by Dr. Steven D. Graham, Licensed Psychologist, in Tampa, FL

A Look Inside the ADHD Brain

If you could look inside the brain of someone diagnosed with untreated ADHD, what would you see? Would the brain look and function differently from a non-ADHD brain? If so, how? In this article, we will look at the neurocognitive functioning of the ADHD brain.

First, however, it might be important to ask what, exactly, is ADHD? Some mental health professionals still utilize the term “ADD.” What we used to believe was that someone had either an attention disorder or a hyperactivity/impulsivity disorder, or sometimes both; “ADD” was shorthand for ADHD without the hyperactivity. What we now realize is that ADHD is one disorder: sometimes the inattention is prominent; other times the hyperactivity or impulsivity seems to be. Often both sets of symptoms occur together.

Our Brains Can Heal!

Neurocognition refers to what happens in our brains and nervous systems that affects the way we think. You may imagine that if something is different or “wrong” in the brain, then the situation is hopeless. Indeed, in years past, neurologists would often shrug and say they could not do much if something were awry in our brains. But what we have discovered over the past 30 years, however, is the phenomenon of neuroplasticity, our brain’s amazing ability to repair, re-route, and restore functioning. Our brains find a way to heal! Often this takes time, but sometimes we begin to see glimpses of improved brain functioning within just a few weeks of beginning treatment. We have also learned ways of assisting that process, which we will explore in later issues.

This is good news for all of us, since many of us sustain some type of brain injury, including life’s traumas that come our way. And, once our brains begin to heal, the way we think and process information will improve. As a result, we can work to enhance how we take in information, how we encode and decode information, and how we store and retrieve data when we need it. We can also then enrich how we make decisions and exercise sound judgment. It is also amazing to see how individuals with ADHD often discover, on their own, workarounds and tools to help them achieve and succeed in life.

People with ADHD may be labeled as narcissistic, bipolar, histrionic, or some other disorder both by those frustrated with these behaviors and by professionals who are ill-informed. In either case, the person struggling with ADHD continues to feel unseen and misunderstood, which only deepens the sense of being an outcast.

What Causes These Particular Symptoms?

It is one thing to describe the symptoms of ADHD, but I think it is also helpful to understand what is taking place in the brain to produce those symptoms. It goes without saying that in this article I will not be able to explore everything in the ADHD brain, so I will focus on some of the most important highlights. According to the latest research,* the prefrontal cortex (PFC) in an ADHD brain is underactive. The PFC is the executive center of the brain, where we plan, organize, strategize, prioritize, exercise restraint, and make good decisions. What I want to do now is to look at three further differences in the ADHD brain.

Brain and Brain-Part Size

Functional imaging shows that the untreated ADHD brain is smaller than the non-ADHD brain. This difference is greater in children than in adults, revealing that the ADHD brain matures at a slower pace than non-ADHD brains. Further, the amygdala (which processes fear and threats) and the hippocampus (responsible for a great deal of learning and memory), both parts of the limbic system, the emotional center of the brain, also tend to be smaller, suggesting that regulation of oneself may be difficult without some additional help. (This information comes from the largest worldwide review of ADHD patient brain scans, conducted by Radboud University Nijmegen Medical Centre, Netherlands, in 2018.) For example, many with ADHD seem to have no fear. They sometimes take unnecessary risks or engage in hazardous sports or activities, while others can be particularly fearful and may wrestle with one or more of the anxiety disorders.

Neurotransmitters: The Communication System of the Brain

Arguably the most important finding regarding ADHD is the abnormally low levels of neurotransmitters in the PFC. This impacts a person’s ability to bypass urges or exercise discipline or make difficult choices. As previously noted, the PFC as the executive center of the brain (which we will discuss further in the next article) is responsible for planning, deciding, prioritizing, organizing, and everything necessary to resist impulses. It enables us to escape the cycle of stimulus-response by adding the important intermediate step of thinking.

Neurotransmitters are what our nervous system uses to communicate between nerve cells. The two most important neurotransmitters of the PFC are dopamine and norepinephrine. Without adequate levels of dopamine, we feel bored and unmotivated. Life can seem dull. Dopamine is largely associated with a sense of feeling rewarded. If I am not getting enough dopamine naturally, I will go after it in other ways, hence the attraction toward that which is fun, novel, or stimulating.

Norepinephrine, on the other hand, is associated with alertness and arousal and can speed up my reaction time. Without adequate norepinephrine, attention and focus can be blunted. Taken together, these low levels of dopamine and norepinephrine (along with the other developmental challenges of the brain noted above) impair one’s ability to be still, to self-regulate, to concentrate, and to make sensible choices.

Two Ways Dopamine Gets Released

Let’s dive just a little deeper into dopamine. We have found that dopamine is released in two fashions, essentially: by tonic release and by phasic release. Tonic release refers to the normal supply which is steadily released for us in the brain, while phasic release describes the process of getting dopamine from the environment. In the ADHD brain, tonic release basically underperforms while phasic release overperforms. In other words, in the non-ADHD brain, where dopamine is released normally, there is a steady, ongoing source of dopamine available, especially to the PFC. The opposite is true for the ADHD-brain: the tonic or steady release of dopamine does not occur efficiently at all.

Phasic release, on the other hand, which occurs when some stimulus from the environment enters the situation, boosts the dopamine in the PFC. In other words, if I am not getting enough tonic release of dopamine on a regular basis, then I am especially sensitive to anything environmental — phasic — which will produce dopamine. This means that when the brain is dopamine-hungry, it will get dopamine anywhere it can. If that happens naturally (as in the non-ADHD brain), we find ourselves easily rewarded and content. If it happens by outside stimuli (as in the ADHD brain), we will seek arousal and reward anywhere we can.

How It All Works Together

In summary, if we look at these three aspects of the brain and brain functioning — 1) brain and brain-part size, 2) neurotransmitter activity, and 3) less-than-adequate tonic release of dopamine — we begin to understand why someone might be hyperactive/impulsive along with inattentive. With the relative sizes of the amygdala and hippocampus, first, we see how someone with ADHD may have an impaired fear-response. We can also understand that if the hippocampus is affected, then my ability to put information into memory and be able to retrieve it might be compromised.

Second, if my PFC is not receiving adequate amounts of dopamine and epinephrine, then I will feel unmotivated to persevere, and my ability to delay gratification will be compromised. My life will feel drab unless I spice it up a lot, which can get me into trouble of all kinds. Third, if the tonic release system of adrenaline is underfunctioning, then I will rely on my ability to use the environment to enhance the phasic release of adrenaline, which will leave me distracted and searching for dopamine-producing stimuli.

I hope this brief overview helps to explain why ADHD symptoms exist just from a look inside the brain alone. When we focus on enhancing a healthy release of dopamine and norepinephrine in the PFC, function is dramatically improved. What is more, we are discovering ways of improving the size and action of the amygdala and hippocampus using both pharmaceutical and non-pharmaceutic means.

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*See CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder), founded in 1987, http://chadd.org. See also the research of Dr. Daniel Amen at www.amenclinics.com. In his Healing ADD: The Breakthrough Program That Allows You to See and Heal the 7 Types of ADD, Dr. Amen provides actual SPECT (Single Proton Emission Computed Tomography) images of the various types of ADHD from actual patients his clinic has treated.

7 Habits for Good Brain Health

Maintaining good brain health is key to a long and healthy life. Theories about what brain health looks like and how to achieve it abound, but there are some straightforward ideas about how to keep your mind sharp and well cared for that don’t depend on those theories. Here are seven habits to implement in your life that will help you keep your brain healthy.

1. Stay Well Rested

Your entire body needs rest, including your brain. Whether you’re a night owl or a morning person, getting plenty of sleep is essential for your whole body. While your other organs slow down during sleep and your body goes into “rest mode,” your brain does not shut off. While you sleep, you dream, you heal, and you prepare. Adults need between 7-9 hours of sleep a night to gain the full benefits of sleep so that they can perform their best each day.

Did you know that sleep issues can be addressed in therapy? You can search your area to find a therapist near you, then filter your results by Common Specialty > All other issues > Sleep Disorders.

2. Stay Active

An active lifestyle is also key to good brain health. Staying active helps your brain produce the hormones it needs to fuel the rest of your body. Physical activity encourages your body to produce hormones that promote brain health and improve your mood. While you do not need to exercise constantly to achieve good brain health, many experts recommend including exercise in your daily routine to increase blood flow and keep you healthy.

3. Pay Attention to Your Body

Your body will give you signals if your brain health is not quite right. This could include symptoms of vitamin deficiency. For example, if you feel foggy and tired during the winter months, you might have low vitamin D levels. Talking to your doctor about these symptoms can help you get what you need to achieve a healthy mind and body.

4. Stay Hydrated

Our bodies need water to function. When we are dehydrated, our brains are not at their best. According to a 2018 study from Georgia Tech, cognitive functioning decreases with dehydration, with noticeable effects within as little as two hours. Be intentional about your water consumption will promote brain health and support the rest of your body, too. 

5. Find Balance

The concept of work-life balance is something we’ve all heard of. Still, sometimes we forget that healthy balance in our lives could look very different depending on our circumstances. Figuring out what balance looks like for you right now, and being curious and adaptive about changes that need to be made down the line, can help you flourish. Be mindful of all the aspects of your life that need to be in balance (it’s not all about work and home – rest, friends, self-care, a hobby, spirituality, the outdoors can all be pieces of the pie as well). By appropriately devoting time and attention to what you value, you can relieve stress and allow your brain to engage with the world in a multitude of ways. 

6. Stimulate Your Brain

Your brain needs exercise just like the rest of your body. Brain games, puzzles, critical thinking, learning new things, hobbies, memorization, brain training, and reading can all function as brain exercises.

7. Care for Your Mental Health

Mental health is vital for keeping our brains healthy. If you have symptoms of depression or anxiety, or if you feel you cannot slow your brain down, we advise you to talk to a mental health professional. A mental health professional can guide you in developing skills and strategies to help you achieve a healthy mind.

Start your search for the right-fit psychotherapist today!

The limbic system is a set of brain structures that plays a role in emotions, particularly those that evolved early and which play an important role in survival.

Research has linked the limbic system to feelings of motivation and reward, learning, memory, the fight or flight response, hunger, thirst, and production of hormones that help regulate the autonomic nervous system. The autonomic nervous system supports automatic, non-conscious functions such as thirst, hunger, heart rate, and regulating the body’s internal clock.

What Is the Limbic System?

The limbic system isn’t a specific organ or part of the body, but rather a group of brain structures that work together.

It includes the hippocampus and amygdala, each of which is actually a pair of organs on either side of the brain. The hippocampi play important roles in memory, learning, long-term information storage, and spatial reasoning. The amygdalae help the body process emotions. They also help attach emotional meaning to memories. Problems with either of these organs can affect memory, learning, and emotional regulation.

The limbic system also includes the hypothalamus. This organ plays a role in myriad functions by releasing hormones hat help sustain homeostasis—the ability of the body to maintain relatively consistent conditions. Other limbic system organs include neurons, the basal ganglia, portions of the prefrontal cortex, the cingulate gyrus, and the ventral tegmental area.

What Does the Limbic System Do?

The limbic system acts as a control center for conscious and unconscious functions, regulating much of what the body does. In some ways, it connects the mind to body, bridging the gap between psychological and physiological experiences. For example, by activating the fight or flight response, the limbic system triggers a physical response to emotional experiences such as fear. The limbic system acts as a control center for conscious and unconscious functions, regulating much of what the body does.

1. Reward, Motivation, and Addiction

Research suggests that feelings of motivation and reward originate in the ventral tegmental area (VTA), a group of neurons that connects to the nucleus accumbens in the basal ganglia. Those neurons release dopamine, a neurotransmitter that supports feelings of pleasure.

In a healthy brain, dopamine helps people feel motivated to learn, meet new people, or try new experiences. Drug and alcohol abuse, however, can change the functioning of the limbic system. Drugs act on dopamine, and over time, the release of dopamine can become addictive. Over time, addiction can deplete the brain’s dopamine stores, making it difficult to feel pleasure without drugs. This is why many people with addictions find little relief from activities that were once pleasurable.

2. Emotional Responses

The amygdala and hippocampus work together to regulate emotions, especially evolutionarily “old” emotions that play a role in survival—love for one’s children, aggression, fear, and anxiety.

Together, these two organs also help the brain interpret the emotional content of memories. The amygdala assigns emotional meaning to memories and helps the brain form fear-based memories. The hippocampus helps form sensory memories, which are memories associated with sensory input. When the smell of a crisp apple or warm beach air brings back memories of a long-ago summer, the hippocampus is responsible.

3. Fight or Flight

The limbic system helps the body respond to intense emotions of fear and anger by activating the fight or flight response. This response is also sometimes called the fight, flight, or freeze response, thanks to new evidence suggesting the role of freezing in response to danger.

When the amygdala perceives a threat, it activates the limbic system to prepare to handle the threat. The adrenal glands release hormones such as epinephrine that raise blood pressure and heart rate, improve blood flow to muscles and organs, and elevate breathing rate.

In the short-term, the fight or flight response can be life-saving. Over time, however, chronic stress can activate the limbic system in a way that damages the body. Long-term release of epinephrine and other hormones can damage blood vessels, cause high blood pressure, and change appetite.

4. Memory

Both the amygdala and hippocampus help the brain form new memories, store those memories, retrieve them, and make sense of their emotional content. The hippocampus is particularly important in long-term memory formation. It also supports spatial memory and spatial reasoning.

5. Hormones Affecting Automatic Functions

Hormones are the body’s chemical messengers, sending a signal from one area to the body in response to environmental input and other information.

The hypothalamus releases hormones that play a role in a wide range of emotions, including pain, hunger, thirst, pleasure, sexual feelings, anger, and aggression. It also helps the body maintain a state of homeostasis by regulating the autonomic nervous system. Some examples of this function include:

• Getting information from the vagus nerve about blood pressure and how full the stomach is. Using this information, it releases chemicals that regulate appetite and blood pressure.
• Gathering information from the reticular formation of the brain stem about temperature and then using that to manage the body’s response to heat or cold.
• Regulating the body’s internal clock, the circadian rhythm, based on light, darkness, and other sensory input.

6. Attention and Learning

By helping the brain form new memories, the limbic system helps the body learn and remember information. It also plays a role in regulating cognitive attention. Research suggests, for example, that the cingulate gyrus focuses the brain’s attention on emotionally significant events. The anterior cingulate may also help with conscious attempts to control emotions.

Some research suggests people with attention-deficit hyperactivity (ADHD) have enlarged hippocampi. This may be the body’s attempt to compensate for issues with the hippocampus’s ability to regulate attention.

The brain makes new neurons from stem cells in the hippocampus, suggesting the hippocampus and the feelings and memories it supports can change with new experiences. This ability of the hippocampus to change with time supports the ability to learn new things. Research on the brains of people with Alzheimer’s and other dementias has found the disease attacks the hippocampus. This may explain why dementia so quickly compromises the ability to learn new things, even as long-ago memories remain intact.

The limbic system is dynamic, changing with input from a person’s environment. Experience changes this important brain region, and that may help explain why people’s psychological and physiological experiences change over time. Therapy, too, may change the limbic system by training the brain to process information differently, assigning new emotions to old memories or supporting a client in managing chronic stress.

Many disorders can damage the limbic system. Memories and experiences matter, too. Therapy can help people make sense of these experiences, ameliorate some effects of chronic stress, help a person better manage their emotions, and potentially even reduce the risk of stress-related disorders such as cardiovascular disease.

References:

1. Boeree, G. C. (2009). The emotional nervous system. Retrieved from https://webspace.ship.edu/cgboer/limbicsystem.html
2. Bonner-Jackson, A. (2015, October 15). Alzheimer’s and a shrinking hippocampus. Retrieved from https://blogs.biomedcentral.com/on-medicine/2015/10/15/alzheimers-shrinking-hippocampus
3. Drugs and the limbic system. (n.d.). Retrieved from https://www1.udel.edu/chem/C465/senior/fall00/DrugAddiction/Parts.html
4. Rajmohan, V., & Mohandas, E. (2007). The limbic system. Indian Journal of Psychiatry, 49(2), 132-139. doi: 10.4103/0019-5545.33264
5. The limbic system. (n.d.). Retrieved from https://qbi.uq.edu.au/brain/brain-anatomy/limbic-system
6. Understanding the stress response. (2018, May 1). Retrieved from https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response

Children experience the world through action, play, and exploration. They are propelled by their bodies and guided by their senses. Thus, it is important children in therapy are not expected to sit on a couch for 50 minutes and spout logic and reason. This is not the natural state of childhood.

A child’s biological tendencies do not begin with logical thought—though this does come with time. Children are more driven by their impulses, feeling sensations, and day-to-day happenings. It is vital a children are able to bring their whole selves, brain and body both, into the therapy room, a setting of safety and acceptance.

When the body is engaged in therapy, the brain is also engaged. Higher brain processes, such as critical thinking, are often the focal points of therapy. But this means the body and all of its wisdom, skill, and purpose may be left out of the interaction. It is important to enlist both the brain and the body when working with children. Doing so can help the brain integrate information and work toward easing symptoms that present in the body. Engaging the body in the therapy process can also help therapists meet children at their developmental level by facilitating a more interactive learning experience.

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How Can the Brain Be Integrated?

It is often obvious when a child is upset or struggling. You can see the signs in their body. For example, a child might sob, stomp their feet, throw themselves on the floor in a physical tantrum, run away, scream, or hit. In a heightened emotional state, a child’s body takes over, while logical thought and reason are put on pause. But when the body is active in therapy, brain processes, and integration of the brain overall, are likely to improve.

Integration of the brain can happen in two ways:

1. On the right and left sides of the brain. The right side of the brain is generally responsible for non-verbal (bodily) communication and for creative processes. It is also responsible for play and autobiographical expression. The left side of the brain is connected to logic, language, and organization. Children, especially young children, are generally right-brain dominant. They express through play and creative processes (Siegel & Bryson, 2012). By allowing the right side of the brain to be active in therapy through movement, play, and action, a therapist can meet the child at the developmentally appropriate level. Furthering the process with age-appropriate verbal reflection assists in integrating both sides of the brain.
2. In the upper and lower parts of the brain. The lower part of the brain governs automatic responses, including the fight, flight, or freeze response to danger. The higher, outer part of the brain is involved with judgment, problem solving, and thinking through situations (Siegel & Bryson, 2012). The higher, thinking part of the brain has limited capacity when the lower brain is activated. Not feeling safe, experiencing new situations, and/or having a history of trauma are just a few ways the lower brain may be activated. Regulation of the lower brain generally comes from interventions involving the senses. Smell, sound, body movements, grounding, and breathwork might all be used to assist a child with lower brain regulation.

In summary, children are generally more right-brained, which connects closely to the body. Ideally all parts of the brain can be engaged in the therapy process. But this requires both the brain and the body to be involved.

Symptoms in the Body

Children express their feelings, and show symptoms, on a bodily level. A therapist might notice some of the following body-based symptoms:

• Tension
• Fidgeting
• Repetitive movements
• Physical aggression
• Self-harming behaviors such as head-banging
• Low energy
• Hyperactivity

Children might also experience body-based symptoms that are not visible, such as:

• Increased heart rate
• Rapid breathing
• Somatic pains such as headaches and stomachaches

Addressing a child’s presentation through brain-based interventions may provide some change and relief. However, because integration of the whole brain is vital for overall well-being, a quicker and more direct path to healing may be to address symptoms in their organic form—in other words, through the body. For example, a child who experiences hyperactive and impulsive behavior may need to learn and practice new ways of using the body while utilizing a physical outlet for the presenting hyperactivity.

How Can Therapy Be Made Enjoyable?

Which therapy experience would a child most likely prefer: sitting on a couch, verbally describing their day and memorizing coping mechanisms? Or engaging in movement and/or play to reenact parts of their day while learning to cope with difficult experiences through the body?

Children are not biologically designed to sit in one place and think critically. They are movers, explorers, and creative expressers. Children engage with the world through action. Therefore, therapy should be a space for clinical intervention with age-appropriate, action-oriented techniques. Having the tools of childhood (action, play and creative expression) in the therapy room will help make room for a therapy experience that is positive and validating. As a result, it is likely to lead children to increase their investment in therapy

What Types of Therapy Engage Both the Brain and Body?

Many forms of child-focused therapies provide intervention that support both the brain and body. Dance/movement therapy, play therapy, and other expressive arts therapies (art, music, and drama therapies) are structured around holistic engagement.

Dance/Movement Therapy

The psychotherapeutic use of movement to further the social, cognitive, physical, and emotional integration of a child, dance/movement therapy is rooted in the belief that there is an inherent connection between the mind and body. Specially trained dance/movement therapists use movement as the primary tool to address clinical goals.

Play Therapy

The use of play theory and methods can help establish an interpersonal process in which trained therapists help children prevent or resolve psychosocial difficulties and achieve optimal growth and development through play. Play therapists use the languages of childhood: play, imagination and exploration. These typically involve the whole body with a goal of facilitating emotional processing and change in children.

Art therapy, music therapy and drama therapy are other action-oriented therapies that engage the both body and brain in the therapy process. [amazon_affiliate]

Looking for a dance/movement, play, or expressive arts therapist? Begin your search for a counselor with GoodTherapy’s therapist directory.

References:

1. American Dance Therapy Association. (n.d.). Retrieved from https://adta.org
2. Siegel, D. J., & Bryson, T. P. (2012). The whole-brain child: 12 proven strategies to nurture your child’s developing mind. London: Robinson.
3. Why play therapy? (n.d.). Retrieved from http://www.a4pt.org/page/WhyPlayTherapy

“If we could somehow end child abuse and neglect, the eight hundred pages of the Diagnostic and Statistical Manual of Mental Disorders (and the need for the easier explanations such as DSM-IV Made Easy: The Clinician’s Guide to Diagnosis) would be shrunk to a pamphlet in two generations.” —John Briere

Conversion disorder is not one of the better known mental health conditions. Google search inquiries, perhaps the most reliable way of measuring public interest in the internet age, show only a fraction of the interest generated by bipolar, OCD, or schizophrenia. The DSM-5 uses a more explanatory name: “functional neurological symptom disorder.” But this name is even less known. Ironically, conversion disorder is the modern term for one of the oldest and most famous—though now rather taboo—concepts in mental health: hysteria.

Over two thousand years ago, the cultures most interested in medical knowledge—ancient Egypt and Greece—observed that a person’s physical symptoms sometimes seemed unconnected to the usual causes. Of course, it must be said that the ancient Greek theory of illness and health, based on imbalances in the “four humors,” did not provide the most solid basis for identifying what was and wasn’t a “normal” symptom. Nevertheless, Greek scientists were correct in observing that symptoms like shortness of breath, partial paralysis, and pain were sometimes not prompted by a physical injury or illness and would recede when the patient calmed, even without medical treatment.

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However, this accurate observation was taken on a walk down a blind alley—something common in the premodern age. Doctors observed that these “phantom” symptoms were far more common in women. (This has been repeatedly confirmed by modern studies.) But doctors at the time used the observation to make the factually inaccurate inference that the symptoms must be specific to women. If these mysterious symptoms were peculiar to women, the next step in the logic ran, they must be caused by something specific to women, or the womb, known in Greek as the hyster. Thus the concept of hysteria was born. In one of intellectual history’s odder chapters, bizarre theories of the wandering uterus playing havoc by pressing against internal organs were formulated and debated by some of the greatest minds of premodern medicine. Even stranger was the long-running medical debate on whether masturbation should be prescribed as a cure for hysterical symptoms or whether marriage was the proper prescription.

Conversion Disorder Today

Fast-forward to the 19th century. The new science of psychiatry at last produced the insight that these symptoms were caused by brain disturbances, not reproductive system issues. The broad category of hysteria was divided into several more defined categories. The most extreme of these became known as hysterical neurosis, conversion type. Finally, after decades of limping along without any particular reason, “hysterical” was dropped. The diagnostic name became “conversion disorder.” The condition was characterized by the presence of neurological symptoms without an identifiable organic cause.

Whether pain originates physically (from an outside source), from a neurological dysfunction, from a mental health condition, or even from the power of suggestion or auto-suggestion, it all consists of the same thing: electrical signals in the brain.

The symptoms of conversion disorder are diverse. They include pain, paralysis, numbness, fits, and even temporary blindness. One of the most interesting features of this condition is that before diagnosis, all other possible reasons for the pain must be ruled out. Doctors must confirm that a patient is not feigning or deliberately inducing the symptoms. They must also make certain the symptoms do not stem from a neurological disease. Practically speaking, this is extremely difficult. As a result, conversion disorder is one of the hardest mental health concerns to diagnose, often leading to vigorous debate on the rate of misdiagnosis.

Conversion disorder also raises an interesting philosophical issue about the nature of pain and other unpleasant physical symptoms. We tend to distinguish between “real” and “imaginary” pain. If a rock falls on your foot and you experience a sharp pain, then that is real pain. But if you experience the same sensation in the absence of any outside stimulus, you might consider that pain imaginary.

The reality, however, is that all pain exists within the nervous system. The sensation of feeling pain, in any part of your body, is an illusion the nervous system creates to make you respond in a certain way. Whether pain originates physically (from an outside source), from a neurological dysfunction, from a mental health condition, or even from the power of suggestion or auto-suggestion, it all consists of the same thing: electrical signals in the brain.

Now, this is not to suggest that there is no point in distinguishing between different forms of pain. In fact, identifying what causes the nervous system to act in a certain way is a critically important step toward effective treatment. I do want to suggest, however, that we consider changing our attitude about what constitutes an injury.

Everyone would agree that a parent who caused their child a serious physical injury was guilty of inflicting an injury. But what about emotional wounds, such as those resulting from trauma? Children who experience abuse, frequent conflict in the home, neglect, or other trauma may experience physical symptoms that last a lifetime and are no less “real” for being indirectly caused.

A growing body of research indicates conversion disorder may be strongly linked to childhood trauma. Indeed, it may be the case that many diagnosed cases of conversion disorder are really symptoms of underlying C-PTSD, which can manifest itself in a variety of ways. Future research may help shed more light on the interesting phenomenon of conversion disorder.

If you experience symptoms that have no clear cause, I encourage you to seek support from a medical and/or mental health professional.

References:

1. Akyüz, F., Gökalp, P. G., Erdiman, S., Oflaz, S., Karşıdağ, C. (2017). Conversion disorder comorbidity and childhood trauma. Archives of Neuropsychiatry, 54(1), 15–20. Retrieved from http://www.noropsikiyatriarsivi.com/en_makaleOzet?id=829
2. Ali, S., Jabeen, S., Pate, R. J., Shahid, M., Chinala, S., Nathani, M., & Shah, R. (2015). Conversion disorder— Mind versus body: A review. Innovations in Clinical Neuroscience, 12(5-6), 27–33.
3. Allin, M., Streeruwitz, A., & Curtis, V. (2005). Progress in understanding conversion disorder. Neuropsychiatric Disease and Treatment, 1(3), 205–209.
4. 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. http://doi.org/10.1186/2051-6673-1-9
5. Stone, J., Smyth, R., Carson, A., Lewis, S., Prescott, R., Warlow, C., & Sharpe, M. (2005, October 27). Systematic review of misdiagnosis of conversion symptoms and “hysteria.” British Medical Journal, 331(7523), 989. Retrieved from https://www.bmj.com/content/331/7523/989

Editor’s note: Dr. Siegel will be presenting a continuing education web conference for GoodTherapy, titled “Meditation Practice for a Healthier Brain,” at 9 a.m. Pacific on May 10, 2019. This event is available at no additional cost to Premium and Pro GoodTherapy members ($29.95 for non-members) and is eligible for two CE credits. Register or see more details.

Daniel J. Siegel, MD is a psychiatrist, neuroscientist, educator, and critically acclaimed author. Most recently, he is the co-author (with Tina Payne Bryson, PhD) of The Yes Brain: How to Cultivate Courage, Curiosity, and Resilience in Your Child.

After attending the University of Southern California for his undergraduate studies, Dr. Siegel received his medical degree from Harvard Medical School in 1983 and completed postgraduate medical studies at UCLA, where he still works as a clinical professor of psychiatry and the founding co-director of the Mindful Awareness Research Center. One of the focal points of his research and teachings is interpersonal neurobiology (IPNB), a field that focuses on finding similarities between otherwise separate disciplines.

Dr. Siegel is also the executive director of the Mindsight Institute, an organization that offers workshops and online courses teaching the concept of mindsight, the ability to recognize and comprehend internal processes of the brain. On top of his professional achievements, he is a proud and happy father and husband.

As an author and editor of many books on parenting, child development, neuroscience, and personal transformation, Dr. Siegel expertly distills scientific research into clear and accessible learning resources. Dr. Siegel was generous enough to spare time from his busy schedule to speak with us about The Yes Brain, his work, and his life. [fat_widget_right]

What does it mean to have a “Yes Brain” or a “No Brain”?

A Yes Brain is the state of being receptive and open. Yes Brain and No Brain come from a workshop where I would say “no” harshly several times, pause, and then say “yes” calmly several times. A No Brain is a state of threat, and people in the workshops would feel that they want to fight me or run away. In contrast, after the pause when I say “yes”, they experienced something totally different—A feeling of openness, calmness, and clarity. This is a state of receptivity. And this Yes Brain state is where we have our ideal way of interacting with other people. For example, parenting. People sometimes think Tina Bryson and I mean Yes Brain means say “yes” to everything. That’s not what we mean, and we try to make that very clear in the beginning of the book.  [amazon_affiliate]

Can you explain the four fundamentals of the Yes Brain and how they positively impact a child’s development?

Absolutely. What Tina Payne Bryson, my co-author, and I want to do in the books is provide science-based facts that can be practical, accessible, and memorable. In this case, we’ve used a “cheesy” acronym, the cheese brie, B-R-I-E, that are the four fundamentals of the Yes Brain. ‘B’ stands for balance, ‘R’ stands for resilience, ‘I’ stands for insight, and ‘E’ stands for empathy. If you look at how these positively impact a child’s development, you can see where balance, the ability to access a wide range of emotional states, can be called the “green zone.” When you get out of balance, you go either to a chaotic state we call the “red zone” or a rigid state we call the “blue zone.”

We’re using balance here as the accessible meaning of the scientific term integration. When you’re integrated, you’re moving in a harmonious flow, and when you’re not, you are moving towards chaos or rigidity. ‘R’ is resilience, and this means you’re widening that green zone. You’re giving them the skill of saying, “I’m not in balance. How do I get back?” Insight is the capacity to be aware of what’s happening in the inner world, and empathy is the ability to know the inner life of someone else. These are what we call ‘mindsight’ skills that allow you to develop the essentials of social and emotional intelligence.

You mention that a key part of childhood is experiencing various types and intensities of emotion. What can parents do to support children without interfering with their opportunity to learn from said emotions?

These days, with children elementary school age and beyond, the time spent using screens is making the focus of a child’s attention primarily on the outside world. This compelling stimulus keeps kids from having the time they need to reflect inwardly, either on their own state or the state of other people. The downside is when you get an emotion, you may not have had the opportunity to learn how to just be with that emotion. And so, the emotion floods you like surf on a pounding shore. What we want to do is teach kids to surf the wave, not avoid the water or be trounced by the waves. When you teach a kid to surf their emotions, these emotions are given permission to enter awareness, and then you can use them for your benefit. And this is the whole idea of how you support children without interfering with their opportunity to learn—you want to give them the opportunity to reflect on the nature of their minds.

Why is free play becoming less common with children today, and why is it so important?

I think people have not emphasized enough in our scientific studies that play is to the mind like oxygen is to the body. We think of play from an intellectual point of view, we say, “It’s not serious. What a waste of time.” Well, thinking in brain terms, the way the brain tries different combinations, explores them with curiosity, and enters a state of spontaneity without judgment, [is] what play is all about. I think what’s happening is if you get into a frame of mind that’s utilizing certain brain circuits, you believe your own story that play is not important because it may be diminished in your life, or you’re just using a certain way of thinking about things.

What are mindsight skills, and how can they help children navigate difficult situations?

The word “mindsight” is a term I made up for seeing the mind. What that means at a minimum is an acknowledgment that we all have something called subjective experience. Subjective experience is what’s in consciousness [and] includes the thoughts, memories, and emotions you might have. What we do by naming mindsight is take one facet of mind, subjective experience, and say you can perceive that or not.

So, if a child makes a request for ice cream before dinner, and you say, “That’s so dumb! Go to your room,” you’re responding to their behavior, not to a very understandable feeling: “I love ice cream, I’m about to eat dinner, we’re about to eat, I’d like to eat ice cream first.” In contrast to the No Brain approach, a Yes Brain approach would say, “I sense your mind beneath your behavior. I sense your excitement about ice cream. And I share that. That would be awesome to eat ice cream before dinner. We’re not going to, because the sugar and the fat in ice cream satisfies our dopamine-based reward circuit, and we won’t have any drive to eat more food. We need our nutrition first, and we can do ice cream for dessert.” What you’re doing there is teaching your child that they are a good person, but their behavior is not necessarily something you’re going to agree to.

There’s a dance between summarizing many individuals into categories and patterns and applying that to the individual, but also always honoring the individual experience that may not conform to the statistical summaries. I think being a therapist has reinforced what I always felt was true since I was a young kid, which was that no matter what science [says], you have to honor individual things.

How do Yes and No Brains develop as children mature into adults?

There’s a simple neuroscience principle I like to summarize this way: Where attention goes, neural firing flows, and neural connection grows. If you’ve been focusing a lot of attention on No! No! No!, this is where neural firing flows, a No Brain reactive state. In contrast, if you do these four elements of the Yes Brain, you’re driving attention in these positive Yes Brain ways which will strengthen what we call an internal compass. And that’s what you want to do as you launch your child out into the world, is have provided parenting experiences which build a skill of sensing the mind.

How important is it for parents to work on their own Yes Brains?

That’s exactly the point! We have sections of the book for parents to work on their own Yes Brain because, if you’re busy being harsh to yourself, you’re more likely to be harsh to your child. And that No approach isn’t particularly good for you, so we provide relief from your own tormentor, so you can create a Yes Brain approach for yourself.

How can psychotherapy help develop a Yes Brain in both parents and children?

It’s so interesting when therapists do this. I’ve given workshops for therapists on The Yes Brain. When therapists learn this approach, they begin with themselves, so they become more mindfully aware and enter this receptive state. [Then], they can really begin to appreciate how their clients may have had repeated experience of No Brain emphasis in their own childhoods. You can translate, as I’ve done in these workshops, every Yes Brain parenting skill into a Yes Brain therapy skill.

Can you take us through the process of using complex scientific research on the brain and human behavior to create relatable and understandable content for parents and families?

First thing, I’m a dad. I have two kids now in their mid-20s, and that privilege of being their dad and co-parenting with my wife [has] led me to reflect on the experience of parenting. Since I’m also a child and adolescent psychiatrist, I work with very young people, and I can see them all the way into adulthood. And then, I’m a scientist, trained to study parent-child relationships and how they shape the development of the mind. On top of that, I work in a field called interpersonal neurobiology, where for the last 25 years we’ve been asking the question, “If you combined all of the sciences together into one framework, what would that framework look like?”

For me, it’s helpful because I have a continuing revision process of The Developing Mind. I’m always asking the interns that work with me to prove these ideas wrong. The Whole-Brain Child, No-Drama Discipline, and our next book, these all basically say to a parent, “Here’s the science of integration, here’s how you can find it useful in your life.” And we’ve been so grateful that we hear from people all over the place about how these simple strategies, which come from very complex science, actually work. We try to explain enough of the science so it really makes sense, but not too much, because the art of writing a book like this is to know what not to put in. [amazon_affiliate]

How do the ideas and strategies you explore in The Yes Brain relate and connect to the previous books you’ve co-written with Dr. Bryson, The Whole Brain Child and No Drama Discipline?

We get feedback from parents about certain initial ideas that were helpful. Like Yes Brain, as an example. We found there was a topic that was skirted on in both No Drama Discipline, which reminds parents that discipline means to teach, not to punish, and The Whole Brain Child, the grounding book that says, “Look, here are the different domains of integration you can work on.” For this book, what we wanted to do was take this idea that parents told us they needed to know more about, which is, “How do you redefine what success is?” And when you look at how much depression, anxiety, and even suicide rates there are in children and adolescents, you realize something is going really wrong. This Yes Brain approach is something we all need to provide that balance, resilience, insight, and empathy to guide us through [difficult] times.

Do you think your experiences in private practice have influenced your writing, or vice versa? How so?

The incredible privilege of getting to know people in therapy as a therapist completely made it possible for me to be a writer. I never wrote much until I became a psychotherapy trainee, and I realized that it was helpful to have an individual patient and see how reviewing all the scientific studies gave me a different way of approaching [them] in therapy. There’s a dance between summarizing many individuals into categories and patterns and applying that to the individual, but also always honoring the individual experience that may not conform to the statistical summaries. I think being a therapist has reinforced what I always felt was true since I was a young kid, which was that no matter what science [says], you have to honor individual things.

Writing made me figure out how to articulate certain principles. As you’re typing words out, editing them, and releasing them into the world, it’s quite an experience of, “Do I really believe in what I just said? And is there science backing it up? And is it said in a practical way?” But here’s the secret: I find that the relationship I get with readers, when you get positive feedback about how a book really changed their life, that’s what gave me the drive to go forward.