What Parents Should Know About Infections and Mental Health
After infections, some children are misdiagnosed with mental health conditions.
Posted June 28, 2019 | Reviewed by Gary Drevitch
A reality of trauma and many other mental health symptoms is the complexity of causes. This means that sustainable solutions have to be complex as well. Single-cause approaches don’t work for very long.
Professionals—counselors, psychologists, medical doctors, nutritionists, and therapists of all kinds—are schooled in a particular field of diagnosis and treatment. They trust the tools they know, often had teachers and mentors who did wonderful things with them, and see these tools as the answer to problems they encounter.
In other words, they tend to define the symptoms they see as problems caused by the issues they are trained to deal with. As the saying goes: “If the only tool you have is a hammer, everything you see is a nail.”
All this is natural and perhaps not so bad, if not for something else. Science is increasingly revealing that a large number of medical and mental problems are interrelated. In ways unknown to the teachers who mentored the practitioners of today, diet and exercise, community, environment, and mind are inextricably woven together. Problems in one area often manifest in other areas.
Few professionals are equipped to diagnose and treat people in the integrative way required. A large number of people receive care that is less effective and less sustainable than if the practitioners working with them were up-to-date about cross-linkages among disciplines.
I was first introduced to the brain-gut connection over a decade ago. At that time, few doctors or other practitioners were aware of this connection. In recent years, social media and numerous evidence-based studies have made it far easier to learn about the many implications of this interaction.
In my last post , I wrote about inflammation, one of the best-researched and most promising areas for integrative approaches to mental health. In this post, I go a step further and explore a question with implications for almost all aspects of mental health: What are the root causes of inflammation?
Stress , the Gut and Inflammation
Inflammation is a protective mechanism that, once triggered, tries to isolate invaders in the body to prevent injury from spreading and to bring extra resources to locations the body selects as in need of special support. When exposed to events, organisms, or substances that trigger inflammation, the body produces small protein cells called cytokines. These cells promote inflammation in the body in response to a threat. Depending on the trigger, inflammation may be limited to one location, or it may be systematic.
An area where research has most clearly established inflammation as a body response that links mental health to physical illness is autoimmune disorders. You can find many essays on the web by searching on “emotional stress and autoimmune disorders.”
For example, a recent study by Song et al., (2018) analyzed more than 100,000 people who were diagnosed with stress-related symptoms. The researchers studied how many of these people developed an autoimmune disease a year or more later. They compared this to the incidence of autoimmune disorders in their siblings and in a pool of a million people who had no diagnosis of stress symptoms. They found that, after a year, people who had a diagnosis of stress-related symptoms were significantly more likely to develop an autoimmune condition than those who did not.
Stress, the Gut, and Autoimmunity
Much has been learned in recent years about the gut and the central role it plays in human functioning of many kinds. Until recently we thought the gut was simply a system for breaking down food and converting it into energy and waste. How little we knew!
The gut is now recognized as home to a vast microbiome of bacteria, viruses, pathogens, and fungi that interact with the brain in complex ways. When these organisms get out of balance with each other—something that can happen as a result of food or chemical intakes, changes in body chemistry, and many other factors that may favor one kind of organism over others—complex results can follow.
One is damage to the lining of the gut, often called “leaky gut.” In a weakened condition, the intestinal walls of the gut no longer provide an impermeable barrier between the teaming microbiome within and the rest of the body. Toxins and bacteria may penetrate intestinal walls and enter the bloodstream.
This triggers a reaction of the immune system, including inflammation. Through the “leaky gut,” inflammation can cross the blood-brain barrier (BBB) to the brain, and this is when many mental health symptoms emerge. To make things worse, sometimes inflammation triggers an overreaction in the body’s immune response, and the body mistakenly begins attacking itself in a misdirected autoimmune response. Such a response can sometimes become a full-blown autoimmune disease.
After a misdirected autoimmune response has been triggered once, inflammation will be triggered in the future in response to even small amounts of whatever first triggered that response. Viruses, infections, environmental toxins, stress, and trauma can trigger a renewed inflammatory response at any time. The byproducts of such responses cross the blood-brain barrier and trigger mental health symptoms.
There are many variables that trigger inflammation and initiate mental and physical symptoms. Usually, it is not just one, but a mix of several variables, such as:
Underlying Infections as Root Causes
It is now widely known that it is important to maintain routines, sleep, and diet to promote and maintain good emotional health. Less commonly recognized is the role of underlying infections and pathogens as root causes that manifest in mental health symptoms. The body responds to these invaders with inflammation, and the inflammation can penetrate the blood-brain barrier described above.
The result can be mental health symptoms that are often misdiagnosed as ODD, ASD, ADHD , depression , bipolar , OCD , sensory processing disorder , anorexia and restrictive eating, tic disorders, schizophrenia, etc.
A Set of Complex, Debilitating Symptoms
The people that come to see me usually have been in therapy for many years. Often, they suffer from complex symptoms. They have been to more than one therapist and have been treated for more than one diagnosis. They have not able to reduce their symptoms and regain a sense of wellness. They struggle to retain hope of ever reaching sustainability.
In spite of their past experiences, almost all of my clients achieve improvement in their symptoms. The key, I am convinced, is an all-wellness approach (see my post ) that targets the emotional, cognitive, physical, and spiritual aspects of a client’s life.
In addition to therapy, often focused on trauma since that’s my specialty, at the onset of work with clients I help them review their routines of diet and nutrition , movement and exercise, and sleep. Improvements in these areas bring improvement in emotional symptoms for such a large majority of my clients that I now include attention to them as a standard part of treatment.
As an integrative therapist, I sometimes think of my role as being a private investigator. I study each client’s personal history thoroughly. I find valuable information in medical reports, psychological evaluations, teacher evaluations, childhood pictures, old art making, and anything that can help me fill in more pieces of the puzzle of their debilitating symptoms.
I also often play a role as a “case manager” and maintain close contact with other professionals involved with my clients, such as medical doctors (when I am making a referral to a doctor I refer to an integrative MD), occupational therapists, speech therapists, physical therapists, neurotherapists, neuropsychologists, psychologists who conduct evaluations, private coaches, sports coaches, teachers, etc.
Over the years, I have come to learn that most of my clients who are survivors of developmental trauma are also suffering from some sort of inflammation and or autoimmune conditions.
An influential experience for me was working with a child with severe developmental trauma, manifested in some of the most difficult behavioral symptoms I have seen. The client came one day with what seemed like a minor cold with behavioral symptoms even more difficult than before.
As usual, I was also working closely with the parents and maintaining a joint journal with them. So, I knew that the only variable that had changed for the child was acquiring this cold.
A rapid test revealed a strep infection. This is a huge red flag, as strep is a predecessor for a neuroimmune syndrome that some refer to as autoimmune encephalitis (hereafter, AE, also known as PANDAS or PANS; see below for more info).
I referred the family to an integrative medical doctor who did more testing and administered antibiotics. Within days the symptoms were reduced to a level well below what they had ever been during my work with this client, who made steady progress during the months of that followed.
Childhood Adversity and Later Life Inflammation
Early adversity and exposure to stress at a young age were found to be linked with the development of inflammatory conditions later in life. Several authors have suggested that trauma can lead to medical illnesses (Callaghan et al., 2019; Flory and Yehuda , 2018; Hemmings et al., 2017; Renna et al., 2018;).
Autoimmune Encephalitis — One Example of the Interaction of Body and Mind
An example of the interaction of emotional and physical systems is Autoimmune Encephalitis (AE), an umbrella diagnosis for a spectrum of symptoms thought to be caused by neuroinflammation (inflammation of the brain). This inflammation appears when the immune system of the body overreacts to infection from bacteria or virus and mistakenly targets cells of the body rather than the invader.
I learned about AE when I grew puzzled with lack of progress in a few clients I was seeing with unusual emotional dysregulation issues. Extensive conversation with the parents and the basic orientation to integrative frameworks I already had led me to AE as a potential diagnosis. I continue to read and profit a great deal from the ongoing research and resulting exchanges, and I’ll focus on this syndrome for the remainder of this blog as a sort of case study in the kind of awareness and treatment approaches which I believe mental health practitioners must begin to adopt.
For readers who appreciate formal definitions, here’s one: AE (referred to as PANS/PANDAS OGK) “criteria define a broad spectrum of neuropsychiatric conditions, the syndrome is presumed to result from a variety of disease mechanisms and to have multiple etiologies, ranging from psychological trauma or underlying neurological, endocrine , and metabolic disorders to post-infectious autoimmune and neuroinflammatory disorders, such as pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS), cerebral vasculitis, neuropsychiatric lupus, and others” (Swedo et al., 2017).
This article is part of the Bringwise Psychology Journal — daily insights on human behavior, mental health, and personal growth.