Have you ever wondered whether trauma can cause the autoimmune form of diabetes? Or if there is, at the very least, any research about links between trauma and type 1 diabetes (T1D)? Or if trauma contributed to your risk of developing some other chronic illness, whatever it may be?
The science backs you.
The research will also help explain why you can be your harshest critic and blame yourself for your chronic disease or symptom flares. It will explain why it’s not your fault for getting sick.
This includes a look at some of writer and media/public affairs consultant Dan Fleshler‘s symptoms, particularly emotional symptoms that society and medical professionals still too often dismiss as less valid or real. These are also consistent with his insight about the role of his seemingly ordinary, everyday triggering event.
Free Series Download
(includes this post)
The series includes 4 diabetes-related blog posts summarizing the research on how adverse life events increase risk for type 1 diabetes. The series includes 3 checklists to get a sense of adverse events that can affect risk for T1D and other chronic illnesses.
I. Dan Fleshler’s Traumatic Experience and Diabetes Onset
Writer and media/public affairs consultant Dan Fleshler was diagnosed with type 1 diabetes in 1962 when he was 7 years old. His symptoms started within hours of visiting his grandmother Pearl, after his grandfather died:
… As soon as we arrived at Pearl’s apartment in Morningside Heights, my mother and grandmother … hurtled towards each other, … letting loose with wild high screams just before they embraced. This was the first time I had ever heard the sounds of raw grief, and I was terrified …
That evening, I got an ear ache and began to guzzle massive amounts of black cherry soda. The next morning, there was a scratchy throat and more thirst. Two days later … I was rushed to Babies Hospital in Upper Manhattan (from Dan’s Blog).
Dan’s grandfather had been in a nursing home with Alzheimer’s when he died and he hadn’t known him very well. It wasn’t therefore the loss of his grandfather that was so traumatic for Dan but the fear triggered by the almost unrecognizable sounds coming from the ones he was closest to:
I have always assumed that the keening sounds from the women I loved were partly responsible, and even now, flashbacks of that 7-year-old boy fleeing from grief still recur sometimes, of their own accord.
… When I was a kid, the conventional wisdom was that traumatic events — loss of a loved one, accidents — played an important role in diabetes onset. This appeared to be substantiated by a number of population studies in the ensuing decades, but the evidence hasn’t impressed major players in diabetes research … the NIH barely touches upon the matter, gives it a few throwaway lines …
Sorry, NIH, but I am convinced that a specific traumatic event played a major, albeit partial, role in triggering my diabetes.
II. Symptoms Consistent With Trauma
Like so many other children, Dan’s experiences fit well-known characteristics of trauma even though the event that triggered onset may have seemed remarkable for its seeming “ordinariness.”
Just as trauma is an underlying driver and risk factor for type 1 diabetes according to the significant amount of research completed to date, it may also be driving many of Dan’s other symptoms. To reiterate, this is not because these symptoms are psychological, but because adverse life events alter genes and have many different effects on long-term health (1)Shonkoff, J. P., et al. (2012). “The lifelong effects of early childhood adversity and toxic stress.” Pediatrics 129(1): e232-246, (2)Romens, S. E., et al. (2015). “Associations between early life stress and gene methylation in children.” Child Dev 86(1): 303-309.
1. Trauma is About Perception and Meaning
Contrary to what is generally believed, potentially traumatizing events are not only from exposure to war, natural disasters or physical or sexual abuse.
Trauma is about how we experience an event and what it means to us.
The experience of trauma is therefore about perception rather than a particular type of event (3)McFarlane, A. C. and G. De Girolamo (1996). Chapter 7: The Nature of Traumatic Stressors and the Epidemiology of Posttraumatic Reactions. Traumatic stress: the effects of overwhelming experience on mind, body, and society. B. A. van der Kolk, A. C. McFarlane and L. Weisaeth. New York, Guilford: 129-154, p. 138. An event can be traumatizing because it feels horrifying, overwhelming or shocking; or because it is beyond our ability to manage or cope with or adapt to.
In Dan’s case, it was an experience of terror from something he had never encountered before. One that involved the caring adults most involved in his sense of safety and belonging.
I have started to refer to these types of triggering events as “Adverse pre-onset experiences” or (APOEs). APOEs show similar patterns in all kinds of chronic illnesses. One common factor is that there are usually a number of stressful or traumatic experiences before the one that is the last straw. The effects of these adversities add up over the years if there is not enough support or when the body is unable to resolve or adapt to them. Then there can then be a single, isolated event that triggers a full blow onset of disease (see more in #9 below).
Healing trauma, even months, years, or decades after an event can help to relieve and shift the perceptions and our sense of meaning. That’s why it’s helpful to understand the links and that the research supports it.
2. Children are Vulnerable and Sensitive
Babies and children are inherently more vulnerable than adults because they are unable to fully and independently care for their own needs.
Like other young animals, children are more sensitive to their environments and to whether or not they feel secure and in safe hands. Psychologist and trauma expert Peter Levine, Ph.D., who has been developing and refining ways of helping children and adults heal from trauma since the 1970s (4)he developed the somatically based approach for working with trauma known as Somatic Experiencing explains how even loud sounds “such as thunder and angry shouting” can be overwhelming – and experienced as potentially life-threatening – by babies and children (5)Levine, P. (2005/2008). Healing Trauma: A pioneering program for restoring the wisdom of your body. Boulder (CO), Sounds True, p. 11.
For Dan it was the unfamiliar sounds of raw grief.
The good news is that it is possible to heal the effects of childhood trauma even in adulthood.
3. Parental Experiences of Trauma and Loss
Events that are traumatic for parents – including loss and grief – can have a profound impact on their children.
Parental states of emotional distress can have important influences because their babies’ and children’s brains and development are shaped by interactions with their environments. Parents are THE primary environment for kids (6)Siegel, D. and M. Hartzell (2003). Parenting from the Inside Out. New York, Tarcher/Penguin, see Chapter 5.
The All Babies in Southeast Sweden (ABIS) study followed 10,000 babies. Two-year-olds who had antibodies associated with risk for T1D had three times more exposures in which their mothers experienced domestic violence or divorce (7)Sepa, A., et al. (2005). “Mothers’ experiences of serious life events increase the risk of diabetes-related autoimmunity in their children.” Diabetes Care 28(2394-2399. Abstract and Full Text. This and other studies from antibody patterns have found that the evolution of T1D occurs over many years (8)Steck, A. K., et al. (2011). “Age of islet autoantibody appearance and mean levels of insulin, but not GAD or IA-2 autoantibodies, predict age of diagnosis of type 1 diabetes: diabetes autoimmunity study in the young.” Diabetes Care 34(6): 1397-1399, (9)Ziegler, A. G., et al. (2013). “Seroconversion to multiple islet autoantibodies and risk of progression to diabetes in children.” JAMA 309(23): 2473-2479, (10)Knip, M., et al. (2005). “Environmental triggers and determinants of type 1 diabetes.” Diabetes 54 Suppl 2: S125-136.
The ABIS results published in 2015 showed that a parent’s loss of a loved one, such as the loss of their mother. father or of a child, were one of the serious life events associated with increased risk for T1D (11)Nygren, M., et al. (2015). “Experience of a serious life event increases the risk for childhood type 1 diabetes: the ABIS population-based prospective cohort study.” Diabetologia 58(6): 1188-1197.
Understanding trauma explains how it’s not only abuse, neglect or the other types of obvious forms of extreme trauma that are associated with increased risk for autoimmune diseases such as type 1 diabetes. It’s also seemingly ordinary, everyday challenges that can influence risk.
To restate it one more time, trauma can come in many forms including events that can appear minor.
Important information for parents to know is that taking care of themselves – including obtaining the support they need to recover and heal from their own traumatic experiences and losses – is an under-appreciated and powerful tool for helping them maximize their children’s health (12)Madrid, A. (2005). “Helping children with asthma by repairing maternal-infant bonding problems.” Am J Clin Hypn 48(2-3): 199-211.
4. Flashbacks are a Symptom of Trauma
Flashbacks are involuntary memories from past events that are re-experienced in the present. They are different from regular memories in that they feel as though they are happening right now. They include many elements from the original event, such as the feelings and physical sensations that happened at the time. As a result, flashbacks can be especially distressing. These memories are formed in different ways from other memories and do not change with each occurrence.
Flashbacks are one of the criteria for the diagnosis of post-traumatic stress disorder (PTSD) along with intrusive memories or nightmares. They indicate that past trauma remains unresolved.
Dan still experiences flashbacks from the traumatic event that triggered the onset of his type 1 diabetes, even though it happened decades ago. This is common in trauma.
Flashbacks
- are often triggered by reminders of past traumatic events
- evoke states of distress
- occur outside of our control
- can occur without our realizing what’s happening
- and can take place at any time
Dan’s flashbacks have the characteristic of unpredictability: “flashbacks of that 7-year-old boy fleeing from grief still recur sometimes, of their own accord” (13)Lawrence-Wood, E., et al. (2015). “Re-experiencing phenomena following a disaster: The long-term predictive role of intrusion symptoms in the development of post-trauma depression and anxiety.” J Affect Disord 190: 278-281. Abstract. Flashbacks are one of the symptoms of trauma that can improve or heal by working through and beginning to address and resolve difficult events. It is not often known that such symptoms can actually heal or resolve. Knowledge from the field of traumatic stress, however, offers insights and the potential for new tools for those of us with chronic diseases to consider.
5. Self Blame is a Symptom of Trauma
Dan has personally experienced the common characteristic in which “people with diabetes (PWDs) often blame themselves for their inability to tame the beast of blood sugar” (14)Fleshler, D. (2014). Diabetes, Depression and Chasing Away the Dybbuk. The Insulin Chronicles. D. Fleshler. USA. 2015.
While self blame is common for those of us with chronic illnesses of all kinds (myself included), trauma research shows is that it is also a characteristic of unresolved trauma.
Self blame, guilt, shame and other negative beliefs are symptoms used for the diagnosis of PTSD (15)Yehuda, R., et al. (2015). “Post-traumatic stress disorder.” Nature Reviews Disease Primers October: 150-157. Table 1. Abstract..
This is not saying that Dan has a diagnosis of PTSD but that this symptom is another reflection that trauma occurred in his life and may be the cause of both his type 1 diabetes as well as his other symptoms.
Here too, healing is possible using tools that are not yet commonly known or recommended in medicine nor in traditional approaches to mental health. I had never heard of them when I was a doctor until I looked into the research. I especially learned about them when I retrained in the field of trauma therapy and began experimenting with my own numerous symptoms.
Learning about the effects of trauma introduces approaches for working with the nervous system and offers the potential for supporting greater ease and growing back in feelings of self-respect and self-confidence. It can also help each one of us recognize that feelings of self-blame are associated with past events rather than truth or current reality.
Our bodies are designed to heal. Sometimes it helps to have the added support from therapy and other approaches, especially if we already experience effects of trauma.
6. Depression is the Most Common Symptom of Unresolved Trauma
Self blame is a common symptom of depression. And depression is one of the most frequent symptoms of unresolved trauma, whether as part of PTSD or as a separate symptom (16)McFarlane, A. C. and G. De Girolamo (1996). Chapter 7: The Nature of Traumatic Stressors and the Epidemiology of Posttraumatic Reactions. Traumatic stress: the effects of overwhelming experience on mind, body, and society. B. A. van der Kolk, A. C. McFarlane and L. Weisaeth. New York, Guilford: 129-154, p. 137.
Dan has experienced significant depression for decades:
One night in the middle of my senior year of college when I could not get out of bed, and I could not taste my food, and I could not answer the phone … I felt that there was something vile and rotten coursing through my blood … [The] black dog of depression never seemed very far away. And I could never fully account for it. Somehow my particular set of stories, and my particular capacity to overcome them, and what little I knew about biochemistry never came close to explaining it … there often seemed to be something from somewhere outside of myself that grabbed hold, or threatened to grab hold, something beyond my control and imagining (from Dan’s blog post on Diabetes and Depression).
What Dan describes is something many of us with chronic illness see to understand for years if not decades: a way of making sense of why our emotions seem so unwieldy and out of our control; why we feel so much to blame for our chronic diseases and symptom spikes, or why we sometimes have such difficulty in tolerating treatment or in getting better.
Our understanding of trauma, still relatively unknown in medicine and in the clinical treatment of chronic illness, provides a remarkably large context for understanding a host of symptoms that most of us who are living with chronic illness experience on a regular basis.
My own experiences of depression started in childhood, continued through my medical training and gradually improved afterwards as a result of career and lifestyle changes. But it was also due to healing effects of trauma with trauma therapies that work with the nervous system.
Dan has made significant progress in healing his symptoms of depression too and his story (more below) shows that there are many ways of healing from trauma that do not include a specific focus on trauma or trauma therapy.
7. Flashbacks are a Predictor of Depression
An Australian study followed over 500 children for 28 years after they experienced a natural disaster in the form of a major brush fire. Twenty years following the event 75% of participants still experienced intrusive states such as flashbacks and painful reactions to reminders of the fire (17)McFarlane, A. C. and M. Van Hooff (2009). “Impact of childhood exposure to a natural disaster on adult mental health: 20-year longitudinal follow-up study.” Br J Psychiatry 195(2): 142-148. Full Text p. 146.
Eight years later participants who experienced intrusions such as flashbacks were also more than 4 times as likely to experience major depression as the participants who did not (18)Lawrence-Wood, E., et al. (2015). “Re-experiencing phenomena following a disaster: The long-term predictive role of intrusion symptoms in the development of post-trauma depression and anxiety.” J Affect Disord 190: 278-281. Abstract..
The emphasis the authors made is that symptoms such as flashbacks are an important indication of unresolved trauma even when a person does not meet diagnostic criteria for full blown PTSD. Such symptoms can provide important markers for noticing early effects of trauma and predicting future effects outside of the presence of PTSD.
8. A Sense of “No Future” is a Symptom of Trauma
Another symptom that Dan articulates in his New York Times article is his lifelong sense of “impending death.”
Dan has spent much of his life expecting that any time he had after the age of 35 was a bonus because of the complications associated with diabetes. This is a completely natural response when faced with the trauma of living with an incurable, life-threatening disease. It could also be an indication of trauma prior to the onset of T1D.
Dan’s inability to envision himself farther out than a year into the future has a name in the field of trauma. It is referred to as a sense of a “foreshortened future.” It is another criteria in the diagnosis of PTSD.
Guidelines for PTSD have “been expanded to include persistent negative expectations regarding many aspects of life rather than just a focus on negative expectations about one’s lifespan.”
When Dan’s endocrinologist told him that he could live for decades more he was floored.
Over the years, the likelihood of impending death was usually not a conscious obsession; it was more like a background hum, akin to annoying traffic noise outside an apartment building. But it was always there when I decided to stop ignoring it. One consequence was an anxious urgency to get things done.
Dan’s sense of future began to shift after that chance remark from his doctor.
The prospect of longer life brings … unexpected challenges. For one, I’m confronting the tangible possibility of retirement for the first time. While I’ve put aside money for that purpose and my wife and I have met with financial planners, these were dutiful gestures for the sake of her and our daughter. Their future demanded a kind of automatic tribute, but not mine, as I could never envision myself in a time period that stretched more than a year or so from the present.
The shift in Dan’s sense of a future is another marker of how we can begin to heal from old trauma in many different ways. Such as when a doctor or other professional who is a holder of knowledge and in a position to assist us with debilitating diseases and other threatening circumstances – shares encouraging, optimistic or supportive information.
Dan’s experience is another indication of how symptoms of trauma can heal at any time, sometimes in the simplest of ways. And how important it is for health care professionals to learn about trauma and understand that its effects include and also go beyond the psychological. This is part of what it means to become trauma-informed.
9. Trauma is a Risk Factor for Type 1 Diabetes and a Trigger for Onset
Trauma is the well-known trigger for PTSD. Post-traumatic stress disorder was initially studied in soldiers and research has found that the greatest risk of developing PTSD is for those who have experienced prior trauma, especially if it’s been severe, repeated, or at a young age (19)Halligan, S. L. and R. Yehuda (2000). “Risk Factors for PTSD.” PTSD Research Quarterly 11(3). Full Text. The event that triggers the onset of PTSD is therefore usually the last in a series of stressors rather than the first or only event.
The same pattern is seen in chronic illnesses of all kinds, including T1D.
It is also becoming more and more clear that trauma is a driver of type 1 diabetes as well as a trigger for onset (here’s a review of the trauma and T1D research).
Rather than being the sole cause of T1D, the event that triggered Dan’s T1D was likely the last in a series of adverse events whose effects were cumulative.
I’ve shared some of the research identifying serious life events as triggers for the onset of T1D in the review mentioned above. I’ve also written about increased risk for T1D from trauma that occurs at earlier times in life, such as during pregnancy and birth.
Recent science finds that environmental stressors – from infections and toxins to physical and psychological trauma – can all trigger the cell danger response and defense mechanisms in the body. While our bodies are designed to recover from such exposures, they can get stuck in a prolonged cell danger response if too many things happen too fast and the body is unable to recover fully in between exposures.
Although most relevant treatment modalities remain poorly known in medical care, there are ways of healing effects of trauma from early in our lives and even from our parents’ and grandparents’ lives. Here’s a list of my favorite books and therapies for working with the effects of trauma that are relevant to chronic illness.
III. Depression: A Symptom of Trauma That is Also More Common in Diabetes
In 2012 Dan discovered a New York Times article by Alice Dembner that explained how depression is much more frequent in both type 1 and type 2 diabetes (type 2 is the more well-known and common form of diabetes that usually does not require insulin for treatment). It was something none of his doctors had ever named, asked about or explained to him.
Depression is twice as common in people with diabetes as it is in the general population. It affects 1 person in 4 with diabetes.
The research establishing links between depression and diabetes was not something I ever heard of in my medical career either and it was not until I started exploring potential relationships between trauma and type 1 diabetes that I learned of it (20)de Groot, M., et al. (2001). “Association of depression and diabetes complications: a meta- analysis.” Psychosom Med 63(4): 619-630, (21)Anderson, R. J., et al. (2001). “The prevalence of comorbid depression in adults with diabetes: a meta- analysis.” Diabetes Care 24(6): 1069-1078.
Researchers don’t understand the causes of this depression yet but are finding changes in brain chemistry, in nervous system functioning and the HPA axis (hypothalamic-pituitary-adrenal axis) and in cortisol in people with depression and diabetes (22)Holt, R. I., et al. (2014). “Diabetes and depression.” Curr Diab Rep 14(6): 491. Abstract and Full Text.
They’ve also found that depression in diabetes is harder to treat, lasts longer, and recurs more often in people with diabetes.
When looked at from a trauma perspective, the fact that depression can occur before the onset of diabetes introduces the possibility that what causes depression may also be what causes T1D.
Patterns described above in #6 and #7 support the literature suggesting that trauma is an underlying cause of type 1 diabetes as well as a cause of depression.
Here, too, healing from the effects of trauma can relieve and dissipate even long-standing symptoms of depression.
IV. The Research: Trauma and Type 1 Diabetes
The cause of type 1 diabetes is only partly due to genetics.
Fifty percent (50%) or more of risk is due to environmental (non genetic) risk factors (23)Pociot, F. and A. Lernmark (2016). “Genetic risk factors for type 1 diabetes.” Lancet 387(10035): 2331-2339, (24)Michels, A., et al. (2015). “Prediction and prevention of type 1 diabetes: update on success of prediction and struggles at prevention.” Pediatr Diabetes, (25)Eringsmark Regnell, S. and A. Lernmark (2013). “The environment and the origins of islet autoimmunity and Type 1 diabetes.” Diabet Med 30(2): 155-160.
Researchers have been looking at environmental risk factors such as diet and cow’s milk, infections, parental socioeconomic status, seasonality, birth weight, vitamin D and more. New research has grouped risk factors like these together and found that they can all trigger a cell danger response.
The kinds of serious life events that affect risk, as we see in Dan’s story, are often so subtle that we fail to recognize them.
It would be easy – and quite common – to dismiss the event that triggered Dan’s diabetes as “trivial” (26)McFarlane, A. C. and G. De Girolamo (1996). Chapter 7: The Nature of Traumatic Stressors and the Epidemiology of Posttraumatic Reactions. Traumatic stress: the effects of overwhelming experience on mind, body, and society. B. A. van der Kolk, A. C. McFarlane and L. Weisaeth. New York, Guilford: 129-154, p. 138. To say that it was not serious enough to be considered life-threatening or traumatic. But events do not have to be extreme to affect our nervous systems, our health or to trigger onset of a chronic disease such as T1D.
Even though they can be subtle and poorly recognized, they are risk factors nonetheless.
The study in Sweden I referred to earlier followed 10,000 babies from the general population for 15 years. Serious life events were three times more common in children who developed T1D after their toddler years than in their counterparts who did not (27)Nygren, M., et al. (2015). “Experience of a serious life event increases the risk for childhood type 1 diabetes: the ABIS population-based prospective cohort study.” Diabetologia 58(6): 1188-1197. Abstract. The findings were presented in the media around the world, including in the New York Times, Time Magazine, and Reuters.
The adverse childhood experiences (ACEs) studies also repeatedly show that trauma increases risk for chronic illness, including T1D and other autoimmune diseases. Many of these events are the same as the SLEs included in the ABIS study questionnaire.
The ACE studies find that risk for autoimmune diseases such as T1D increases with each additional adverse event a child is exposed to (28)Dube, S. R., et al. (2009). “Cumulative Childhood Stress and Autoimmune Diseases in Adults.” Psychosom Med 71(2 %U http://www.psychosomaticmedicine.org/cgi/content/abstract/71/2/243 %8 February 1, 2009): 243-250, p. 245. Full Text.
V. Why Care About Trauma if You Already Have Type 1 Diabetes?
Insights from research in traumatic stress is typically relegated to the field of mental health and overlooked when evaluating trauma as potential contributor to risk for chronic physical diseases such as T1D.
The science, however, offers a fresh and comprehensive perspective on how the pieces of Dan’s puzzle may make sense of his experiences, symptoms, diagnosis and the larger picture.
While trauma is recognized for its ability to cause psychological symptoms such as those seen in PTSD, the patterns identified in the development and expression of PTSD show that trauma can also affect our biology and physiology. These patterns suggest that trauma leads to PTSD in some people while it leads to chronic illness in others or to both in some.
This is not because chronic illnesses are “psychological” when linked to trauma, but because difficult life events have a greater impact on all aspects of our health than has been appreciated.
Trauma and adverse events also alter our genes.
The value in understanding the role of trauma is that it offers hope for those of us with chronic illnesses of all kinds.
Hope because working with trauma can be helpful in reducing symptom flares as well as some of the ups and downs that seem so inherent when you have a chronic illness.
Healing trauma also offers the possibility of symptom improvement (here’s a post showing that treating early trauma, which is often recognized, can cure asthma in kids). From research as well as personal experience over the years, I hypothesize that it may also help reduce complications after the onset of chronic illness.
Understanding trauma has helped me make sense of my own illness and addressing the effects of trauma has helped me begin to heal.
My great curiosity is whether the resolution of trauma can, over time, offer significant or even full resolution of symptoms for myself, for individuals with type 1 diabetes, as well as for others with different chronic illnesses.
There’s no clear or quick fix and it’s not a direct or linear path – but what if it is possible? This as an area that is well worth exploring.
In the long run, the research suggests that resolving trauma may serve as a powerful tool for reducing symptoms of chronic illnesses such as T1D as well as in potential prevention.
Understanding chronic illness from a trauma perspective shows us why humans are sensitive to challenging life events – which happen outside of our control – rather than being to blame for having caused our illnesses.
Understanding the role of serious life events in the development of chronic illness is about how trauma affects biochemistry and physiology and not just about our psychology. The emerging science is changing the paradigm of how we make sense of and understand chronic illness and other health conditions (29)Shonkoff, J. P., et al. (2012). “The lifelong effects of early childhood adversity and toxic stress.” Pediatrics 129(1): e232-246.
VI. Healing from Trauma
It may not be clear whether Dan’s sense of a foreshortened future comes from the trauma of living with a life-threatening chronic disease (30)Alonzo, A. A. (2000). “The experience of chronic illness and post-traumatic stress disorder: the consequences of cumulative adversity.” Soc Sci Med 50(10): 1475-1484. Abstract or from childhood experience(s) or both, but chances are that his perspective has been the result of accumulated life-time experiences of trauma. Just like the rest of us, including so many of us living with chronic illness.
The good news is that the cheery, light-hearted message from his doctor may have helped Dan’s system resolve some of his trauma even now and even though he still has a chronic illness.
And it’s inspiring and encouraging to see just how many ways healing can happen.
Even a single interaction, such as Dan had with his endocrinologist, can shift the direction of our perspectives and of our lives.
Following his doctor’s comment and the process that it elicited for him (along with other practices Dan is implementing, a number of which he refers to in the quote below) is lightening and enlivening Dan’s world.
Some of the symptoms Dan experienced that may represent unresolved effects of trauma were beginning to shift at the time I first wrote this blog post in 2015.
His descriptions included some of the very same kinds of changes we see as therapists when the resolution of trauma begins to happen.
This process offers the kind of hope that comes with healing:
Astonishingly, I’ve made a little progress lately. A meditation practice that I’m taking seriously has helped me focus more intently on what’s in front of me. The world sometimes seems more vivid, and I’ve even been cheerful while laughing at an inane reality TV show with my daughter, and holding my wife’s hand and walking in the woods, and praying at a new synagogue we’ve recently joined. The improvements are incremental, and I don’t yet have confidence that in 20 or 30 years I will be a different person. But I have some cautious hope.
Learn more about Dan on his blog The Insulin Chronicles and in his articles in the New York Times and the Huffington Post.
Get the PDF or Kindle on Trauma and Type 1 Diabetes
Learn more about the role of trauma and how it affects risk for type 1 diabetes as well as other autoimmune and chronic physical diseases in these two free downloads. Book 1 is an overview of how trauma shapes health. Book 4 describes the role of adverse babyhood events (ABEs) in initiating as well as shaping risk for chronic disease. Although I focus on chronic illness in these books and on my blog, the science applies to all chronic health conditions including mental health conditions, chronic pain and beyond.
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For another story, read Justice Sonia Sotomayor’s memoir or a synopsis of her story and childhood onset of T1D in my Guide to Chronic Illness, Trauma and the Nervous System (under Adverse Childhood Experiences). It’s also in chapter 7 of my free ebook 1, An Overview of Trauma (downloadable here).
You can learn more in my blog posts about how trauma has been a suspected risk factor for T1D for 2000 years and the top reasons it has been (mistakenly) dismissed. Here’s the research about how stressful events in pregnancy, birth and infancy increase risk for T1D and my review of 25 years of trauma research in diabetes showing that it can trigger onset. Similar risk factors exist for asthma. Helping mothers heal from these difficult experiences, which occur outside of their control, helps improve and often cure asthma in their children. Understanding trauma helped make sense of my own chronic illnesses and gradually helping me to heal, including from asthma and chronic fatigue (ME/CFS). Here’s a list of books and therapies for healing the effects of different types of trauma by working with the nervous system, and a list of my favorite tools that support healing.
Related Posts:
#1 Early Trauma and Autoimmune Disease: Clues from Antibodies, Birth & Type 1 Diabetes
#5 Stress, Trauma and Type 1 Diabetes (Why Doctors Don’t Know the Research)
Essential Guide to Chronic Illness, Trauma and The Nervous System: Keys to Quelling the Volcano
The Cell Danger Response: The New Disease Paradigm (Diabetes, Metabolic Syndrome, ME/CFS and Beyond)
References
If the mind can cure (according to some) the mind can damage. As far as physical trauma causing T1D, absolutely. I had a cousin went to his annual physical with the whole work-up for his insurance. On the way home he was in a car-accident and the car went off the road and wasn’t found for two days. A highway patrolmen finally found him and they got him to a hospital. When he got blood-work at the hospital they found out he was T1D. The blood tests from his physical showed normal, not even slightly elevated, blood-sugar.
Hi Jon,
Your cousin’s story is very poignant – especially that he was not found for two days. What a remarkable example of trauma as a trigger, and with two back to back sets of labs to boot. It must have been a hard way to get diagnosed with a chronic illness on top of it all. Research papers as far back as the late 1800s and some from the 1930s and 40s have a number of very similar stories of sudden onset of T1D. Some of the later years have diagnoses right after car accidents in particular. Thanks for writing with your example.
I have type 1 and also believe that stress and a traumatic accident are the reasons. When I was a teenager, a car backed up and hit the passenger side of my Moms car while I was getting in. My legs were still outside the door when the other car backed up into the door, closing it on my legs. I ended up with 2 scars on each leg. Soon after, the scar on my right leg changed, and started to spread 4-5 inches beyond the original scar. My Dr. did a biopsy and told me I had diabetes. There is a name for what appeared near the scar on my leg but I can only remember the first word which is necrotiting.
Hi Emily,
Thank you so much for sharing your story. I’m so sorry about your accident – it sounds like the spreading of your scar with what was perhaps a severe infection known as necrotizing fascitis was tremendously stressful and possibly life-threatening and traumatic in addition to the trauma of getting backed into like that.
Because healing from trauma can benefit symptoms in chronic illnesses of all kinds I’m curious about whether other events might have influenced your risk for T1D (and you don’t have to answer any of these questions here in the public eye. It’s just food for thought in case it might be helpful.) I wonder from the perspective that stress and trauma play a role in chronic illness whether, when looking back after your diagnosis, you ever noted other symptoms of type 1 diabetes that happened (perhaps only briefly) before this traumatic event. Such as whether you experienced other stressful or traumatic events before this one – including a difficult time during pregnancy when you were in the womb or at the time of your birth or if there were losses in you or your parents’ lives in your childhood etc (I write more about this in The Chronic Illness Model and in my free doanloadable ebook). These types of difficult experiences appear to contribute to the evolution of chronic illness such as T1D and what I’ve been learning is that healing unresolved effects from such events may help stabilize or ease or reduce symptoms of a chronic illness (such as difficult or hard to predict/prevent highs and lows in T1D). This is not because T1D or other diseases are “all in our heads,” but because of what we’ve learning about it’s effects on our bodies and on our physiologies and nervous systems.
Thanks again so much for sharing your experience and I wish you all the best on your journey!
Hi Veronique. I searched online for the name of the reddish scars on my legs. It is called Necrobiosis Lipoidica Diabeticorum. I found a picture online and will post if I can. I had a great deal of stress and trauma growing up, before the accident and my Mom had a very long and complicated labor when I was born. I believe stress and traumatic events are the reason I have type 1. I have brothers and a sister, I am the oldest and they don’t have it.
Hi Emily,
Thanks for sharing more of your story. It really sounds like you experienced a significant accumulation of stress and trauma. I’m so sorry to hear it. How have you coped with linking these difficult events and your diabetes?
I also just looked up NLD and see how severe it can be and that it is also commonly associated not only with diabetes but also with local trauma, such as you experienced (here’s a link on wiki that includes a picture). It sounds as though you experience coming and going of this issue that is on both of your legs. Do you notice any links to this and any other symptoms relating to stress or reminders of past traumatic events (sometimes links to past events can be very overt and other times they can be quite subtle)?
Thank you Veronique. The NLD on my legs gradually improved as I started taking insulin and after my blood testing numbers went down. When I was admitted into the hospital, my blood sugar was 600. I can still see where the NLD was, looks kind of shiny with visible blood vessels and light brown. Since it appeared near the scar from the accident and shortly after the accident, I always thought there was a connection to my diabetes. I still have a lot of stress, always worry and nervous and think of past traumatic events, situations. If the accident never happened and I only experienced a minimal amount of stress, had a normal childhood without trauma, would I still have it or would it have decreased the chances. If other auto immune diseases are caused by stress and trauma, it’s hard to believe Type 1 is not.
Hi Emily,
I think it is gathering detailed stories like yours and Dan’s in this post and mine and others – that we will begin to see the connections between traumatic events, reactivity to stress later in life, and chronic illnesses of all kinds. Phew – 600! So glad you are still with us! and that your NLD is not an issue.
Given how you describe still experiencing a lot of stress and worry and thinking of past events have you ever sought to heal the wounds and effects from these old traumas? I have a blog page with different approaches for working with trauma that I respect and use myself, and that I have found and continue to find very helpful. It’s a slow process when working with multiple and complex issues – but it is powerful and makes a difference – emotionally and psychologically, but in the long run it may help the physiology too (blood sugar stability, slowing down rates or risk of long term side effects of T1D etc…). It is possible to work with all the different kinds of traumas (from prenatal and birth events to childhood events to the accidents and other stressors that trigger onset) – it’s in my blog post on Therapies (updated 10/8/21 to update the link).
Hello, I’d like to share my story as well.
I’m almost certain I have this trauma triggered T1D.
I’m 21 now.
Diagnosed 6 years ago.
I’d lived all of my life with my grandma in same house. We knew she was going to die few weeks before her death. I was so sad, I used to cry while lying next to her when she was in her bed.
She died and next day, blood tests confirmed my diabetes (BS 550). I was having symptoms for 9 days before that at the time I already knew she won’t be here anymore.
You really have a point about self
blame etc.because over the years I had many dreams, real feel dreams where she was alive and sick and in that dreams, I was curing her with natural things (about which I’ve started studying when I was diagnosed, because I’ve started to care about general health much more after I was diagnosed, so I’m very wise about healthcare now since of my many problems with health I’ve encountered during past years with diabetes. I was soo healthy before my diabetes tho). And I had a lot of these dreams during years after she died. Although I wasn’t thinking about her consciously during days at all, but I’m maybe thinking about her somewhere deep although I dont realize about that at all, so she sometimes subconsciously appeared in my dreams this way. These dreams subsided now and I don’t remember dream like that in a months or maybe even a year.
I downloaded your book and will try to find some time to read it.
Do you think it can be somehow improved now after 6 years by, let’s call it, mental couching? Even if my dreams with healing her subsided?
I have many other issues which certainly contribute to my hardly manageable diabetes, because when I do everything same e.g.for 2 days, and then compare thmm,one day my BS after breakfast(same time same meal same insulin dose) was 74 and the other day 240!!..so I have to measure my BS 6 times a day because every day is different. I’d taken some pancreas regenerators few years back and trying to stay away from diary as much as possible, and I still produce some insulin myself after 6 years! And my insulin doses are not that high, but every day is different for me. I will try to use that regenerants again and see what happens.
Great post!
Hi John,
Thank you so much for sharing your story. I’m so sorry that you lost your grandmother. It is really painful to lose someone we love. I’m glad you were able to lie in bed with her and be with her during her final days. The fact that it all happened so fast – her death, your symptoms and the onset of your diabetes – probably made it more difficult too.
From my understanding of trauma it is my sense that trauma therapy could be helpful although I don’t know to what extent. At the least, I would think it could, over time, help you gain more stability with blood sugars such as by possibly decreasing the variability in your sugars. This could be that it makes your sugars – and nervous system – more “stable” as trauma patterns heal. Another way it might help would be to give you more awareness of subtle things influencing your body and nervous system (and therefore your sugar levels), such as allowing you to track very subtle sensations, emotional shifts or “triggers.” Triggers are unconscious reminders of past traumas you may not even be aware of (they can be very subtle). My own experience is that trauma therapy is very powerful but is not a quick fix and takes time. My big question is just how far our chronic illnesses can change as we heal.
Here are a few blog posts that might be helpful if you haven’t found them already. They offer a shorter intro before you dive into the book:
Different approaches for working with trauma. You could start with working with the feelings and dreams that happened when your grandmother died as they may be accessible and have just gone a little underground.
The research suggests that the kind of stressful event you experienced that triggered the onset of your T1D is not likely the cause but the last stressful event in a series. Here’s more info about the types of trauma we can experience without recognizing them, which can influence what type of therapy you try:
The Chronic Illness Model
Here’s a little more detail about traumatic events during pregnancy and around the time of birth that affect risk for T1D (and other chronic illnesses). There are ways of working with these in the approaches link.
best wishes to you on your journey and let me know how things go if you are up for it. xoxo
Relevance to ME/CFS and Other Chronic Illnesses,So much convenient.
Yes, relevance to so many different kinds of chronic illnesses indeed.
I got type 1 diabetes in 1975, age 15. On 1st April 2018, I hit 43 years of type 1. I had experienced repeated childhood sexual, physical, ritual and emotional abuse and still being sexually abused at 15, blocked out as soon as it happened. I had just started to menstruate regularly when I was diagnosed. I link it to the abuse and the risk of pregnancy to my father. My periods were irregular the rest of my life and this I feel was protection. Totally convinced of the link.
Wallaroo
Hi Wallaroo,
I’m so sorry you went through all that as a child and I appreciate the clarity you have around the links between your T1D and those horrific experiences. Our bodies are amazing in the ways they protect us and it makes complete sense to me that your periods could have supported your survival by being irregular. I suspect that’s what our chronic illnesses are – a trade off between the unbearable and surviving. Glad you’re here these 43 years later! Thanks for sharing your story here.
Veronique
Good evening Veronique.
My 16 year old daughter was diagnosed in mid June of 2017. Leading into her DX, she had a very stressful month…year actually. January, March, and June of the same year she feared and refused to visit her mother in Colorado (we live in California). This is also the time in which she mustered the courage to expose her mom as a person who had physically and verbally abused her on a regular basis for many many years. Add to this the events that occurred in the first two weeks of June: Kara is (was) dreadfully afraid of needles and had blood drawn for tests…she fought and cried…it was tough for them to draw her blood and it was a very big ordeal. A week later, she again refused to get on an airplane to visit her mom…this was again very stressfull. Lastly, she became aware under moms threats of an upcoming court hearing on June 20th…this really stressed her out.
On June 15th, the ugliest day in my life, she texted me letting me know she wasn’t feeling well. Took her to her doctor who had me take her immediately to the ER…the rest is history.
I trully believe that stress, anxiety, ptsd, and / or traumatic events contribute to the onset of T1D. I am aware that it may not be the cause, but I believe that it puts significant stress on ones pancreas leading to triggering T1D to occur sooner than otherwise.
Hi Javier,
I’m so sorry to hear how stressful your daughter’s year was leading up to her diagnosis and I can understand how the date of would stand out as the ugliest day of your life. We never expect such things to happen to our loved ones.
Yes, these kinds of events make sense as triggers for onset of T1D, as well as potentially triggering it earlier than might have otherwise occurred. Having been physically and verbally abused likely contributed to risk as well based on the Nygren study in Sweden that followed 10,000 babies for 14 years and found a 3 times greater incidence of serious life events. On the other side, her taking a stance to speak out may have helped counteract these effects to some degree as she took those huge steps of empowerment.
Wishing you both all the very best on this big journey, which carries much unexpected richness and learning even as it is challenging and life-changing to have such a serious chronic illness. Thank you so much for writing and sharing this. warmly, Veronique
Thank you for this article. My dad had T1D, adult onset, and we believe it was triggered by a traumatic event. He was in his early twenties and fighting in WW2. He stepped on a land mine and for one hour his fellow soldiers tried to figure what to do. They realized after this very long hour that they had to get moving and he just had no choice but to take his chances and step off the mine. Thankfully, it was a dud. Days later he fell ill and was diagnosed with the diabetes. Although no one knew the science behind it at the time, he was convinced there was a link to that trauma.
Hi Marcie,
That is an incredible story. I cannot even imagine what it would have been like, pondering for an hour with your foot on a land mine. I love that he was not alone and they all put their heads together and then simply “went for it” AND that it was a dud. Here’s to gratitude for miracles. And yes, to think of that degree of relative helplessness in the face of life threat, even if mitigated perhaps by having friends / colleagues there, is classic for a definition of potential trauma. I’m working on a journal article about the role of trauma and hope it will be accepted as the science we now have really helps explain mechanisms and patterns. Thanks so much for sharing your / and your Dad’s story.
Hello Veronique I follow you on Youtube tho:)
I was diagnosed with T1D one month prior to my 23rd
birthday. The story goes like this (Week1) uni starts and
studying and the pressure that comes with it, life is
normal. (Week2) Likewise going to uni nothing much
changed, but something happened which is having an
argument and physical fight with one of my family
members resulted in not talking with each other for the
next coming weeks sadly. (Week3,4) my grades started
to decline as well as my mental health. (Week5,6) I
started developing symptoms of diabetes like extreme
fatigue, excessive thirst, drinking, eating, and urinating
frequently. Last days before diagnoses week 6 I started
to lose consciousness even while driving to uni. I had
two exams and wasn’t able to concentrate even though I
was pushing myself to my limits. At the end of week 6
Wednesday the day of my diagnosis with T1D I was at
uni and my symptoms were so hard to tolerate that I was
urinating every 30 min with excessive thirst that my
tongue was like a piece of wood so I decided to check
myself in the uni’s medical clinic where I passed out
after receiving the news of my diagnosis where my
blood sugar was above 549 mg/dL then took me to ER.
Also, my diagnosis was one month post
my second Pfizer jab. Also one man I know was diagnosed after the second jab.
Thank you!
Hi Ali,
I think we’ve exchanged comments on youtube :-). I’m so sorry to hear about your recent events including with and in your family, which is such a painful thing to happen. It sounds like there was a buildup of challenging events and more “regular” events (like your jabs) and one just never expects such things to lead to a chronic disease, including type 1 diabetes. I’m glad you were able to get checked – sounds like you paying attention, and having that support, saved your life. Thank you for sharing a little of your story here and I wish you well with your next steps!
Hi Veronique,
Yes we have and your response was so informative! I agree it is a buildup of stressful events lead up to diabetes onset. I am doing better than months prior.
Thank you!
Ali
I’m so glad you are doing better now Ali – and you are welcome!
I forgot to say that I’ve had allergic asthma which I got rid of closely prior to my type 1 diabetes diagnosis. I believe I partly was healed from my childhood and adolescence traumas as my asthma gone plus I did some lung strengthening and nose opening exercises.
I believe I’ve had allergic asthma and OCD. They might still affect me at some level but I am dealing okay with them!
That’s great to hear you are dealing okay with these!!