BLOG No. EIGHT

Welcome back to my eighth blog on anxiety and depression. This is Dr. G. In my last blog we looked at the two different STAR-D trials that proved there is more to depression and anxiety then serotonin and norepinephrine. Elevation of D2 dopamine, driven by the imbalance of glutamate and GABA, plays a huge role in depression, but unfortunately is not treated correctly very often.

But today I want to stretch our little cerebral hemispheres and discuss behaviors that can scar us for life— Cutting, burning, and trichotillomania (pulling of hair).

Cutting, burning, trichotillomania, and self mutilation is something I have consistently seen in patients with type 2 dopamine issues for two decades.

I have treated many a patient that have self-mutilated with the above three behaviors. Perhaps you know someone who does one of these behaviors, or perhaps, you do it. Either way, no one is proud of cutting, but to the patient it may just feel like a compulsion.- like you need to do it to feel better. But cutting, burning, or pulling goes far beyond compulsion.

The neurochemistry behind these behaviors can be complex, but I’ve worked with these patients for two decades and I feel like I've got a pretty good grip on what is going on. (of course I said that about my hand rail, and now I have a big bruise!) Nearly all of the young and older self-mutilator types have type 2 dopamine issues. And when the suffering from the D2 elevation (anger, anxiety, rollercoaster moods, insomnia, etc.) are not relieved, patients can begin cutting, burning, or plucking or any other forms of self injury to cope. Understand, this is not a thought out issue or an act to get attention. This is a response to unrelieved mental anguish that comes in many forms.

But why?

When any of the painful rituals are performed, the body responds with a release of endogenous (self-made) opioids, specifically beta-endorphin and metenkephalon. (I promise these will not be on the test later). These opioids do exactly what opioids normally do—they block pain. And opioids do not discriminate. They can block physical pain or emotional pain. Although some psychiatrists and psychologists have previously attributed self-injury to serotonin and other monoamines, this just is not true.

When cutting, burning, and self mutilation occurs, the body responds with a release of endogenous (self-made) opioids, which do exactly what opioids normally do—they block pain- physical or emotional.

What is the difference between a psychiatrist and psychologist? About $200 an hour.

In an excellent study by Dr. Barbara Stanley PhD and a few others, cerebral spinal fluid was collected in patients prior to self-injury and then after self- injury. Increased level of the two opioids listed above were measured after the self- mutilating behavior. All monoamine levels were however unchanged.

So in summary, self -injury is performed to relieve the pain of D2 dopamine excess.

And now that we have good studies to prove that, you might ask about tattooing and piercing. Are these just another form of self injury?

There have been a flurry of experts weighing in on this, but without a resolution. My own thoughts, at least with the basic piercings and tattoos would be to say no. Where cutters, burners, and pullers try to hide their wounds, people with tattoos and piercings do want to show off their art.

However, at some point I think body art can become self-injury. I have a gentleman in my practice who has suffered with D2 issues for a long while, until I treated him and he got better. When I first met him he was covered in tats and piercings. Since I’ve treated his type D2 dopamine excess, he has not got another piercing nor tattoo.

Well, as a wise Sage once told me, better a glass of Chard than a shard of glass. Until next time where we will look at the spectrum of psychiatry according to Dr. G.

Until then keep the faith!