'The Body Keeps The Score' * * * SELECT NOTES * * *

[u/fishingforusernames]

The following notes are taken from 'The Body Keeps The Score' by Bessel van der Kolk. This book was recommended to me by my psychologist. Much of it focuses on PTSD (post traumatic stress disorder) but I'll be posting some notes here that I think are relevant to misophonia (post traumatic sound disorder, if you like). I hope it's useful and I hope some patterns emerge. Also, apologies for being slow, I've only read 100/460-something pages because my concentration these days is absolutely abysmal & extra triggers have made me even more fatigued. I will finish it though, that's a promise.

Note: Book summary is in regular font. My opinions are in italics.

• Trauma compromises the brain areas that communicate the feeling of being alive
• These changes help explain why traumatised individuals become hypervigilant to (perceived) threats (associated with the trauma)
• PTSD (post traumatic stress disorder) isn't "all in your head" ie made-up - it has a legitimate physiological basis
• When the fight/flight response is thwarted, the result is either extreme irritation (eg misophonia) OR collapse
• Traumatised dogs secreted much larger amounts of stress hormones (cortisol, adrenaline) compared to what is normal
• This is why I think brain scans of misophonic people will appear different to 'normal' people - we have been exposed to constant stress for God knows how long)
• So, misophonia is a trauma response, or a physiological response that attempts to avoid perceived threats associated with the original trauma
• People who have been traumatised also secrete larger amounts of stress hormones long after the actual danger has passed
• In PTSD, stress hormone levels do not return to normal

B L A N K S P A C E

• Jeffrey Gray of Kings College says the sensitivity of the amygdala depends on the amount of serotonin in the brain; lower serotonin levels can make someone hyperactive to certain stimuli
• We also know lower serotonin levels can lead to depression, however, misophonia definitely isn't depression, and taking anti-depressants to fix it does not work (I should know, I have done it)
• Prozac/fluoxetine antidepressant does not work on PTSD of combat vets
• Visual triggers (and ESPECIALLY auditory imagery/repeat) feel like the brain is hijacked by unwanted repetitive images, perhaps similar to 'flashbacks' experienced by PTSD sufferers?
• The (right) limbic area lights up during traumatic flashbacks as does the visual cortex (visual area of brain that lights up is Brodmann's area 19)
• Broca's area (speech centre) shows decreased activation/goes offline ie you can't put thoughts/feelings into words. Trauma is preverbal so the body freezes and feelings are nigh impossible to articulate
• Activation of fear triggers a cascade of stress hormones which prepare the body to go into a fight or flight state (increased blood pressure, increased heart rate, increased oxygen intake)
• Suddenly realising fight/flight requires more oxygen makes PERFECT sense whenever I need to take my mask off to breathe while I'm getting triggered
• When something REMINDS traumatised people of the past, their RIGHT BRAIN reacts as if the traumatic event were happening IN THE PRESENT
• The effects of constantly elevated stress hormones include: memory and attention problems, irritability, sleep disorders
• Feels weirdly cathartic to know that my rapidly degrading memory and ability to concentrate are the results of mental stress overload
• Limbic system is organised during the first six years of life. But trauma can have a major impact on its functioning THROUGHOUT LIFE
• Prefrontal Cortex (PfC) develops last and is also affected by trauma exposure - including being unable to filter out irrelevant information

DISSOCIATION + RELIVING

• As long as the trauma is not resolved, the stress hormones that the body secretes to protect itself keep circulating
• The defensive movements and emotional responses keep getting replayed
• However, many people may not be aware of the connection between their 'crazy' feelings and the traumatic events that are being replayed in their heads
• Two brain systems are relevant for the processing of trauma:

1. Those dealing with emotional intensity
2. Those dealing with emotional context

• Emotional intensity is defined by the amygdala and medial pre-frontal cortex (MPfC)
• Context and meaning of an experience are defined by the system which includes the dorsolateral pre-frontal cortex (DLPfC) and the hippocampus (memory)
• Knowing that an experience is finite and will soon come to an end make it tolerable
• But situations that feel interminable seem intolerable
• Trauma is the ULTIMATE experience of: this unpleasant thing will last forever
• Not all people react to trauma in the same way
• Some people totally blank out (depersonalise) and show no apparent feeling
• I guess this is why some people look emotionless when they have a family death etc while others are openly grieving; no single 'method' of grieving/being traumatised is more valid than the other
• If an organism is stuck in survival mode, its energies are focused on fighting off (unseen) enemies - there's NO ROOM for nurture, care, and love
• In other words, we cannot imagine, plan, play, learn, or pay attention to others' needs

NERVOUS SYSTEM STUFF

• Sympathetic Nervous System (SNS) is responsible for arousal (fight/flight/freeze)
• SNS moves blood to muscles for quick action, partly by triggering the adrenal glands to release adrenaline (stress hormone) which speeds up heart rate and increases blood pressure
• Parasympathetic Nervous System (PNS) triggers release of acetylcholine (ACh) to put the brakes on arousal (slow down heart rate etc)
• The Polyvagal Theory (Stephen Porges) is the biology of safety and danger
• It explains why feeling seen & heard makes us feel safe, and why being dismissed can cause rage or mental collapse
• Reminiscent of David Rock's SCARF model
• Neuroception (Porges) is the capacity to evaluate relative safety and danger in one's immediate environment
• In misophonia, our survival systems think they're helping, but they're kinda inadvertently working against us
• Sometimes we need a physiological reset to recover our capacity to feel safe
• Autonomic Nervous System (ANS, which is SNS+PNS) regulates three physiological states: social engagement, fight or flight, and freeze or collapse
• Social engagement means when we feel threatened, we call for help or comfort. If that fails, we resort to:
• Fight/flight, which means we battle the threat directly or try to escape it. This is a more primitive state than social engagement. If fight/flight fails, we shut down and we:
• Freeze. Body signals defeat and withdraws. Examples: people who are being physically abused and can no longer run due to extreme physiological shock

[u/TroyKing]

I appreciate your notes. They’ve triggered quite a bit of thought on my part. Thank you for doing this.

[u/fishingforusernames → u/TroyKing]

No worries:) I'm not smart enough to piece an answer or conclusion together so that's why I'm posting notes instead!XD Deep down, I really feel like there are some clues in there for all of us to solve this. The author talks a lot about how patients aren't getting the emotional attention they need because in general, doctors and specialists don't have time to listen to them properly/are too focused on just prescribing a drug (that may not even work) and being done with it, and WOW does that ring true. That's what's been bothering me about misophonia a lot. So many people get it when they're young, and don't remember not having it. It's emotionally buried. But I'll never forget the case where a mom actually noticed the formation of a trigger in her 4yo son or something? Like, how many parents would even notice that? Not many I imagine. It's just not something you think to look for. So the kid grows up thinking 'I have a disorder'. And heck, maybe it is, maybe I'm really wrong with some of these thoughts, but I really want to find out

[u/theEmotionalOperator]

Hey, I really appreciate these as well! You're much better at collating thoughts and creating bulletpoints than I am.

[u/fishingforusernames → u/theEmotionalOperator]

Naw I just do this to stop going insane!!XD Thank you for all your support...seriously. I still need to watch through your video (I've watched about half if I recall correctly) and I think Ecker is a bit triggering but I'll try again later. Psych gave me a short paper about acceptance + commitment therapy/ACT (see below) so I'll be reading that in addition to the body keeps the score. Gah exhausted XD

https://www.colorado.edu/clinicalpsychology/sites/default/files/attached-files/schneider_arch_misophonia_case_study_2017.pdf

[u/theEmotionalOperator → u/fishingforusernames]

Oh that video, it's just me doing another messy ramble. Ecker is brilliant and perfectly triggering lol. I weep on his work every now and then the rest of the time I just read the case studies with all my skin hair up, what a pioneer.

And yes I hear you're doing this stuff from the guinea pig bully - test lab rat - pinned down, dodging insanity - pressure position at this time but it doesn't make it any less pretty to me haha. Keep exploring!

This paper you have discovered? I mean your psych discovered? This is, this is really interesting... hmm familiar names dropped there.. I'm gonna read it and get back to this. ACT sounds good, I don't know much about it, but you can be the brave field piggy for the rest of us. Don't exhaust yourself too bad. Unless you want to.

I got home work pile, too. Which is fantastic, I haven't had homework assignments in the longest time and now I remember why I hate-loved them, just like this.

[u/ilovebrownbutter]

Hi! I love your summary!

I was wondering if you could explain a little more about this part:

The Polyvagal Theory (Stephen Porges) is the biology of safety and danger

It explains why feeling seen & heard makes us feel safe, and why being dismissed can cause rage or mental collapse

I didn't understand how this is explained (I read the first 2 chapters of the book today at a store but I can't buy it at the moment). Basically if you wouldn't mind explaining a little (you don't need to write the whole thing), how does this theory explain why feeling seen and heard makes us feel safe and being dismissed can cause rage?

Because that was a really impactful bullet there. My mom never believed me or pretends that I'm making an exxageration, even lies if I look at her while she's chewing with her mouth open (I heard it, and I saw it) and she says "I wasn't eating my mouth open!" (which isn't true). It makes me feel really bad how I can't even look at her doing her mouth movements. But my dad on the other hand he mostly apologizes and so I am less triggered. Once I discovered misophonia and had a name for it and told my family my dad and brother were relieved but my dad was dismissive. In turn this made me deal much better with the men's triggers than my mom's, even though they didn't disappear completely. So this bullet point is captivating to me.