A Neurologist’s Explanation for Trauma, Dissociation and Chronic Pain
During his keynote address to the Association for Applied Psychophysiology and Biofeedback, Dr. Robert C. Scaer invited fellow clinicians to “look beyond the dysfunctional behavior apparent in many PTSD patients to the neurophysiological and autonomic dysregulation that is the source of their symptoms and eventually their disease.”
“Medical science must shed the concept that a symptom, not measurable by current technology, is ‘psychological’ and therefore invalid,” he stated, and encouraged physicians to reject the pejorative implications of the term “somatization” and to stop further traumatization of patients by subtly implied rejection.
Referencing extensive research carried out over several decades, including that of Dr. Peter Levine in the field of somatic experiencing (SE), Dr. Scaer proposes a model of PTSD linked to “cyclical autonomic dysfunction.”
Case In Point: Whiplash Syndrome
According to Dr. Scaer, Whiplash Syndrome constitutes a model for traumatization rather than physical injury; many of its symptoms and clinical manifestations are in fact a universal, animal response to a life threat in the face of helplessness.
This hypothesis is based on the occurrence of dissociation at the time of the motor vehicle accident in the form of numbing and an altered state of awareness, often attributed to concussion. Scaer reminded the audience that individuals who actively dissociate at the time of a traumatic event are much more likely to develop subsequent symptoms of PTSD than those who do not. Furthermore, he added, children are especially prone to dissociate at the time of a traumatic experience.
Whiplash Syndrome has proven very difficult to treat. Individuals who develop it after a whiplash trauma suffer continual headaches and pain, reduced movement at the back of the neck, tingling in the arms, lumbar pains, fatigue, sleep disruptions and reduced libido. Moreover, in a small percentage of people, these symptoms can persist for months or even years before settling. Yet, even then, residual long-term neck discomfort may be experienced.
These subsequent clinical symptoms are explained by theories of limbic “kindling,” Scaer said. Kindling, he explained, is the name given to the phenomenon of the progressive development of self-perpetuating neural circuits. The symptom can be produced in rats by repetitive time- and frequency-contingent regional electrical brain stimulation. The behavioral expression of kindling in humans may include epileptic seizures and is also a model for a number of clinical syndromes, including PTSD.
How the Brain and the Body Really Respond to Danger and Threat
Dr. Scaer’s model of altered brain function is a physiological one, supporting Dr. Peter Levine’s lifelong research and clinical observation of trauma. In his work, trauma is precipitated by a life-threatening event whose completion or resolution is truncated or aborted by the lack of a spontaneous resolution of the freeze/immobility response, a biological response found in all animals.
It is, he noted, a phenomenon closely allied to the clinical psychological state of dissociation. In addition to the arbitrary psychiatric diagnosis of PTSD, this state is associated with a complex set of somatic pathologic events characterized by cyclical autonomic dysregulation and an evolving state of vagal dominance involving primarily the dorsal vagal nucleus. Specifically, the sympathetic portion of this cyclical physiologic complex primarily involves vasoconstriction, with dystrophic and ischemic regional changes, especially in regions of the body that have been subject to dissociation. The symptoms persist because there is residual representation of sensory messages of threat stored in procedural memory.
The experimental model of kindling is intrinsic to the self-perpetuation of this pathologic process. And it is driven by internal cues derived from unresolved procedural memory of threat and enhanced by endorphinergic mechanisms inherent to both the initial response to threat, and to subsequent freeze/dissociation.
In this context, it suggests that a variety of chronic diseases represent late somatic expressions of traumatic stress.
Neurophysiology: Trauma and Chronic Pain In Perspective
These chronic diseases are of remarkably varied expression, Dr. Scaer noted, but with a common thread of autonomic cyclical instability, frequently subtle vasoconstrictive/ischemic features, and usually pain. They are generally distinct from those diseases frequently attributed to stress, although, he added, these “stress-related” diseases often occur simultaneously and can be more frequent in persons who have experienced trauma.
The neurophysiological model, Scaer concluded, rejects the concept that the terms “somatization,” “conversion,” “hysterical,” “psychological” or “psychosomatic” have any viable meaning in the definition of a symptom complex or disease state. In fact, it places all of these terms in a pathologic somatic context associated with subtle but definable and objective clinical findings and manifestations of disease. In short, it moves beyond the concept of mind/body medicine to the concept of a mind/brain/body continuum.
By attempting to isolate psychosomatic disease processes into a distinct category, Scaer cautions us that we are ignoring perhaps the major cause for the group of diseases that members of the healing professions probably understand the least, and treat the most ineffectively—chronic diseases of unknown cause.
The neurophysiological model now clearly indicates that many of these diseases are due to impairment of regulation, rather than due to the invasion of microbes, toxins or other extrinsic agents. As such, Scaer said, they present a unique opportunity for practitioners, researchers and teachers in the area of applied psychophysiology and biofeedback who have dealt with concepts of self-regulation and healing for the past forty years.
Biofeedback Techniques Work
Body awareness, biodfeedback, and somatic experiencing offer effective treatment techniques, often more effective than polypharmacy and many medical/surgical techniques. Scaer predicted that the application of advanced techniques, such as cerebral regulation through neurofeedback and autonomic regulation through control of heart rate variability, may have profound implications for healing trauma by providing a unique means of access to the conditioned autonomic responses that drive the trauma reflex.
Of interest to practitioners, therapists and teachers is Dr. Scaer’s book, The Trauma Spectrum Hidden Wounds and Human Resiliency, that California Bookwatch has described as a “powerful documentation of the wider-reaching nature of trauma than medical science would usually permit.”
To reference the complete document that was published in “Applied Psychophysiology and Biofeedback”, click Neurophysiology of Dissociation and Chronic Disease for the Author’s reference and text.
The Trauma Spectrum Hidden Wounds and Human Resiliency,
Robert C. Scaer, MD
W. W. Norton & Company; 1 edition 2005
Research Writings from Peter A. Levine, MD, can be reviewed by clicking Observations on Traumatic Stress Utilizing the “Whiplash Syndrome” Model.