Past trauma triggers flares in all kinds of chronic diseases as can infections, mold, and other exposures. This understanding builds on the cell danger response (CDR) and other science I share on this blog. It enables you to see how you can begin to change your health.
Included below are 16 aspects of triggers that will give you more context on how to do this because triggers play a critical role in chronic disease.
I’ll share highlights about the concept of triggers and flares with excerpts from my most recent discussion with Ameé Quiriconi of One Broken Mom who has rheumatoid arthritis / disease (RA/RD). You’ll also learn from two examples of triggers from my own history with chronic fatigue syndrome (ME/CFS) and another from author and psychiatrist Dan Siegel MD.
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In her excerpts, Ameé describes breakthroughs she’s having from looking at her illness through a lens that understands disease to represent a body stuck in a threat response.
Her insights come from recognizing how trauma triggers flares linked to old attachment wounds.
The process has helped her catch flares very early. In what is especially empowering, it’s also helping her find ways to decrease their severity and even completely resolve a long-standing flare. Dr. Siegel and I have also had success in resolving triggers and flares in similar ways.
I’ll define triggers, explain flares, and give you examples of different types of trauma that trigger flares below.
This information about triggers is consistent with Dr. Robert Naviaux’ cell danger response (CDR) research and new paradigm of disease, which proposes that chronic illnesses reflect survival responses and may be more reversible than has been recognized. The points I share on how trauma triggers flares draws from research in traumatic stress (1)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, (2)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.” Journal of Affective Disorders 190: 278-281, (3)Yehuda, R., et al. (2015). “Post-traumatic stress disorder.” Nature Reviews Disease Primers October: 150-157, (4)McFarlane, A. C., et al. (2002). “Biologic models of traumatic memories and post-traumatic stress disorder. The role of neural networks.” Psychiatric Clinics of North America 25(2): 253-270, (5)Scaer, R. (2005). The Trauma Spectrum: Hidden wounds and human resiliency. New York, W.W. Norton, (6)Levine, P. A. (2010). In an Unspoken Voice: How the body releases trauma and restores goodness. Berkeley, North Atlantic, (7)Levine, P. (1997). Waking the Tiger: Healing Trauma. Berkeley, North Atlantic Books. The information will help you get a sense of why it’s important to consider trauma triggers. I’ll write more on how to do this in a future post.
You’ll get some of the important points Ameé makes about her triggers and flares here, which was a part of our conversation about the role of the cell danger response and adversity as important risk factors for chronic disease. You can find us on youtube and as a podcast on Ameé’s site.
Triggers often link to past adversity and unresolved trauma from difficult experiences or overwhelming exposures.
Triggers are not “psychological” or “all in your head.”
Triggers – and the flares they can cause – are in our nervous systems and cell danger responses.
The links between triggers and flares are real. In addition, they hold powerful clues that can help us understand symptoms and begin to decrease and even prevent them.
1.What are triggers? They are reminders of past events
Triggers are a well-known characteristic of trauma. They are reminders of past experiences that have been intense or overwhelming enough that even subtle reminders can stimulate symptoms months, years or decades later. Risk factors for triggers include events that have evoked some degree of helplessness to escape, successfully fight our way through or to somehow overcome threat.
An example comes from stories of veterans who have flashbacks when they hear a helicopter, even though they are home and safe. A veteran might also fall into an automatic defensive crouch on hearing a car backfire, which sounds like gunfire.
These responses in the present moment are based on triggers from unresolved issues the past.
2. What are flares in chronic disease?
Flares refer to increases in old symptoms or onset of new ones in people living with chronic disease. Flares are also known as flare-ups, exacerbations, spikes, crashes and by all kinds of other terms.
The first point I made above describes symptoms flares of PTSD in veterans after exposure to certain triggers.
In chronic illness, flares are seen with periods of temporary or gradual worsening that can look like the following:
- blood sugar highs or lows in diabetes
- crashes with increased exhaustion, brain fog or immune dysfunction in chronic fatigue syndrome (ME/CFS)
- spikes in migraines and other pain that seems to come out of the blue
- redness, swelling, painful joints and other symptoms in rheumatoid disease
- cycles of severe diarrhea or constipation and pain in Crohn’s and Ulcerative Colitis (inflammatory bowel disease) or irritable bowel syndrome (IBS)
- new symptoms or worsening of old ones in MS, fibromyalgia (FMS)
- asthma attacks
- blood pressure spikes or drops in POTS
- cycles of heart arrhythmias such as atrial fibrillation
- periods of depression or anxiety in PTSD
- bouts of brain fog, disconnection or feeling numb
- greater sensitivity to infections, mold and other environmental stressors
3. Triggers are often unrecognized
Triggers frequently lie outside of our memory and awareness. This means that symptoms and flares can seem to come out of the blue.
Psychiatrist Daniel Siegel is a leader on how early relationships influence development and health.
In his book, Parenting From the Inside Out, he describes how confused he was when he first noticed that his infant son’s crying triggered a sense of panic in him.
I used to feel a strange sensation when my son was an infant and he would be inconsolable in his crying. I was surprised at the panic that would come over me as I became filled with a sense of dread and terror. Instead of being a calm center of patience and insight, I became fearful and impatient.
Being curious and suspicious that we might be experiencing a trigger is helpful and sometimes even necessary to uncover their source.
Because Siegel wondered whether he was experiencing a trigger, he looked for images, feelings, sensations or impulses that might identify a source of his symptoms.
It was some time before he had an insight and the source of the panic surfaced.
It had shown up as a flashback to his medical training from years before, when he had cared for children who were sick, often terrified, and crying. As their doctor, he had felt helpless when he had to perform procedures that scared them or that caused pain. This is part of what can be so traumatizing in medical training (and similar to experiences I had as well). Like most physicians-in-training, Siegel had also had too little time and support himself to process what was happening or figure out how to do it differently:
My empathic connection with the children’s terror in the hospital was overwhelming. The year was so intense, the work so demanding, the number of patients so high, the turnover so quick, and the illnesses so severe that my coping skills were put on high alert.
You may recognize that this is also a description of trauma and how the cell danger response gets stuck to lead to symptoms and disease.
Dr. Siegel explains that he worked through this trigger and his response to his son’s crying in part by recognizing, understanding and being with his fears, even though it was difficult. It also helped him grow and heal so that his trauma didn’t interfere with this aspect of being a parent.
Fortunately, through painful self-reflection, I was able to see this as an unresolved issue in myself and not as a deficit in my son.
You can learn more about triggers and how to work with them in Dan Siegel’s book, Parenting From the Inside Out and the Mindsight institute he founded to support healing and integration in the nervous system. His work with triggers helps with parenting as well as the ability to more fully relate to yourself and to others. It’s also a example of how this kind of work can help us with chronic disease.
I’ll write more about working with triggers in a future post. For now, I want to say that both Ameé and I needed to first become curious about whether trauma triggered our flares so that we could then actively begin to look for them. It took both of us a year to recognize our first triggers. As you’ll see, it is worth it and a huge component of healing. Ameé describes her trigger and the improvement in her flare in excerpts that follow.
4. Triggers come in all shapes & sizes
As we saw with the examples I’ve mentioned above, symptoms often arise following reminders of past exposures, adversities or traumas that are unresolved and that are associated with some degree of helplessness or overwhelm.
Triggers can include:
- hearing reminders of traumatic events, such as helicopters for veterans and crying for Siegel
- going to a hospital where you or a loved one spent time for a serious illness or stressful procedure, even if you’re just getting your blood drawn
- visiting family who were psychologically abusive to you in the past
- smelling antiseptics you had for surgery, for care after an accident or for your chronic disease, or because you once worked in a hospital where you witnessed trauma, loss or death
- seeing a doctor (or other person in a position of relative power over you) who doesn’t believe you or who dismisses your symptoms because nothing is visible and your labs are normal
- interacting with someone who feels invasive, rude, cruel or who is focused on their own needs at the expense of yours
Symptoms and triggers are unique for each of us based on our histories. They can arise from ordinary, non-threatening sights or sounds, people, places or things.
Soldiers who crouch or have flashbacks are experiencing appropriate symptoms of self-protection and defense but to situations that are no longer happening and that are no longer dangerous.
This is how unresolved trauma can affect us long after the event has passed.
As I describe in this post about the cell danger response, exposures to various degrees of overwhelm or threat can evoke threat responses that get stuck and lead to chronic diseases of all kinds.
Ameé’s attachment trauma triggers RA flares
29:27 to 29:43
5.Triggers arise from unresolved trauma
In the clip above, Ameé describes one of the most insidious, underrecognized and perhaps most common types of triggers, which stems from early attachment wounds that arose when growing up in our families.
These are also known as attachment or relationship trauma, complex trauma or complex PTSD. I refer to them as adverse childhood relationship experiences (ACREs) and invisible ACEs (adverse childhood experiences) because their effects go well beyond PTSD to include flares in chronic disease. I also use the term ACREs to build on ACEs research, which explains how abuse and neglect include our earliest relationships to affect risk for chronic disease.
Ameé realized when looking for triggers that her RA flares up when she interacts with people who act like the adults she lived with in her childhood. Interactions with such folks trigger an overwhelmed fight response that was repeatedly squashed when she was a child.
In our conversation, Ameé relates that she was unable to tell the truth without being scapegoated by some of her family members throughout her childhood. She did not feel heard and was unable to set boundaries.
Boundaries are a form of self protection using the social nervous system’s verbal self-protective mechanisms to say “NO.”
When this “no” gets overridden and there is payback, it can become threatening to express yourself, your views, your needs or your wants. This is life-threatening at a level that we don’t usually acknowledge or recognize in our culture. It’s not necessarily because parents and other family members don’t love us, but it stems from their own trauma and difficulty connecting in nurturing ways. In other words, these kinds of behaviors and adversity have an impact even if the members of your family love you.
When a child can’t tell the truth as they see it without getting shamed, blamed, judged or otherwise criticized, their nervous systems can turn to the next natural form of defense. This can be a fight response that has a stronger push of “Hear Me!” and “No!”
In Ameé’s case, this fight response wasn’t effective either. As a result, her ability to defend herself got overwhelmed.
In such cases, our bodies can’t succeed at being heard and seen, which is necessary for a child to feel that she is actually real and alive, wanted, loved and lovable.
The nervous system’s last remaining alternative in such situations is to immobilize or freeze.
This is one way that a cell danger response (CDR) can get stuck to drive disease later in life.
6. Events that trigger flares may not be dangerous or stressful
Triggers may be stressful, but they often aren’t threatening in the ways they might have been in the past. Triggers are often not dangerous in and of themselves in the present day.
The example Ameé gives is about a stressful encounter with her ex who she is in the process of divorcing. Her trigger is not actually a life-threatening event as it might have been when she experienced it repeatedly throughout her childhood.
As another example, the helicopter that monitors traffic for the drive-time radio show is not the kind of helicopter that was present for a veteran when they were fighting in a war. Hearing it can, however, trigger the same response of fight, flight or freeze as it did in the past.
The smell of antiseptics is also not generally a threat in and of itself. If symptoms or flares arise from smelling them, however, it suggests that there is a trigger from prior unresolved trauma, such as from a medical procedure or event that happened in a hospital or medical setting.
7. Symptoms are intelligent responses that have gotten stuck
We all have natural responses to threat. Responses such as fight, flight or freeze, and the cell danger response are designed to resolve when the threat has gone.
As I’ve mentioned in recent posts, responses of fight, flight and freeze cause problems when they get stuck and are unable to resolve.
Symptoms that arise from triggers are intelligent expressions of fight, flight, or freeze that are stuck in these modes of self protection or self expression.
They can also make us feel as though we are back in the past, reliving the moment.
Symptoms that get triggered can replicate the actions that did not resolve the threatening situation in the past. In Ameé’s case, she realizes that the flares in her wrists are a symptom of a fight response that was long thwarted as a child.
What she’s intrigued by is how they feel just like her fight response of wanting to punch someone and how they act now as an early detection system. I’ll describe this characteristic in more detail a little further down.
8. Symptoms are stimulated by triggers
One indication of a symptom that has been triggered is that it tends to be out of proportion or even irrelevant to the situation in the present.
A soldier who crouches on hearing a car backfire is acting as though she or he is still fighting a war and is back in another place and time.
Feeling threatened when passing the scene of a previous accident is an indication that something remains unresolved from that event since the location itself is not a threat.
Feeling panic when his son cries is Dan’s indication that something is amiss.
Ameé’s impulse of wanting to punch someone reflects the extent of life-threat her body felt as a child when she couldn’t get heard or was crushed for trying to express herself. Wanting to physically fight is the result of an old response and, as she clearly recognizes, it is not the best solution to the issue she is facing today.
9. Triggers can be identified
In our conversation, Ameé describes that she learned to identify her triggers by watching for precursors to her flares and by paying attention to her emotions and to the somatic experience of sensations in her body.
What Ameé caught over a period of paying close attention, was the very first indicator that precedes a flare.
For Ameé, it’s a sensation of tightness in her chest, which she refers to as her “Early Warning Detection System.”
This is a really helpful name because it describes just what it does – gives us space and time to make new choices in the present instead of falling into old patterns that don’t serve us.
These early warning signs are something we can all learn to identify with time when we start looking.
10. Flares often reflect symptoms of fight, flight and freeze
Symptoms of unresolved flight, flight and freeze can show up in all kinds of ways in flares and in our baseline symptoms of chronic disease.
From this perspective, a chronic illness is like one long flare that has slight variations of increases and decreases depending on the day and the triggers.
Symptoms of unresolved fight include irritability or attacks of rage or frustration.
In Ameé’s experience with rheumatoid disease, her symptoms align with a fitht response that show up as tension in her chest followed by pain and swelling in her wrists and shoulder. She also feels anger .
These are natural, intelligent symptoms of our natural protective responses. When they cause symptoms of disease or flares, however, they are indications of cell danger responses and nervous systems that are stuck in defense mode and unable to exit so they (and we) can relax, recover, and feel safety.
This emerging paradigm of disease explains that chronic illnesses reflect bodies and physiologies caught in prolonged perceptions of threat.
The new science and Dr. Robert Naviaux’ theory about the cell danger response suggest this is the origin of over 100 common diseases, from Parkinson’s and Alzheimer’s to asthma, autoimmune disease, depression, bipolar illness and more. They also explain that it’s not psychological. This is another list of over 30 diseases affected by early adversity, which includes other autoimmune diseases such as type 1 diabetes, lupus and MS and other chronic illnesses such as environmental illness, ME/CFS, fibromyalgia, asthma and more.
11. Working with triggers can decrease flares
When I heard Ameé describe how she had identified how trauma triggers flares I felt awe and excitement. Not because flares are a good thing (they can be very stressful, scary and painful) but because understanding the nature of flares helps us identify triggers.
Beginning to connect the dots between old traumas and flares is a big step that supports healing in chronic disease.
As Ameé described what she had figured out I felt as though I was jumping up and down on the inside wanting to shout “YES!!! WHAT YOU’RE SAYING AND DOING IS HUGE!!”
This is because identifying how trauma triggers flares represents a whole new way of understanding symptoms and working with chronic illness.
Ameé is doing it.
Hers is a potent example of the new paradigm of disease I keep talking about on my blog.
It’s also profoundly practical because, as Ameé describes in the clip below, awareness gives her new options that actually DECREASE HER FLARES.
It happened because she asserted a boundary, which is a healthy, present-moment act of self-care and protection. This is one way of healing old trauma wounds.
53:21 to 54:47
As Ameé states,
Once I asserted that boundary,… then all the pain started to recede. I was able to modulate it …. I was like Oh My Gosh!! Ok!, I actually did work myself back off the cliff and back down and brought my physical body back…and it all happened outside the realm of the medication… There is something here… I think there is a way… to bring relief to people that are suffering from this disease.
As Dr. Robert Naviaux, Dr. Stephen Porges, Dr. Peter Levine and others state, the power of understanding how environmental exposures such as trauma affect our health is that it offers a vast new context with tools for beginning to work with symptoms and potentially reverse disease.
12. An example from my ME/CFS
I didn’t know whether anything could actually trigger my flares of exhaustion in chronic fatigue syndrome (ME/CFS) when I first started wondering about it almost 20 years ago. So I simply started paying attention when I had bouts of feeling worse.
I explored this by considering whether anything I had done or experienced in the hours or days preceding it might have played a role.
It took me a year to catch my very first trigger. I noticed a dip in my already low levels of energy one day and, thinking back, realized that I had experienced some conflict in a seemingly ordinary phone call I’d just had.
I remember feeling elated on realizing that there might really be a connection to previous life experiences and that it implied my disease wasn’t completely random or outside of my power to work with. Like Ameé, this was linked to my early attachment experiences. I don’t remember what happened with that flare such as if it resolved more quickly or lightened after my insight.
The second major instance happened when I’d been feeling a significant decrease in my already low baseline energy levels. I figured it might be from having overdone it and being too active, but resting didn’t help me get back to baseline after a few days, as it sometimes did with flares. I had then begun to consider that maybe I’d been triggered. But I couldn’t put a finger on anything new or unusual.
I had therefore simply rested some more.
10 days into my flare, which was much longer than usual and beginning to seem like a worsening of my baseline, I again got curious about whether something might have triggered it.
Somehow this time, I realized that I had been triggered by another seemingly ordinary phone conversation with a friend.
We had talked about a patient of hers who had started having problems while having her baby and going through labor at home. I recognized that I had felt worried that something terrible could have happened even though it had all turned out well.
Things fell into place when I acknowledged how much stress and trauma I had had in my obstetrical training, similar to what Dr. Siegel mentions above. I was also aware that both of my parents and my grandmother had had very challenging situations in their own births (one was breech, another’s mother had such severe vomiting throughout pregnancy that she had to be hospitalized, the third’s mother had toxemia and nearly died from a hemorrhage after her cesarean birth).
My trigger could have been from my own life or compounded and intensified because of multigenerational trauma.
The conformation that I had indeed been experiencing a flare and that it had been triggered by this even came when my 10-day-long flare resolved completely within 2 hours of simply identifying the trigger.
This was one of many eye-opening experiences I’ve had since then, showing just how powerful this awareness can be.
I still get flares on occasion. They are much less frequent, however, and less severe. This is partly because I recognize many of them from having learned what they are over the years and can choose different responses, as Ameé does.
It’s also because I’ve worked through many of my old traumas. This means that fewer things trigger me. Having done the work has also contributed to my having a much better baseline of health.
In addition, I tend to recognize most of my triggers more easily and rapidly, and to recover more quickly.
Awareness doesn’t always help a flare resolve completely but it gives me clarity about what I need to work with.
Each piece of the puzzle helps with the rest. It’s like planting seeds – every seed you plant helps with overall improvements and resilience in health as well as with decreasing reactivity to environmental stressors, triggers, and flares. You can learn more about my story and how I understand my health from these perspectives.
13. How trauma perspectives help resolve flares
Ameé and I did a podcast recently where Ameé told the story of her onset of RA/RD and how a long-standing flare resolved completely overnight (here’s the full podcast on Amee’s blog and my post with highlights and excerpts).
The segment below briefly describes how the understanding she’s gained and the work she’s doing in therapy are making a difference. Amee’s is paying attention to her feelings, sensations and insights with mindful curiosity and nonjudging awareness. This is how she’s working with her nervous system and stuck patterns of survival responses and perceptions of threat. Together, these tools are giving her new options and helping her work with her disease in an entirely different way. The most exquisite part is that it’s making a difference.
14. Important questions about healing in chronic illness
In our video, I respond to some of Ameé’s early questions by summarizing the cell danger response and the polyvagal nervous system. I offer insights into the role of trauma in chronic disease in other parts of the video.
Ameé asks 2 other really important questions later in our conversation.
1. Is there a test to know if our bodies have gotten stuck to cause disease? The best way I currently know how to answer this is to explore whether symptoms reflect states of fight, flight or freeze that feel stuck or keep repeating in unnecessary ways and situations.
Another way is to get a sense of whether you have unresolved trauma such as adverse childhood experiences and other adverse events (here’s a guide to understanding how trauma affects the nervous system). You can learn more in our discussion and in my free books below.
2. A second major question Ameé asks is, “Is there a way to unlock these patterns of sequestered fight, flight or freeze?”
This is actually the 64 million dollar question that we all wish had a clear answer. I had trouble answering this one, as it is complex and unique for each one of us.
I name some ways Ameé is working with this from about 36 minutes to 43 minutes in the video. Dr. Dan Siegel describes what he did and does in Parenting from the Inside Out.
For most of us with chronic illness and other long-standing symptoms, healing the effects of trauma is not a direct, linear or clear process.
It’s also different for everyone. The process generally involves mindfulness and slowing down. It’s also helpful to have a trained somatic trauma psychotherapist to help you along the way.
There are common factors I find useful in supporting healing from this new paradigm. As an example of doing this very thing, Ameé is doing it. She is
- looking for and paying attention to her triggers without judging or blaming herself or her symptoms
- staying curious, which creates space for her system to access it’s own innate ability to heal
- not reacting in the old way that “wants to punch someone,” which strengthens and reinforces old, unhelpful, stuck patterns of survival
- using the space her awareness creates to look for, notice and act on impulses that offer new ways of taking action when she identifies a trigger (such as setting boundaries with her words and holding herself or the other person to what she says she will do)
The new ways Ameé is engaging in as she reworks the old stuck pathways are creating new patterns that are no longer stuck in freeze or in overt fight responses. These new pathways are more empowered, effective, relational and self-supportive.
The new pathways Ameé is creating come from a social nervous system rather than a survival response of fight, flight or freeze.
The social nervous system is the branch of the parasympathetic system referred to as the ventral vagus or just “The Vagus.” It can inhibit fight, flight and freeze, just as Ameé has done by resisting the urge to hit someone.
A stronger social nervous system helps pull our bodies out of stuck cell danger responses and begin to unwind and resolve old patterns.
This is an example of how healing happens in chronic disease.
15. If your triggers are mold, infections or other exposures
Dr. Robert Naviaux’ research in the cell danger response finds that exposures to mold, infections, vaccines and other environmental events can trigger the onset of all kinds of different chronic diseases.
These same exposures can also trigger flares.
One of the most helpful strategies if these kinds of exposures trigger symptoms or disease is to remove the toxins, treat the infection or otherwise avoid these elements as much as possible. If this heals your chronic illness it can sometimes be a relatively quick or even painless process.
A common problem, however, is that many people with chronic disease are unable to recover using these straight forward approaches.
If you don’t heal or can’t successfully remove or avoid triggers, or treat an infection; if you can’t live far enough away from cell phone towers or other EMF devices that affect your health; if your food intolerances are growing so fast that you’re left with a diet that’s so restricted it’s hard to live on or maintain; or if you can’t otherwise resolve environmental stressors that are triggers for you, it is possible that your autonomic nervous system and cell danger responses are stuck in states of threat and survival from other underlying drivers.
If this is the case, doing what you can to avoid these triggers buys you time while you work to heal in other ways.
One powerful approach based on what I’ve presented in this post and elsewhere on this blog is to work with the effects of prior adversity and trauma in your life.
This is because adverse life events (in adulthood, babyhood, childhood and in your parents and grandparents’ lives) affect gene function, the cell danger response, as well as nervous system and immune system patterns of regulation. Such events make us more sensitive to stressors such as infections and other exposures. As I emphasize throughout my blog, it’s not psychological.
16. Tools and therapies for working with triggers
As Ameé, Dr. Dan Siegel and I (and others) have found, it’s possible to identify triggers and work with them.
This will help you begin to decrease flares and, in time, begin to resolve and even prevent them. This is one way of working to heal chronic illness and perceptions of threat.
You’ll learn more from this list of my favorite books and self-help tools for understanding trauma, which will give you more context for how this all works.
Also take a look at my posts on therapies and ways to find a therapist, and about tools that help.
Watch our full conversation on youtube
I’ve set the settings to “public” but if any of you have problems please contact me to let me know.
Ameé’s RA/RD Survey & Contact Information
Ameé is curious whether others with rheumatoid arthritis have similar triggers as hers or similar histories, reactions or flare patterns. She invites you to take her brief survey. You can contact her through her website or FB page and listen to our full conversation on youtube. You can also listen to her onset story and how she nipped a long flare in the bud in our podcast conversation.
You can learn more about research specifically looking at how trauma and adverse life events affect risk for rheumatoid arthritis / disease in my free ebooks below.
My free ebooks page has other pdfs and kindle documents about trauma in general and about trauma as a risk factor for other diseases. As I write about on this blog, the research is finding similar patterns regardless of which disease or chronic symptoms you may have, including if you have a mental health condition, chronic pain, or feelings of loneliness or difficulty in relationships or parenting, and more.
Although some of the following posts use a single disease as an example, they provide introductions to fight, flight freeze and are just as relevant for other diseases.
The Cell Danger Response: The New Disease Paradigm (Diabetes, Metabolic Syndrome, ME/CFS and Beyond)
I. ME/CFS and Freeze: A Metabolic State of Hibernation That is Not in Your Head
IIA. ME/CFS and The Cell Danger Response: How the CDR Gets Stuck in Freeze
Rheumatoid Arthritis and Trauma: A Podcast with Ameé Quiriconi of One Broken Mom
|↑1||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|
|↑2||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.” Journal of Affective Disorders 190: 278-281|
|↑3||Yehuda, R., et al. (2015). “Post-traumatic stress disorder.” Nature Reviews Disease Primers October: 150-157|
|↑4||McFarlane, A. C., et al. (2002). “Biologic models of traumatic memories and post-traumatic stress disorder. The role of neural networks.” Psychiatric Clinics of North America 25(2): 253-270|
|↑5||Scaer, R. (2005). The Trauma Spectrum: Hidden wounds and human resiliency. New York, W.W. Norton|
|↑6||Levine, P. A. (2010). In an Unspoken Voice: How the body releases trauma and restores goodness. Berkeley, North Atlantic|
|↑7||Levine, P. (1997). Waking the Tiger: Healing Trauma. Berkeley, North Atlantic Books|
Thank you sooo much for this wonderful website. I am in the midst of reading all the content and I cannot believe how I resonate with so much of what you have said.
I was raped by a work colleague 19 years ago at a work team building event. I put it behind me and was advised to get on with my life which I tried to do, but it has wreaked havoc with my life! My life has gone downhill over the last few years and it was only 2 years ago that I discovered I have had PTSD for so many years.As soon as I started getting therapy and started to make some headway in my recovery I got diagnosed with Leukemia. I have been in remission since last year April. For many years I had psychosomatic symptoms, and while the doctors couldn’t find anything physical I knew I was running out of time to getting a serious physical illness.How right I was!
It has taken a tremendous amount of work for me to be where I am at emotional and mental PTSD recovery right now, and this has been solitary experience for me because therapy has not helped me very much. The cancer helped me in my PTSD recovery, and I am now turning a corner and starting to feel like life is heading in a new direction. I have landed a job (that has never been a problem, I just generally cannot keep a job because I get triggered and have to walk out from an illogical fear of being raped again) and started to make some headway in my relationships (I have been lonely and relationship-less for many years because of the PTSD). I am worried that I might get another serious illness (or God forbid) the cancer might return if I don’t deal with the PTSD. When the cancer showed up in December 2017 I had made a turning point in my recover, so I couldn’t understand the tremendous leap forward was met by sudden cancer??I am fortunate that I have no drug or alcohol addictions due to the longstanding PTSD, but even now with the cancer in remission I am still struggling physically with chronic pain and other symptoms. I am worried that if I don’t resolve my PTSD I will forever be trapped in this misery. Emotionally and spiritually I have seen SOOOO many improvements but then I have been working hard to make that happen,yet physically I am at a loss. I have lost 25 kg in this last year, I eat healthier and I have started to exercise,but clearly so much more has to happen for me to regain my full health.
In so many ways the cancer was easier to deal with than the PTSD because the PTSD poses so many challenges that affect ALL areas of my life that I am struggling to resolve. But my greatest loss has been the fact that I lost my sense of self and feeling safe in the world, and so having relationships became impossible for so many years. So I have been lonely but numbed out for so many years and it it’s only now that I am craving human interaction. It saddens me how much the rape has cost me in all areas of my life.Sometimes I wonder that the worst part of being rape was not just the actual event (I was unconscious so do not have memories) but rather the fact that the rape robbed me of so much that feels hard to replace or get back. What pearls of wisdom could you give me for moving forward? I have so much to offer but I feel so alone in my recovery because therapy doesn’t begin to address trauma recovery and all itr’s complexities. What I have done in the last 2 years by myself would not be achieved in therapy over 1000 sessions. The process is woefully inadequate for me. I just wish it wasn’t so difficult. I just want to be happy and healthy.
Veronique Mead, MD, MA says
Oh, what a deep deep journey you have been on. I hear the pain and havoc it has wreaked in your life and I’m so sorry for all you’ve been going through. I also hear just how much is changing for you in a direction that feels good even as you are looking for ways to get over some additional important hoops.
The process of healing trauma can be complex, as you describe. Research is also finding that having PTSD can arise from other previous traumas that may not have evoked symptoms until that “final” triggering event. The other part that may be adding to the challenge of recovery could be that you weren’t conscious when you were raped. This adds layers of complexity.
I have a list of tools that I’ve found to be very helpful, some of which you are implementing already. I explain how they work with the nervous system from a trauma perspective. My sense is that they each create more space in your own system so that your body’s inner capacities for healing can have more time and room to work.
I realize therapy hasn’t worked so far and that you’ve gone a huge distance in other ways. Yet I wonder – what kind of therapy have you done? Often people have tried the most well-known therapies such as CBT for their symptoms. CBT and talk therapies, however, are not able to access PTSD and other effects of trauma, which live in the realm of the brain / nervous system and unconscious processes.
Have you tried anything like the somatic trauma therapies with someone who has experience and can help you go slowly and gently? If not, consider that as an option as it is completely different from traditional cognitive approaches (here’s a list of therapies and directories for finding someone).
Hang in there – the fact that you are wanting and craving social connection feels like a sign of reaping work you’ve done already as it sounds like your social nervous system is waking up. This is the part of your nervous system that has a lot of capacity to help the rest of it all shift and heal.
Wishing you all the best and continued courage and patience on this journey you are working with so diligently and beautifully,
I would recommend the book The Body Keeps the Score by Bessel Van Der Kolk. It’s a fantastic read that details the effects of trauma on the body/mind. It also explains why traditional talk therapy doesn’t work for trauma. I would also recommend EMDR. It’s been hugely beneficial in helping me to heal from my various traumas. I hope you find a path to recovery and peace. xxx
Veronique Mead, MD, MA says
Hi Tanya! Thanks for sharing these – Bessel’s book is a really helpful way to make sense of trauma, as you say and explains some of the history of how we started to learn about PTSD as well as the importance of the body in treatment. I mention EMDR and have links to help readers find a therapist through a database on my therapies page for anyone wanting to learn more.
Ronald de Caluwe says
Thanks for your wok and sharing, Veronique!
Veronique Mead, MD, MA says
Thanks for the lovely comment Roland, you’re so welcome!
Sara Joy Dean says
Veronique, this work is so meaty I think I’ll probably have to come back several times to this one post alone to watch all of the videos and download the pdfs. I am so glad I found the Chronic Illness Bloggers group. You have made some fascinating discoveries.
Veronique Mead, MD, MA says
Hi Sara Joy,
There are a lot of courageous folks on CIB and it’s so good to meet you. I hope you find some meaty tips in the post – happily the video segments are all really short excerpts :-). Thanks so much for your comment!
Thank you for this insightful post! It really resonated with me, and I so appreciate this forward thinking research you are doing, as it will bring relief to many of us who live with trauma.
I am wondering a bit about the idea that triggers are usually to events that are disproportionate to the original trauma. I completely get the example of the car backfiring vs. an actual gunshot that veterans respond to, but in my experience, my triggers are in some cases (maybe like 25 percent) to less benign situations. For example, I am someone who is in the public eye, and has been bullied and “called out” (unfairly) by people as a result. These people tried to sabotage my career and smear my name. This is not the source of my original childhood trauma, but rather compounded my original trauma in adulthood (along with exploitative working conditions, abusive marriages, and other situations).
I find that I am often triggered by situations where someone actually is being creepy, abusive, or otherwise messed up toward me. I recognize I may come across more of these situations due to the nature of my work/field, and being in the public eye–but what I am trying to say is that the triggers are not so innocuous as a car backfiring and there is a real threat of danger, albeit it is usually in its earliest moment–the moment when I need to set a boundary and protect myself. If I do that, further danger does not usually arise, but I was still dealing with a circumstance of impending real threat (someone trying to sabotage my career and get others on board to bully me, for example).
I have been able to make great progress in my life in dealing with situations like responding poorly to hospital settings (I got very sick from PTSD a few years ago and was mistreated at the hospital, so it was hard for me to return to them for medical care, but I have worked to overcome that trigger). What I am struggling to progress with is continuing to be a public person surrounded by many nice people but also enough totally creepy people who try and cause me and my career harm. In the moments when, for example, someone tries to accuse me on a panel presentation of something unethical and offensive (bc this is just the type of thing people do in my field to each other), I am both triggered and under real threat.
Should I simply change fields? How does one deal with triggers that come as a result of real threats? These are the situations where my fight or flight goes really intensely into overdrive. i have to deal with the reality of the situation but then afterward I really struggle to want to put myself out there again and my PTSD flares up immensely. My safety mechanisms tell me that being in the public eye at all is unsafe. And maybe it is?
Veronique Mead, MD, MA says
It sounds as though you have a great deal of clarity about these important triggers that can threaten your career and cause you harm. That makes complete sense as a trigger (they are not always simple ones, just as you say!).
I also see that you have done a great deal to decrease your reactions to these and many other triggers.
Without knowing your particular work setting, I wonder about a couple possibilities while acknowledging that this is quite complex, that it may take some 1:1 therapy to identify clear ways to stay safe and respond to such people, and that I may miss some important points.
One thought comes with a question – can you imagine yourself or someone else standing up to such people? Is there a way that is clear enough with responses, supporting documentation / research / arguments or even simply from a non-reactive stance – that such people might not be as big a threat? In other words, are these people a threat to anyone in your field with similar views as yours? If so, perhaps changing fields WOULD be helpful.
On the other hand, if such people aren’t as abusive or risky for others, I wonder if there are old attachment trauma patterns from your own early relationships that trigger you in such a way that it is harder to hold your own / make your point / stand them down / defend yourself etc… If such is the case, then working from that angle could be a way to see how far you can get with this particular situation and trigger.
This type of trauma may be something you’ve already worked with or are familiar with. If not, know that it can be hard to recognize and is known under many different names, including complex PTSD and relational trauma. It is linked to verbal, emotional and physical abuse in childhood, but also to more subtle lack of safety, support and connection with the adults who take care of us in childhood or from later adversities in relationships (you mention abusive marriage). I write about this more subtle version in a post about invisible ACEs. You can also learn more on Dr. Jonice Webb’s website or a recent podcast interview she did with Amee Quiriconi. Dan Siegel’s book that I reference in this post is also useful for working with ourselves.
Let me know if that helps and you are welcome to email me if you want a more specific or private conversation.
I listened to a talk by Gabor Mate recently where he described Developmental Trauma as the reduction of the range of emotions a person can experience due to the way they were raised in childhood. I understood him to be describing a narrowing of the Window of Tolerance for experiencing emotional states. Would you agree with this description? It would mean to me that pretty subtle influences could be described as traumatic to a child.
Veronique Mead, MD, MA says
That sounds like a really good way to think about it re a reduced capacity to tolerate a wider range of emotions because we did not get the kind of regulation needed to help us grown that capacity. Here’s an online definition of the Window of Tolerance (WOT) for anyone reading this comment who is not familiar. It includes a helpful infographic.
“Our clients are best able to cope with stressors and triggers when they’re operating within their window of tolerance. But a traumatic experience can narrow our clients’ window of tolerance, leading to states of either hyper- or hypo-arousal.”
And yes, events that influence our capacity emotional and physiological self-regulation can indeed be very subtle. If it’s of use, here’s a blog post on attachment trauma (what I refer to as “invisible ACEs“).
Thanks Veronique. Your blog post on “Invisible ACEs” is fantastic! I like the way you mention the importance of physiological self-regulation. I find there to be a strong tendency in local people to pay a great deal of attention to the cognitive and emotional aspects of healing trauma but little interest in the physical aspects. This is challenging for me because the physiological aspects are so clear. Connecting them to emotional and mental states gives me some insight into a bigger picture of how I get stuck. Fortunately my therapist has a strong foundation in the somatic aspects of trauma healing. Between him and you I seem to be able to survive my encounters with highly triggering people in the local community. Thanks for your help. Hugs to you! :-)
I’m seeing that when it comes to self-regulation, flow is important. If I get stuck then, well I’m stuck and afraid to allow some aspect of myself. I think Peter Levine calls this “fixity” and a central aspect of unhealed past trauma. So maybe unstuckness (flow) arises while allowing the body to do what it wants, or allowing repressed emotions to express themselves or releasing the mental judgements around the state I’m in (i.e. going from fighting it to befriending it). It seems that the body/emotion/thought package is one connected thing. Usually I’m unaware of one or more parts of this complex. Does this fit with your understanding?
Veronique Mead, MD, MA says
Yes – the more we can be mindful and aware of what is happening without judgment, the more room it all has to be and the less we add secondary distress on top of the underlying pattern. As we grow our ability to stop reacting, it also helps the patterns themselves begin to change and loosen. The flow can come in lots of ways!
Hugs back to you in response to your other comments! And I’m so glad to hear you have a really supportive therapist – and that support here (and being me :-) has been helpful too! xoxo
Ana Larson says
Mind over matter is a very powerful thing, but lifestyle is important too, chronic illness may have its triggers freed but there are still deficiencies and missed diagnosis that goes on never resolving the issues. After 6 decades of arguing with professionals I got my answers. Looking back it seem so obvious, all the things others complained about me were due to my condition and how it exhausted me. Have a collagen disease affects the whole body, so now I know and yes its an uphill battle due to my age but with answers and being balanced with the rest of my life I can set better limits and boundaries and not let others decide for me because they do not understand, even if they are a professional and should know better. Having HEDS and MTHFR along with many other symptoms resulting from the lack of energy and over sensitivity I now do not let doctors play guinea pig and live a life that allows me to be healthy and thrive much better instead of barely surviving. I have scars from being the guinea pig but I wear them as a badge having survived that and finding my answers by never letting go and always moving forward. I now try to educate others, we have to look at our big picture and not ignore it, taking assessments of life and a good long medical history will reveal many things just as meditating and relasing can reveal those underlying feelings that have come along in the process trying to confuse things. I am glad there are those like you doing what you do, but we need more for folks to address why certain things linger no matter what, what is missed. The scariest thing I find in our current society is how certain aspects of medicine are just shots in the dark and have not prepatory protocol let alone one for recovery, it leaves so many hanging not feeling well. Prayers to the journey, mine is just beginning and I am thrilled to know why it is the way it is. May God guide us all well.
Veronique Mead, MD, MA says
Congratulations on finding a way to thrive and Live Your Life. It can take decades for most of us to gain a helpful context about our health because it so very often – and maybe increasingly often – has to come from outside our medical paradigm. Once we have a context, it can be so very helpful to see how lifestyle changes help, and how setting limits and having boundaries are important and how not accepting everything others say. Wishing you well on your continued journey and sending prayers right back!