How trauma was connected to her psychological and metabolic life

D came at 15-years’-old with some mild deliberate self-harm symptoms, possibly accompanied by low mood, Her mother had found certain things written down which concerned her about D’s view of herself and had also found it particularly difficult to access how she might be feeling.

There were some of the usual adolescent tensions around phone use and she was poor at sleeping, but this was not a new feature. She was an intelligent high achieving young woman with great sporting prowess and spent time split between the care of her parents, who had both re-partnered, and with whom she had reasonably good relationships.

She started in some psychological work with a colleague, and made a good connection but remained quite closed. Then she took an overdose out of the blue and was unable to say why. It then emerged that she had been sexually abused some time back by a distant family member. This then made sense of her closed-off communication and, to some extent, why she was out of touch with her feelings and persistently unable to sleep: this is a classic hyper-aroused trauma picture.

She was begun on some anti-depressants because her mood was low. These are not always helpful in trauma situations as they can block resolution. But they have a role in getting people through, perhaps precisely because they numb to a certain extent. Eventually these were stopped (and later restarted) but sleep was never really good and in the end she had a small dose of a sedative drug to help settling at nights which it did for quite a while, thought that, too, wore off a bit.

At the time or writing the focus is on managing her high cortisol levels via supplementation not medicines, and also on managing her gut health which is not optimum and may thus be contributing to her mood difficulties, which do wax and wane. The problem is that D is not really willing to engage in any trauma work yet and in my view until she does her stress in her psychological and metabolic life will remain high. Timing is everything and you have to wait for people to be ready. In the meantime we do what we can to prop up.