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   . example of type 1 diabetes .

Chronic Illness and Nervous System Patterns:

An Example of Type 1 Diabetes

From the somatic psychology perspective presented here, chronic illness and symptoms represent a change in normal patterns of nervous system regulation. According to this lens, chronic illness and symptoms evolve from and reflect an intelligent attempt to cope with an overwhelming situation (... more). Different types of symptoms and chronic illnesses reflect each individual's unique set of life experiences as well as the timing of exposure in early life. The resulting disease or symptom is unique to each individual and may show up as multiple sclerosis, chronic fatigue, or type 2 diabetes, etc.

This page illustrates the somatic psychology model for the origins of disease with an example of type 1 diabetes (presented in general terms in origins). Worldwide research has identified many risk factors for type 1 diabetes, both in early life and in the few years preceding diagnosis. The common link between these risk factors remains poorly understood, however, as does the relationship between risk factors and disease. Somatic psychology offers a new lens from which to consider the links between risk factors and disease, as well as between stress and glucose variability. It appears to provide a comprehensive means for understanding the origins of type 1 diabetes, and to be applicable to understanding the origins of other chronic illnesses and symptoms. For more view or download PDF (200k) (160 references, article published in Medical Hypotheses).



Overview (see origins for more)
   Dominance of the Sympathetic Nervous System
   A Conditioned Response
   Critical Period Programming
   Kindling
   Latency Period
   Diagnosis
   Symptom Variability

The Origins of Type 1 Diabetes
   Stage 1: Risk Factors in Early Life
   Stage 2: The Latency Period: Autoimmune Destruction
   Stage 3: The "Final Stressor"
   Stage 4: Diagnosis
   Symptom Variability and Age of Diagnosis

Overview
(see origins for more depth)


Diabetes as a state of Altered Nervous System Regulation


Dominance of the Sympathetic Nervous System
Type 1 diabetes appears to represent a prolonged state of fight or flight that specifically involves the regulation of glucose (sugar). During an increase in sympathetic nervous system (SNS) activity, glucose is secreted and made available as fuel for movement and survival activities, while insulin is simultaneously inhibited to prevent glucose storage, which would otherwise decrease the availability of fuel. The hallmark of type 1 diabetes is an increase in glucose in the face of active destruction of insulin producing cells and other signs of high sympathetic nervous system activity are common, including high blood pressure (hypertension), decreased circulation in the extremities, and heart disease.

Conditioned Response
The initiation of an exaggerated state of survival occurs during emotionally overwhelming experiences such as trauma.

Critical Period Programming The organ systems involved in a conditioned response associated with chronic illness are proposed to occur during "critical period programming" in early life ie: during the time that a particular organ system is developing. High glucose and low insulin, which are the hallmark of type 1 diabetes, are an inherent part of the fight / flight response (sympathetic nervous system) and involve the pancreas, which produces insulin. Timing of the original stressor in type 1 diabetes is proposed to occur during the development of the nervous system's capacity to regulate glucose and insulin, and may also occur during development of the pancreas in prenatal life.

Kindling
Over a period of months or years, an increasing number of stimuli trigger and strengthen (kindle) the conditioned response that leads to high glucose and low insulin. These triggers stimulate changes in glucose levels, which are often affected by stress.

The Latency Period
Predisposition to type 1 diabetes often involves the presence of antibodies and the gradual destruction of insulin producing cells. The period during which antibodies arise and the pancreas is actively destroyed can last for 10 years or longer and during this time there are no symptoms of diabetes. This period represents a time when continued and repeated activation of the conditioned response of sympathetic arousal conveys to the body that insulin-producing cells are no longer "necessary" since they are not being used. The nervous system recruits the immune system to destroy these "unnecessary" cells, very specifically avoiding similar cells that produce different, and necessary, chemicals... more

Diagnosis
Diagnosis of diabetes occurs when the number of insulin-producing pancreatic cells becomes too small to meet the needs of the body when processing glucose in normal circumstances. Diabetes usually begins within 2-3 years of a significant life stressor (such as loss, a move, infection, divorce or marriage, job loss or promotion,...). From the model's perspective, this "final stressor" makes the conditioned response fully active such that a state of sympathetic dominance (fight/flight) becomes the norm for a particular individual.

Symptom Variability
After diagnosis, the same stimuli that have triggered the conditioned response of sympathetic arousal in the past now cause exacerbations in glucose control. This stress response well known in diabetes but the fact that individuals appear to have different responses to different stressors has long confused this finding. According to the somatic psychology model, the stimuli that cause changes in glucose in individuals with type 1 diabetes will be different for every individual because the original traumatic event and conditioned response is different for everyone. Furthermore, some individuals will have no glucose change in response to an apparent stressor because it does not stimulate their specific conditioned response, while others will have an increase, and still others will have a decrease in glucose. Low glucose levels appear to represent elicitation of the faint or freeze response (parasympathetic nervous system).



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I. The Origins of Type 1 Diabetes
Stage 1: The Initiating Event

Risk Factors in Early Life




risk factors for type 1 diabetes with diagram of stressors in early life

Prenatal Risk Factors:
  • infection in mother or baby
  • blood group incompatibility
  • preeclampsia
Perinatal Risk Factors:
  • jaundice & light therapy
  • infection
  • cesarean section
  • decreased breastfeeding

Individuals who develop type 1 diabetes have had a higher exposure to certain events in early life. A lack of consistency across studies makes this confusing from medical perspectives. According to the somatic psychology model, however,, the common link between early risk factors is trauma (life-threatening stress).

Prenatal Risk Factors

Events identified in the prenatal period include infection in the mother or baby, incompatibility between blood types between mother and baby, and preeclampsia, all of which may be life threatening to both mother and baby. Preeclampsia is an illness that remains poorly understood but that appears to represent a state of increased sympathetic nervous system activity (fight / flight). Since nervous system regulation is influenced by the environment, babies exposed to preeclampsia may develop a tendency to regulate in states of sympathetic arousal.

Perinatal Risk Factors

Events in the period around birth include jaundice (yellowness) in the baby requiring light therapy; infection in the baby; birth by cesarean section; and a decrease in the frequency and duration of breastfeeding. Perinatal risk factors are all associated with increased risk for separation between mother and baby in the hours and days immediately after birth. Early separation can have a strong impact on bonding, nervous system development, and conditioning towards perceptions of threat (... more)

The model of somatic psychology proposes the following:

.
  1. Individuals who develop type 1 diabetes following certain types of events in early life are those who experienced them as life-threatening. Because of the influence of environmental factors on the nervous system, such experiences are imprinted in memory and act as a conditioned response for learning to repeatedly perceive the environment as threatening.

  2. The more intense the experience of the initial stressor(s) and the stronger the perception of life threat, the stronger the conditioned response and the greater the risk for changes in patterns of nervous system regulation. In this example, the result is a higher risk for type 1 diabetes.

  3. Organ systems that are most likely to be influenced by environmental stressors are those undergoing rapid change and growth. The timing of a stressor during early development plays a role in determining the organ system affected by patterns of nervous system regulation, and influences the type of chronic illness that may develop. This is known as critical period programming.

  4. Despite early exposure to intense risk factcors, some individuals at risk for diabetes never develop the disease. This is consistent with our understanding of conditioned responses, which may fail to develop due to lack of ongoing stimuli and kindling. Lack of exposure to stressors and the presence of strong buffers such as supportive environments may play an important role in preventing diabetes in individuals at risk.

  5. Specific risk factors are not always associated with increased risk for diabetes. This is consistent with an understanding of trauma and conditioning, which are based on the way an event is perceived. In other words, it is not a particular experience or event that affects risk for type 1 diabetes, but the way in which it is perceived (as life-threatening, or not). In this context, certain events are more likely to be experienced as stressful and are therefore more likely to be consistently identified as associated with higher risk.

  6. A common link between the risk factors mentioned above is that all result in a disruption in the maternal-infant bond, usually because the infant is separated from the mother for treatment (light therapy, antibiotics, mother's recovery following cesarean section, etc). Maternal-infant separation, particularly in the first hours and days after birth, have been found to play a significant role in bonding, which in turn influences nervous system development (... more).



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II. The Origins of Type 1 Diabetes
Stage 2: The Latency Period

Type 1 diabetes is usually diagnosed in early childhood and in adolescence. The period preceding diagnosis can often be identified by the presence of certain types of antibodies, including antibodies that destroy insulin-producing cells. Insulin has been found to decrease and antibodies to be present up to 10 years before diagnosis. Antibodies usually increase over time in individuals that eventually develop the disease. Many individuals who do have antibodies, however, never develop type 1 diabetes. (Antibodies resolve spontaneously in over 75% of individuals who have them).

Antibodies fluctuate over time, may increase, decrease, resolve and return. The variability in concentration and the length of time over which antibodies develop is consistent with the concept of "kindling", in which a particular conditioned response develops over time if triggered sufficiently by life experiences such as stress. The process by which the immune system destroys insulin-producing cells is not well understood in the research community, nor is the specificity of the attack on some cells (insulin-producing) and not others. According to a model that seeks to understand the intelligence behind physiological activities, it is hypothesized that the immune system is actively recruited by the nervous system in individuals who eventually develop type 1 diabetes. In these instances, the immune system destroys insulin producing cells because the nervous system is conditioned towards a state of sympathetic dominance, which promotes increases in glucose and simultaneous inhibition of insulin secretion and activity.


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III. The Origins of Type 1 Diabetes
Stage 3: The "Final Stressor" is the Unmasking Event

risk factors for type 1 diabetes with diagram of stressors in early life

Stress (red star) prior to Diagnosis:
  • infection
  • trauma
  • cold climate
  • other stressor:
    loss, divorce,
    marriage, promotion...


It has been clearly established that stress plays a role in the onset of diabetes in the 2-3 years prior to diagnosis. Many different types of stressors have been identified, including infection, cold climate, trauma, and stress. The stressor most commonly associated with diabetes is evident because it occurs within a relatively small time frame and can be recalled, identified and studied. The stressor that occurs prior to diagnosis is simply the last of many stressors, however. It plays a role in making the pre-existing conditioned response fully operational so that a particular state of nervous system percetpion and regulation becomes dominant. In type 1 diabetes, this is a state of dominance of sympathetic nervous system arousal.

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IV. The Origins of Type 1 Diabetes
Stage 4: Diagnosis

Type 1 diabetes is most commonly diagnosed in some age groups in fall and winter in areas that have cold climates. Mammals and humans have, over time, developed a familiarity with seasonal change and automatically go into states of increased sympathetic activity in preparation for the stress of cold temperatures. From the somatic psychology perspective, one would expect environments requiring sympathetic arousal to unmask individuals predisposed to states of sympathetic arousal.

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V. Symptom Variability and Age of Onset

Variation in Glucose Levels

There are a broad range of symptoms in individuals with type 1 diabetes, the most common of which is variation in glucose levels. According to the theories presented here, elevations in glucose represent a self-perpetuating conditioned response in which states of sympathetic arousal are triggered from one moment to the next. Similarly, glucose may vary after diagnosis in response to ongoing internal and external triggers. Because each individual has a unique history of intiating stressors in early life (stage 1) as well as kindling stressors during the latency period (stage 2), each will respond in his or her own unique way to ongoing life stressors. Being late for an appointment, for example, may result in an increase in one person's blood sugar, a decrease in another (a freeze response), and no change in a third.

"Brittle" blood sugars

The ease or difficulty with which someone is able to control blood sugars is likely related to the severity and sensitivity of their conditioned response. This is more a problem of increased sensitivity and reactivity to a higher number of triggers than a problem of will power or "irresponsible behavior" and poor skills in regulating blood sugars with insulin and close self-monitoring.

Risk for other Complications and Earlier Age of Onset

Individuals with a severe initiating stressor and intense kindling stressors are more likely to
  • have "brittle" diabetes in which glucose levels change rapidly, frequently, and for no apparent reason

  • be at increased risk of more rapid kindling and younger age of onset

  • be at increased risk for additional complications, not simply because of greater frequency of high blood sugars, but because the underlying state of conditioned sympathetic arousal may influence many other organ systems as well (hypertension, heart disease, blood clotting, neuropathy, decreased circulation in limbs...).

The Potential Benefits of Somatic Psychology

Through the use of nonjudgment, and mindful observation, somatic psychology invites the use of different parts of the brain than those involved in the conditioned response. By looking for triggers, exploring the experience of a reaction to a trigger (whether emotional or physical, or related to changes in blood sugar) an individual can use the variability of symptoms to change the dominant pattern of arousal to one of curiosity and calm. This process reestablishes dialogue between parts of the body and mind, teaches the nervous how to perceive more accurately in the present moment, and retrains the body towards more effective patterns of nervous system regulation.




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