Saturday, July 3, 2010

Fibromyalgia and Child Abuse

Hi all!  Thank you to those who emailed to let me know you missed my blog entries. While I have planned to write a number of times, I have been dealing with a severe Fibromyalgia flare which has interfered with many of my regular activities.  Since fibromyalgia has been occupying much of my thoughts I decided it would make a good blog topic. 

For those of you who are unfamiliar with fibromyalgia, it is "a chronic condition characterized by widespread pain in your muscles, ligaments and tendons, as well as fatigue and multiple tender points — places on your body where slight pressure causes pain."1

Until fairly recently Fibromyalgia was considered a Psychological disorder.  Patients were told the pain was "in their head", and did not really exist.  However, in the last 5-10 years new research has shown that the pain fibromyalgia patients suffer has an actual physical basis.  This physical basis is referred to as "central sensitization".1 It is believed that "repeated nerve stimulation causes the brains of people with fibromyalgia to change. This change involves an abnormal increase in levels of certain chemicals in the brain that signal pain (neurotransmitters). In addition, the brain's pain receptors seem to develop a sort of memory of the pain and become more sensitive, meaning they can overreact to pain signals."(emphasis added) 1

While current scientists cannot explain what causes Fibromyalgia, many recent studies show that previous physical, sexual and severe emotional abuse are risk factors, at a minimum.  A few organizations, such as the Mayo Clinic,  have gone so far as to list "Emotional and Physical Trauma"1, as one of the factors with the potential to cause Fibromyalgia.  One recent clinical  study concluded that Fibromyalgia patients were three times more likely to have been emotionally or sexually abused, and four times more likely to have been physically abused than the non-fibromyalgia control group.2 Others studies can be found which place the statistical association even higher.   

So why does this matter?  Most individuals must deal with some sort of medical condition at some point in their lives, whether Fibromyalgia or something else.  That is absolutely true.  There are a number of reasons why it matters that child abuse leads to an increased risk of Fibromyalgia (among other medical disorders).  I will limit myself to two: more evidence that early intervention is needed in abusive family situations; and the need for greater awareness that child abuse affects an individual for life.

First, what constitutes early intervention?  In this case, I am not referring to the police or social workers swooping down on a parent that swats a child's hand for trying to touch the stove.  Our culture seems to have a fear that "the authorities" are watching, waiting with baited breath, to remove our children from home.  I hate to burst your bubble, but "the authorities" do not have the time, money, or inclination to do so.  Actually when I say that early intervention is needed, I am referring to something that you and I can do.  We come in contact with people everyday.  Do we care enough to really connect with those people?  Oftentimes the abusive spiral can be prevented before it gets started if we are aware and willing to become involved.  Think about yourself raising your young children. Do you remember how easy it was to become overwhelmed and frustrated?  Did you have a support system- someone to talk to about your frustrations, or someone to trade babysitting?  Go over the last few days in your mind.  Did you notice anyone in your community who seemed particularly stressed with their children?  Could you have helped in some way? Did you offer an encouraging word?  It is amazing how even a simple word of encouragement can make us aware that we are not alone on the world.  The few minutes you give up to speak kindly and show compassion may be enough to make a difference in their life and the lives of their children.

Sometimes the situation is more drastic.  I recall noticing that a young father seemed to regularly speak to his three year old quite harshly.  I tried to gently point it out to no avail.  Finally, one Shabbos, I was in the sanctuary, the doors were closed, and the outer building's doors were closed, yet I could hear this father outside, berating his son.  I went outside to speak with him.  I admit, I was quite angry, but I did not want to yell at him and have him become defensive.  Instead, I tried to relate to him.  I tried to explain that I knew what it was like to be angry and frustrated by your child's behavior, but that I was concerned about his pattern of yelling and speaking harshly with his son.  I expressed my concern that this could easily permanently damage his relationship with his son, even if it never went beyond yelling.  I asked him to notice the fear on his son's face.  And, yes, I did mention that I was concerned that his anger could lead to him physically harm his child if he was not careful (being sure to mention that I realized he had no desire to harm his son).  He was angry with me.  Okay, I'm a big girl.  I can take it.  He was so angry he talked his wife about it- great!  One positive step.  She and I spoke about it, as well- uncomfortable, but, not too bad.  And, best of all, over time I noticed significant changes in the father-son relationship.  If I hadn't, and things continued, I would have spoken to them again, or called social services.

Second, as a culture and community we need to accept the fact that child abuse affects an individual for the rest of their life.  It's not just those who have suffered catastrophic abuse leaving them physically crippled, or the person who becomes a drug addict, criminal or falls into the cycle of abusing their own children, but even the person who has "overcome" their abusive background and built a healthy family.  We need to stop assuming that once a child is removed from an abusive home they will be fine.  These children (or adult survivors) need compassion from those around them, physicians as well as friends.  We must stop minimizing the physical pain survivors experience because we do not understand. They are not attempting to "play the victim".  The scars run deep, and apparently science is catching up to what we as survivors already knew, the pain is not only psychological, but can be physical as well.   

On a personal note, I understand that it can be frustrating to deal with someone with Fibromyalgia, or any chronic medical condition.  Please know that we are at least as frustrated as you are with our limitations and pain.  For you it is an inconvenience because we have to reschedule plans or bow out of activities we would like to participate in.  For those of us who are abuse survivors, it is also a reminder that our abuser still affects our lives no matter how many years ago the abuse ended. Thank you for being patient with us!

You will see that I have quoted the Mayo Clinic numerous times throughout my entry. This is not because this is the only source, but rather it is the source which uses the most user friendly language to discuss Fibromyalgia.  I will list additional articles for further reading below the footnotes.

1 "Fibromyalgia." 23 Jan. 2009. Web. 1 July 2010.

2 Katz, Robert S., et al. "Adverse Childhood Environment In Fibromyalgia Patients". Rush University Medical Center, Chicago, IL.

Websites/Articles of Interest
"Understanding Chronic Pain and Fibromyalgia: A Review of Recent Discoveries" by Robert M. Bennett MD, FRCP, Professor of Medicine, Oregon Health Sciences University

"Childhood Trauma and Diurnal Cortisol Disruption in Fibromyalgia Syndrome" by Inka Weissbeckera, Andrea Floyda, Eric Dederta, Paul Salmona, Sandra Sephton