Integrative Psychiatry and Mental Health: Beyond Traditional Diagnosis
In integrative psychiatry, it's not uncommon to encounter individuals whose symptoms may meet the critieria for ADHD or Bipolar II Disorder, as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). However, it is not uncommon for there to be an underlying common denominator here. Their symptoms may check the boxes for ADHD and Bipolar 2 Disorder but those diagnoses may miss the mark and may be better explained by a long-term sympathetic nervous system response, otherwise known as fight or flight, or hyperarousal.
People with chronic activation of the fight or flight response can have symptoms such as:
agitation, irritability, or low frustration tolerance
mood swings
restlessness
physical aggression or feelings of rage or anger
hyper-vigilance
difficulties with focus or concentration
intrusive thoughts
feelings of anxiety or fear
These symptoms have a lot of overlap with symptoms of ADHD and Bipolar 2 Disorder but it's important that clinicians carefully assess for chronic sympathetic nervous system response. To add complexity, psychiatrists may still recommend traditional psychiatric medications for ADHD and bipolar 2 disorder to help patient with chronic activation of the fight or flight response symptomatically feel better.
Learning more about polyvagal theory and the way that our nervous systems and brains can physiologically change, beyond our control, in the event of trauma can help validate and put words to what people are experiencing - rather than being simply told they have ADHD and the treatment is limited to stimulants.
Do Psychiatric Medications Have a Role for Nervous System Regulation?
In short, they can. Psychiatric medications utilized or recommended may include stimulants for executive dysfunction and concentration, lamotrigine for mood stabilization, or antidepressants for anxiety. They can be very helpful and serve as tools, depending on a patient's preferences and the severity of their symptoms.
At the same time, I see time and time again in clinical practice that committing to learning tools and practices for regulating one's nervous system will have durable and benefits beyond what medications can offer - a stronger sense of self-trust and a deeper connection with others and oneself.
Thoughtful medication use can sometimes help people have the ability to even begin the process of learning how to balance their nervous systems. However, it's important to note that sometimes medications can cause people to feel less connected to their bodies, emotions, and intuition.
The Role of the Vagus Nerve
A major component of nervous system regulation is learning how to train your vagus nerve. I know, it sounds weird - but stay with me! The vagus nerve is a large nerve that carries all sorts of information from our gut to our brain and vice versa. It transports critical information between our nervous system and immune system. Additionally, it communicates both sensory and motor information, as well as controlling inflammation. When someone's vagus nerve is healthy, it will keep you calm in stressful situations and let them know when the threat is gone.
And the great news is, the vagus nerve can be toned or trained to function more optimally which can help individuals respond to stress, threats, or triggers in more resilient and helpful ways. This can be best measured indirectly through heart rate variability (HRV) which is available on most wearable technology such as Whoop or Oura rings. Overall, a lower HRV can be an indicator of a less resilient nervous system and a higher HRV, an indicator of having more resilience to general stressors and overall improved wellbeing.
Connecting with your Nervous System
There are many different ways people can balance their nervous system and the great news is that people can choose to work through a workbook or book at their own pace, group settings, or individual one-to-one therapy/teaching. Even if you are in a rural area, many of these are accessible virtually. There is no specific timeline for how long this takes - each person is different but these practices need to be practiced consistently for them to be helpful. Reprogramming and balancingg your nervous system takes time and effort!
The first step is for individuals to learn what safety in their body is and what it feels like. They learn how to "secure their base" by learning what they need, non-judgmental observation, reconnecting with emotions, and grounding in their bodies. This is best learned through experiential practices rather than talk therapy or reading strictly in a book.
After this, individuals can learn how how to become more aware of what they are feeling and noticing in their bodies and practice deepening connection to the body and mind through practices such as yoga, somatic release, and mindful movement. Communities often have practitioners skilled in these areas - in our nearby town of Viroqua (population 5000), there are yin yoga classes, somatic dance, body ecology classes that connect movement and nature, dance, and tai chi classes. So if they are plentiful here, I'm hopeful they exist where you live as well. Beyond that are other useful skills that help further balance your nervous system: co-regulation (through trusted connections, one borrows from a regulated nervous system in order to self regulate) and learning other vagal toning practices that can further improve mental health and resilience.
Nervous System Balancing Benefits the Whole Body
A significant piece of research in 'Frontiers in Immunology' highlighted the role of the vagus nerve in immune system regulation, suggesting that vagus nerve toning could potentially reduce inflammation in autoimmune diseases. When individuals present with autoimmune conditions - or symptoms concerning for autoimmune processes such as food intolerances, endometriosis, rashes, gut issues, an approach that prioritizes nervous system balancing may have downstream benefits on improving these symptoms as well. This often serves as the foundation that is needed in order for people to get better.
In integrative psychiatry, understanding the influence of the vagus nerve on energy, mood, and physical/emotional health is crucial, particularly for those with a history of trauma, and/or those who have autoimmune or inflammatory conditions. Managing the nervous system effectively can potentially alleviate some symptoms associated with these conditions. We work in partnership to provide relief from debilitating anxiety, trauma, and symptoms that are mistakenly called ADHD or Bipolar 2 Disorder. Interested in working together? Dr. Burger currently accepting new patients interested in a whole person, integrative psychiatry approach. Learn more here.
A kind reminder: This blog post is designed as a general guide. This is not a substitute for personalized medical advice, nor is a patient-physician relationship established in this blog post.