I am a patient of Dr. Farias, moderator on his dystonia recovery program and coordinator of it’s Emotional Well Being section. Following are some things I’ve come to believe about Dystonia, depression, and mental health issues by learning from Dr. Farias, researching and through my own experiences. Perhaps something written here can give you ideas for self-discovery, or topics to explore with your neurologist, general practitioner or psychological counselor.
Those with dystonia can have a higher incidence of emotional issues, such as depression and anxiety caused by Dystonia symptoms, than the general population and working on these issues can dramatically affect our recovery efforts in a positive way.
Dr. Farias writes:
“Dystonia is not just a problem of movement control. The prefrontal lobes and the basal ganglia as well as the cerebellum are all areas that manage movement, emotion, behavior, and cognitive processing control at the same time. For this reason, patients affected by dystonia not only experience motor symptoms, but also more frequently affective-emotional ones. The management of emotions is also affected, producing emotional blocks.
The patient can feel constant sadness or loneliness, finding it difficult to change their internal emotional tone even though they are aware that no external reasons to feel that way exist. Thus, a prefrontal deficit leads to deregulation of the emotional response, producing depression in 65% of cases. It’s also common that inefficient cortical inhibition triggers impulse control problems (4%) or obsessive-compulsive episodes (43%).”
Large numbers of dystonia patients can have a comorbidity (a simultaneous presence of two chronic conditions) with psychiatric issues. Developing any chronic health condition can cause emotional disturbances as we struggle to make sense of what we’ve lost and our new lives going forward. The difference with dystonia is that there are significantly more patients that have or develop psychiatric problems (minor or major) than patients who develop a different chronic condition with similar degrees of disabilities and concerns.
Another noteworthy aspect is that these psychological issues can occur before the first movement irregularity does, sometimes months, years or even decades prior. An excerpt from a scholarly article:
“Psychiatric disorders are highly prevalent in patients with dystonia and can have a profound effect on quality of life. Patients with dystonia frequently meet criteria for anxiety disorders, especially social phobia, and major depressive disorder. Deficits in emotional processing have also been demonstrated in some dystonia populations. Onset of psychiatric disturbances in patients with dystonia often precedes onset of motor symptoms, suggesting that the pathophysiology of dystonia itself contributes to the genesis of psychiatric disturbances. This article examines the hypothesis that mood and anxiety disorders are intrinsic to the neurobiology of dystonia, citing the available literature, which is derived mostly from research on focal isolated dystonias.”
We are learning how intertwined emotion and movement can be. Many with dystonia noticed emotional changes, whether anxiety, depression, social anxiety or obsessive behaviors, escalated around the time of diagnosis or in the months and years prior. Some have also been aware that they showed tendencies of these emotional issues throughout their lives even prior to developing dystonia’s movement issues. This is by no means saying we are ‘imagining’ our condition, not at all, but it does mean we are more likely to also have emotional issues.
Since emotion and movement affect each other in the brain, we can understand more clearly why our stress triggers movement symptoms, and of course when we have symptoms it triggers stress – and one feeds the other and we develop a stress-symptom-stress-symptom feedback loop. We can interrupt the loop by improving the flow of movement, nervous system balance, and brain synchronization through exercises and relaxation techniques. We also work to diminish any external or any internal emotional stress. Over time, by continually interrupting the loop we can break the feedback cycle and at the same time effectively learn to manage both our movement and emotional symptoms going forward.
As you approach or continue this recovery journey, I hope you reach out for the appropriate psychological counsel when needed. When I first met Dr. Farias, I will admit to being what I would now compassionately call ‘nuts’ – anxiety, obsessiveness and social anxiety were overwhelming. These emotional issues began well before the first movement irregularities. After two years of work with only Farias’s protocol, I noticed dramatic improvement with not only movement and overall physical health, but with psychological issues. After that, even though movement issues had leveled off to a manageable and comfortable level, the emotional aspect has continued to improve as I continue to work on it. Seven years later I can clearly say I returned from ‘nuts’ to my baseline normal.. even better than my baseline. I’m now able to recognize emotional (and movement) instabilities if they start to creep back in and can manage them before they become a landslide.
Dr. Farias writes:
“Intervention for psychological elements is a basic component in the therapeutic process.”
By addressing psychological issues, we can dramatically help ourselves to manage dystonia’s movement issues – and at the same time, relief from emotional strife enables us to enjoy life more fully.
With knowledge comes hope for a brighter future.
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* Limitless, How Your Movements Can Heal Your Brain. Joaquin Farias, PhD here
** Psychiatric Comorbidities in Dystonia, Emerging Concepts. NCBI, PMC here
***Cognitive and Neuropsychiatric Impairment in Dystonia NCBI, PMC here
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