Childhood Trauma linked to Obesity and Illness throughout the Lifespan

Check out this amazing slideshow by Kathleen Kendall-Tackett about the links among childhood trauma, race, size, and socioeconomic discrimination,  and later physical illness, sleep disturbances, depression and obesity. This goes beyond the ACE studies and to look at all forms of stress/trauma including cultural ones. The worse the developmental trauma (this includes poverty and social discrimination), the greater the impact on physical and mental health, insulin resistance and obesity. Time to stop blaming the survivors and start challenging the causes. 

Lesser Known Causes of Obesity

We hear it in the news every day.  There is an obesity epidemic.  We are obese.  We just keep getting fatter and fatter.  

Who's responsible?  We must find someone to blame.  Why not blame the fat people?  Many people in Western society seem to have opted for distancing ourselves from the intolerable and projecting it onto “fat” and "fat people".  Our society's rage against fat as sin today may be comparable to the Victorian attitude about sex. Our desperation to avoid the stigma of fat is reflected in how we spend our money. 

In 2012 in the U.S. alone, the weight-loss industry raked in $61 billion on weight loss foods, food replacement products (i.e. Jenny Craig, Weight Watchers), books, surgeries, diet programmes, and diet supplements (in 1980 that number was $10 billion). 

After all, we can't control our age, our height, our colour, our socioeconomic status at birth, our parentage, our increasingly poisonous environment - we need something to claim control over - right?  If we can't control our body weight, there's no hope for us - right?  Wrong.

Obese people have been found to expend less energy while sleeping and resting than those who are not obese, making it easier to gain weight on lower caloric intake than those with higher resting energy expenditure rates:

"Resting energy expenditure (REE) was investigated by indirect calorimetry in relation to body composition and to different degrees of obesity in order to assess if a defective energy expenditure contributes to extra body fat accumulation …. The analysis showed a negative impact of obesity on REE beyond body composition variables."  (⁶Verga, p. 47)

Recent research by 12 Dallman suggests that high levels of stress over a long period of time (such as those caused poverty, chronic trauma and childhood abuse) can create changes in the brain that causes the body to redistribute its fat stores to the abdominal area and increases sucrose (sweets) appetite. 

Pagato, et al, 2012 observed that

• PTSD alters functioning of the HPA axis, which regulates cortisol secretion Cortisol hypothesized to promote obesity
• Cortisol secretion linked to stress-related weight gain
• People with PTSD have lower circulating cortisol relative to healthy controls

Ironically, the stigma from being fat, especially as a child, and the consequent vulnerability to ongoing bullying and abuse by peers can set this viscous cycle in motion or exacerbate it early on.

Additional causes of obesity unrelated to compulsive eating were also found by studies from the ⁷National Institutes for Health, and by ⁴Heitmann.  Obesity has been shown to have a significant genetic component according to cross-sectional twin and family studies done by ²Coady. And this genetic component is compounded by the tendency of obese people to mate with each other, as they are often excluded from mainstream dating circles.  From  ³Hebebrand:

"Our results indicate that assortative mating is common among parents of extremely obese children and adolescents, ascertained between 1995 and 1997. In addition, the parental loading on the tenth decile is most prominent for the most obese children."  (p. 345)

Major Cause of Obesity Epidemic: Weight-Loss Attempts

• Research on 17,000 children showed that twins who embarked on one intentional weight loss episode were two to three times more likely to become overweight compared to their non-dieting twin counterpart. Furthermore, the risk of becoming overweight increased in a dose-dependent manner, with each dieting episode. #1

• A 1999 report on 4,193 women and 3,536 men participating in the Finnish Twin Cohort Study revealed that dieters were several times more likely than non-dieters to experience major weight gain (more than 22 pounds) during a follow-up lasting 15 years. (pp.31) #2

#1. Alison E. Field, S. Bryn Austin, C. Barr Taylor, Susan Malspeis, Bernard Rosner (2003)

#2. Korkelia, M., A Rissanen, J Kaprio, TIA Sorensen, & M Koskenvuo (1999)

According to a 2007 Meta-Study (a study of 31 other studies, internationally)

• Diets do lead to short-term weight loss, on average of 5%–10% of the person's body weight

• These losses are not maintained

• The more time that elapses between the end of a diet and the follow-up, the more weight is regained.

• Among patients who were followed for two or more years, 83% gained back more weight than they lost

• In studies with the longest follow-up times (of four or five years post-diet), the weight regain trajectories continued to increase suggesting that if participants were followed for even longer, their weight would continue to increase. #3

#3 Mann, T., Tomiyama, AJ, Westling,E, Lew, AM, Samuels, B. (2007) Medicare’s Search for Effective Obesity Treatments in American Psychologist Vol. 62, No. 3, 220–233

Putting people on caloric restriction regimens is bound to fail, as their bodies will tell them that they are not getting enough to eat (they will have a constant nagging hunger that will only ease up when they eat).  Checking for medications that cause weight gain, educating about food additives such as trans fatty acids or trans-fats, explaining about the connections between genes, stress, childhood abuse and body size to de-stigmatise, and encouraging an increase in activity levels with guidance on how to incorporate regular exercise into daily routines is the only humane prescription for obesity when it is not related to overeating.

References:
²Coady, S.A., Jaquish, C.E., Fabsitz, R.R., Larson, M.G., Cupples, L.A., & Myers, R.H. (2002). Genetic variability of adult body mass index: a longitudinal assessment in Framingham families. Obesity Research, 10, 675-81.
^1aColditz, G.A. (1992). Economic costs of obesity. American Journal of Clinical Nutrition, 55, 503-507.
¹²Dallman, M.F., Pecorary, N., Akana, S.F., la Fleur, S.E., Gomez, F., houshyar, H., Bell, M.E., Bhatnagar, S., Laugero, K.D., and Manalo, S. (2003) Chronic stress and obesity: A new view of "comfort food".  Proceedings of the National Academy of Sciences of the USA, 100/20, 11696-1170^1
11 Trust for America's Health Report. (2005). F as in Fat: How obesity policies are failing in America.
¹⁰Farley, Tom,  (2005). Prescription for a Healthy Nation : A New Approach to Improving Our Lives by Fixing Our Everyday World. Boston: Beacon Press
⁸Gallagher, D., Testolin, C., Heshka, S., & Heymsfield, S.B. (n.d.). Body mass index: Differential misclassification of under and over-fatness. New York City: Obesity Research Center, St.
³Hebebrand, J., Wulftange, H., Goerg, T., Ziegler, A., Hinney, A., Barth, N., Mayer, H., & Remschmidt, H. (2000). Epidemic obesity: are genetic factors involved via increased rates of assortative mating? International Journal of Obesity Related Metabolic Disorders, 24, 345-53
⁴Heitmann, B.L., Harris, J.R., Lissner, L., & Pedersen, N.L. (1999). Genetic effects on weight change and food intake in Swedish adult twins. American Journal of Clinical Nutrition, 69, 597-602.
^1bMetropolitan Life Insurance Company (1983). Metropolitan height and weight tables. New York: Author.
⁷National Institutes for Health (2001). Understanding adult obesity. NIH Publication No. 01-3680. Washington, DC: U.S. Government Printing Office.
⁵U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (1996). Physical activity and health: A report of the surgeon general. Washington, DC: U.S. Government Printing Office.
⁶Verga, S, Buscemi, S., & Caimi, G. (1994). Resting energy expenditure and body composition in morbidly obese, obese and control subjects. Acta Diabetologia, 31(1), 47-51.
 
  

HUGE news: Judge Rules Causal Link Between Sexual Abuse and Schizophrenia Must be Aknowledged by Insurance Company

This is HUGE! For those not from New Zealand, ACC (Accident Compensation Corporation) is a government-contracted insurance company that covers counselling and psychotherapy for those who can demonstrate  "mental injury due to sexual abuse." It's one of the many reasons I moved to New Zealand as I figured a country that not only recognises that: abuse exists, can be forgotten,and then return in memory; but that actually compensates the people who suffer because of this, can't be all bad. Two days ago...

"A judge has ruled in favour of an ACC claimant in a case expected to have "enormous" ramifications for the way mental health patients are treated.

In the decision, released recently, Judge Grant Powell in the Wellington District Court agreed with a psychiatrist who said a man's schizophrenia had been caused by trauma from sexual abuse in childhood.....

"(The) judge agreed with a growing body of research that says traumatic events can cause psychosis.

The research includes the work of clinical psychologist John Read, who has been at the forefront of research to show a relationship between childhood sexual and physical abuse and psychotic symptoms, including schizophrenia."  Thank you John Read for years of painstaking ground-breaking (and myth-busting) work. .Click here for more on this

Healing from Childhood Abuse, Trauma and Neglect (Part 1)

When searching for counselling and therapy to heal the wounds of trauma, childhood abuse, and/or childhood neglect one can be faced with an overwhelming myriad of choices.   Most treatment techniques (both  medical and psychological) that are studied scientifically take into  account that a significant percentage (actual numbers vary based on condition or treatment being studied) of those being studied get better spontaneously simply because they believe they are being given a  (called the placebo effect).

A number of new approaches that take into account the recent discoveries of neuroscience, made possible by modern brain imaging techniques, have been shown either scientifically (in placebo controlled randomised blind or double-blind studies) or anecdotally (based on empirical observations and patient/client reports) to be highly effective in a shorter period of time than conventional "talking only" therapy. All of these approaches, of course, need to be integrated by a skilled and experienced clinician, into an overall treatment style and plan that will include talking therapy as well as a healthy respect for the power of the therapeutic relationship and the need for the therapist to earn the client's trust by creating safety.

Below I list some of the approaches that have been shown to be effective  with survivors of adult trauma and childhood physical, sexual, and emotional or psychological abuse, plus a link to another blog entry I wrote on effective  approaches for those suffering from the effects of "poor affect regulation",  commonly caused by emotional neglect or the unavailability of reliable  soothing in early childhood.  I only list those methods that I have personally learned and tried and observed to be effective, and the reasons (if known) that they work. 

Affect regulation treatment approaches are also useful with survivors of trauma and/or childhood abuse. The basis for this is  described in a separate blog entry (Learning to Comfort and Soothe) as they are more generic therapy approaches used for a broader range of problems and causes.  Since writing that entry, I have been learning about "memory reconsolidation" which claims that rather than going through the painstaking process of learning to "regulate" out of control feelings, one can "re-write" the implicit memory itself so that feelings become self-regulating, as they would have been if the original "dysfunctional implicit memory" hadn't been laid down in the first place. I will explore this in depth in another blog entry (coming as soon as I finish writing it).

I mention anecdotal or scientific (placebo-controlled) in brackets next to the name of each approach to identify the type of documentation of  effectiveness. I include approaches that have primarily anecdotal evidence because it is extremely difficult to measure approaches to complex trauma and dissociation in a laboratory setting. In my opinion, there are too many uncontrollable variables once you try to measure treatment effects with this population, especially since it isn't ethical to in any way limit access to anything that might help simply because it could confound the scientific evidence of your study.  The DNMS, Sensorimotor Psychotherapy,  and Ego State Work, for example, have ample anecdotal evidence presented in scientific journals as controlled case studies, and are based upon modern scientific insights into the brain,  but that is not the same as evidence based on rigorously controlled scientific studies.

Ego State Therapy (anecdotal)

Founders: John and Helen Watkins

The concept of segmentation of personality into discreet parts of self has been around for many years, but has only recently been validated scientifically by new brain scanning technologies. These technologies, by measuring blood flow patterns in the brain, demonstrate how ego states are formed by neural clusters repeatedly firing together (and therefore "wiring together"). 

Such neural nets form the basis for most implicit learning - such as learning how to ride a bicycle - a skill that improves and eventually "clicks" as the neurons, which fire together in the same pattern whenever riding is practised, form a network with a particular skill set. When such a neural net forms in the context of a relationship, it will develop a unique point of view and way of behaving.

Ego states exist as a collection of perceptions, cognitions and emotions in organised clusters. An ego state may be defined as an organized system of behaviour and experience, whose elements are bound together by a common principle. Ego states may also vary in volume. A larger ego state may include all the various behaviours activated in one's occupation, whereas a smaller ego state might be formed around a simple action, such as using a mobile phone. They may encompass current modes of behaviour and experiences or include many memories, postures, feelings, etc., that were learned at an earlier age.

The human mind is a collective "family of self" within a single individual. How well these "family" members get along, and how effectively they cooperate can vary considerably from individual to individual. 

This segmentation has been called many names over the years, depending upon which psychological theory is being used. In Freudian language we are all divided into Ego, Id and Superego; Jungians refer to "complexes" which are described almost identically to ego states; Transactional Analysts talk about the internal Parent, Adult and Child; and Psychosynthesis refers to "sub-personalities." Ego states exist on a continuum of separateness, with the most extreme dividedness being caused by the most extreme early relational trauma.

Although everyone has ego states, those states formed in response to loving supportive experiences do not tend to require psychotherapeutic intervention. When ego states are more split off and engage in internal battles, Ego State Therapy can be employed to help resolve some of these conflicts, often using techniques found in conflict resolution, group or family therapy, to enable a kind of internal diplomacy. This approach has demonstrated that complex psychodynamic problems can often be resolved in a much shorter period than with analytic therapies. 

PLEASE NOTE: The techniques described here have been integrated into PSI^TM (PsychoSomatic Integration), an overall approach I teach for working with trauma and abuse survivors. PSI^TM is described here in more detail.  

More approaches to come....to be continued

Overcoming Powerlessness

"We who lived in concentration camps can remember the men who walked through the huts
comforting others, giving away their last piece of bread. They may have been few in number, but they offer sufficient proof that everything can be taken from a man but one thing: the last of the human freedoms -- to choose one's attitude in any given set of circumstances."-- Victor Frankl

When you feel powerless, you feel afraid to express your needs because you fear (often rightly) that what little you have will be taken from you. You may have learned powerlessness if you were kept in powerless positions repeatedly and/or over long periods of time (possibly during childhood) by those who used external forces (money, physical strength, legal status, and/or military force) to control you. You may have been abused as a child, a partner or spouse, an employee, a soldier, or you may have been the victim of racial or ethnic attacks. Such prolonged abuse can cause you to become afraid to feel even your own needs, i.e., to admit to yourself that you need something. You become immobilized. And in certain critical ways you stop growing, you cease to thrive.


Distinguishing Externally Imposed Powerlessness from Learned Powerlessness


When powerlessness is "learned", it becomes self-perpetuating, even if the external forces are no longer there. An abused child may grow up to feel permanently powerless as an adult, even though his/her parents no longer have physical or economic power over him/her. One may then enter into a situation that repeats childhood experiences (e.g., living with or marrying an abusive partner), and therefore keeping oneself in externally imposed danger. Or one may keep oneself down through self-abuse, compulsive behaviors, and/or depression...because the powerlessness has become internalized.

This is different from the externally imposed powerlessness of racial, class, and gender oppression, which may be enforced through economic, legal, physical, or military, might. The secretary who is being sexually harassed, the single mother who cannot get a promotion due to sex discrimination, the homeless family that cannot afford housing: these are victims that require collective power and direct action to overcome their powerlessness. Collective power may take the form of a union, or a "network" of friends, supporters and professional helpers. Direct action might involve a lawsuit, going to the media, or organizing a strike or protest. Collective power and direct action together make an even more powerful combination.
Even more insidious than this is when--as is often the case--externally imposed powerlessness is combined with learned powerlessness. When this is the case, the above methods are not possible because the person is emotionally incapable of asserting her/his rights.

Overcoming Learned Powerlessness

The first step to overcoming learned powerlessness is to learn to feel entitled to your personal rights. You have the right to live a life free from physical, emotional, sexual, and financial mistreatment. You have the right to be treated with respect, to earn a livable income, to be informed of matters that affect you, and to express yourself freely (without harming others). Most importantly, you have the right to ask for what you need (even though you may be turned down) and to fight for what you need and want (even if you are turned down!). This list of "legitimate entitlements" is easier to read than to experience. Most people who have learned powerlessness barely feel entitled to speak, let alone to speak freely. Often professional therapy is necessary to overcome the ingrained patterns. Never the less, to overcome learned powerlessness, you must gradually, haltingly, but persistently lay claim to each and every human right, one after the other.

Click here to find out about distance learning programs for therapists and here to find out about general training and supervision options.