Why is dissociation so hard for even mainstream psychologists to understand? How can we better diagnose Dissociative Identity Disorder (DID). Our guest, Dr. Simone Reinders, helps us explore the answers.
Dr. Reinders is a leader and international expert in the neurobiology of dissociation. She was the first to provide evidence that DID is related to early traumatization, and her research has been pivotal in our understanding of it. As a Senior Research Associate & Lecturer at the Department of Psychological Medicine in the Institute of Psychiatry, Psychology & Neuroscience at King's College London, Dr. Reinders has shown that DID and post-traumatic stress disorder share neurostructural biomarkers. We also talk about how Dr. Reinders’ work can aid the diagnosis of DID, which also points to how machine learning could assist in the diagnostic process.
Resources:
Dr. Simone Reinders Bio Kings College
This episode was produced by Bright Sighted Podcasting
FULL TRANSCRIPT BELOW
- This transcript was auto-generated
Lisa Danylchuk 0:02
Welcome to the How we can heal podcast. My name is Lisa Danylchuk and I'm a psychotherapist specializing in complex trauma treatment. I'm a graduate of UCLA and Harvard University, and I'm thrilled to share these reflections on how we can heal with you today.
Today, our guest is Dr. Simone Reinders. Dr. Reinders is a leader and international expert in the neurobiology of dissociation. Her research has been pivotal in deepening our understanding of dissociative identity disorder or DID, and was the first to provide evidence that DID is related to early traumatization. She's also a senior research associate and lecturer at the Department of psychological medicine. In the Institute of psychiatry, psychology and neuroscience at King's College London. Dr. Reinders was among the first to publish studies on brain imaging in pathological dissociation. Her research was the first to show on the basis of brain activation data that different personality states in patients with dissociative identity disorder show different brain activation patterns in response to trauma related cues. And an important follow up study showed that these patterns can not be simulated. Dr. Reinders has also used structural data to show that DID, and post traumatic stress disorder share neuro structural biomarkers, which we'll talk about today. We also talk about how Dr. Reinders work can aid the diagnosis of DID, which also points to how machine learning could even assist in the diagnostic process. I connected with Dr. Reinders, after a talk she gave for the ISS TD years ago. And wish everyone were aware of her research and findings, which after this episode, you will be let's welcome Dr. Winders. To the show. I am so happy to have you here on the how we can heal podcast I have been lucky to hear you present before to the ISS TD and your research is phenomenal. And I think everyone needs to hear about it, learn about it, read it, study it, understand it. So I'm excited to today at least start a conversation because I think there are some folks listening who know your research well, and will be excited to hear from you. And some folks who haven't heard your name or your research before. And so I'm so excited to just share this, because it's really powerful stuff. So thank you for being here.
Speaker 2 2:32
Thank you so much, Lisa, for for having me. It's a great honor to be able to do this with you.
Lisa Danylchuk 2:38
So I always have just this curiosity. I always want to know the origin story. How did you get into this work? What led you to study the brain biomarkers of dissociation?
Speaker 2 2:48
Well, I need to go very far back. I think it's now almost 25 years. And I was a student, I was looking for a thesis project to complete my studies at the University of Groningen. At that time, I was studying artificial intelligence, after I've done some physics studies as well. So more methodological based approach to, to where I am now. But through my studies of artificial intelligence, I learned about brain imaging, we're talking about 1997 1998. So it was still all all coming up. And when I was looking for a thesis project, I was made aware about a project at the Department of Psychiatry with Professor core. And this project was in collaboration with Dr. Nyan house, whom hopefully some of the readers will have heard off because he has developed a large theoretical body for theory on dissociative identity disorder, and he wanted to do brain imaging research. And initially, I was mostly interested in the methodology of brain imaging and on how to analyze the data and especially on how to analyze the data correctly, because it's easy to put in the data and then some blobs come out. But it's very important to understand that you're doing the right thing to do running the right test. But once I got the hang of that, I became more and more fascinated by the ID and dissociative identity disorder, post traumatic stress disorder, and especially
Lisa Danylchuk 4:47
dissociation. And I know some folks listening may have heard the term sonata form dissociation which I know comes from some of Elert Nian houses work so they might be familiar in that way, even if not with the name So, you've done a ton of research. I know. Some of its really groundbreaking. As I said, some people might not be as familiar with your work. Can you give us a summary of like, what have you and the students in your lab accomplished in these years as you've started to study the brain biomarkers of dissociation and complex trauma,
Speaker 2 5:19
my very first research publication was based on my thesis from my university studies. And I think that is also one of the most important papers that I published together with Dr. Nyan house. And this research paper was done with an imaging technique that is called Positron Emission Tomography. Because it was an early technique 1998, like I just said, and this show, this study showed that different brain activation patterns were linked to different identity states, and individuals with dissociative identity disorder.
Lisa Danylchuk 6:07
So you had people with dissociative identity disorder go into the PET scan, and you saw that when they switched and identity, there were different brain biomarkers of those identities,
Speaker 2 6:18
I need to take that a small step further, because what is important there is that they were listening to an autobiographical text. Okay, so this type of studies is called a symptom, provocation paradigm or symptom provocation study. So we wanted to induce symptoms in different identity states. So we use the same text in a trauma avoidant state. And in a trauma aware state that I also referred to as a neutral identity state and a trauma identity states. So when the text is the same, and identity state differs, we see different brain activation patterns in the brain. And this has challenged the core of the understanding of the existence of of di D, we showed using objective measures, that different identity states within one individual show different brain activation patterns on the same ad text.
Lisa Danylchuk 7:40
So they're being introduced to the same stimuli, and they're having different brain patterning responses.
Speaker 2 7:45
That is a fantastic summary, Lisa think that?
Lisa Danylchuk 7:49
Well, and I think it's important with this type of work, I feel like, you know, we live in a world where people talk a lot about dissociation and, and the extreme forms of it in terms of dissociative identity, and dissociative identity disorder. And I feel like the larger clinical world, the larger mental health world is just picking up on some of this in terms of what is dissociation? What can it look like. And it's so fascinating to me, when we get this kind of data, because it's so tangible. And so much of this work can feel intangible and confusing and amorphous and overwhelming. And so when you say, Oh, we exposed them to the same, you know, image or narrative. And there were different brain pattern responses from different states, that I feel like it's something I mean, even now, we're maybe looking at brain scans, it's not like you can kind of hold a brain scan in your hand, or you look at a picture of it, right? It's, it makes it more. I think, comprehendible for folks who maybe haven't, haven't studied dissociation or having to their knowledge worked with someone with the ID.
Speaker 2 8:59
For me, from a methodological point. It's also important for me to say that when they listen to a neutral Stax, a neutral text that does not include any trauma cues, then there was no different difference in brain activation patterns between the identity state states. So this makes sense. It's like a control condition. Because then we have the they still listen to a text, but there's no trauma information. And so there is no difference in brain activation patterns. But as soon as as they got the trauma triggers, yeah. Then the brain in the trauma state, the brain goes in overdrive with emotional responses and limbic activation, while in that trauma avoidant state. We see no amygdala, less limbic activation, and especially higher cognitive areas as if they had their brain says Oh, Okay, we need to process this, this information differently, we need to process it by dissociating not allowing it to enter our conscious awareness.
Lisa Danylchuk 10:11
And I feel like this is such an important point for folks to get in a broad way, which is, when we talk about trauma, there's that activation response even neurologically, in our brains, the amygdala response, you know, you might see certain patterning or heightened activity. And then when we go, really how I think of it further into, into trauma or more complex, more horrific experiences, not everyone, but many people then go to this more trauma avoidance state where you see less activity where it's more of a shutdown, or you know, people might say, hypo arousal, but you really see this in brain scans. So we see it as myself as a clinician, I see it in front of me, or I hear it come up in stories. But it's amazing that you can also measure it in this way. And I think the two sides of that coin, people are picking up on Okay, PTSD, and maybe triggers and hyper arousal or nightmares or intrusions, but, but there's this whole other side of the coin that can exist within the same person of shutdown, numbing avoidance, however we want to call it we can, we can see it in our brain activity. And I think that's really powerful.
Speaker 2 11:28
Yes. So what is, I think what is important to understand is, is the shutting down does not mean shutting down brain activation, what it means the emotional processing is being shut down, yes. But for the brain to be able to shut down this emotional processing. brain areas need to be activated to suppress emotional arousal. So in my view, it is an active cognitive test that is running in the brain to be able to dissociate from these horrible memories.
Lisa Danylchuk 12:11
Yeah, that's an important distinction, right? Because we tend to think I think in a little of a binary hyper arousal hypo arousal, as I was saying earlier, and this gets more nuanced, right? When you're really looking inside of what's happening in someone's brain, you can see this, would it be fair to call it like a cognitive override or something like that?
Speaker 2 12:33
The terminology they do use hyper arousal and hyper arousal refers to the emotional reactions, yes. For me, it does not refer to what is happening in the brain, right? Because in my research, I Eve I actually see more breadnut brain activation during hypo arousal.
Lisa Danylchuk 12:56
Yeah, that's so interesting. That is so interesting. So what has been most challenging for you, in your research, I'd imagine some of this is you find things that maybe have more nuance, or go against maybe a more simple way of thinking that we might bring, and then you've got to communicate that. But what are some of the challenges you've seen?
Speaker 2 13:22
Most challenging, in my research have been the reviewer comments. And especially my earlier papers, I've received lengthy comments or immediate rejection. As some papers, I had to resubmit five or six times before we were able to publish. I even had one reviewer who said, the ID does not exist. So I do not understand the purpose of this paper. And then it gets rejected. And I just just have to continue, because I know, that's how I analyze my data with methodological rigor. We had expert clinicians involved that it was just true. So I just did, I was determined, I persevered. And then at some point, I was able to publish research. And then yeah, the second most challenging is currently trying to get Funland. Yes, and this is why it's in the same line. Probably anxiety of funding bodies, or choosing more accepted disorders like psychosis to fund even if I get excellent and exceptional evaluations or my research proposals. The funding bodies decide not to not To find me, but yeah, that can be very challenging.
Lisa Danylchuk 15:03
Do you have a sense of why this ascension is so hard for folks to understand in a broader way?
Speaker 2 15:09
I think it's still the historical perspective on on the ID.
Lisa Danylchuk 15:17
Which is so ironic, because your research basically just proves the fantasy model of di D, which is what makes it so powerful. But you still end up submitting a paper to someone who says something like a D ID doesn't exist. So while you have the evidence of
Speaker 2 15:34
Yes, well, this, this was for my earlier research. Fortunately, I do not get don't get that anymore. No, it's interesting, because it has really changed. Now, when I now get reviewer comments, mostly, they are very constructive. Right? Yeah, reviews are usually very helpful. And I can really see that there's an effort on on getting making the paper better. And sometimes I can sense that not in in the field. And then I just have to add a bit more clarification. So fortunately, this has changed. Now, I hope that the funding bodies will follow at some point.
Lisa Danylchuk 16:18
So I have thoughts about this. But I'm wondering what you feel like has been your greatest discovery through research to date?
Speaker 2 16:25
I tell you, my lips Yeah, tell me yours. After this, I will. For me, the greatest discovery is that I used structural data to show that smaller hippocampal volumes in PTSD, and di D, are related to a history of childhood traumatization. And why is this my greatest discovery is because I think that these findings provide evidence for a childhood trauma related etiology for smaller hippocampal volume and PTSD ndnd a patient in this way through this work that my PhD student, Dr. Charles Sophie did together with the team. This data research provided neuro anatomical evidence for the clinical observation that the ideas were related to severe childhood trauma, and it is indicative of etiology related to childhood maltreatment for this disorder.
Lisa Danylchuk 17:33
Does that then connect? Because I know one of your most popular papers is comparing a fantasy model to a childhood trauma based model of dissociation. Is that is that falling into that then
Speaker 2 17:48
there are two legs to that research. The first one is brain activation studies. At first, we showed a different activation patterns between identity states that we just we talked about earlier, the follow up study was to show that these cannot be an accident, and not related to fantasy proudness. But this is still brain activation. Critics could still say Oh, this is due to some role playing or lying because we did not control for lying or whatever. It's brain activation. People can influence neurofeedback, that whole idea behind it from how I've done my research and my analysis, I know that this is not the case. But skeptics can still think otherwise. However, when you look at the brain, the structural tissue of the brain, that is not you cannot simulate that. That is it is just what it is. Yeah. So when we use brain structure as a biomarker for a trauma related origin of the ID, that is more solid evidence. I must say that this is of course, all based on correlation analysis, and I have not shown causality in this study. However, there have been other studies in the general population that show that trauma is related to small and hippocampal volume. Yeah. If we don't find smaller hippocampal volume in a sample of PTSD and DOD, that have been exposed to early childhood trauma zation. And there is a correlation between these measures of traumatization and small hippocampal volume. This builds a strong case for a trauma model for the ID
Lisa Danylchuk 19:56
and it makes sense ethically speaking, you know, in terms of causation studies, people aren't going to go, you know, control group and then put people through horrific trauma and see if it impacts their hippocampus. That's not that's not going to be a thing?
Speaker 2 20:10
No, there are a few studies that have followed people who have experienced medical trauma. So that would be a line of research. But usually, it's ethical issues are very difficult. Yeah. And studies like that. And this is why what we have to do with doing correlational studies with knowledge that has been obtained in general populations or in other disorders.
Lisa Danylchuk 20:40
So what's been the most surprising for you, through your research, the most
Speaker 2 20:44
surprising, perhaps you don't, you don't expect this but my most surprising result is the results from a pattern recognition study that was published in 2019, in the British Journal of Psychiatry. And in that pattern recognition study, we found that people with the ID can be distinguished from healthy controls at an individual level, using math, statistical methodology and methods. And what was most surprising is one, that the sensitivity, and the specificity of this differentiation was around 70 to 73%. And then, if you look at the literature, you find that this level of accuracy is actually comparable to what has been demonstrated for most psychiatric disorders, including psychosis. And I found that very surprising, a powerful result as well. The surprising aspect of this finding is that the computer can actually tell us Yeah, on the basis of a brain scan, if it is somebody with D ID, or healthy control. Yeah, there's no, there's no clinician involved.
Lisa Danylchuk 22:12
That's powerful. I mean, that's where we start going in the direction, which gets a little scary in my mind, but like, of machine learning, and being able to differentiate these things,
Speaker 2 22:23
can be very useful for differential diagnostics,
Lisa Danylchuk 22:27
differential diagnosis, or it can help with misdiagnosis. I know I've been in a lot of conversations lately about differentiating psychosis from dissociation or dissociative identity disorder, differentiating schizophrenia, right? So I think when these types of discoveries and work like yours is shared, and people understand it more, they at least know where to go and get those, you know, brain scans, and and then we can say, Oh, now we have help in understanding, what is the etiology? Where is this coming from? And then we can decide, well, what's the best course of treatment than if we're seeing a smaller hippocampus, and we're seeing these biomarkers of dissociation, and we're picking up on things relationally that feel like psychosis, that helps us sort of either separate apart or blend together what we're understanding so we can go, oh, this is more of a complete picture of what's happening for this person. And then we can respond to what's actually happening for them rather than our limited information or our misdiagnosis.
Speaker 2 23:37
Exactly, exactly. I think machine learning and pattern classification techniques are very important and very powerful. And I would like to point out that there is also a study basis on brain function, functional brain scans that was conducted in half it by Dr. Kaufman and Lavoie. And they were also able to show differences between patient groups on the basis of their brain scans. Those are functional brain scans. I have done anatomical brain scans. But it is very important that different groups across the world independently find results that support each other.
Lisa Danylchuk 24:32
Absolutely. And that's what's been happening with a lot of your research. Right. I know. Dr. Melissa Kaufman and Dr. Lauren Lavoie over at McLean at Harvard. They've done some of their own studies, they've replicated some things. I feel like other people have replicated some of the work that you've done and the more that we independently find similar findings, the stronger the research body gets.
Speaker 2 24:55
Absolutely. I mean, it's nice and very exciting to be a pioneer. hear in your field. But if that is that doesn't mean anything, if follow up studies don't show the same result. And I feel very grateful that other people are undertaking this follow up research and the group from Harvard has done excellent research, and very important for other centers and other groups to do this research as well. So what
Lisa Danylchuk 25:27
are some of the big takeaways from from research you've done that people have replicated, that you feel like really has started to create a foundational understanding around trauma and dissociation like what do you wish? Anyone listening? Who might not be a mental health professional or not have studied or read these type of research papers? What do you wish they knew when they could take away from the years and the decades of research that you've done, and that people have replicated? There's a shift in our foundational understanding, they're wondering if you can articulate that
Speaker 2 26:04
the D ID is a genuine disorder. And it's not an accident. D ID is not what you see on the television, or in in those Marvel comic things. And I have given interviews on that to try to reach the more general audience, and make them aware that this is not helpful for people who suffer from the idea. So what I wish is that more people in the general public knew is that di D is a genuine disorder, and that these people have actually suffered through tremendous trauma. And it's not a fancy tweak. And that you see in a comic movie, or in a is all this crime movies, like there was a case in in CSI, and you see them frequently popping up on the television. But that is not what the idea is about. is about a survival mechanism. Yes. And I wish that the general audience would understand that and just not go and see these movies with spread the ideas, portray them as exciting. Because having the idea is not exciting. Nobody wants to have this disorder. And you see also see more and more on social media. Industry, these cases get a lot of attention. They get a little a lot of followers, there was a case presented at the Maudsley at Kings flamboyant case seeking the confirmation that they have the disorder. Fortunately, the Maudsley has a well trained trauma dissociation clinic. And they will not able also on the diagnosis.
Lisa Danylchuk 28:05
Yeah, that opens up a whole can of worms. I know there's a lot of conversations happening in around social media, there's a lot of education. There's a lot of questions. And I noticed even in the last year or so that that sort of differential diagnosis piece has been a hot topic, especially around around social media. And there's been a lot of conversation about self diagnosis and things like that, which is again, why I feel like your research is so powerful, because even in this case, you're sharing someone who's going, is this what I have, right? Help? Help me figure it out. They can I mean, if they have the resources and access to the right institution and support, they can do a brain scan and get a sense of what does this look like compared to other brain scans we have? And can that help me understand myself? Can they help me understand and my treatment team understand what's best if I'm seeking some form of healing, you know, what's going to get me there? So this is just another reason I feel like your your research is so important. And it makes me become aware as you're talking that not all mental health diagnoses have this level, this depth of study, right, you said some are more well funded, perhaps psychosis or I'm guessing schizophrenia, but I think about things like the most common referrals most psychotherapists get are anxiety and depression. And there's a ton of research in those areas. But I don't think there's the level of correlation that you've picked up on in terms of brain structure. Do you know of any other mental health condition that has this level of ideological study?
Speaker 2 29:58
I think di D is is unique for having to provide proof that the disorder is not an accident when, when somebody with who says that they have depression or anxiety, they go to a GP or to a psychologist or psychiatrist, and nobody will tell them, Oh, you're just an acting, your disorder, your disorder is this, your disorder does not exist from that perspective is unique.
Lisa Danylchuk 30:31
If you had unlimited funding, what research would you do next?
Speaker 2 30:36
The research, what I would like to do are treatment outcome studies. People who go into treatment at the start, and then during treatment, taking biological measures. And then at the end of treatment, how has the brain change? Is there any change? What is the effect of treatment on the brain? There are no neurobiological studies with methodological rigor that have shown effects of treatment outcomes. The other research I would like to do is studying neurotransmitters involved. Yes, in the brain, because the ID needs to be. It's all about the whole brain works on the basis of neurotransmitters. So the identity state regulation and switches, neurotransmitters must be involved. Yes. And I'm very keen to understand which neurotransmitters are involved. Yes. And what once we know this, how can this knowledge help in treatment?
Lisa Danylchuk 31:49
Yeah, it makes me think of the general understanding we have, again, going back to just the sort of basic hyper arousal hypo arousal, we have this general understanding that in hyper arousal, there's adrenaline and cortisol and all these things. And then that in dissociation, there's more of, like, endogenous opioid response. But again, that's really general. And it's not looking at the function and the interaction that's happening, like perhaps during a switch or perhaps during healing, right. That would be so fascinating. And I hope you get that, how many bake sales? Do we have to have? Funding for your work? I'm so I'm actually curious, because I've stepped out of the world of research. I mean, I did it in in grad school and decided to focus more clinically, but like, what level of grant would give you that, that permission to do some of that research? How much money does it take to run these studies?
Speaker 2 32:49
I think my last grant application, I applied for around 800 900,000 pounds. Okay. And then we need around 60 individuals with with the ID. And then we have control groups. And that would also include salary for a postdoc, yes. And part time salary for myself, because I'm determined to keep publishing the data that I have at the moment. It is strenuous. And to do that, yeah, without proper funding and employment.
Lisa Danylchuk 33:32
Right. I mean, publication becomes its own full time job, especially when you get five revisions or notes back and things are you really have to dive in. And so a lot you've been carrying.
Speaker 2 33:43
Yeah, that has been challenging. But I think I'm also still supervising two PhD students who are also self funded. And I want to support them through their thesis. And of course, the participants in my studies, they have donated their time. Yeah. And most importantly, they have donated their energy, the energy that they have given and the time that they have given to do the research, the research and undertake the research that I I, my team has asked them to do be in the scanner to go to sessions and do all the questionnaires. So I keep that in mind as well, when I sit down, and I do my data analysis, and I write the papers. So I do have as much as steal as much as I can on that. But it would be helpful. If at some point, there will be funding for my research, my research team to be able to build further on, you know what I've done.
Lisa Danylchuk 34:49
So it sounds like if you've got, let's just say like a million pound grant that you could move forward with some of these things we're talking about. Yes. Yeah. Wonderful. I'm just going to put that out there. Well, if any listeners are working for foundations, I know we have some listeners who work in philanthropy. So she's gonna put that out there. And how do you think that would help, that understanding of dissociation would help? Let's just say someone with PTSD with a dissociative subtype or something and they're going in for counseling or, you know, how would that help us as individuals or as a society to have some of that treatment outcome research some of that neurotransmitter research done,
Speaker 2 35:29
that is that is going to work on two levels. personal well being off the individuals suffering from dissociation, but also the societal burden of financially, but also mental health care. Because at the moment, and I also wrote about that in my 2019, paper, the pattern recognition paper, there are other studies who cite this as well that currently with somebody who suffers from dissociation, and like a severe PTSD, PTSD, involving dissociation, dissociative identity disorder, or other dissociative disorders, it can take five to up to 12 years for somebody to get the correct diagnosis, I find that unacceptable. Unbelievable, I would like to be able to help change that. Because then it will, most importantly, benefit the individual who's suffering, because they get a diagnosis faster. So they will be healthier, fast, they will be happier, faster. But on top of that, it will also reduce the waiting list for other people who need mental health care. And that doesn't need people who have acid severe disorder as dissociative, PTSD or odd. But it will also help people who will have a depression and need help with that. Because it's all all built up on top of each other.
Lisa Danylchuk 37:14
Do you see a difference? I mean, you're in the UK, I'm in the United States. I know we have lots of folks also in Australia, New Zealand that are invested in this care. I mean, it's really an international phenomenon. We see dissociation across different countries. We see a little bit more of the researcher, I do from my perspective, in the US, Canada and UK. Do you have a sense of where the care for the ideas first,
Speaker 2 37:43
I actually think the struggle for the appropriate care is similar across the countries that you that you have referred to. Because you're here in the UK, we have a a couple of specialized centers, for example, the clinic for dissociative studies here in London, but they are specialized clinics, they are not mainstream embedded in the national healthcare system, the NHS in the Netherlands as well, their specialized treatment centers. And it takes a long time to get from your GP through the the mainstream healthcare system to this specialized center. Awareness should be much earlier on, or sample even at the GP. I've had discussions but mighty be with ya. So what actually I do? Well, the thing and then he said, Oh, I've never seen a patient like that. I'm like, What, exactly? That's exactly. That's exactly the problem. Yeah. Because you probably don't have you have not been trained. Yeah. You have not been trained to recognize this. Yeah. If I just may elaborate a little bit more on training. Here in the UK, there's not an MSc program that you can follow on, on dissociation. Well, and I have written proposals like this is important. Yeah. Now we need to train people. We need to do it at you know, undergraduate level, better level medicine, people who study medicine, they need to learn about what is dissociation? Absolutely. How do you recognize but if there's no training in an early phase, then the recognition is can go come too late. And that is what we see now that it takes so long for somebody to correct can get the right diagnosis. And this also links back back in to who would would my research and other people's read should help. Yeah. Well, with more recognition and more research out, hopefully it will trickle down. Yes. To undergraduate level, like, Okay, we need to develop courses on this, we need to develop courses to train people sooner on the recognition, what is the association?
Lisa Danylchuk 40:23
Yes. And if we do that, I mean, I go back to what you mentioned earlier, which is the same statistics I've heard of, you know, five, seven, even 12 years for people to get an accurate diagnosis. And when you think about, I mean, we can think about this, just in medical terms, people have sometimes had medical issues where they're struggling and going to different doctors and trying to get understood, and they have to end up in this specialty clinic to understand it was their kidney, it wasn't their liver or whatever. Right? Like that process. Most of us can maybe relate to that a little bit more, if we haven't had serious mental health issues and been in the system, we can relate to having something going on with our body and going no, that's not quite right, this person isn't getting it right, this medication isn't working. That's a struggle like that is uncomfortable, that is impacting that person, their experience of life, it's impacting their family, their friends, their workplace, wherever, whatever they're touching, that process of not being diagnosed
Speaker 2 41:25
their children, their children, into children's education, the next generation. Yeah.
Lisa Danylchuk 41:31
And so when we have a way to understand and get clear diagnosis sooner, you know, whether that's for a physical ailment, or it's for a mental health condition, or it's for something like dissociation, which, you know, interestingly, I think of most mental health, mental health challenges or issues, their bio psychosocial, right, they're not just it's not just in your head, it's not even just in your brain. It's in its biology, it's psychology, it's social relationships. It's relates to career and like you said, it can impact even how youth and even generations are raised. So people getting an accurate diagnosis and getting treatment sooner, dispels or makes unnecessary years of suffering, not only for the individual, but for everyone that that person is connected to. And when we talk about trauma and intergenerational trauma, I do want to have Dr. Rachel Yehuda, on the show as well to talk a little bit about intergenerational trauma. So I don't think it's gonna happen this season. But hopefully soon, we can really shift things in a profound way where it impacts a lot of people, someone listening might want these resources for themselves, like can can I figure out if I have di D? What kind of PTSD? Do I have? Can I get a brain scan, right? Like that is helpful initiative to try to understand, you know, what we're going through, but other folks who might think, Oh, this doesn't really apply to me, it really impacts the soup we swimmin made and the people, our communities and our general sense of mental health and even our societal structures.
Speaker 2 43:13
Absolutely, yes, the societal impact is huge for the person, but also financially, and the numbers that we just talked about, like a million pounds, that sounds that sounds a lot. But if you think about 1%, or one and a half percent of people with the ID will have been trying to get the right diagnosis for 12 years, five to 12 years, and they have been in ambulances and a&e and to the GP and I've had scans for all kinds of psychosomatic pains, how much how much money does that cost? Right? Quite a lot. And then, and then I'm only only talking about the money aspect, because you have already raised and discussed all the other other aspects.
Lisa Danylchuk 44:08
And we haven't even talked about the professional or career oriented context to where if someone has any, you know, physical or mental health challenge, if they can get help with that, and get support and have it be addressed? Well, then they're going to have more energy to contribute to whatever their work is, right. I mean, some people are very high functioning, I don't want to make it sound like they're not some people with physical and mental health issues can be very high functioning at work. But generally speaking, if you're having to spend those five 712 years going to doctors, that's time that you can't spend elsewhere. So, I want to wrap up and I just want to re restate for folks who may be just listening for the first time and hearing about your research for the first time. Really state what dissociation looks like from this neurological perspective? Right? What what might people continue to look for in themselves or in their research studies? What might help them identify and differentiate dissociation?
Speaker 2 45:19
Okay can answer that very short. That is frontal and parietal brain activation, and decreased social capital, Foyle
Lisa Danylchuk 45:30
decreased hippocampal volume in frontal and parietal activation,
Speaker 2 45:34
brain activation. And if people want to have more details on the biomarkers of dissociation, they can best read the review that I published in 2021. That describes four types of biomarker categories. And because we have not even talked about hormones, we have not talked about genetics, all these aspects I have reviewed, but the take home message from that paper are the frontal and parietal brain activation. And decreased hippocampal volume dose, I would call biomarkers for dissociation.
Lisa Danylchuk 46:21
Lovely. So we'll link to that paper in the show notes as well. So people can go and read it directly. And what's next for you? What's What are your current or upcoming projects?
Speaker 2 46:34
At the moment, and like I said earlier, at the moment, I'm working on trying to get my papers published on the on the basis of the data that I have, and supporting my PhD students. And I'm planning to submit my grant proposal that got very good review scores. I'm planning to resubmit that in September. Just have to collect my energy submit another round. And hopefully the time is right, then.
Lisa Danylchuk 47:11
Yes. pulling for you over here.
Speaker 2 47:15
I know, I know, Lisa. And I know a lot of people are, but it's just what I have to work with at the moment. And I think it also helps me to get good feedback on my grant proposals, and I know it's a funders decision. Yeah, because they have all this grant proposals lying on the table, right. And all of them all have excellent and exceptional ratings. And then at some point, their board has to decide which proposals they're going to fund. And they cannot fund all excellent and exceptional reviewed projects. At the moment, from what I see they go with psychosis, depression, anxiety, bipolar disorder, but very little on dissociation. I know there's a large project running on moral dissociation in, in younger adults, adolescents. But that is more dissociation in general terms, not specific study of clinical dissociation in the body and dissociative PTSD. And that is really my niche, what I've been working on. And that is also I've decided that for myself as well, that is also what I would like to do with my life, because I've had colleagues who have asked me, oh, why don't you just write a grant proposal on psychosis of schizophrenia, because I worked on in the psychosis department for for a while. And I learned a lot there. And I'm grateful for that time there. But it's just not what I want to do with my life. And this is what energizes me, this is what I want to do. And this is why I'm going to give it another try. Hopefully, I can continue and if not, I hope other groups in the world, like the group and half it, they just continue and compounds the important work.
Lisa Danylchuk 49:33
I think they will take it and run with it. And I hope that that's gratifying for you. I know it is hard to be a pioneer and to be in this place where and I think one of the reasons funding has been so challenging is because of what your research does, which is build understanding of dissociation. Right? So because there isn't an understanding of dissociation is a little bit of this like chicken in the egg thing, then there's not as much fun doing, and then you're left struggling, although you have this phenomenal research. And so I, I hope there's a turn around the corner and that there's some good funding coming through for you soon. And if folks have any resources on funding or just an interest in your work, how could they connect with you and support you?
Speaker 2 50:17
Well, my email addresses or most of the pay on my papers, I think there's a system via KCL. If they find me, King's College London, sorry, I always call it KCL, God's law law Mon, I have, I still have a web page there because I still have an honorary affiliation with King's College, and I'm on Twitter as well. But even even they can even contact you or somebody else that they have contact information from, and then they can contact me. I'm not that hard to find.
Lisa Danylchuk 50:54
And I just have one last question. As we wrap up, I think doing this type of work and coming up against the systemic challenges that you've come up against, and dealing with something that's such a serious and challenging and for many people long term mental health challenge. What brings you hope, as you're doing this type of work?
Speaker 2 51:15
What gives me hope? Well, what drives me what gives me the Wonder still gives me the energy is the feedback I get from the community that you are part of Lisa, but also from individuals with the ad. A who sent me email that explaining how much my work has changed our lives, or that my research is being used in in textbooks in the Netherlands, to educate the next generation of psychotherapists? Yes, I feel greatly honored by that. But that also gives me energy, keep going.
Lisa Danylchuk 51:58
And I hope you continue and keep going. I know Christine foreigner who came on to an earlier episode of the show. I told her I was interviewing you today. And she said, Please tell her I think she should be awarded a Nobel Prize for Medicine and physiology. I know, it's hard when you know, there's
Speaker 2 52:18
some bolts with a Nobel Prize, but I wouldn't, I wouldn't be happy with only the money.
Lisa Danylchuk 52:24
Just want the grant. Yeah, well, I hope you get the recognition and the grants. And I just want to thank you for your time today. And for you know, all the research you've done. I feel like, you know, we talked earlier about favorite studies. And, you know, no, I'm waffling. Because there's, you've done so much great work. But I feel like the the meta analysis that you've done, as well, as, you know, the most popular paper of really putting the fantasy model and the biomarker model side by side.
Speaker 2 52:54
Lisa, can I say one more thing about a paper that I have written that I think might be a nice start off. For listeners who do not know much about imaging or about dissociation. That is the editorial that I wrote with Professor Feldman, in the British Journal of Psychiatry. And that is from last year. And it's an editorial, and it's more easier access. So that might be a nice paper for people to start. The title is did dissociative identity disorder out of the shadows at last. Okay, I think this is also when people ask me for information, or a starting point for re starting to read the literature on imaging, and D ID, this, I would give as a starting point for paper.
Lisa Danylchuk 53:53
That's a great place to start. And I know there's so much more you could share, especially if we were using slides. Maybe we'll circle back with you on that. Or folks can look on YouTube to see, you know, you have a lecture that comes live there, I think it'd be a great resource for people. I agree. Thank you, Dr. Reynders, for all your time and all the energy and effort you've put into your research. And I hope this episode helps folks access that research, make sense of that research, apply it and really just understand complex trauma and dissociation at a more neurological level and a more concrete way and in a way that helps people get care faster and better.
Speaker 2 54:40
Exactly, because in the end, that's what it's all about.
Lisa Danylchuk 54:43
Yes. 100% agree. Thanks so much for listening. My hope is that you walk away from these episodes feeling supported, and like you have a place to come to find the hope and inspiration you need to take your next small step forward. For more information and resources, please visit my website how we can heal.com. There you'll find tons of helpful resources and the full transcript of each show. You can also click the podcast menu to submit requests for upcoming topics and guests. I look forward to hearing your ideas
Transcribed by https://otter.ai
Comments are closed