I Think I Know Why You’re Here: How Nervous System Dysregulation Is Connected to Chronic Stress, Trauma, Gut Issues, and More
INTRODUCTION
I think I know why you’re here
Something feels ‘off’ in your body, heart and mind, and you’re searching for information to ease your physical or emotional distress. You may have spent a year or more cycling through appointments with various healthcare professionals to address these issues, and even had bloodwork or other lab tests done in an effort to get to the bottom of whatever’s going on. You’ve probably trialled one or more medications and/or supplement regimes, and I bet you’ve exhausted Google looking for answers.
Am I on the right track? If I am, it’s because I’ve seen these scenarios play out hundreds of times over the many years I’ve been guiding people through their healing journey – first as a physiotherapist, and now as a leading global educator on the nervous system. I understand how hard it is to stay positive and afloat in this sea of uncertainty, and I’ve seen how living with chronic health problems without an obvious cause or solution can bring people to the brink of despair and even make them wonder if the problem is all in their head.
Does this sound like you?
By the time people come to me for help, they’re usually tired, in pain and emotionally drained from months, years or even decades of an uphill health battle. Alex was one of these patients.
Alex’s story: Restoring balance
My first impression of Alex was that she was full of life and a perfectly healthy 31-year-old, but a few minutes of conversation changed my mind. Alex had lived with ongoing health issues since the age of 25. Initially, she suffered with severe skin irritation in her twenties, but before long she was also dealing with pain in her stomach, along with anxiety and a cluster of other conditions, each requiring different treatments. Over the years, Alex had seen dozens of doctors and been prescribed a litany of medications – so many she could hardly remember them all.
Some of Alex’s doctors had hypothesized that her skin condition was a result of irritation from cosmetics and other products, so she dutifully switched to the creams they prescribed and changed every product she used, from her soap to her laundry detergent. When that didn’t help, other doctors wondered if she was causing ongoing irritation by scratching her arms without realizing it – perhaps in her sleep or while worrying about some- thing. Though Alex was adamant she hadn’t been doing this, their best advice was for her to make an effort not to touch the affected areas at all, and then see if anything changed. It didn’t.
All of this was very frustrating, and didn’t help soothe the itchiness, pain or appearance of the red blotches that covered her arms. She grew increasingly self-conscious about her skin and started dreading going to work. If a colleague or friend happened to mention her skin in any way, she became angry and defensive. When her body aches, stomach pain and digestive issues cropped up, Alex was diagnosed with irritable bowel syndrome (IBS) and prescribed a strict diet. Despite following that diet to the letter, her symptoms continued unchecked. With no relief, she resorted to reorganizing her life around her stomach pain – avoiding social occasions and dinners with friends in case a rogue ingredient caused a flare-up.
While dealing with these health challenges, Alex developed anxiety, which worsened despite visits to specialists and various prescriptions. As I took her history, I noticed that she described herself as ‘a worry wart’ and ‘an anxious person’. This was an important detail, because it gave me a lot of insight into the stories Alex was telling about herself. She obviously believed that these descriptions of herself were accurate, because she stated them as factually as she’d reported her experience of physical pain.
Alex characterizing herself in this way – as a ‘worrier’ – was contributing to a lack of trust in herself. Despite all she’d been through, I was starting to wonder if her anxious nature was leading her brain to sound alarms that amplified her pain.
What was clear to me, though, was that Alex’s conditions were not only very real, but had also gone unvalidated and unseen for years. That lack of support and validation had, in turn, created the perfect environment for other issues to arise. I’ve listened to many patients and students describe mental and physical pain, and express disillusionment with medical approaches and various mindset practices they’ve been advised to try. Many have been told that their symptoms are either psychosomatic or ‘not that bad.’
Others have been assured that talking about their suffering and mindfulness will cure them, and then been frustrated when they’ve pursued those strategies without any improvement. While these are both good interventions in certain situations, in Alex’s case they were only treating the visible symptoms rather than the root of her pain.
After I’d taken a thorough case history from Alex, she confided that it hadn’t just been her skin condition that had first led to her anxiety developing. Around the same time she sought treatment for her skin, she’d also had a major blow-up with her housemate. For months, Alex had been coming home from work to find piles of her housemate’s dishes in the sink and clutter in the living room. Initially, she’d tried ignoring the mess, hoping her housemate would take the hint, but when they didn’t, she started cleaning up after them – though doing so made her furious. After months of doing this without so much as a thank you, Alex sat her housemate down and told them things had to change – but they didn’t seem very interested in changing.
This situation went on for well over a year, but when Alex had to cover her housemate’s late rent payment for the second time, she’d finally had enough and confronted her housemate. They’d argued, but the housemate had eventually apologized and promised to do better. When Alex got home from work the next day, however, her housemate was gone and so was all of their stuff. Though Alex was relieved not to be living with them any more, it put her in a tough spot financially. She maxed out her credit card covering the extra rent and bills while she scrambled to find a new housemate. She felt helpless about her financial situation and at times she’d felt a sense of panic, knowing that she simply couldn’t cover the cost and there was a current rental shortage in her area.
This information was the missing piece of the puzzle for me, and I felt confident that nervous system dysregulation had not only triggered the inflammatory response that had caused Alex’s skin condition, but was also behind many of the health problems she was currently experiencing.
Our internal thermostat and set point
Every one of us has an internal set point at which we feel and function our best. Like a thermostat in a house, our brain and body work together via our nervous system to bring us back to our set point and maintain this beautiful equilibrium – or what scientists call homeostasis.
Ideally, we’d spend the majority of our lives thriving at this comfortable set point, but it’s not the only setting on our internal thermostat. There are two others – hot and cold – and both are necessary – even life-saving in certain circumstances. We’re wired to slip in and out of these two quickly as life demands. If we’re under attack, for example, switching to a hotter state allows us to react quickly and with aggression to defend ourselves or to run away. This is colloquially known as fight or flight. In a well- regulated system, once the threat has passed we come back to our set point and return to our lives.
The remarkable thing about this set point is that it’s calibrated to meet our true needs (i.e. the needs of our lived reality). Unfortunately, factors such as illness, trauma and chronic stress can swing us away from this set point, and even change it entirely.
If we exist in a hot or cold state for long enough for our brain to perceive it as our new reality, our set point will recalibrate to meet what it believes to be our true needs. Our brain is a ‘prediction machine’ and if we’ve experienced traumatic stress and become hypervigilant to threat, our set point may shift so that it’s cali- brated to our predicted needs (how we perceive our reality).
In Alex’s case, the stress of living with an inconsiderate house- mate had dialled her thermostat up to a hotter temperature. And after months of her swallowing her irritation, anger and stress, Alex’s thermostat had decided that this hotter temperature was her new normal, and had adjusted her set point accordingly. The final straw was the helplessness she felt of not being able to find a housemate and being left with the responsibility of paying rent that was more than she could afford.
If we want to feel good and perform at our best, the most powerful thing we can do is recalibrate what’s going on inside our body and brain, to match the real demands of our environment.
Just imagine how uncomfortable it would be to live in a house where the thermostat was stuck on an extreme temperature. Your mood, not to mention your capacity to deal with stress would be radically altered. Every task would require more effort and energy – you’d either have to keep a fire burning constantly and wear extra clothing to stay warm, or find ways to stay cool in the stifling heat. Left unchecked, those extreme temperatures start to cause short-term emergencies. Hardwood floors start to buckle or crack in the heat. Pipes freeze and burst in the cold and, just like that, the ongoing temperature problem becomes an all-out emergency – draining precious resources and distracting you from the routine maintenance projects that keep your house running smoothly.
A similar type of wear and tear goes on inside us. Yes, we can handle certain situations and environments in the short term, such as staying up all night to meet a work deadline, or being a 24-hour caregiver for an ill family member over a couple of weeks. But when we push past our natural limits to meet expectations or please others, our body sends us warning signs to let us know we’re shifting away from our set-point. The longer we stay in those situations and the more we yield to the pervasive cultural pressure to be busy, work hard and achieve more, the more we overstep our natural limits, the further we get from that healthy, regulated set point, and the worse we feel. Regulation turns into dysregulation and, over time, this manifests as mental and/or physical conditions we can no longer ignore.
Stress, trauma and our shifting baseline
Like so many of our feelings, emotions and experiences, stress and trauma exist on a spectrum, and while all trauma is stressful, not all stress is traumatic. Stress refers to the way our brain and body respond to an event or situation we perceive as threatening or challenging. As we all know, stress can be mild or major. Everyday stressors are rarely threats to our survival, but our brain doesn’t usually realise that. In the face of stress, we’re hardwired to mobi- lise energy and trigger stress-arousal responses.
These hardwired fight-or-flight responses prepare us for danger by turning up the temperature on our set point, but if the stress is only mild, it sharpens our focus and mobilises our energy so we’re ready for action. And just as we’re designed to cope with stressful moments, a process known as allostasis gives us the capacity to return to our baseline once that threat has passed. It’s a process of mobilising energy to meet demands and then completing that stress activation cycle. With a healthy, functioning nervous system, we can return to a calm state where we feel social and at ease fairly quickly. Provided we get to recover fully from stress, it’s not bad for us. In fact, in most cases it makes us more resilient.
But when stress is chronic and we experience panic or anxiety on an ongoing basis, it depletes our resources and energy and takes a toll on our body. The wear and tear caused by this cumulative stress is known as allostatic load, and it can contribute to physical ailments such as digestive disorders and hypertension, as well as mental health issues such as depression. The important consequence of allostatic load is that it can prevent us from returning to our original set point. The same is true of traumatic stress, which occurs when we experience too much stress, too quickly.
Cortisol gets a bad rap for being the ‘stress hormone’, but it performs the vital job of mobilising glucose so we have the energy we need to meet challenges. Prolonged periods of stress can cause fluctuations in our cortisol levels, and this can lead to burnout, an increasingly common condition, as too little cortisol leaves us feeling flat, unmotivated and fatigued. When we spend a long time feeling depleted like this, our nervous system can shift even further into that ‘too cold’ state, and this can lead to feeling flat, numb and depressed. Crucially, this can also change our inner thermostat and recalibrate our set point to a lower temperature.
At the other end of the spectrum is trauma, which ranges from extreme ongoing stress to highly distressing events. Like stress, trauma can recalibrate our set point. It’s important to note that there’s no one point on this continuum where stress crosses the line into trauma. This is because trauma is subjective and context matters. Our individual history (especially events that are similar), personality, beliefs, values and genetics inform what our idea of trauma is and how we experience it. What’s traumatic for one person may be only annoying to another.
We can also understand trauma as an experience (or several experiences) that overwhelms our capacity to regulate our emotions and bodily sensations, and make sense of the world and our own experience. It leads to a fragmentation, a dissociation that can cause us to feel disconnected from our body, and lead to a dysregulation of our nervous system and our emotions, making it hard for our body to control or regulate our mood and emotional responses.
Trauma is not about a past event, but about our present experience and the reaction we’re still having in our brain and our body today.
The exact point at which we label or judge our stress, or an experience, as traumatic is less important than recognizing and healing the dysregulation that lives on in our brain and body. Dysregulation can spread beyond our nervous system to the many systems it communicates closely with, including our immune, endocrine, cardiovascular, musculoskeletal and digestive systems.
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