Emotional Dysregulation

Emotional Dysregulation, Trauma, and Paths to Recovery Mel Pohl MD

Disclosure • Nothing to Disclose

Learning Objectives • Describe fundamentals of pain and suffering • Review the neurobiology of pain and trauma • List non-medication treatments for chronic pain

Emotional Abandonment Abandonment When you have to hide a part of who you are in order to be acceptable/ to protect self.

When you have to hide: —Your mistakes/ vulnerabilities — Your feelings — Your needs — Your accomplishments/ success

Emotional Abandonment -- cannot live up to expectations -- attack whole being, worth, and value versus action -- you are to be an extension of another’s dreams.

-- you are responsible for another’s feelings, thoughts, and behaviors.

-- parents’ esteem is derived through child’s behavior.

-- children are treated as peers with no parent child distinction.

Damaged Inadequate Damaged goods

SHAME

Dirty

Stupid Not good enough

Less than

Trauma “stress that causes physical or emotional harm from which you cannot remove yourself�

Larke Huang (SAMHSA)

Greater trauma

=

Greater likelihood of addiction

Greater number of Traumas

=

Greater likelihood of multiple addictions

Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: Adverse Childhood Experiences (ACE) Study --Childhood abuse, neglect, and exposure to other traumatic stressors = ACE Almost two-thirds of study participants reported at least one ACE more than one in five reported three or more ACEs. short and long-term outcomes of these childhood exposures ďƒ health and social problems.

CDC and Kaiser Permanente, San Diego

As the number of ACEs increase, the risk for the following health problems increases in a strong and graded fashion: • Alcoholism & alcohol abuse • Chronic obstructive pulmonary disease (COPD) • Depression • Fetal death • Health-related quality of life • Illicit drug use • Ischemic heart disease (IHD)

• Liver disease • Risk for intimate partner violence • Multiple sexual partners • STDs & HIV • Early initiation of smoking • Suicide attempts • Unintended pregnancies

Finally, as the number of ACEs increases, the number of co-occurring or “co-morbid” conditions increases.

Pain Switchboard GENETICS N O C I C E P T I O N

COMT

TRAUMA

P A I N

Patient with Pain Pain

‘Injury’

Patient with Pain Suffering Pain

‘Injury’

“…When touched with a feeling of pain, the ordinary uninstructed person sorrows, grieves, and laments, beats his breast, becomes distraught.

So he feels two pains, physical and mental.

Just as if they were to shoot a man with an arrow and, right afterward, were to shoot him with another one, so that he would feel the pains of two arrows…”

The Buddha

Emotional Intensifiers • • • • •

Guilt Anger – Resentments Loneliness Helplessness Fear

Cycle of Uncontrolled Pain and Fear Avoidance Behaviors Pain

Decreased Mobility FEAR

FEAR

Social Limitations

Diminished SelfEfficacy

Altered Functional Status

Reversal of Cycle of Fear and Pain

Exercise Pain

Increased Mobility

Less Pain

Improved Function

Enhanced SelfEfficacy

Pain Pearls • Conditioning Increases Pain.

• Pain Patients Are A Pain.

• Secondary Gain Prevents Getting Well.

Trauma Pain Addictions

Trauma Addictions Pain

Trauma Addictions New Trauma Pain Addiction Worsens Pain Worsens

emotional abuse

4

12

19

typhoon

Birth

Vietnam combat

physical abuse

Today

Birth

emotional abuse

4

12

19

typhoon

physical abuse

Vietnam combat

Alcohol

Today

Birth

emotional abuse

4

12

19

Opioids

Pain typhoon

physical abuse

Vietnam combat

Alcohol

Today

Addiction Trauma Pain Medications Addiction Worsens Pain Worsens

Pain Recovery – Develop Balance • • • •

Mental Emotional Physical Spiritual

RESULTING CHANGES – Relationships – Positive actions and behaviors

Non-Medication Treatments at LVRC • • • • • • • • • •

Exercise – Physical Therapy Chiropractic Treatments Therapeutic Massage Reiki Acupuncture EMDR Equine therapy Mindfulness-Based Stress Reduction (Kabat-Zinn) Yoga - Chi Gong Individual + group therapy

Research confirms that drugs give the same benefits as yoga !!!

Halasana Excellent for back pain and insomnia.

Balasana Position that brings the sensation of peace and calm.

Savasana Position of total relaxation.

References • • • • • • • • • • • •

•

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References •

• • • • • • • • • • • •

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References • • • • • • • • • •

• • • • •

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