There are a lot of unanswered questions about chronic illness.
Why do so many of us develop our diseases after periods of stress, for example? Why are we then unable to recover by addressing, removing or reducing the stress in our lives?
Why do some people with type 1 diabetes, or chronic fatigue, or other chronic illnesses have a sudden onset, such as after an infection or traumatic event, while others with the same illness have a slow onset with no observable cause (like me)?
For that matter, why is there such a variation in the first symptoms people have, even when they have the same disease?
There are also important questions about other chronic symptoms such as chronic pain, and having a system that is super sensitive, such as to being around other people, to many foods, to fluorescent lighting, noise, wifi and more.
This post introduces links between trauma and chronic illness. It’s relevant for other chronic conditions as well, including anxiety, depression and beyond.
Discovering the science about the physiological effects of adversity is how I’ve come to make sense of chronic illness based on the science I discovered over the past 20 years.
The information comes from research I never learned about as a doctor.
Note: I’ve updated this post in January 2021 but have not yet updated images, which will not always have the correct number for the section it is now in.
Table of Contents
- Introduction: How Trauma Affects Risk for Chronic Illness
- Links Between Trauma & Chronic Illness
- 5 Characteristics of Trauma
- 8 Characteristic Types of Trauma: Risk Factors for Chronic Illness
- 1. Adverse Babyhood Experiences (ABEs)
- 2. Adverse Multigenerational Experiences (AMEs)
- 3. Adverse Childhood Experiences (ACEs)
- 4. Adverse Childhood Experiences Plus (ACEs+)
- 5. Adverse Childhood Relationships Experiences (ACREs)
- 6. Adverse Pre-Onset Triggers (APOEs)
- 7. Adverse Adulthood Experiences (AAEs)
- 8. Adverse Institutional Experiences (AIEs)
- Mechanisms: Life Events Alter Genes
- The Trauma and Chronic Illness Model
- Insights for Treating Chronic Illness
- Different Illnesses, Same Cause?
- Chrillogs: Our Chronic Illness Stories
- Resources, Books, and Trauma Therapies
- What You Can Do
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Trauma is different from stress. And it’s not psychological. What I discovered helped make sense of my own chronic illness of disabling chronic fatigue and realize that I had experienced subtle trauma that I had never recognized. Here’s a summary of what I’ve learned over the past 20 years of digging through and pulling the research together.
The traumas we experience are often invisible and can seem like just a part of ordinary life. But these often stressful, overwhelming or difficult events can affect us just the same.
Periods of stress or trauma occur before the onset of all kinds of different chronic illnesses, including my own. But I don’t think that a particular stressful event is the cause of most chronic illnesses. Rather, it’s more like the last straw in a series of events.
Introduction: How Trauma Affects Risk for Chronic Illness
The research linking trauma and chronic Illness and how it makes sense of symptoms, flares and opportunities for improvement are the main theme of my blog. I sometimes refer to the theories I’ve been developing through research and personal experience over the past few decades as the trauma and chronic illness model.
Here I summarize research suggesting how experiences can induce perceptions of threat in the nervous system – either through overtly traumatic events such as surviving war, natural disasters, and abuse – or in subtle and unrecognized ways that can begin before and during birth.
The research shows remarkable findings on how stress and trauma are risk factors for chronic illness. And it’s not psychological.
The growing field of epigenetics is beginning to reveal one of the mechanisms for understanding how nongenetic factors affect risk for chronic diseases of all kinds.
My hope is that understanding trauma can help us recognize ways to prevent the onset of chronic illnesses in the long-term, as well as slow down the progression and reduce symptoms in those of us who are already sick. Ultimately I believe the emerging science will enable us to recover from chronic diseases of all kinds.
I hope to introduce – and teach – this to doctors and other health care professionals one day.
Trauma Affects our Nervous Systems
One of the answers to the questions we have about how stress and trauma affect risk for chronic illness lies in our nervous systems.
Our nervous systems are much, much more adaptable to our unique, individual environments than we ever imagined. The term used to describe this quality is that our nervous systems are plastic (1)Doidge, N. (2015). The Brain’s Way of Healing: Remarkable Discoveries and Recoveries from the Frontiers of Neuroplasticity Viking Adult. This means that our nervous systems are moldable and flexible, can strengthen and weaken pathways to influence our emotions, behaviors, physical health and symptoms, even in adulthood.
This means there’s hope – much more hope than we ever imagined.
Our brains and nervous systems are also much more sensitive, and dependent, on our environments than we have realized.
Interactions between our bodies and our physical, emotional and psychological environments shape our developing nervous systems as we grow and later in life. These interactions influence our nervous systems by altering our genes.
Nature and Nurture
One example of interactions between environment and developing physiology happens at birth.
Being born through the vaginal canal is actually designed to serve many purposes and is not just a “random” event.
Traveling through the birth canal squeezes fluid from a baby’s lungs in preparation for the great shift that enables us to start breathing air for the first time. The journey also inoculates us with healthy bacteria from our mothers, which populates our guts.
After birth, the nervous system activity that was high during labor and the birth process is designed to shift. Babies start to calm down and settle when they find their ways into the arms of their mothers and fathers. There is often a quiet period at this time, which allows for bonding, resting, and recovering.
These are examples of life events that affect how our nervous systems learn to regulate. This is how we, as biological beings who are aspects of Nature, are designed to grow and develop through interactions with others through Nurture.
The belief that it’s either nature or nurture is out of date. The science is showing us that health and development are the result of an ongoing dance between nature and nurture (2)Shonkoff JP, Garner AS, Committee on Psychosocial Aspects of C, et al. The lifelong effects of early childhood adversity and toxic stress. Pediatrics 2012;129(1):e232-46. doi: 10.1542/peds.2011-2663, p. 234.
Advances in our understanding of the factors that either promote or undermine early human development have set the stage for a significant paradigm shift.
In simple terms, the process of development is now understood as a function of “nature dancing with nurture over time,” in contrast to the longstanding but now outdated debate about the influence of “nature versus nurture.
That is to say, beginning prenatally, continuing through infancy, and extending into childhood and beyond, development is driven by an ongoing, inextricable interaction between biology (as defined by genetic predispositions) and ecology (as defined by the social and physical environment) p. e234
Links Between Trauma & Chronic Illness
Trauma can be described as an experience that is overwhelming. Trauma can also stem from events or experiences that are perceived as life-threatening and inescapable. The effects of trauma include posttraumatic stress disorder (PTSD). The effects of trauma can result from exposure to war, being in a car accident, or during natural disasters. Trauma can also be much more subtle.
Trauma can occur in early relationships with parents who are emotionally unavailable (which is generally due to their own trauma).
Trauma can happen from seemingly small accidents and more.
Either way, trauma can leave tremendous, life-altering physical as well as emotional wounds.
We have been greatly underestimating the impact of trauma – as a culture, as a population, in medicine – on the nervous system, on the psyche, on behavior, and on our emotions.
What we’ve been learning from research is significant. Below are five of the main characteristics of trauma that are remarkably applicable to a different way of understanding chronic illness.
Two books that provide good overviews of trauma are Peter Levine’s Waking the Tiger (3)Levine, P., Waking the Tiger. 1997, Berkeley: North Atlantic Books., and Robert Scaer’s The Trauma Spectrum (4)Scaer, R., The Trauma Spectrum: hidden wounds and human resiliency. 2005, New York: W.W. Norton.
5 Characteristics of Trauma
1. Not a Single Event
Soldiers are at higher risk of developing posttraumatic stress disorder following a traumatic event when they have a history of prior, unresolved trauma, such as trauma from life before joining the military. This is part of the reason that not everyone who serves in a war (or is in an accident or goes through medical training), gets PTSD. Similarly, not everyone who experiences trauma, or the stress of divorce, job loss, or a severe infection develops a chronic illness. If you have a chronic illness and a history of trauma it does not mean it’s psychological. It’s because trauma has many different kinds of effects depending on when it happens. Risk for chronic illness appears to start in the womb.
The effect of multiple traumas over time is additive. In the trauma literature, this is referred to as “compounding.” Studies throughout the chronic illness literature find that there have been more stressful life events in those of us who develop a physical disease, compared to our peers who do not.
3. Delay Between Trauma and Onset
There is generally a delay between a traumatic event and the onset of symptoms of PTSD. The time period can vary from weeks to months or longer, and is referred to as a “latency” period.
Most of us with chronic illness had intermittent symptoms, just like those of our diseases, months or years before the full onset.
Researchers looking at chronic illnesses have noted latency periods. In illnesses where antibodies have been identified, they are being found to precede the onset of symptoms. In lupus, it has been by as much as 7 years. In type 1 diabetes, antibodies are sometimes present at birth. Antibodies are also found years before onset of type 1 diabetes, rheumatoid arthritis and other chronic illnesses. Unidentified factors affecting risk for Alzheimer’s are believed to occur as much as 30 years prior to onset.
Buffers are resources that support healthy patterns of nervous system functioning. They reduce risk of experiencing an event as traumatic, enable greater recovery when patterns arise, or may reduce risk of symptoms of PTSD altogether. Whether a nervous system pattern leads to PTSD depends on the timing and interaction between trauma and buffers.
As in PTSD, buffers also reduce risk for chronic illness. In some babies who are born with antibodies associated with type 1 diabetes, for example, these antibodies disappear and they do not get the disease. I suspect this is the result of factors such as buffers, and shows why so many people with traumatic life events, or who seem predisposed to risk from family histories or other factors, never develop a chronic illness.
The reason we develop a chronic illness (rather than a mental illness or no illness) may be that we were exposed to adverse experiences during a critical period early in life. Such a period could have been when a particular organ system was developing, such as during the formation of the pancreas and blood sugar regulation in someone how develops diabetes, or when parts of our brains that deal with mental processing were growing in someone who became susceptible to depression, autism or schizophrenia.
Critical Periods: Why Me? Why this Illness?
Exposure to toxins during pregnancy is known to affect organs developing at the time of exposure, leading to such problems as birth defects. This occurred with thalidomide, for example, which interrupted the growth of limbs and other organ systems when taken early in pregnancy, specifically between days 20 and 36.
The degree of organ system sensitivity depends on the speed at which an organ is growing and the stage of development it is in (early, late etc). This is known as a sensitive or critical period.
8 Characteristic Types of Trauma: Risk Factors for Chronic Illness
As with trauma, we’ve also greatly underestimated the influence of relationships and how they contribute to the ways in which our nervous systems learn to perceive and respond to threat. The next 8 factors all play key roles in shaping our nervous systems.
The book From Neurons to Neighborhoods (5)National Research Council and Institute of Medicine, From neurons to neighborhoods: the science of early childhood development. Committee on integrating the science of early childhood development, ed. J.P. Shonkoff and D.A. Phillips. 2000, Board on children, youth, and families, Commission on behavioral and social sciences and education. Washington, D.C.: National Academy Press, by the National Research Council, is an excellent resource. I refer to the characteristics mentioned next as “adverse babyhood experiences” or ABEs, a term I’ve coined and described in a detailed summary in this post. ABES are a subset of risk factors in childhood known known as adverse childhood experiences (ACEs), presented in #3. I will list several other books that I have greatly appreciated for informing me about specific fields of developmental research, in context, below.
1. Adverse Babyhood Experiences (ABEs)
Birth is an example of a critical period because many significant changes are happening. They are also taking place in a very short period of time.
A baby’s heart, digestive system and lungs, for example, undergo dramatic shifts as they prepare to disconnect from the mother’s support system to eat, metabolize food, circulate blood and breathe air all on their own.
Studies find that there are critical periods in the development of risk for chronic illnesses. If a person isn’t exposed to risk factors for MS before the age of 15 or 16, for example, researchers suspect that they don’t develop the illness even if they might be at risk. An increasing number of researchers are also beginning to suspect that initiation of risk for chronic illness, such as type 1 diabetes, begins before or around birth.
Prenatal stress can decrease organ size and size at birth while also increasing risk of being born prematurely, among other effects. These factors, in addition to stress and trauma at birth and in the first few weeks of life, also increase risk for chronic illness. I tell the story of how research changed my views about chronic illness in the Discovery Series, which introduces studies that lead to an understanding of how early life events affect risk. Here’s post 1 about type 1 diabetes and antibodies. Post 2 describes how helping a mother heal from trauma can cure asthma (and other chronic diseases) in her child.
There have been decades of research in this area, including in one field known as the Fetal Origins of Adult Disease.
Events During Pregnancy, Birth and Infancy
The impulse parents have to hold their babies after birth not only supports bonding, it also helps to regulate a newborn’s immature physiology.
Holding newborns skin to skin, referred to as kangaroo care in hospital settings, helps premature babies better regulate body temperature and heart rate and enables them to grow and recover more quickly than babies who spend all of their time in incubators.
Separation of parents from their newborns, which remains common practice in many hospitals, not only affects the parent-infant bond can also influence how a baby’s nervous system responds to stress. The duration of separation tends to be longer with difficult or complicated deliveries, including cesareans.
This is an example of how stress and trauma are risk factors for chronic illness in the most subtle and unexpected ways. Learn more in this post on adverse babyhood experiences (ABEs).
My favorite book on bonding and the effects of early separation is Maternal-Infant Bonding (6)Klaus, M.H. and J.H. Kennell, Maternal-Infant Bonding. 1976, St. Louis: Mosby, which has an updated version I just learned about called Parent-Infant Bonding (7)Klaus, M.H. and J.H. Kennell, Parent/Infant Bonding. 2nd ed. 1982: Mosby. 326.
Many studies find that individuals who develop a chronic illness had more interventions, stressful events, and longer separations at birth. Part of the trauma and chronic illness model is about recognizing how subtle and even seemingly minor interventions can actually be experienced as life-threatening – and therefore potentially traumatizing – to babies. Some of my blog posts describe this area of research in more detail: Causes of Chronic Illness Part 1: Insights from Type 1 Diabetes, Part 2: Insights from Asthma,Part 3: Early Life Events Alter Genes to Affect Risk for Chronic Illness and Part 4: A Recap. You can also learn more about Early Risk Factors for Rheumatoid Arthritis.
2. Adverse Multigenerational Experiences (AMEs)
Experiences in our ancestors’ lives, such as trauma a mother experiences during and around the time of pregnancy, and that a man experiences in his teen years, can affect their children’s and grandchildren’s health. I refer to these as adverse multigenerational experiences (AMEs).
Our health can also be influenced by traumatic events our parents and grandparents and other family members experience at other times in their lives. These include the loss of a parent in childhood, miscarriages and abortions, and other overwhelming events they have been unable to overcome (see this terrific, compassionate, nonjudgemental overview book by Family Systems Constellator Stephan Hausner “Even if it Costs Me My Life,” for examples of histories, stories and recovery from all kinds of chronic diseases; see this post about my trip to work with Stephan in 2019 in Spain).
One of the mechanisms by which multigenerational trauma influences health in later generations involves our genes.
The degree of nurturing behavior a mother rat gives her offspring, for example, affects its genes during a critical period in the first week of life (see this terrific article in Discover magazine). This happens through epigenetics, a process by which molecules attach to specific genes to turn them on or off. In this and similar studies, molecules increased the rat pups’ stress response system by altering genes that regulate cortisol (8)Weaver IC, Cervoni N, Champagne FA, et al. Epigenetic programming by maternal behavior. Nat Neurosci 2004;7(8):847-54. doi: 10.1038/nn1276. These effects help prepare a rat pup for a stressful environment by making it more sensitive and responsive to stress in attempt to increase its chances of survival in a difficult environment. Rat pups with more nurturing dams have fewer epigenetic changes on cortisol receptors, and are calmer.
Our relationships, life experiences and our family’s experiences influence our health through epigenetics and not just through the genes we inherit. This means that healing multigenerational trauma can help heal chronic illness even when they have failed to respond to other treatments.
There are other mechanisms in multigenerational trauma yet to be discovered, some of which I describe in my article on how healing trauma in mothers can cure asthma in their children.
Learn more about the role of multigenerational trauma in this 2014 article in New Republic about how kids are inheriting their parents’ trauma.”
Nova also has a documentary about a discovery that the stress of famine in one European village affected risk for type 1 diabetes in the population’s grandchildren. Here’s the first 10 minutes of the 5 part series on youtube.
I’ve written a little about the role of transgenerational trauma in my own family tree, starting with a look at my paternal grandfather and events that may have influenced the development of his rheumatoid arthritis. I’m currently (July, 2019) doing more learning and healing through Family Constellation work as a way of addressing effects of multigenerational trauma in my own life. I will write more as I integrate and pull things together in a more cohesive way.
3. Adverse Childhood Experiences (ACEs)
Trauma that is inflicted by other human beings, who are supposed to care for and protect us, is one of the most difficult and influential kinds of adversities we can experience. The effects are most severe with children, because brains and immune systems that are growing and developing are the most sensitive to life experiences and trauma. Children, in other words, are the most vulnerable among us.
The adverse childhood experiences (ACE) studies (9)The study included 17,000 participants who completed surveys about their childhoods. Their average age at the time of first participation was 57. Participants were followed prospectively for 15 years after completing the surveys. Over 60 papers have been published to date. The researchers Dr. Vincent J. Filetti and Dr. Robert Anda and colleagues have followed 10 areas of trauma in childhood that affect risk for health problems in adulthood and which you can identify to calculate your own “ACE score.” find that trauma in childhood is an important risk factor for chronic illness in adults. The higher the number of adverse events experienced, the greater the risk.
This is an example of compounding of trauma occurring during critical periods of development.
- Figure out your ACE score in a post summarizing the ACEs and Chronic Illness.
- See a list of over 30 chronic diseases that are increased by ACEs, including type 1 diabetes, rheumatoid arthritis, MS and others in this blog post.
- You can download a FREE one page ACE Fact Sheet to give your doctor and other health care professionals, as well as your teacher (s), lawyer(s) and others from the blog post mentioned above or with the form below.
4. Adverse Childhood Experiences Plus (ACEs+)
This category includes other types of adversity before our 18th birthdays that also affect long term health. Learn about some of my ACEs+ in my ME/CFS story and others in My Prediabetes Story and examples in type 2 diabetes. I will post a link here when I write a post on ACEs+.
5. Adverse Childhood Relationships Experiences (ACREs)
The kind of experiences children have with their parents or other adult caregivers is one of the single most underestimated and unrecognized sources of trauma that affects risk for chronic illness and other health issues in adulthood. I refer to these as adverse childhood relationship experiences (ACREs) because they occur with our first and most important relationships. They are also known as Attachment Trauma or Relationship Trauma.
It’s the risk factor those of us with an ACE score of Zero and who have no obvious histories of trauma are likely to have experienced even as we’ve learned to think is completely normal.
It reflects the long-term impact of how an adult’s nervous system is an essential contributor to how a child’s nervous system develops and learns to respond to stress and trauma (10)Schore, A. N. (2001). “The effects of secure attachment relationship on right brain development, affect regulation, and infant mental health.” Infant Ment Health J 22: 7-66. These effects are not limited to mental and psychological health and behavior.
A 36-year+ prospective study (11)Sroufe, L.A., et al., The Development of the Person: the Minnesota study of risk and adaptation from birth to adulthood. 2005, New York: Guilford Press, which is still ongoing, has found that the imperfections in early relationships can increase risk for physical health problems in adults (12)Puig, J., et al., Predicting Adult Physical Illness From Infant Attachment: A Prospective Longitudinal Study. Health Psychol, 2012. I’ve written a detailed post about this called “Chronic Illness and Invisible ACEs: When your ACE score is Zero.” The 2013 article in Discover magazine, mentioned above about multigenerational trauma, also touches on this topic.
6. Adverse Pre-Onset Triggers (APOEs)
Stressors that cause exacerbations of PTSD are called triggers. The more intense the experience of trauma, the bigger the impact, and the more quickly the pattern gets stabilized. This can lead to an earlier onset of symptoms. Triggers are unique to the individual and to the way a traumatic event was perceived. What constitutes a trigger is therefore different for everyone.
This is similar to chronic illness, where the kinds of stressful events that precipitate the same chronic illness in different people varies. The trigger for one person may be an infection, while for another it is exposure to chemicals or toxins, or to trauma and other difficult life events, among others. I suspect that what these stressors have in common is the ability to stimulate existing patterns of nervous system responsivity and sensitivity to threat. What we see in the trauma and chronic illness model is that the trigger that affects risk varies for each a particular individual and is influenced by past experiences. The more frequent or intense the traumatic events in the past, the earlier the age of onset of chronic illnesses.
7. Adverse Adulthood Experiences (AAEs)
This category includes stressful and traumatic events that happen after our 18th birthdays such as divorce, job loss, accidents, the loss of loved ones and more. Effects of these events can add up over time. Even as they do not trigger the onset of a chronic illness exposures to such events can strengthen cell danger responses and other survival pathways that may eventually strengthen enough to drive symptoms of chronic illness or be tipped over by a final “last straw” triggering event (adverse pre-onset experience or APOE).
8. Adverse Institutional Experiences (AIEs)
I’ve added this category since first writing this post to include the effects of trauma from discrimination of all kinds – whether for gender, race, religion, sexual orientation, ability or disability, chronic illness, mental illness and beyond. See more (and take the mini survey) in this section of my Essential Guide to Nervous System Perspectives on Trauma and Chronic Illness.
See my post on type 2 diabetes for a detailed example of how the effects of discrimination add up to influence risk for chronic illness as well as complications and approaches (or lack of approaches) to treatment.
Mechanisms: Life Events Alter Genes
The emerging field of epigenetics is providing a mechanism for understanding how life events such as stress and trauma that occur in prenatal and early life serve as risk factors for chronic illness (13)Francis, R.C., Epigenetics: how environment shapes our genes [kindle edition]. 2012, W. W. Norton & Company: New York. p. 256. Epigenetic changes occur outside of our DNA and affect how genes behave (read more in an introductory post on epigenetics). Epigenetic factors shape the level of activity of genes, which in turn regulate how our nervous systems and other organ systems work and how we respond to experiences such as trauma and early relationships, diet and exercise and potential perceived threats such as infections and toxins.
Veterans with posttraumatic stress disorder have epigenetic changes not seen in veterans who don’t have PTSD. These epigenetic changes have been found to be reversible following trauma therapy (14)Yehuda, R., et al., Epigenetic Biomarkers as Predictors and Correlates of Symptom Improvement Following Psychotherapy in Combat Veterans with PTSD. Front Psychiatry, 2013. 4: p. 118.
Long-standing studies of people who survived the famine of the Dutch Hunger Winter in World War II have found that starvation during prenatal life affects health in adulthood and that the timing of exposure influences the type of diseases that develop. The study has been ongoing for 70 years and has found that there are multigenerational effects, in that the children of individuals born during the famine have also had an increased risk for disease. When starvation occurs during a war the type of stress that is experienced is not only nutritional but also emotional and potentially physical.
The field of epigenetics is helping us understand how life events affect risk for chronic illness. It is also exploring ways to identify and diagnose chronic illnesses such as chronic fatigue syndrome (ME/CFS). Most importantly, I think, epigenetic research may help identify different approaches for treating chronic illness. If trauma and life events affect risk for chronic disease, for example, treating the effects of these experiences may play an important and as yet completely unexpected role in health.
What of the aspects I love about this trauma and chronic illness model and way of thinking is that it enables those of us with chronic illness to explore such therapies immediately and without having to wait for science to figure it out. Here’s an example of epigenetic discoveries that help explain why asthma cures happen in kids by healing the effects of trauma from very early in life.
The Trauma and Chronic Illness Model
The following is a summary of my ever-evolving trauma and chronic illness model that integrates existing science to make sense of symptoms and chronic disease.
For another, similar point of view, see the book by Gabor Mate, a former family physician. It’s called When the Body Says No (15)Mate, G., When the Body Says No: Understanding the stress-disease connection. 2003, Hoboken, NJ: Wiley & Sons as well as Dr. Robert Scaer’s book mentioned under the section on trauma (16)Scaer, R., The Trauma Spectrum: hidden wounds and human resiliency. 2005, New York: W.W. Norton.
6 Characteristic Patterns of Trauma
1. Initiating Events
Chronic illness arises when our nervous system gets interrupted and learns a reactive pattern from which it is unable to shift. A series of traumatic events, from accidents and abuse, to emotional unavailability and mis-attunement in parent-child relationships, are important initiators and contributors to the development of altered patterns of nervous system regulation. The initiation of patterns leading to chronic illness occurs during critical periods of development, and probably happens very early in life, most likely before birth. Patterns are shaped and influenced, at least in part, by parental emotional and physical environments.
2. Perpetuating Events
Trauma and triggers, whether emotional, physical, or psychological, perpetuate and strengthen a pattern once it has begun, creating what is probably a conditioned response. After a pattern begins, it starts to affect our physiology. It causes occasional symptoms, such as anxiety and depression, fatigue and pain, a rash that is later recognized when lupus is diagnosed, or the formation of antibodies etc. These symptoms, and triggers, are unique to the person, their experiences to date, and to the pattern.
When there are sufficient buffers, including the treatment of trauma and repairs in the parent-child relationship, patterns may never arise, or may soften or even resolve. Patterns emerge and progress when traumatic events during critical periods outweigh buffers.
3. Precipitating Events
The final stressor that occurs before a chronic illness is a precipitator, not a cause. It unmasks an existing conditioned response pattern that has been developing, often over a long period of time. There may be years or decades between the initiation of the pattern, which likely began before birth or earlier, and the onset of chronic illness. This is known as a latency period. I refer to the events that trigger onset as adverse pre-onset experiences (APOEs). Here’s an example from my prediabetes story and weight gain.
4. Symptom Variability
Symptoms and exacerbations are affected by the same types of stressors and triggers that created, perpetuated, and intensified the pattern before the illness ever began. They are therefore unique to each person, rather than to the chronic disease.
5. Interactions between Mind, Body and Emotions
Chronic illnesses of all kinds, including chronic fatigue and other “psychosomatic illnesses” such as fibromyalgia, asthma, and irritable bowel syndrome, are not attempts to get attention or “play the victim.” Chronic illnesses are the result of an interplay between our brains and bodies, thoughts and emotions, and the environment. The patterns that lead to chronic illness occur outside of conscious awareness and are not created by will. Symptoms that cannot be measured or understood are not “all in your head.” Life experiences, including stress, trauma and family dynamics play an important role in the formation of unconscious patterns that can affect our risk for chronic illness. From the perspective of the trauma and chronic illness model, trauma leads the body and brain to baseline levels of increased sensitivity and responsivity to threat. This perception of threat – which is stimulated by unresolved trauma and can outlast traumatic events by decades – is what drives the changes in biochemistry and physiology that cause chronic illness.
6. The Small Stuff is Important
An emphasis I want to make in the trauma and chronic illness model is that we’ve been failing to understand, and therefore notice, the little traumas and life events that happen every day and in the most subtle of ways in people’s lives. These experiences are often considered normal. Or they are minimized. But they, too, affect and shape our nervous systems. Small events are cumulative and play a very important role in risk for chronic illness. Possibly as much or even more important than the large, overt events we commonly think of as trauma.
Insights for Treating Chronic Illness
Reducing stress can resolve some chronic illnesses for some people. Dean Ornish is a physician who believed that stress reduction and lifestyle changes could heal heart disease. He couldn’t get funding for his initial studies because no one believed it was possible to reverse heart disease, let alone treat it through such simple interventions as lifestyle changes. He proved them wrong in study after study after study. So, this is one approach that really works for some.
Leaving medicine, taking a year off and greatly reducing my stress did not improve my fatigue. In fact, my symptoms worsened. Our very definition of chronic illness is that it is unrelenting, and that there is no cure. But some people recover some of the time from chronic illnesses of all kinds. These “anecodotes” are overlooked and often denigrated by many of our current approaches to research, science and medicine, but they are worth their weight in gold. What did these people do to recover? Can any sense be made of their stories? What can we learn from them?
Tony Madrid, Ph.D. is a psychologist in California who stumbled upon an approach for treating asthma in kids by treating trauma. The youngest children in his studies recover fully. The older they get (after about 9 years of age), the less fully they recover, although his treatment approach can still be very helpful in reducing symptoms.
The most fascinating aspect of his research is that he doesn’t treat the kids. He treats their MOTHERS for unresolved trauma that made it difficult or impossible for them to bond with their babies. Treating mothers heals their childrens’ asthma (see his book The Mother and Child Reunion (17)Madrid, A., The Mother and Child Reunion: Repairing the broken bond. 3rd printing. 2010, Monte Rio: AsthmaBusters. Tony helps these moms resolve the traumatic experiences they had during pregnancies, labor and deliveries, and when their kids were young. Their babies’ and kids’ asthma often resolves over night. He’s been finding that when he helps mothers repair their trauma wounds, the innate, underlying impulse parents have to bond with their kids is restored. And that’s when the asthma resolves or improves.
I find his work to be a remarkable statement about the role of trauma and bonding in chronic illness. It supports another tenet from the science of how stress and trauma affect risk for chronic illness, which is that having a chronic illness does not imply you have done something wrong. It’s about what has happened to you.
As I have explored the trauma and chronic illness model over the years I have experimented with and come to like a number of approaches for working with my own chronic illness and addressing the effects of trauma in my own life.
They have turned out to be quite powerful and are helping me to gradually recover and improve. Here are 11 under-utilized tools for treating chronic illness that fit with the tenets of the trauma and chronic illness model. Here’s a post on what trauma therapy and recovery look like.
Different Illnesses, Same Cause?
The literature on how stress and trauma are risk factors for chronic illness repeatedly shows there is no specific event or single risk factor that leads to each particular chronic illness. Rather, it’s about the cumulative effects of environmental stressors such as emotional and physical trauma, infections and toxins and more (18) Naviaux, R. (2018 (epub ahead of print. “Metabolic features and regulation of the healing cycle—A new model for chronic disease pathogenesis and treatment.” Mitochondrian)), (19)Baldwin, D. V. (2013). “Primitive mechanisms of trauma response: an evolutionary perspective on trauma-related disorders.” Neuroscience and Biobehavioral Reviews 37(8): 1549-1566. The adverse life events make us more susceptible to later exposures such as mold, vaccines and other potential stressors.
And so, it is more about patterns. Patterns that are affected by both 1) the timing of trauma, which determines the organ system(s) affected, the type of pattern(s) that develop, and therefore specific type of illness(es) that we may each develop; and 2) the way events are experienced, which leads to either the continuation or resolution of a particular pattern.
These views are not new and come for integrating studies from all kinds of different disciplines (20)Mead, V.P., A New Model for Understanding the Role of Environmental Factors in the Origins of Chronic Illness: a case study of type 1 diabetes mellitus. Med Hypotheses, 2004. 63(6): p. 1035-46; Mead, V.P., Timing, Bonding, and Trauma: Applications from experience-dependent maturation and traumatic stress provide insights for understanding environmental origins of disease, in Advances in Psychology Research, A.M. Columbus, Editor. 2007, Nova Science Publishers. p. 1-80. These studies generally look at one disease, one type of mechanism, or one particular type of trauma. They are usually very distinct and separate. There are studies of all kinds that look at the influence of events in our ancestors’ lives, as well as in prenatal, birth and early life that find a relationship to later physical health. The trauma and chronic illness model integrates the research from these different fields of study to help make sense of chronic illness.
The science of how stress and trauma are risk factors for chronic illness also brings together links between life events and individual chronic illnesses.
Most of these studies are done by different researchers, each looking for causes in different areas and time periods and diseases. The following slide shows some of the studies showing a role for trauma in risk for and development of multiple sclerosis (MS) using perspectives from this trauma and chronic illness model. Most of them find an increased risk for MS in the areas we’ve been looking at in this post.
There is a growing understanding of how stress and trauma are risk factors for chronic illness of all kinds.
In addition to research in MS, I’ve been finding studies that support this model in asthma, type 1 diabetes, inflammatory bowel disease (such as Crohn’s and Ulcerative Colitis), chronic fatigue syndrome (ME/CFS), fibromyalgia, type 2 diabetes, lupus, multiple chemical sensitivities, Parkinson’s, and rheumatoid arthritis, as well as with autism and schizophrenia, among others. Studies in the Fetal Origins of Adult Disease have also been finding relationships between prenatal stress and many diseases in adults ranging from the metabolic syndrome (high blood pressure, cholesterol, weight, and sugar; heart disease, type 2 diabetes, and stroke) to celiac disease, inflammatory bowel disease, and osteoporosis; to autism and asthma.
Chrillogs: Our Chronic Illness Stories
Chrillogs are a new series on my blog introduced February 2021 and are stories aka “chronic illness weblogs.” Chrillogs are about our personal chronic illness journeys as seen through the trauma lens presented above. You will find an introduction to Chrillogs where you will also find a list of other people’s stories (see the bottom of the blog post’s page).
My Chrillog and others help you begin to make sense of your chronic illness or other health problems and discover new tools to support your pathway of healing.
Resources, Books, and Trauma Therapies
Get my free downloadable ebooks+ on the research and how trauma affects symptoms and risk.
Books for Understanding and Working with Trauma
Therapies for Healing Trauma and Nervous System Perceptions of Threat
What You Can Do
Learn more about the many kinds of approaches for working with different types of trauma that can help with symptoms of chronic illness.
Also take a look at my detailed description of 11 tools for health and healing and where I also share some of my story and how I’ve been using these in the past on my own journey of healing as well as during Covid.
Read this Post in a PDF
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|↑1||Doidge, N. (2015). The Brain’s Way of Healing: Remarkable Discoveries and Recoveries from the Frontiers of Neuroplasticity Viking Adult|
|↑2||Shonkoff JP, Garner AS, Committee on Psychosocial Aspects of C, et al. The lifelong effects of early childhood adversity and toxic stress. Pediatrics 2012;129(1):e232-46. doi: 10.1542/peds.2011-2663, p. 234|
|↑3||Levine, P., Waking the Tiger. 1997, Berkeley: North Atlantic Books.|
|↑4, ↑16||Scaer, R., The Trauma Spectrum: hidden wounds and human resiliency. 2005, New York: W.W. Norton|
|↑5||National Research Council and Institute of Medicine, From neurons to neighborhoods: the science of early childhood development. Committee on integrating the science of early childhood development, ed. J.P. Shonkoff and D.A. Phillips. 2000, Board on children, youth, and families, Commission on behavioral and social sciences and education. Washington, D.C.: National Academy Press|
|↑6||Klaus, M.H. and J.H. Kennell, Maternal-Infant Bonding. 1976, St. Louis: Mosby|
|↑7||Klaus, M.H. and J.H. Kennell, Parent/Infant Bonding. 2nd ed. 1982: Mosby. 326|
|↑8||Weaver IC, Cervoni N, Champagne FA, et al. Epigenetic programming by maternal behavior. Nat Neurosci 2004;7(8):847-54. doi: 10.1038/nn1276|
|↑9||The study included 17,000 participants who completed surveys about their childhoods. Their average age at the time of first participation was 57. Participants were followed prospectively for 15 years after completing the surveys. Over 60 papers have been published to date. The researchers Dr. Vincent J. Filetti and Dr. Robert Anda and colleagues have followed 10 areas of trauma in childhood that affect risk for health problems in adulthood and which you can identify to calculate your own “ACE score.”|
|↑10||Schore, A. N. (2001). “The effects of secure attachment relationship on right brain development, affect regulation, and infant mental health.” Infant Ment Health J 22: 7-66|
|↑11||Sroufe, L.A., et al., The Development of the Person: the Minnesota study of risk and adaptation from birth to adulthood. 2005, New York: Guilford Press|
|↑12||Puig, J., et al., Predicting Adult Physical Illness From Infant Attachment: A Prospective Longitudinal Study. Health Psychol, 2012|
|↑13||Francis, R.C., Epigenetics: how environment shapes our genes [kindle edition]. 2012, W. W. Norton & Company: New York. p. 256|
|↑14||Yehuda, R., et al., Epigenetic Biomarkers as Predictors and Correlates of Symptom Improvement Following Psychotherapy in Combat Veterans with PTSD. Front Psychiatry, 2013. 4: p. 118|
|↑15||Mate, G., When the Body Says No: Understanding the stress-disease connection. 2003, Hoboken, NJ: Wiley & Sons|
|↑17||Madrid, A., The Mother and Child Reunion: Repairing the broken bond. 3rd printing. 2010, Monte Rio: AsthmaBusters|
|↑18||Naviaux, R. (2018 (epub ahead of print|
|↑19||Baldwin, D. V. (2013). “Primitive mechanisms of trauma response: an evolutionary perspective on trauma-related disorders.” Neuroscience and Biobehavioral Reviews 37(8): 1549-1566|
|↑20||Mead, V.P., A New Model for Understanding the Role of Environmental Factors in the Origins of Chronic Illness: a case study of type 1 diabetes mellitus. Med Hypotheses, 2004. 63(6): p. 1035-46; Mead, V.P., Timing, Bonding, and Trauma: Applications from experience-dependent maturation and traumatic stress provide insights for understanding environmental origins of disease, in Advances in Psychology Research, A.M. Columbus, Editor. 2007, Nova Science Publishers. p. 1-80|