Trauma therapy and diabetes

Daniel Sher addresses the overlooked connection of trauma therapy and diabetes and how trauma therapy should be integrated into diabetes care with a holistic and patient-centred approach.

Listen to this article below or wherever you get your podcasts or visit our playlist.

As people with diabetes, we often tend to focus on the physical aspects of this condition. Food, insulin, blood glucose testing, and exercise, for example. However, often the psychological side of diabetes gets overlooked. The intersection of trauma and diabetes is important to understand, as unaddressed trauma can significantly impact the ability to manage diabetes effectively.

What is psychological trauma?

Trauma can be broadly defined as the emotional and psychological response to an event or series of events that are overwhelmingly stressful or life-threatening.

Examples of trauma outside of diabetes might include experiences like being in a car accident, enduring physical or emotional abuse, or surviving a natural disaster. These events can leave lasting emotional scars and may trigger the development of post-traumatic stress disorder (PTSD).

PTSD is a specific type of trauma response that occurs when the brain struggles to process the traumatic event, leading to symptoms like flashbacks, nightmares, hypervigilance, and avoidance of anything that reminds the person of the trauma. Unlike normal trauma responses, which may fade over time, PTSD symptoms are persistent and can significantly interfere with a person’s daily life.

For people with diabetes, trauma can include the shock of diagnosis, difficult circumstances around being in hospital, insensitive disclosure of diagnosis, or traumatising processes related to finger-pricks and injections. Especially if the diagnosis occurs at a young age, all of the above can represent acute traumas.

On the other hand, the experience of living with diabetes can itself be traumatic. The constant need for vigilance, the fear of complications, and the potential for life-threatening events (including severe lows or diabetic ketoacidosis) can lead to chronic stress and anxiety. This stress can be compounded if the individual has a history of trauma, creating a cycle of fear and distress that makes diabetes management even more challenging.

The impact of trauma on diabetes management

Trauma, especially when unrecognised or untreated, can significantly hinder diabetes management. It often leads to psychological conditions, such as PTSD, depression, and anxiety, which can severely impair an individual’s ability to adhere to their diabetes care regimen.

For instance, someone with a history of trauma may struggle with flashbacks, nightmares, or intrusive thoughts, making it difficult to concentrate on daily tasks like blood glucose monitoring or medication adherence.

Additionally, trauma can alter how individuals perceive their bodies and their relationship with food; both crucial aspects of diabetes management. Survivors of trauma may develop disordered eating behaviours, such as binge eating, restrictive eating, or emotional eating, as coping mechanisms for overwhelming emotions. These behaviours can disrupt blood glucose levels and overall diabetes control.

Recent research¹ underscores the significant impact of PTSD on diabetes management, particularly among younger patients with Type 1 diabetes (T1D). The study, published in Scientific Reports, found that T1D patients under 25 with comorbid PTSD experience worse glycaemic control, higher rates of diabetic ketoacidosis, and more frequent hospitalisations compared to those without PTSD. This highlights the critical need for integrated psychological support in diabetes care, especially for vulnerable groups facing PTSD.

Moreover, the stress associated with trauma can lead to diabetes distress, a term that describes the emotional burden and anxiety specific to living with diabetes. Diabetes distress or burnout occurs when the demands of managing diabetes become overwhelming, leading to neglect of care. This creates a dangerous cycle where poor diabetes management leads to health complications, which in turn exacerbates the individual’s stress and trauma.

The role of trauma therapy in diabetes care

Given the significant impact that trauma can have on diabetes management, it’s important to incorporate trauma-informed care into diabetes treatment. Psychological therapy, which focuses on recognising and addressing the effects of trauma, can be a vital component of a comprehensive diabetes care plan.

Trauma therapy can take many forms, including cognitive-behavioural therapy (CBT), eye movement desensitisation and reprocessing (EMDR), and somatic experiencing. These therapies aim to help individuals process their trauma, reduce symptoms of PTSD, anxiety, or depression, and develop healthier coping mechanisms.

For example, a person with diabetes who struggles with emotional eating due to past trauma may benefit from CBT to challenge and change their thoughts and behaviours around food.

EMDR might help someone process traumatic memories that trigger anxiety and lead to diabetes burnout. By reducing the psychological burden of trauma, these therapies can make it easier for people to recover and learn to thrive with this condition.

Integrating trauma therapy into diabetes care

For healthcare providers, integrating trauma therapy into diabetes care requires a holistic and patient-centred approach. This means recognising the signs of trauma, understanding its impact on diabetes management, and referring patients to appropriate mental health services when needed. It also means creating a safe and supportive environment where patients feel comfortable discussing their emotional and psychological challenges.

In practice, this could involve routine screening for trauma and mental health conditions in patients with diabetes, providing education on the link between trauma and diabetes management, and collaborating with mental health professionals to provide integrated care. It’s also essential to educate patients about the connection between their mental and physical health and to empower them to seek help for both.

Summing up

The connection between trauma and diabetes is a critical but often overlooked aspect of diabetes care. By recognising and addressing trauma through specialised therapy, healthcare providers can help individuals with diabetes improve not only their mental health but also their ability to manage their condition effectively.

As our understanding of this connection grows, it becomes increasingly clear that a holistic approach to diabetes care—one that integrates trauma therapy—can lead to better outcomes and improved quality of life for those living with this challenging condition.

References

1. Lunkenheimer, F., Eckert, A. J., Hilgard, D., et al. (2023). Posttraumatic stress disorder and diabetes-related outcomes in patients with type 1 diabetes. Scientific Reports, 13, 1556. https://doi.org/10.1038/s41598-023-28373-x

Header image by FreePik