional Neglect as Trauma

The body and the nervous system experience neglect in a way that is similar to abuse. The child who is not nurtured and cared for emotionally may experience continuous high levels of stress and sadness with no one to turn to for comfort. Over time, this can take a serious toll on the ability to develop resilience as the child matures into adolescence and adulthood.

Adults with histories of neglect often develop a range of emotional and mental health issues, including depression, low self-esteem, hyperactivity, and aggression. Neglect often leads to the child feeling unwanted and unloved, and it can lead to a distorted perception of the self.

In the case of BDD, emotional neglect may foster a distorted self-perception in terms of physical appearance. The individual with BDD may believe they are deeply flawed and unacceptable to others as a result of their physical appearance.

Developmental Timing and Neglect

The impact of physical and emotional neglect may be influenced by when it occurs during the child’s development. A child who is neglected during the early years of development can miss out on crucial opportunities for social, emotional, and cognitive development. An important factor that underlies each of these aspects of childhood development is the ability to develop resilience and cope with stress (Cicchetti & Toth, 1995).

Very young children and infants are not biologically capable of reducing the autonomic stress response once it is activated. During times of heightened emotional upset or fear, increased levels of stress hormones begin to circulate in the brain and nervous system. A child without comfort and guidance from an adult is forced to expend all of their energy in bringing the body and mind back to a balanced state. When the child is put in the position of having no help or comfort, all resources are expended and the child has little left for anything else. In this way, opportunities for development in other areas such as social and cognitive learning are lost.

As the child gets older, it is understandable why neglect can lead to intense feelings of shame and a distortion of body image. Body image is connected to self-esteem. When children grow and develop in circumstances that teach them they are unworthy of love and even send messages that there is something wrong with them, the child is likely to internalize these perceptions as they grow.

Therapy for Trauma and Body Dysmorphia

Exposure therapy (Neziroglu & Yaryura-Tobias, 1993; Linde et al., 2015) and cognitive behavioral therapy (CBT) can help some people process and heal the effects of past trauma and neglect. Cognitive behavioral therapy may be helpful for BDD because it helps the person discover the source of distorted and unrealistic perceptions. Once it’s understood where the negative thought patterns are coming from, CBT teaches us how to correct these patterns and then move into a more realistic and healthy way of thinking (Neziroglu & Khemlani-Patel, 2002). In this way, CBT can be effective in treating distorted perceptions of the body. At the same time, CBT can help in developing healthier thinking patterns that address depression and anxiety, which often co-occur with trauma and BDD.

If you think childhood emotional neglect or body dysmorphia are issues that could be impacting you, support is available. Reach out to a licensed and compassionate therapist.

References:

  1. Body dysmorphic disorder (BDD). (n.d.). Anxiety and Depression Association of America. Retrieved from https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/body-dysmorphic-disorder-bdd
  2. Carey, W. B., Crocker, A. C., Elias, E. R., Feldman, H. M., & Coleman, W. L. (2009). Developmental-Behavioral Pediatrics E-Book. Philadelphia, PA: Elsevier Health Sciences.
  3. Cicchetti, D., & Toth, S. L. (1995). A developmental psychopathology perspective on child abuse and neglect. Journal of the American Academy of Child and Adolescent Psychiatry, 34(5), 541-565. doi: 10.1097/00004583-199505000-00008
  4. Didie, E. R., Tortolani, C. C., Pope, C. G., Menard, W., Fay, C., & Phillips, K. A. (2006, September 26). Childhood abuse and neglect in body dysmorphic disorder. Child Abuse & Neglect, 30(10), 1105-1115. doi: 10.1016/j.chiabu.2006.03.007
  5. Linde, J., Rück, C., Bjureberg, J., Ivanov, V. Z., Djurfeldt, D. R., & Ramnerö, J. (2015). Acceptance-based exposure therapy for body dysmorphic disorder: A pilot study. Behavior Therapy, 46(4), 423-431. doi: 10.1016/j.beth.2015.05.002
  6. Neziroglu, F., & Khemlani-Patel, S. (2002). A review of cognitive and behavioral treatment for body dysmorphic disorder. CNS Spectrums, 7(6), 464-471. doi: 10.1017/s1092852900017971
  7. Neziroglu, F. A., & Yaryura-Tobias, J. A. (1993). Exposure, response prevention, and cognitive therapy in the treatment of body dysmorphic disorder. Behavior Therapy, 24(3), 431-438. Retrieved from https://psycnet.apa.org/record/1994-26859-001
  8. Phillips, K. A., & Castle, D. J. (2001, November 3). Body dysmorphic disorder in men: Psychiatric treatments are usually effective. The BMJ, 323(7320), 1015-1016. doi: 10.1136/bmj.323.7320.1015

Woman looking backPosttraumatic stress (PTSD) and complex posttraumatic stress (C-PTSD) are related but distinct from each other. C-PTSD is thought to be an enhanced version of PTSD. C-PTSD is, in turn, related to borderline personality (BPD).

Ongoing Interpersonal Trauma and C-PTSD

PTSD is usually caused by a single traumatic event (or a series of traumatic events) that result in a real or imagined threat to one’s life or bodily integrity. Events that could cause PTSD include exposure to war, a terrorist attack, physical or sexual assault, or even the threat of such attacks. C-PTSD is different in that it’s typically caused by ongoing trauma which is often interpersonal in nature. C-PTSD tends to be associated with continued trauma that occurs at a young age. Children who grow up in neglectful or abusive environments may go on to develop C-PTSD (Giourou et al., 2018).

Borderline Personality and Ongoing Interpersonal Trauma

Borderline personality is also connected to ongoing interpersonal trauma during childhood. Researchers have linked exposure to chronic fear and stress as a child, as well as suffering from physical, sexual, and/or emotional abuse as a child, to the development of BPD. Growing up with a parent who had a serious mental health issue is also a risk factor for the development of BPD.

BPD and C-PTSD share an association with maltreatment in childhood, and up to 71% of individuals who experience BPD report severe abuse in childhood.

BPD is a serious issue characterized by a constellation of emotional, social, cognitive, and behavioral dysregulation. The most notable features of BPD are difficulty managing emotions, impulsivity, identity problems, and dysfunctional interpersonal relationships (Hecht, Cicchetti, Rogosch, & Crick, 2014).

Common Characteristics of C-PTSD and BPD

BPD and C-PTSD share an association with maltreatment in childhood, and up to 71% of individuals who experience BPD report severe abuse in childhood. BPD and C-PTSD also share symptoms. Overlapping symptoms relate to the areas of emotion processing and regulation, security in relationships, and self-concept (Ford & Courtois, 2014).

Some common symptoms of BPD and C-PTSD include:

Emotion processing and regulation difficulties

People with BPD and C-PTSD are known to have difficulties managing and regulating emotions. When experiencing uncomfortable emotions such as anger, fear, or sadness, the person may have difficulty controlling the intensity and duration of the emotion. It can be very hard to “let things go” and return to a neutral or uplifted mood once they’ve been thrown off balance.

Relationship issues

Those with BPD and C-PTSD often have relationship issues. Relationships may be unstable, insecure, and can often be traumatic or stressful for one or both partners. We start learning how relationships work in childhood. If our caregivers in childhood were neglectful or abusive, we tend to carry these learned perceptions of ourselves, such as “I’m bad, worthless, or not worthy of support,” into our adult relationships, as well as lessons about relationships, such as “They are unpredictable, unreliable, and sometimes dangerous.”

Individuals with BPD may have an especially difficult time trusting and relating to others. It is thought that because they may not have experienced empathy from their primary caregivers during childhood, they have developed limited abilities to see past their own emotional responses and understand how others may be feeling.

Adults with C-PTSD may also have difficulty with empathy and relationships, although it depends on the nature of the trauma and whether they had access to at least one caring adult during their childhood. We are all unique, and how we develop and respond to early trauma is variable and can depend on many different factors within the environment and the individual.

Self-concept

BPD and C-PTSD are both associated with impulsive behaviors and dissociation. People may behave in ways that are self-destructive and reckless. Unsafe sex, abuse of drugs and alcohol, and disregard for one’s own safety can occur.

Dissociation is highly prevalent in BPD, and it’s known to occur in PTSD as well (Krause-Utz & Elzinga, 2018). Dissociation can result in a feeling of being disconnected from oneself and the world. Especially during times where stress levels are high, dissociation can act as a defense mechanism where the sufferer feels detached from themselves and what’s happening around them. In certain cases, amnesia may result, as well as a feeling of “lost time.” Identity confusion can also occur, and the person may feel as though they don’t have a strong sense of self or that their identity seems to shift depending on the circumstances and the environment they find themselves in.

High levels of worry, sadness, and shame

Borderline personality and C-PTSD are associated with high levels of general distress. Many feel isolated and empty, as a significant portion of their symptoms can affect their relationships and connection with others. They may have high levels of shame and sometimes experience a feeling that they have been permanently damaged. This can lead to the desire to withdraw from others, as relationships are often a source of stress, insecurity, and/or conflict.

What If You Have Symptoms of Both C-PTSD and BPD?

Complex posttraumatic stress and BPD require treatment and support. If you are experiencing symptoms of C-PTSD and BPD, it can help to first receive an accurate assessment and diagnosis. It is important to understand that nobody is permanently damaged, and there are treatment approaches that have demonstrated effectiveness for both C-PTSD and BPD.

Therapy can help you develop strategies and techniques that allow you to better cope with stress and manage difficult emotions. Ongoing support from a therapist who understands what you are experiencing and where your feelings and symptoms are coming from can be enormously helpful for your healing journey. Find a therapist near me.

If you are struggling, it is important to reach out and take advantage of the support and options available. With treatment, you can not only feel better, but also avoid the negative consequences of behavioral and emotional symptoms. Feeling better and coping with stress can improve other areas of your life as well, such as how you function in professional and personal relationships.

References:

  1. Ford, J. D., & Courtois, C. A. (2014, July 9). Complex PTSD, affect dysregulation, and borderline personality disorder. Borderline Personality Disorder and Emotion Dysregulation, 1, 9. doi: 10.1186/2051-6673-1-9
  2. Giourou, E., Skokou, M., Andrew, S. P., Alexopoulou, K., Gourzis, P., & Jelastopulu, E. (2018, March 22). Complex posttraumatic stress disorder: The need to consolidate a distinct clinical syndrome or to reevaluate features of psychiatric disorders following interpersonal trauma? World Journal of Psychiatry, 8(1), 12-19. doi: 10.5498/wjp.v8.i1.12
  3. Hecht, K. F., Cicchetti, D., Rogosch, F. A., & Crick, N. R. (2014). Borderline personality features in childhood: The role of subtype, developmental timing, and chronicity of child maltreatment. Development and Psychopathology, 26(3), 805-815. doi: 10.1017/S0954579414000406
  4. Krause-Utz, A., & Elzinga, B. (2018). Current understanding of the neural mechanisms of dissociation in borderline personality disorder. Current Behavioral Neuroscience Reports, 5(1), 113-123. doi: 10.1007/s40473-018-0146-9
  5. Luyten, P., Campbell, C., & Fonagy, P. (2019, May 7). Borderline personality disorder, complex trauma, and problems with self and identity: A social‐communicative approach. Journal of Personality. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/jopy.12483

Boy in white shirt looks out of a window.This topic likely comes as a surprise to many. Just the idea of abuse of this nature, between a mother and her son, is shocking to most. The idea of mother-son incest is so far out of the realm of what we as a culture understand about mothers and women that even its victims rarely seek help.

As a society, our views of mothers as nurturers who would never willingly hurt their children may be so ingrained in our psyche that even trained psychologists can be uncomfortable entertaining the idea that sexual abuse can happen between a mother and her son (Osborne, 2015).

Why the Silence?

Incest (sexual relationships between family members) is taboo and can bring a strong sense of guilt and shame to its victims (Kluft, 2011). While the idea that fathers sexually abuse their children is disturbing, it is accepted as something that can (and does) happen. It is well documented and studied.

Although the idea that some fathers can be sexual predators towards their own family is accepted, the parallel idea, that mothers can be sexual predators towards their own children, has not been widely accepted. We live in a culture that tends to idolize motherhood. Mothers sacrifice so much to give us everything we need. In our society, speaking against a mother is almost sacrilegious. Unfortunately, the perception of a male monopoly on perpetrating incest has led to the creation of damaging myths that silence the male victim.

Reporting incest and seeking professional help may be both shameful and difficult in any situation, but it can be even more difficult in the case of a mother. Often, the reaction will be complete rejection or disbelief. Unfortunately, the perception of a male monopoly on perpetrating incest has led to the creation of damaging myths that silence the male victim.

Males and Sexual Abuse: The Myths

Researcher Lucetta Thomas has identified persistent and damaging myths in regard to male sexual victimization. These myths not only exist in the minds of boys and men who themselves are victims—they are also prevalent in the attitudes and perception of social workers, law enforcement, and even psychologists or counselors (Friedersdorf, 2016). Myths around males and sexual abuse include the following:

Prevalence and Long-Term Outcomes of Mother-Son Abuse

Due to the refusal of boys and men to seek help or press charges against mothers who abuse them, it is nearly impossible to determine the prevalence of sexual abuse committed by mothers. However, a few studies offer surprising results and indicate the problem is more widespread than most people would assume.

For example, one study that conducted in-depth interviews of seven men and seven women who reported sexual abuse by a female perpetrator, most of whom experienced severe sexual abuse by their mothers, found a range of long-term damaging effects. Victims reported and/or experienced depression, difficulties with substance abuse, self-injury, increased suicide rate, rage, strained relationships with women, identity issues, and discomfort with sex (Denov, 2004).

Another study conducted in 2002 found that 17 of 67 men who endured sexual abuse during childhood reported mother-son incest. The study found in comparison to the other men in the study, the men who were abused by their mothers experienced more symptoms of trauma. Further, about half of the men abused by their mothers had mixed feelings regarding the abuse, and those with mixed feelings had more adjustment problems compared to men who had purely negative feelings toward the abuse (Kelly, Wood, Gonzalez, MacDonald, & Waterman, 2002).

Lucetta Thomas reported that after her story of mother-son sexual abuse aired on ABC 80, males accessed the online survey over the next two days to report maternal abuse and requested to be interviewed. It must be understood that this type of abuse is possible, does happen, and can do extraordinary damage to its victims.

When we examine outcomes of victims of any type of incest, we find this type of abuse is related to issues around relational trauma and betrayal trauma. Abuse by a trusted family member leads to a significant loss of trust and changes in beliefs around the self and safety in relationships (Kluft, 2011). Understandably, when the perpetrator is a mother, the trauma is likely to carry a particularly high level of damage, especially in light of the cultural perceptions of mothers as nurturers. Furthermore, the implications of reporting abuse of this nature can be catastrophic for the victim, the mother, and the entire family. In many cases, this leaves the victim feeling as if he has no choice but to deal with the trauma in silence.

What Professionals Need to Know

Professionals, particularly those working with sexual abuse cases, need to examine their own perceptions around women as potential abusers. It must be understood that this type of abuse is possible, does happen, and can do extraordinary damage to its victims. In general, many people have been under the impression that a woman cannot really harm another person sexually. This is not the case. As new research surfaces, we are finding that sexual abuse from mother to son can bring lasting trauma and long-term mental health effects (Denov, 2004).

Further, men and boys are much less likely to report sexual abuse (Holmes, Offen, & Waller, 1997). Researchers have put forth the possibility that attitudes and beliefs among mental health professionals in myths regarding the male as an unlikely victim do not create conditions that encourage men or boys to talk about sexual abuse. Professionals need to be aware of the reality of mother-son sexual abuse as well as the existence of the myths surrounding the male as unlikely to be vulnerable to sexual abuse and especially unlikely to be the victim of abuse by his own mother.

If you are a victim of any type of sexual abuse or assault, reach out to a therapist. There is no need to suffer in silence when help is available. If you are a victim of mother-son incest, clearly articulate your experiences to your therapist. The shame is not yours.

References:

  1. Denov, M. S. (2004, October 1). The long-term effects of child sexual abuse by female perpetrators: A qualitative study of male and female victims. Journal of Interpersonal Violence, 19(10), 1,137-1,156. doi: 10.1177/0886260504269093
  2. Friedersdorf, C. (2016, November 28). The understudied female sexual predator. The Atlantic. Retrieved from https://www.theatlantic.com/science/archive/2016/11/the-understudied-female-sexual-predator/503492
  3. Holmes, G. R., Offen, L., & Waller, G. (1997). See no evil, hear no evil, speak no evil: Why do relatively few male victims of childhood sexual abuse receive help for abuse-related issues in adulthood?. Clinical Psychology Review, 17(1), 69-88. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/9125368
  4. Kelly, R. J., Wood, J. J., Gonzalez, L. S., MacDonald, V., & Waterman, J. (2002). Effects of mother-son incest and positive perceptions of sexual abuse experiences on the psychosocial adjustment of clinic-referred men. Child Abuse & Neglect, 26(4), 425-441. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/12092807
  5. Kluft, R. P. (2011, January 12). Ramifications of incest. Psychiatric Times, 27(12). Retrieved from https://www.psychiatrictimes.com/sexual-offenses/ramifications-incest
  6. Osborne, T. (2015, August 7). New research sheds light on sex abuse committed by mothers against their sons. ABC News. Retrieved from https://www.abc.net.au/news/2015-08-08/new-research-mothers-who-sexually-abuse-their-sons/6679102

A person walks home alone in the rain“Memories warm you up from the inside. But they also tear you apart.”  Haruki Murakami

We all know from popular drama (TV shows, movies, etc.) that traumatic events are often forgotten by the sufferer. People who experience a devastating event such as a car accident, natural disaster, or terror attack often cannot remember the incident. It’s also common not to remember what took place right before or right after the incident. In a similar way, many adults who suffered child abuse have difficulty recalling large chunks of time from childhood. In these cases, problems with memory can continue into adulthood as well, particularly when faced with emotional distress.

Our brain and nervous system have evolved to do spectacular things: we can read, write, make music, and contemplate the meaning of life. But the brain’s first and foremost duty is to keep us alive. When it comes to traumatic events, the part of our brain that protects our physical and emotional well-being takes control. In this process, the parts of the brain that are responsible for higher thought processes, such as forming and retrieving memories, are suppressed.

How the Brain Forms Memories

On a regular stress-free day, memories for facts are made and stored in three steps: acquisition, consolidation, and retrieval.

When we are confronted with life-threatening danger, the brain behaves differently. The amygdala sends an emergency signal to the hypothalamus, which in turn activates the fight or flight response. Corticosteroids are then released into the bloodstream in order to prepare the body for action. Blood pressure, heart rate, and respiratory function all increase to provide the body and brain with extra energy and oxygen. Our alertness increases, and our body is ready to move.

When this is happening, the amygdala inhibits the activity of the prefrontal cortex. When faced with danger, this is useful, as the prefrontal cortex operates substantially slower. While it is trying to work out what is happening, our body may be harmed. The quicker, action-oriented part of the brain enables us to respond rapidly and try to avoid danger. We act fast. Later, once we are safe, we have time to think. In respect to memory, the parts of the brain involved in memory formation are shut down when faced with a traumatic experience.

The activation of the fight or flight response prevents the parts of the brain responsible for creating and retrieving memory from functioning effectively. This is why we can forget what occurred around a traumatic event. In the case of ongoing trauma, such as with childhood abuse, ongoing problems with memory and the related process can occur, leading to what is understood as dissociation.

Dissociation and Memories

At the heart of dissociation is memory disruption.At the heart of dissociation is memory disruption. During dissociation, the normally integrated functions of perception, experience, identity, and consciousness are disrupted and do not thread together to form a cohesive sense of self. People with dissociation often experience a sense that things are not real; they can feel disconnected from themselves and the world around them. Their sense of identity can shift, their memories can turn off, and the connection between past and present events can be disrupted.

In understanding the human response to trauma, it is understood that dissociation is a central defense mechanism because it provides a kind of mental escape when physical escape is not possible. This type of defense is often the only kind available for children living in abusive situations. Posttraumatic stress (PTSD) and complex posttraumatic stress (C-PTSD) often go hand in hand with dissociation. In studies investigating the impact of PTSD and memory, researchers have found that people with dissociative symptoms have a greater impairment with both working memory and long-term memory.

Long-Term Impact of Memory Impairment

To understand the long-term impact of memory impairment due to dissociation, we need to look at the context from which it arises. Dissociation occurs as a result of ongoing trauma which is associated with chronic stress. A chronically stressed brain and nervous system have difficulty learning. The hippocampus, critical for memory formation and consolidation, can become damaged from ongoing exposure to stress hormones. Researchers have found that the hippocampus actually shrinks in people who suffer from major depression. In addition to the emotional impact of chronic stress and abuse, difficulties with learning and memory can occur as well.

Implications range from difficulties with academics to reduced on-the-job learning and performance. In terms of survival, the implications are serious, as we all need the ability to prepare for, find, and keep employment. Unfortunately, once a person frees him or herself from an abusive childhood, the effects can follow into adulthood in unexpected ways. A damaged hippocampus and overactive nervous system can make life more difficult than it has to be. Over time, self-esteem and confidence can be negatively impacted as well.

Fortunately, the prognosis of dissociation can be optimistic. Researchers have found treatment with antidepressants can increase hippocampal volume. Talk therapy and other therapeutic approaches that are designed to reduce stress and increase emotional resilience may also help.

If you are experiencing trauma or dissociation, you can find a mental health professional here.

References

  1. Bedard-Gilligan, M., & Zoellner, L. A. (2012). Dissociation and memory fragmentation in post-traumatic stress disorder: An evaluation of the dissociative encoding hypothesis. Memory, 20(3), 277-299. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22348400
  2. Lanius, R. A. (2015). Trauma-related dissociation and altered states of consciousness: A call for clinical, treatment, and neuroscience research. European Journal of Psychotraumatology, 6(1), 27905. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439425
  3. Nuwer, R. (2013, August 1) Why can’t accident victims remember what happened to them? Smithsonian. Retrieved from https://www.smithsonianmag.com/smart-news/why-cant-accident-victims-remember-what-happened-to-them-21942918
  4. Özdemir, O., Özdemir, P. G., Boysan, M., & Yilmaz, E. (2015). The relationships between dissociation, attention, and memory dysfunction. Nöro Psikiyatri Arşivi, 52(1), 36-41. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5352997
  5. Phelps, E. A. (2004). Human emotion and memory: Interactions of the amygdala and hippocampal complex. Current Opinion in Neurobiology, 14(2), 198-202. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/15082325
  6. Rosack, J. (2003, September 5) Antidepressants may prevent hippocampus from shrinking. Psychiatric News. Retrieved from https://psychnews.psychiatryonline.org/doi/full/10.1176/pn.38.17.0024
  7. Sapolsky, R. M. (2001). Depression, antidepressants, and the shrinking hippocampus. Proceedings of the National Academy of Sciences, 98(22), 12320-12322. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC60045

A father holding his newborn is distracted by his phoneAttachment may be understood as the relationship between child and caregiver (often a parent). This relationship is the most important in the child’s life, as the caregiver is the provider of all his or her needs. Not only is the child dependent on the caregiver for basic survival, but the child’s social, emotional, and cognitive development also take shape within this relationship.

Attachment and the Disorganized Response

In a secure relationship, the caregiver is able to recognize and respond to the child’s needs in a way that provides support. The caregiver’s behavior is predictable and stable. In a secure relationship, the child is more likely to develop healthy emotion-regulation abilities as well as a healthy view of the self and world. This is because when the child needs comfort and reassurance, they are available. Over time, the child develops a view of the world that when help is needed, it can be counted on. In addition, the child comes to see themselves as worthy of love and support. In a safe and secure environment, the child is better able to take advantage of important opportunities for learning and development.

In contrast, children with unpredictable or abusive caregivers often experience inner conflict and may not form an organized response to fear or distress. When attachment researchers speak about an “organized response”, they are referring to the strategy the child uses when in need of care. For example, if the child’s caretaker is a source of both safety and danger (as in the case of a violent, neglectful, or abusive caregiver), the child may run to the caregiver when upset and then display ambivalence toward the caregiver, such as refusing to be picked up or displaying anger. This demonstrates a fundamentally conflicted situation for the child, as they need the caregiver for safety and at the same time need to protect themselves from the caregiver. In this way, the child can form a disorganized response to distress.

How Dissociative Symptoms Can Develop

Researchers have found that disorganized attachment is associated with dissociative symptoms. Children in a relationship with an unpredictable or sometimes traumatizing parental caregiver have a difficult time establishing a consistent view of the parent and of themselves. The parent is both needed and to be avoided. The child may not understand what makes them a “good” child or a “bad” child, as the caregiver’s behavior is often confusing and unpredictable.

In order to maintain a relationship with the caregiver—and attempt to make sense of themselves—some children simply forget or deny the abuse. Jennifer Freyd refers to this as betrayal blindness. Forgetting or denying trauma is a symptom of dissociation. It is an adaptive and defensive strategy that enables the child to function within the relationship, but it often leads to the development of a fragmented sense of self.

Disorganized Attachment Is Not Always the Result of an Abusive Caregiver

While disorganized attachment is often associated with abuse, sometimes loving caregivers who have experienced trauma themselves can behave in confusing ways toward the child. This happens because of the caregiver’s own inability to control their emotions. Traumatized parents can have a difficult time managing their emotions and providing a sense of security for the child even though they are not abusive or neglectful. Anger or fear can erupt unexpectedly and traumatize the child. A loving caregiver can be experiencing posttraumatic stress disorder (PTSD) or dissociative identity disorder and unintentionally behave in frightening or confusing ways to their child.

If a caregiver is dealing with their own trauma, it is recommended they seek therapy. In therapy the caregiver can learn to cope with stress, develop emotion-management skills, and learn more about understanding their child’s needs. Often caregivers who were raised in abusive families are unaware of how to appropriately respond to a child’s emotional needs because they themselves did not have their own needs met when they were children.

There are a range of therapeutic treatments for adults suffering from PTSD that have shown to be helpful. These techniques help reduce symptoms of trauma such as anxiety, depression, and chronic stress. Psychotherapy can provide emotional support to caregivers so they can begin to grow and provide a safe and responsive environment for themselves as well as their children.

References:

  1. Bedard-Gilligan, M., & Zoellner, L. A. (2012). Dissociation and memory fragmentation in post-traumatic stress disorder: An evaluation of the dissociative encoding hypothesis. Memory, 20(3), 277-299. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3310188
  2. Firestone, L. (n.d.). Disorganized attachment: How disorganized attachments form & how they can be healed. Retrieved from https://www.psychalive.org/disorganized-attachment
  3. Freyd, J. J. (n.d.). What is betrayal trauma? What is betrayal trauma theory? Retrieved from: https://dynamic.uoregon.edu/jjf/defineBT.html
  4. Gillath, O., Karantzas, G. C., & Fraley, R. C. (2016). Adult attachment: A concise introduction to theory and research. Academic Press.
  5. Paetzold, R. L., Rholes, W. S., & Andrus, J. L. (2017). A Bayesian analysis of the link between adult disorganized attachment and dissociative symptoms. Personality and Individual Differences, 107, 17-22. Retrieved from http://isiarticles.com/bundles/Article/pre/pdf/155055.pdf
  6. Psychological treatment of PTSD in adults. (2005). Post-traumatic stress disorder: The management of PTSD in adults and children in primary and secondary care. Leicester, UK: Gaskell.
  7. Waters, S. F., Virmani, E. A., Thompson, R. A., Meyer, S., Raikes, H. A., & Jochem, R. (2010). Emotion regulation and attachment: Unpacking two constructs and their association. Journal of Psychopathology and Behavioral Assessment, 32(1), 37-47. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2821505

Teenager examining acne in the mirrorBody dysmorphic disorder (BDD), or body dysmorphia, is a condition in which a person thinks their body is severely flawed. The flaw is either imagined or real but minor. For example, a person may have a small skin blemish that others hardly notice, but they develop a preoccupation with and an exaggerated perception of the flaw.

Typically a person’s focus is on their face, head, or the shape of their body. Excessive mirror-checking, grooming, or exercising can all be signs of BDD. The condition is closely related to obsessive compulsive disorder (OCD).

BDD usually begins to develop in adolescence. The average age of onset is 17 years, and studies have shown prevalence begins to drop off after age 44. Body dysmorphia is more common than one might think, occurring in around 2% of the population.

Symptoms of Body Dysmorphia

The following are common signs of body dysmorphia:

  1. Extreme preoccupation with a physical flaw that is minor or can’t be noticed by other people.
  2. A strong belief that said flaw makes you ugly or unattractive, no matter what the rest of your body looks like.
  3. A belief that others take notice of the flaw or flaws in your appearance.
  4. Constantly comparing your appearance to others.
  5. Avoiding social situations due to shame about your appearance.
  6. Always seeking reassurance about your appearance.

We live in a society that places much emphasis on beauty and youth, so it is normal to be concerned about our appearance. However, if your concern over how you look becomes obsessive, begins to interfere with your daily functioning, and/or causes significant distress, you may have BDD.

What Causes Body Dysmorphia?

A survey of individuals with body dysmorphic disorder found a significant association with child maltreatment. Specifically, 78.7% of individuals diagnosed with BDD reported early-life abuse, including:

A child raised by a neglectful parent is unlikely to have had the opportunity to develop good coping skills. For some individuals with BDD, it seems that as a result of maltreatment, they may internalize grief and pain. In time, the individual comes to believe that there is something wrong with them or their body.

Researchers have found that individuals suffering from BDD have abnormal brain network organization. The greater the symptom severity, the greater the disturbances in functioning and organization compared to people without BDD. Researchers also found evidence of abnormal connectivity in visual regions and emotional processing, indicating a deficit in information processing within these brain regions.

Treatment and Outcomes for Body Dysmorphia

Body dysmorphia is a serious issue and should not be treated as simple vanity. Individuals experiencing BDD have a higher risk of suicide as well as impeded social and occupational development. BDD often does not go away without treatment. If left untreated, body dysmorphic disorder can lead to depression, anxiety, and extensive medical expenses.

Body dysmorphia is a serious issue and should not be treated as simple vanity. Given the long-term course of BDD and the significant impact on quality of life, it is important for affected individuals to seek treatment. While there are neurological differences in patients with BDD, it is possible to effect changes in neurological functioning. The brain is plastic and retains the ability to change throughout the entire lifespan.

The most common forms of treatment for BDD are cognitive behavior therapy (CBT) and pharmacotherapy. In a recent study, the medication of choice was a selective serotonin reuptake inhibitor (SSRI). Investigations examining the use of pharmacotherapy and CBT in tandem have found combined therapy to be effective.

BDD may require long-term therapy, and many patient populations are not willing or are unable to take SSRIs, such as pregnant women. However, CBT has been shown to be very effective and is often a preferred course of treatment. CBT has been shown to improve outcomes both when it is the only treatment and when it is combined with medication.

If you or a loved one is experiencing body dysmorphia, you can find a therapist here.

References:

  1. Arienzo, D., Leow, A., Brown, J. A., Zhan, L., GadElkarim, J., Hovav, S., & Feusner, J. D. (2013). Abnormal brain network organization in body dysmorphic disorder. Neuropsychopharmacology, 38(6), 1130-1139.‏ Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3629399
  2. Bjornsson, A. S., Didie, E. R., & Phillips, K. A. (2010). Body dysmorphic disorder. Dialogues in Clinical Neuroscience, 12(2), 221-232. Retrieved from ‏ https://www.ncbi.nlm.nih.gov/pubmed/20623926
  3. Buhlmann, U., Marques, L. M., & Wilhelm, S. (2012). Traumatic experiences in individuals with body dysmorphic disorder. The Journal of Nervous and Mental Disease, 200(1), 95-98. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22210370
  4. DeVos, K. (2017, September 5). Examining the link between body dysmorphia and PTSD. Retrieved from https://www.eatingdisorderhope.com/blog/examining-body-dysmorphia-ptsd
  5. Hong, K., Nezgovorova, V., & Hollander, E. (2018). New perspectives in the treatment of body dysmorphic disorder. F1000Research, 7.‏ Retrieved from https://f1000research.com/articles/7-361/v1
  6. Koran, L. M., Abujaoude, E., Large, M. D., & Serpe, R. T. (2008). The prevalence of body dysmorphic disorder in the United States adult population. CNS Spectrums, 13(4), 316-322.‏ Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/18408651
  7. Vitiello, B. (2009). Combined cognitive-behavioral therapy and pharmacotherapy for adolescent depression. CNS Drugs, 23(4), 271-280.‏ Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671638

Blurred view of elderly woman with a migraineMigraine headaches are one of the most common chronic conditions worldwide. Depending on the study, chronic migraines affect around 1 in 10 people, with twice as many sufferers being female.

Migraine headaches are disabling and cause significant loss of productivity and quality of life. Once they strike, a migraine can last anywhere between 4 and 72 hours. In addition to substantially reducing quality of life, frequent migraines can place one’s job at risk and prevent daily functioning.

Currently, the causes of migraine headaches are not well understood. Genetics are thought to play a role as well as environmental effects and changes in the way the brain interacts with the trigeminal nerve, a pain pathway.

Maladaptive Response to Stress?

It may be that migraine headaches are a result of the brain’s maladaptive response to stress. Researchers have found that when a migraine is triggered, the body’s responses (pain, increases in stress hormones, nausea, and vomiting) are in excess of what is normal. Even during migraine-free periods, a migraine sufferer’s brain is more excitable in response to stimuli.

If we understand how the brain operates on a neural level, we know that much of what is going on inside the brain is inhibitory. It is not optimal to have cascades of neurochemicals circulating through the brain. Overexcitability in the brain reduces the effectiveness of the calming mechanisms in the brain and increase pain sensitivity. What this means is the brain’s response to stimuli between attacks is heightened in an abnormal way.

We know the experience of stress is a significant factor in migraines. Work stress and home stress contribute to the likelihood of a migraine episode.

Childhood Trauma and Headaches

We know that too much stress can change the brain and its reactivity to one’s inner environment, or thoughts, and one’s outer environment, or lights, sounds, and other stimuli. Adults who were exposed to ongoing stress or trauma while growing up often have an impaired ability to calm themselves both mentally and physiologically in response to stress.

A difficult childhood is not a life sentence of heightened stress and suffering. We can take steps to alter our response to stress.

When we look at migraine sufferers as a group, we see a connection between adverse childhood experiences (ACE) and migraine headaches. Examples of ACE are domestic violence, emotional neglect, emotional abuse, and sexual abuse.

Researchers have also begun to investigate the connection between adverse childhood experiences and headaches. Individuals who suffer from migraine headaches are more than twice as likely to have experienced ACEs such as domestic violence while growing up.

How Trauma Results in Migraine: A Possible Mechanism

The connection between childhood stress and migraines is likely linked, at least in part, through the hypothalamic-pituitary-adrenal axis (HPA axis).

The HPA axis is a complex set of interactions among the pituitary gland and the adrenal glands. This hypothalamic-pituitary-adrenal axis controls and regulates bodily processes related to stress reactions. It is easily understood as the fight or flight response. When an individual senses a threat, the body reacts appropriately. Energy is taken away from the digestive and immune systems and is moved to the muscles in order to get ready to run or fight. The adrenal glands are stimulated, and heart-rate, blood pressure, and breathing rates increase. This is an energy-expending state and not optimal for growth or restorative activities.

It is well understood that repeated exposure to stress and trauma during childhood often results in an impaired ability to regulate the stress response over one’s lifetime. Childhood trauma affects the HPA axis. What this means is that over time, the HPA axis loses its ability to effectively control the stress response. During times of upset, the person has an intense reaction that lasts too long. The result is overexposure of the body and brain to high levels of the stress hormone, cortisol.

Migraines may be tied to the same neurochemical conditions associated with trauma, depression, and anxiety, with an overactive stress response (de-regulation of the HPA axis) playing a role. An investigation into certain neurochemicals in migraine sufferers found abnormal patterns of hypothalamic hormonal secretion, a condition also associated with trauma and child abuse.

What Can We Do to Help?

A difficult childhood is not a life sentence of heightened stress and suffering. We can take steps to alter our response to stress. Exercise and meditation have been shown to help calm the mind and body. These activities can begin to reverse the damage caused by an overactive HPA axis. Cognitive behavioral therapy (CBT) is also an effective tool for learning coping strategies and allows individuals to take greater control of reactions to daily life events that cause stress.

Research on migraines and childhood trauma is relatively new and is not well understood. However, if we understand that stress plays a role in migraines, taking steps to reduce stress may help reduce the frequency and duration of migraine episodes. At the very least, a reduction in stress can help us in every area of life, giving us more resilience to deal with a migraine once triggered.

If you think stress or trauma are a source of migraines for you, learning how to manage your stress response in therapy could help. Begin your search for a licensed and compassionate counselor here.

References:

  1. Anda, R., Tietjen, G., Schulman, E., Felitti, V., & Croft, J. (2010). Adverse childhood experiences and frequent headaches in adults. Headache: The Journal of Head and Face Pain, 50(9), 1473-1481. doi: 10.1111/j.1526-4610.2010.01756.x
  2. Brennenstuhl, S., & Fuller‐Thomson, E. (2015). The painful legacy of childhood violence: Migraine headaches among adult survivors of adverse childhood experiences. Headache: The Journal of Head and Face Pain, 55(7), 973-983. doi: 10.1111/head.12614
  3. Dumas, P. (2014). Calling in sick? Good conversations about migraine at work. Retrieved from https://migraineagain.com/calling-sick-good-conversations-about-migraine-work
  4. Exercise and stress: Get moving to manage stress. (2018). Retrieved from https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/exercise-and-stress/art-20044469
  5. Maleki, N., Becerra, L., & Borsook, D. (2012). Migraine: Maladaptive brain responses to stress. Headache: The Journal of Head and Face Pain, 52(2), 102-106. doi: 10.1111/j.1526-4610.2012.02241.x
  6. Migraine. (2018). Retrieved from https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-20360201
  7. Goadsby, P. J. (2009). Pathophysiology of migraine. Neurologic Clinics, 27(2), 335-360. doi: https://doi.org/10.1016/j.ncl.2008.11.012
  8. Lubin, E. (2018). Migraine headache FAQs. Retrieved from https://www.emedicinehealth.com/migraine_headache_faqs/article_em.htm
  9. Nelson, S. M., Cunningham, N. R., & Kashikar-Zuck, S. (2017). A conceptual framework for understanding the role of adverse childhood experiences in pediatric chronic pain. The Clinical Journal of Pain, 33(3), 264-270. doi: 10.1097/AJP.0000000000000397
  10. Peres, M. F. P., Sanchez del Rio, M., Seabra, M. L. V., Tufik, S., Abucham, J., Cipolla-Neto, J., Silberstein, S. D., & Zukerman, E. (2001). Hypothalamic involvement in chronic migraine. Journal of Neurology, Neurosurgery, and Psychiatry, 71, 747-751. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1737637/pdf/v071p00747.pdf
  11. Understanding the stress response. (2018). Harvard Health Publishing. Retrieved from https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response
  12. Woldeamanuel, Y., & Cowan, R. (2015). Worldwide migraine epidemiology: Systematic review and meta-analysis of 302 community-based studies involving 6,216,995. Neurology, 86(16). Retrieved from http://n.neurology.org/content/86/16_Supplement/P6.100
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