Stop Playing Whac-A-Mole With Trauma

"Often these patients think that they lost the genetic lottery; how else could they be so unlucky as to have five or six separate biological brain disorders? To help people understand why I think that they do not have a terrible genetic destiny, I talk about Whac-A-Mole, the arcade game where a player whacks a plastic mole as it pops out of a hole, only to have it disappear and be replaced by another mole somewhere else."

"But the issue with the Whac-A-Mole game isn't the moles; it's the machine in the box under the moles. It turns a crank that pushes the moles out of the holes. You can whack them down as much as you want, but as long as the crank is turning, more moles are going to pop out. In my long experience with hundreds of complex patients, the machine driving the crank is usually trauma."

Patients frequently present with multiple, shifting psychiatric symptoms that can mimic several separate diagnoses. Symptom patterns often substitute for one another: treating suicidality may reveal restrictive eating; addressing eating may reveal obsessive-compulsive behaviors; treating those may uncover mania, self-harm, paranoia, or hallucinations. An underlying, persistent driver commonly found is trauma, particularly early abuse, neglect, or insecure/disorganized attachment occurring before a stable sense of self or language development. Symptoms often serve as communications of unresolved distress and require trauma-informed, integrative assessment and treatment rather than isolated, symptom-only interventions.

Read at Psychology Today