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What does Diagnosis Mean in Trauma?

This is the second in a four part series where I explain and share about specific concepts related to the nervous system. Dr. Steven Porges, PhD, founder of the Polyvagal Approach to the nervous system, focuses on the regulation-dysregulation aspect of the nervous system when understanding diagnosis. Porges' work is groundbreaking in helping to more deeply understand how impactful trauma neurobiology is on our behavior—both during trauma and in the aftermath of trauma. All of the trauma experts are now incorporating his concepts in their approach and understanding of trauma. Dr. Dan Siegel, MD, Founder of the Mindsight Institute, is a leader in studying the impact of mindfulness on trauma, attachment, adolescence and social interaction. He has written numerous books on explaining the brain’s response in trauma and attachment. He states: "Chaos and rigidity are at the heart of all mental health diagnosis…”

In the post I will bring to light the ways in which ideas from these two visionaries overlap. To begin with, both of them refer to neurobiological states as being the underpinnings of any diagnosis. Diagnoses are categories that are descriptors, but diagnosis does not actually describe what is going on in the biology of the person that leads to the presentation. However, states of the autonomic nervous system do explain what is going on on the biological level that can lead to overall behaviors and patterns.

First, let's look at regulation in the Autonomic Nervous System (ANS). A regulated nervous system is when we have a range of responses. Every moment is actually felt and experienced as new in this state. Dr. Bessel Van Der Kolk, MD, of the Boston Trauma Center, says "Trauma is a disorder of being in the here-and-now.” This means that trauma can prevent individuals from experiencing the here and now —as they are perpetually locked into an old reaction, or dysregulation—that is NOT connected to the present moment. When we are dysregulated, certain aspects of our nervous system are available or not—which will actually limit our range of responses. When we are regulated, we can respond in the moment to exactly what is happening—and we are actually responsive. This is not true the trauma state or any dysregulated state.

As human beings we have the potential to get “stuck” in different nervous system states. If one is stuck in fight/flight response there is more possibility for anxiety or anger issues. If one is stuck in the freeze response depressive disorders are more likely to arise. These nervous system states of “stuckness” will limit the range of behavior for an individual—these are dysregulated states. In life, we need to connect, set boundaries, and get out of situations. It is our working nervous system that helps us have appropriate action. In summary, the state of our nervous system will determine our range of behavior. In a regulated nervous system state, we have the most access to a range of behaviors. That is the goal of working with people through a nervous system lens.

Dr. Dan Siegel, MD, talks about chaos and rigidity. In chaos, he is referring to the fight/ flight system. In rigidity, he is talking about the freeze system, or "shut down". He talks about the idea that we are not responsive to life and situations--which is our human goal—rather than reactivity. Dr. Siegel is actually talking about the concept that chaos theory is what leads to trauma in the nervous system—the system is out of balance, not in homeostasis. This chaos actually is what keeps the system being disorganized—it cannot get back to being “ back to normal” again—or in homeostasis. Working with the nervous system directly can begin to help the system reorganize and go back into balance. This helps the person get out the chaos and rigidity.

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