Pilot Workshop – Dental & Mental Health in Young People

This afternoon I took part in a pilot workshop for a research project at Queen Mary University of London’s Institute of Dentistry. It seeks to explore needs and set research priorities for dental health services, focusing on young adults with depression.

I discovered the opportunity through TRIUMPH, which is a transdisciplinary network aiming to improve youth mental public health, based at the University of Glasgow.

The National Survivor User Network (NSUN) email newsletter is also a great place to find opportunities like this. I would recommend signing up with these networks if you want to find out about current research and lived experience opportunities related to trauma and mental health.

Whilst I was outside the criteria of young people aged 18-25 – I have just turned 31 – I emailed the lead researcher anyway. Accessing dental healthcare can be impacted by complex trauma, and I can see how my own lived experiences have made it hard for me to look after my dental health.

I’ve wanted to talk about this subject for a while, so this seems like a great way to have my voice heard and see if there is further potential to be involved as a lived experience expert.

In the end I was welcome to contribute, and took part in an hour-long workshop with the lead researcher, Dr Easter Joury. We were joined by another service user whose lived experience was also valued.

I focused primarily on talking about what a trauma-informed approach is, and how this is relevant to dental healthcare.

I explained how a trauma-informed model of mental health explains depression as a symptom of misdiagnosed and unprocessed complex trauma. Therefore, many people would benefit from a trauma-informed approach to healthcare like this, including young people with depression.

I talked about how people with lived experience of complex trauma need specific trauma-informed care, especially in settings like dental healthcare.

I also shared my insights into the wording and language used in research questions, and suggested further questions which need researching from this trauma-informed lens.

“This was one of the most productive workshops ever – it really shows the value of lived experience. You are the expert, not us. Thank you!”

Dr Joury’s comments at the end of the session

It feels great to be valued like this, and to have the potential to really shape the kind of research which will impact people’s lives for the better. I hope there will be the chance to be involved as a lived experience expert as this research project develops, because trauma-informed dental care is definitely something I’m keen to raise awareness of.

I also think it’s important that research participants are valued for their time spent in workshops like these. I will earn a £20 voucher for my time, and was given a range of choices for this, which I appreciate.

If the researchers want to embed lived experience into the next stages of their project, the INVOLVE lived experience/co-production guidelines are a great framework. In recognition of the great value we can bring to projects, this also includes payment for our work – the only way we can sustainably and fairly continue to progress towards the change we need.

Thanks for the opportunity Dr Joury, and I hope I can continue to be involved as your much-needed research project evolves.

P.S. And a bonus outcome for me – I was empowered to book a dentist appointment for the first time in many years!

Research analysis

Reduced anterior cingulate and orbitofrontal volumes in child abuse-related complex PTSD.

Thomaes K, Dorrepaal E, Draijer N, de Ruiter MB, van Balkom AJ, Smit JH, Veltman DJ. Journal of clinical psychiatry
2010; 71(12):1636-1644

https://europepmc.org/abstract/med/20673548

OBJECTIVE: Classic posttraumatic stress disorder (PTSD) is associated with smaller hippocampus, amygdala, and anterior cingulate cortex (ACC) volumes. We investigated whether child abuse-related complex PTSD–a severe form of PTSD with affect dysregulation and high comorbidity–showed similar brain volume reductions.

METHOD: Measuring gray matter concentrations in referred outpatients with child abuse-related complex PTSD (n = 31) compared to matched healthy nontraumatized controls (n = 28).

RESULTS: As was hypothesized, patients with child abuse-related complex PTSD showed reductions in gray matter concentration in right hippocampus (P(SVC corrected) = .04) and right dorsal ACC (P(SVC corrected) = .02) compared to controls. In addition, a reduction in gray matter concentration in the right orbitofrontal cortex (OFC) was found. Impulsivity correlated negatively with hippocampus volume, and anger, with hippocampus and OFC volume. Comorbidity of borderline personality disorder–compared to comorbid cluster C personality disorder–accounted for more extensive reductions in the ACC and OFC volume.

CONCLUSIONS: In complex PTSD, not only the hippocampus and the ACC but also the OFC seem to be affected, even in the absence of comorbid borderline personality disorder. These results suggest that neural correlates of complex PTSD are more severe than those of classic PTSD.

What does this research study show us?

Important conclusions:

  • Individuals with child-abuse related complex PTSD show reductions in grey matter concentration in brain in these areas:
    • Right hippocampus,
    • Right dorsal ACC and
    • Right orbitofrontal cortex (OFC)
  • Impulsivity correlates negatively with hippocampus volume
  • Anger correlates negatively with hippocampus and OFC volume
  • Comorbidity of borderline personality disorder meant more extensive correlations with ACC and OFC volume
  • Complex PTSD affects the hippocampus, ACC and OFC
  • This neural impact of Complex PTSD is more severe than classic PTSD
  • These effects are seen even without comorbid borderline personality disorder diagnosis

So, the effects are worse if individuals were also diagnosed with comorbid borderline personality disorder. But the effects were otherwise present (and still more so than classic PTSD) in individuals without this diagnosis.

If those both with and without this BPD diagnosis have the same neurological symptoms, then the common correlate is trauma, not the BPD diagnosis.

This is evidence that the borderline personality disorder diagnosis is a meaningless social construct which further serves to re-traumatise survivors of complex childhood trauma.

To explain the fact that those with a BPD diagnosis have markedly more volume differences than those without, we could consider the fact that these individuals’ trauma experiences (perhaps they were more severe; perhaps they were women more likely to be diagnosed with BPD than PTSD; or simply lived in an area with better access to services) led them to try and access help from the mental health system, which gave them their diagnosis of BPD.

Given what we know about the stigma attached to this diagnosis and the lack of a trauma-informed approach within the mental health system, it’s a likely theory that the individuals diagnosed with BPD have higher correlates because they have been diagnosed with BPD. This diagnosis has caused them more trauma to add to their complex trauma.