Case Study: Seven Medications and a Score of Seven — Childhood Trauma, Autoimmune Disease, and the Path from Broken to Whole

Category: Case Studies | All Four Directions | Composite Clinical Case

DISCLAIMER: This is a composite fictional case study based on common clinical patterns observed across integrative and functional medicine practice. It does not represent any single real patient. All names, identifying details, and specific circumstances are invented. The clinical patterns, lab values, treatment protocols, and healing trajectories described reflect well-documented presentations in the literature and are intended for educational purposes.

Presenting Complaint

Yến, a 38-year-old Vietnamese-American woman, presented carrying a folder containing five years of medical records, lab results from seven different specialists, and a current medication list that required its own page:

Levothyroxine 112mcg daily (Hashimoto’s thyroiditis, diagnosed age 33)
Sertraline 100mg daily (depression and anxiety)
Gabapentin 300mg 3x daily (fibromyalgia pain)
Trazodone 100mg at bedtime (insomnia)
Omeprazole 20mg daily (GERD)
Dicyclomine 20mg as needed (IBS cramping)
Ibuprofen 600mg 2-3x daily (pain management)

Her chief complaint, delivered with exhaustion rather than emotion: “I’ve been sick for five years and nobody can tell me why. They just keep adding pills.”

Her diagnoses: Hashimoto’s thyroiditis (autoimmune), IBS-mixed (alternating constipation and diarrhea, bloating, cramping), fibromyalgia (widespread musculoskeletal pain, tender points, fatigue), generalized anxiety disorder, major depressive disorder, chronic insomnia, and chronic fatigue. She rated her energy at 3/10, her pain at 6-7/10 daily, and her quality of life as “barely existing.”

She had seen: a PCP, an endocrinologist (managing thyroid), a rheumatologist (diagnosed fibromyalgia, offered nothing beyond gabapentin and “exercise”), a gastroenterologist (diagnosed IBS after colonoscopy was normal, prescribed dicyclomine), a psychiatrist (prescribed sertraline and trazodone), a pain management specialist (offered trigger point injections, which provided temporary relief), and a neurologist (ruled out MS). Each specialist addressed their organ system. None had looked at the whole picture. None had asked about her childhood.

History

Medical History

Childhood: frequent infections (strep throat repeatedly, treated with multiple antibiotic courses). Chronic stomach aches as a child, attributed to “being nervous.” Menarche at 10 (early — associated with childhood adversity and cortisol exposure in utero and early childhood). History of recurrent UTIs in adolescence and young adulthood. Mononucleosis (EBV) at age 20. Hashimoto’s diagnosed at 33 after a period of severe fatigue and weight gain. IBS symptoms began around age 30. Fibromyalgia diagnosed at 35 after two years of worsening pain, fatigue, and the characteristic tender points. Depression diagnosed at 34. Anxiety had been present since childhood but formally diagnosed at 34.

Surgeries: tonsillectomy at age 7, appendectomy at age 25.

Family History

Mother: fibromyalgia, depression, history of alcohol abuse. Father: absent — left the family when Yến was 3. Mother’s boyfriend (ages 6-12): physically and sexually abusive. Maternal grandmother: rheumatoid arthritis, “nervous breakdowns.” No information available on paternal side.

ACE (Adverse Childhood Experiences) Score: 7/10

Yến completed the ACE questionnaire with the practitioner, marking affirmative for:

Emotional abuse (constant criticism, being told she was “worthless” and “a mistake”)
Physical abuse (mother’s boyfriend — belt, hands, thrown against walls)
Sexual abuse (mother’s boyfriend — from age 8 to 12, when the relationship ended)
Emotional neglect (mother was emotionally absent due to depression and alcohol)
Physical neglect (periods of no food in the house, unwashed clothes, missed medical appointments)
Mother treated violently (Yến witnessed physical violence against her mother)
Household substance abuse (mother’s alcohol abuse)

The ACE score matters clinically because the research is unambiguous: an ACE score of 4 or higher doubles the risk of autoimmune disease, triples the risk of depression, increases the risk of IBS by 200%, and increases the risk of fibromyalgia by 300% (Dube et al., 2009; Afari et al., 2014). An ACE score of 7 places Yến in a population with dramatically elevated risk for virtually every chronic disease — not because of genetics, not because of bad luck, but because chronic childhood stress fundamentally alters the development and function of the immune system, the HPA axis, the gut microbiome, the nervous system, and the brain.

This is the science of embodied trauma: the body keeps the score, and the score has consequences measured in inflammation, autoantibodies, pain sensitivity, and organ dysfunction.

Yến was born in California. Her mother came to the US from Vietnam in the early 1980s. The family lived in poverty. After her father left, her mother cycled through relationships, one of which brought the abuser into their home. Yến never disclosed the sexual abuse until she was 30 — eight years before this presentation. The disclosure was to her PCP, who referred her to a therapist. She attended six sessions of CBT and stopped: “I wasn’t ready. It felt like ripping off a bandage with no skin underneath.”

She graduated from community college with a degree in dental hygiene. She worked full-time despite her illnesses. She was single, having ended a 3-year relationship at age 35 when her partner became controlling. “I seem to pick the same person over and over, just in different packaging.” She had a small social circle and described herself as a “loner” who preferred animals to people. She had a dog, Luna, who was “the only living thing I trust completely.”

Emotional History

Yến presented with a flat affect that was not apathy but protection. She spoke about her history in a dissociated, clinical manner — as if describing someone else’s life. When the practitioner noted this, she said: “If I let myself feel it, I won’t be able to function. And I can’t afford not to function.”

Beneath the flat affect was a complex emotional landscape: chronic shame (the belief that she was fundamentally damaged, defective, “broken” — a word she used repeatedly), hypervigilance (constantly scanning others for threat cues — facial expressions, tone of voice, body language), a deep distrust of others (especially men and authority figures), and a pervasive sense of unworthiness that informed every relationship and life choice.

She had never been in a long-term therapeutic relationship. The six sessions of CBT at age 30 were her only therapy experience. She was, in her own words, “held together with duct tape and caffeine.”

Spiritual History

“I don’t believe in God. If there was a God, He wouldn’t have let those things happen to a kid.” This statement, delivered with quiet conviction, revealed the spiritual wound at the center of Yến’s suffering: the destruction of basic trust in the universe. When a child is harmed by those who are supposed to protect her, the damage extends beyond the psychological to the cosmological — the universe is no longer safe, meaning is no longer available, and the self is no longer connected to anything larger than its own survival.

Assessment Through Four Directions

Serpent / Rắn (South) — Physical Body

Yến’s body was a textbook illustration of the ACE-to-autoimmune pipeline. The mechanisms are well-documented:

Chronic childhood stress → HPA axis developmental programming: Early life stress permanently alters HPA axis calibration. The cortisol thermostat is set too high (initially) and eventually collapses (as adrenal reserves deplete). Yến’s nervous system was programmed for threat from age 3 onward.
HPA dysregulation → immune dysregulation: Cortisol is the primary modulator of immune function. When cortisol signaling becomes chaotic (as in chronic HPA dysfunction), the immune system loses its regulation — overactivating against self-antigens (autoimmunity) while underperforming against actual threats (the frequent infections).
Gut microbiome disruption: Multiple antibiotic courses in childhood, chronic stress, poor nutrition, and emotional trauma all disrupt the developing microbiome. The gut barrier becomes permeable (leaky gut), allowing bacterial endotoxins and food antigens to enter the bloodstream and trigger immune responses. Molecular mimicry between these antigens and self-tissue (thyroid, joints, myelin) drives autoimmune targeting.
Central sensitization → fibromyalgia: Chronic activation of the stress response system, combined with unresolved trauma stored in the body, creates central sensitization — the nervous system’s pain processing centers become hypersensitive, amplifying normal sensory signals into pain. Fibromyalgia is not “imaginary pain” — it is neurologically real pain generated by a nervous system that has been in alarm mode for decades.
Neuroinflammation → depression and anxiety: Gut-derived and stress-derived inflammation crosses the blood-brain barrier and activates microglial cells, producing neuroinflammation. This disrupts serotonin synthesis, impairs dopamine signaling, and creates the neurobiological substrate of depression and anxiety. The SSRIs Yến was taking addressed downstream serotonin availability but did not touch the upstream inflammation driving the deficiency.

The seven medications Yến was taking managed individual symptoms downstream while leaving the upstream drivers — HPA dysfunction, gut permeability, chronic inflammation, central sensitization, and neuroinflammation — completely unaddressed.

Jaguar / Báo (West) — Emotional Body

The Jaguar direction contained the nuclear core of Yến’s illness: a childhood of abuse, neglect, and terror that had never been metabolized.

In IFS terms, Yến’s system was organized into a rigid protective architecture:

The Fortress (Manager): A vigilant, distrustful part that kept the world at a distance. Its methods: isolation, self-reliance, emotional flatness, maintaining control at all times. Its belief: “If I let anyone in, they will hurt me.” This part had kept Yến alive through childhood and was not going to stand down without significant evidence of safety.
The Worker (Manager): A part that drove her to function despite illness — to go to work, to maintain responsibilities, to never appear weak. Its belief: “If I stop, I will die. If I show weakness, I will be exploited.”
The Numb One (Firefighter): The dissociation — the ability to “leave” her body and speak about her history as if it happened to someone else. This part had first appeared during the sexual abuse (dissociation during trauma is a survival mechanism that prevents the psyche from being overwhelmed) and had remained active ever since.
The Shame Bearer (Exile): A young part, carrying the most devastating belief that sexual abuse instills: “This happened because of something wrong with me. I am broken. I am dirty. I am damaged beyond repair.” This exile was the source of the chronic shame that colored every aspect of Yến’s life.
The Rage (Exile): Buried even deeper than the shame — the fury at her mother for failing to protect her, at the abuser for violating her, and at a world that allowed it. This rage, having no safe outlet for decades, had turned inward — contributing to the autoimmune process (the immune system attacking the self as the psyche attacks the self).

Hummingbird / Chim Ruồi (North) — Soul

At the soul level, Yến was living inside a narrative of brokenness. The story she told herself — and that her diagnoses reinforced — was: “I am a broken person. I was broken in childhood, and I am broken now. The diagnoses prove it. Seven medications prove it. I will always be broken.”

This narrative was not true, but it was coherent — it organized her entire experience into a single, devastatingly consistent story. And every specialist who added a diagnosis and a medication, without ever asking about her childhood, reinforced it.

The Hummingbird work would involve nothing less than rewriting the foundational narrative of her life: from “I am broken because I was broken” to “I survived the unsurvivable, and the symptoms I carry are the proof of my survival, not the evidence of my defectiveness.”

Eagle / Đại Bàng (East) — Spirit

The spiritual wound — the destruction of basic trust — was the deepest layer. Without trust that the universe has some fundamental order, that existence has some meaning, that she has some purpose beyond surviving, Yến was spiritually homeless. The atheism she expressed was not philosophical conviction — it was theological trauma. The God she rejected was the God who should have protected a child and didn’t. The spiritual work would not involve arguing for God’s existence but rather exploring whether meaning, connection, and belonging could exist without the God of her childhood — and whether a different understanding of the sacred was available to her.

Testing & Diagnosis

Functional Medicine Laboratory Workup

Complete Thyroid Panel:

TSH: 4.1 mIU/L (on levothyroxine 112mcg — suboptimally managed; target on medication: 0.5-2.0)
Free T4: 1.3 ng/dL (adequate — the medication provides T4)
Free T3: 2.2 pg/mL (low — poor T4-to-T3 conversion despite adequate T4. Gabapentin, SSRIs, and chronic inflammation all impair deiodinase activity)
Reverse T3: 28 ng/dL (elevated — T4 being shunted to inactive rT3)
Free T3/rT3 ratio: 7.9 (optimal >20 — severely impaired conversion)
TPO antibodies: 412 IU/mL (very high — active autoimmune attack despite medication)
Thyroglobulin antibodies: 228 IU/mL (elevated)

Interpretation: Yến’s thyroid was being medicated with T4 (levothyroxine) but was unable to convert it to active T3 due to inflammation, stress, medication interference, and nutrient deficiencies. She was on the “right medication” but her body couldn’t use it. The very high TPO antibodies indicated that the autoimmune process driving the thyroid destruction was completely unaddressed.

DUTCH Complete:

Morning cortisol: low
CAR: absent (flat — no morning cortisol rise)
Afternoon cortisol: low
Evening cortisol: low
Total cortisol metabolites: low
DHEA-S: 82 mcg/dL (severely depleted)

Interpretation: Stage 3 HPA axis dysfunction — complete exhaustion. This is the end-stage of a stress response system that has been in overdrive since childhood and has finally collapsed. The flat cortisol pattern explains: the unrelenting fatigue (no cortisol to drive energy), the pain amplification (cortisol is the body’s anti-inflammatory — without it, pain signaling is unmodulated), the immune dysregulation (cortisol regulates immune function — without it, autoimmunity accelerates), and the emotional flatness (cortisol is involved in emotional reactivity — depletion produces anhedonia).

Comprehensive Stool Analysis (GI-MAP):

Severely reduced microbial diversity (the lowest diversity score the practitioner had seen)
Very low Lactobacillus, very low Bifidobacterium, very low Akkermansia
Elevated Candida albicans
Elevated Klebsiella pneumoniae
Elevated Citrobacter freundii
H. pylori: positive (IgA)
Zonulin: 198 ng/mL (severely elevated — significant intestinal permeability)
Calprotectin: 112 mcg/g (significant intestinal inflammation)
Secretory IgA: 142 mcg/mL (severely depleted — mucosal immune collapse)
Beta-glucuronidase: elevated
Pancreatic elastase: 142 mcg/g (low — pancreatic enzyme insufficiency)
Steatocrit: elevated (fat malabsorption)

SIBO Breath Test:

Positive for hydrogen-dominant SIBO

Blood Work:

hs-CRP: 6.8 mg/L (very high — severe systemic inflammation)
ESR: 28 mm/hr (elevated)
ANA: positive, 1:160, speckled pattern (general autoimmune activation)
Ferritin: 12 ng/mL (depleted — despite inflammation, which usually raises ferritin. True iron deficiency)
Vitamin D, 25-OH: 14 ng/mL (severely deficient)
Vitamin B12: 228 pg/mL (low — malabsorption from gut dysfunction + omeprazole impairs B12 absorption)
Folate: 5.8 ng/mL (low-normal)
RBC Magnesium: 3.4 mg/dL (severely depleted)
Zinc: 48 mcg/dL (severely depleted)
Omega-3 Index: 2.8% (depleted)
Homocysteine: 16.2 umol/L (very elevated — methylation impairment, cardiovascular risk)
Fasting glucose: 88 mg/dL (normal)
Fasting insulin: 8.2 uIU/mL (normal — one of the few normal findings)
CBC: mild anemia — Hgb 11.2 g/dL (iron deficiency anemia)

TCM Assessment

Tongue: pale and swollen (Qi and Blood Deficiency), purple undertone along edges (Blood Stasis), thick greasy coat in center (Damp retention) Pulse: thin, choppy, and deep — the pulse of severe deficiency with underlying stagnation Pattern: Qi and Blood Deficiency, Blood Stasis, Spleen Qi Collapse with Damp, Kidney Essence Depletion, Liver Qi Stagnation

This is the TCM picture of a body that has been depleted at every level: the Qi (vital energy) is exhausted, the Blood is insufficient and stagnant, the Spleen’s transformative capacity has collapsed (unable to extract nourishment from food — hence the malabsorption), the Kidney Essence (the deepest reserves of vitality, set at birth and consumed through life) is depleted, and the Liver is stagnant from decades of suppressed emotion.

Somatic Assessment

Body posture: protective collapse — rounded shoulders, sunken chest, head forward, pelvis tucked. This is the body of a person who has been trying to make herself small for 30 years — taking up less space, being less visible, protecting the vulnerable core by closing around it.

Palpation revealed: widespread myofascial restriction, particularly in the psoas muscles (the “muscle of the soul” in bodywork traditions — the primary hip flexor, directly connected to the fight-or-flight response, chronically contracted in trauma survivors), the diaphragm (restricted — shallow, chest-dominant breathing), the jaw (clenched, TMJ tenderness bilateral), and the pelvic floor (referral to pelvic floor physiotherapist for assessment — chronic pelvic floor tension is near-universal in survivors of childhood sexual abuse).

When the practitioner gently placed a hand on Yến’s upper back (with permission), she flinched. When asked to breathe into her belly, she reported feeling “nothing below the chest — it’s like that part of my body doesn’t exist.” This is somatic dissociation — the body below the waist was the site of the sexual abuse, and consciousness had retreated from it as a survival mechanism.

Treatment Plan

Phase 1: Physical Rescue (Months 1-4) — Serpent Priority

Yến was in a state of severe physical depletion. The first priority was rebuilding the foundation without overwhelming a depleted system.

Medication Optimization:

Add liothyronine (T3): 5mcg twice daily (physician-prescribed; addressing the T4-to-T3 conversion failure. Some patients with chronic inflammation cannot adequately convert T4 to T3 and require direct T3 supplementation. Start low — Stage 3 HPA patients are sensitive to thyroid medication increases)
Begin omeprazole taper (physician-supervised): reduce by 10mg every 2 weeks over 8 weeks (sudden discontinuation causes rebound hypersecretion). Replace with DGL 400mg before meals + zinc carnosine 75mg 2x daily
Ibuprofen reduction plan: the chronic NSAID use was contributing to gut permeability (NSAIDs disrupt the intestinal barrier directly via COX inhibition and prostaglandin suppression). Replace with: curcumin (Meriva phytosome) 1,000mg 2x daily, SPM (Specialized Pro-resolving Mediators) 2 softgels daily, and topical preparations for local pain
Gabapentin and sertraline: NO changes initially. Premature medication tapering in a destabilized system creates more harm. These would be addressed later, when the physical and emotional foundations were stronger.

Gut Protocol (Aggressive, Phased):

Phase 1A (Weeks 1-6): Antimicrobial

H. pylori treatment: mastic gum 1,000mg 2x daily + bismuth subcitrate 240mg 2x daily + berberine 500mg 3x daily (herbal H. pylori protocol; conventional triple therapy option discussed but patient preferred herbal approach given her antibiotic history)
SIBO treatment: allicin 450mg 3x daily + oregano oil 200mg 3x daily
Candida treatment: Saccharomyces boulardii 500mg 2x daily (anti-Candida probiotic)

Phase 1B (Weeks 7-16): Repair

L-glutamine: 5g 3x daily (intestinal epithelial repair)
Zinc carnosine: 75mg 2x daily (mucosal healing)
Collagen peptides: 15g daily
Bone broth: daily (rich in glycine, proline, glutamine — the building blocks of gut lining)
Aloe vera inner fillet: 200mg daily
Comprehensive probiotic: multi-strain, 200 billion CFU daily (aggressive repletion given severity of dysbiosis)
Prebiotic fiber: 5g daily, titrating slowly to 15g (to avoid bloating in SIBO-recovering gut)
Colostrum: 3g daily (IgA repletion, growth factors for mucosal healing)
Digestive enzymes: comprehensive enzyme with each meal (compensating for low elastase)

Nutrient Emergency Repletion:

Iron bisglycinate: 36mg 2x daily (anemia requires more aggressive dosing; with vitamin C 500mg for absorption; recheck CBC and ferritin at 6 weeks)
Vitamin D3: 10,000 IU daily for 12 weeks (aggressive repletion from severe deficiency), then reassess
Vitamin K2 (MK-7): 200mcg daily
Vitamin B12: 5,000mcg methylcobalamin sublingual daily (bypassing impaired gut absorption)
Methylfolate: 800mcg daily
Magnesium glycinate: 400mg 2x daily (split dosing for absorption)
Zinc picolinate: 50mg daily for 8 weeks, then 30mg maintenance
Omega-3: 4g daily EPA/DHA (anti-inflammatory, neurorestorative)
Selenium: 200mcg daily (thyroid support, TPO antibody reduction)
NAC: 1,800mg daily (glutathione support, anti-inflammatory)
CoQ10: 200mg daily (mitochondrial support for energy production)
Vitamin C: 2g daily (adrenal support, immune function, iron absorption)

HPA Axis Recovery (Stage 3 Protocol):

Adrenal glandulars (Thorne Adrenal Cortex): 1 capsule upon waking, 1 at noon
Pantothenic acid (B5): 500mg 2x daily
Licorice root: 200mg in the morning (extending cortisol half-life; BP monitoring)
Rhodiola rosea: 200mg in the morning (bidirectional adaptogen)
Ashwagandha KSM-66: 300mg 2x daily (HPA modulation, thyroid support)
DHEA: 5mg in the morning
Pregnenolone: 10mg in the morning

Autoimmune Modulation:

Vitamin D (as above — immunomodulatory at higher doses)
Selenium (as above — TPO antibody reduction)
Low-dose naltrexone (LDN): 1.5mg at bedtime, titrating to 4.5mg over 6 weeks (physician-prescribed; LDN modulates immune function by transiently blocking opioid receptors, causing a rebound increase in endorphins and enkephalins that has been shown to reduce autoimmune activity, reduce pain in fibromyalgia, and improve fatigue; Younger et al., 2014)
Gluten and dairy elimination (strict — the molecular mimicry between gluten/gliadin and thyroid tissue is well-documented in Hashimoto’s; Vojdani et al., 2014)

Pain Management (Replacing NSAIDs):

Curcumin Meriva: 1,000mg 2x daily
SPMs: as above
PEA (palmitoylethanolamide): 600mg 2x daily (endocannabinoid system support, clinically shown to reduce neuropathic and inflammatory pain; Paladini et al., 2016)
Magnesium (as above — muscle relaxation, NMDA receptor modulation)
LDN (as above — fibromyalgia pain reduction)
Acupuncture weekly (analgesic effect through endorphin release, anti-inflammatory signaling, vagal toning)

Exercise (Extremely Gentle):

Walking 15-20 minutes daily (building from 10 if necessary)
Gentle restorative yoga 2x weekly (no vigorous yoga — contraindicated in Stage 3 HPA dysfunction)
Absolute prohibition on “pushing through” fatigue

Phase 2: Trauma Therapy (Months 3-12) — Jaguar Priority

Yến’s trauma therapy began only after three months of physical stabilization — enough time for the gut to begin healing, cortisol to begin recovering, nutrients to begin repleting, and the nervous system to have some ground to stand on.

Somatic Experiencing (SE) — Weekly, First Priority: SE was chosen as the initial trauma modality because Yến’s system was dominated by the freeze response (dissociation, numbing, somatic disconnection). SE works directly with the body’s stored survival energy, titrating carefully to avoid overwhelm.

Months 3-6: Building Somatic Awareness The initial SE work was simply teaching Yến to feel her body — starting with safe zones (hands, feet, shoulders) and gradually, very gradually, extending awareness. The instruction: “We are not going to touch the trauma memories. We are going to teach your body that it is safe to be felt.”

The psoas work was particularly significant. The psoas — the deep hip flexor connecting the lumbar spine to the femur — is the primary muscle of the fight-or-flight response. In trauma survivors, it is chronically contracted, pulling the body into a protective flexion. Releasing the psoas (through gentle stretching, breathwork, and SE techniques) often produces powerful emotional releases: fear, rage, grief — the emotions the muscle has been holding.

Months 6-9: Titrated Trauma Processing Using Levine’s SIBAM model (Sensation, Image, Behavior, Affect, Meaning), the therapist guided Yến through carefully titrated contact with traumatic material — accessing a small piece of the trauma memory, noticing the body’s response, and then pendulating to a resource (safety, ground, present-moment awareness) before the nervous system became overwhelmed.

The freeze response began to thaw. Yến reported new physical sensations: warmth in her hands (circulation returning as the freeze released), tingling in her legs, spontaneous trembling (the survival energy discharging). She also reported emotional emergence: feelings she “didn’t know she had” — not just about the trauma, but about everything. Music moved her. Sunsets made her tearful. Her dog’s affection made her cry. The emotional flatness was resolving not because the medications changed but because the freeze was releasing.

IFS Therapy (Added at Month 6, Biweekly): Once SE had established sufficient somatic connection, IFS was introduced to work with the parts system directly.

The Fortress was approached first — the protector that kept everyone out. The therapist helped Yến’s Self approach this part with gratitude: “You kept her alive. You protected a child who had no one else to protect her. What would it take for you to trust that she’s safer now?”

The Shame Bearer exile was the central therapeutic target. The belief “I am broken/dirty/damaged” was the radioactive core of Yến’s suffering. The unburdening process took multiple sessions — the exile had been carrying this belief for 30 years and did not release it easily. The moment of unburdening was quiet: Yến, in deep Self-energy, visualized the 8-year-old girl and said to her, simply: “It wasn’t your fault. There was never anything wrong with you.” She wept silently for twenty minutes.

The Rage exile was approached last. The anger at her mother was the most complex emotion — because it was tangled with love. Yến loved her mother and was furious at her mother for failing to protect her. The IFS work held both: love AND rage, not love OR rage.

Pelvic Floor Physiotherapy (Beginning Month 6): Referral to a trauma-informed pelvic floor PT. Chronic pelvic floor hypertonicity from childhood sexual abuse causes pain, urinary symptoms, sexual dysfunction, and contributes to IBS. The PT used internal and external manual techniques, biofeedback, and breathwork to release the chronic holding. This work was done in parallel with SE and IFS — the body, the parts, and the pelvis all needed to heal together.

Phase 3: Rewriting the Story (Months 9-15) — Hummingbird Priority

Narrative Reframing: The central therapeutic work at the Hummingbird level was the deconstruction of the “broken” narrative and the construction of a new one.

The old narrative: “I was broken as a child. My body is broken. My seven diagnoses prove I am broken. I will always be broken.”
The new narrative (not imposed but discovered through therapy, journaling, and lived experience of healing): “I survived seven years of abuse with an ACE score of 7. My body carried that survival in the only way it knew how — through inflammation, pain, and immune activation. These are not signs of brokenness. They are signs of a body that has been fighting for me since I was a child. And now, for the first time, I am fighting alongside it instead of against it.”

Expressive Arts Therapy: Yến discovered, to her surprise, that she could draw. Not representational art — abstract shapes, colors, textures that gave form to emotional states she could not yet name in words. The art became a bridge between the somatic processing (body-level) and the narrative processing (meaning-level), allowing material that was too raw for language to be expressed visually.

Vietnamese Heritage Exploration: Yến had a complicated relationship with her Vietnamese identity — her mother, the primary representative of Vietnamese culture in her life, was also the person who failed to protect her. Vietnamese culture was thus associated with both beauty (food, language, music) and danger (family obligation, silence about abuse, protection of appearances).

The therapeutic work carefully differentiated: Vietnamese culture did not abuse you. A broken person in a broken system abused you while Vietnamese culture provided the silence that protected the abuser. You can reclaim the beauty of your heritage while refusing the silence.

Phase 4: Rebuilding Trust in Existence (Months 12-18) — Eagle Priority

Contemplative Practice: Yến’s atheism was respected — she was not asked to believe in anything. Instead, she was invited into practices that cultivated direct experience rather than belief:

Nature immersion: weekly solo time in nature (a park, a garden, the coast). The instruction: “You don’t need to believe in God. You need to be in a place where your nervous system remembers that the world is not only dangerous. Trees do not threaten. Water does not judge. The wind does not abuse.”
Breathing meditation: beginning with 5 minutes daily, extending to 15. Not “spiritual” meditation — physiological regulation of the nervous system through conscious breathing. The breath became Yến’s first trustworthy companion (always present, always available, not dependent on another person).

Reconstructing Trust: The deepest Eagle work was not about spirituality in the traditional sense. It was about rebuilding basic trust — trust in the body (through SE and somatic reconnection), trust in relationships (through the therapeutic relationship itself — the first safe, consistent, non-exploitative human connection Yến had experienced), and trust in existence (through the accumulating evidence that healing was possible, that suffering was not permanent, that the universe contained both horror and beauty).

The therapeutic relationship was the Eagle intervention. The practitioner’s consistent presence — showing up, being honest, not violating boundaries, not rescuing, not abandoning — provided a corrective relational experience that addressed the attachment wound at the root of Yến’s inability to trust.

Timeline & Progress

Month 1-2

Began gut protocol, nutrient repletion, adrenal support
Omeprazole taper initiated
Ibuprofen being replaced with curcumin + PEA
LDN initiated at 1.5mg, titrating
Energy: no change yet (depleted systems take time to respond)
Pain: marginally reduced (LDN beginning to take effect)
GI: increased bloating initially (die-off from antimicrobials), then improving
Iron: ferritin recheck at 6 weeks: 22 ng/mL (responding)

Month 3

Omeprazole fully discontinued — no rebound symptoms with DGL + zinc carnosine
SIBO retest: clearing (hydrogen levels declining)
LDN at 4.5mg — pain reducing (now 5/10 from 6-7/10)
Energy: 4/10 (slight improvement)
Began SE therapy — first two sessions entirely resource-building
Repeat labs: hs-CRP 4.2 (declining from 6.8), Vitamin D 28 ng/mL, B12 410 pg/mL

Month 4-5

Gut healing phase — bloating significantly reduced, IBS symptoms 50% improved
First formed, regular bowel movements in years
Energy: 5/10
Pain: 4-5/10
SE work deepening — first somatic releases (trembling in legs)
“I felt my legs for the first time in… I don’t know how long. They were warm.”
Dicyclomine use decreasing (IBS improving with gut healing)

Month 6

Repeat comprehensive labs: hs-CRP 2.4 mg/L, TPO antibodies 298 IU/mL (declining from 412), ferritin 38 ng/mL, Vitamin D 42 ng/mL, Hgb 12.4 g/dL (anemia resolving), homocysteine 10.8 umol/L
DUTCH retest: morning cortisol improving, CAR present at 28% rise (was flat), DHEA-S 124 mcg/dL
Energy: 5-6/10
Pain: 4/10 (fibromyalgia pain reducing with inflammation reduction + LDN + central nervous system calming from SE)
IFS therapy beginning — meeting the Fortress
Pelvic floor PT beginning
Began gabapentin taper discussion (physician-coordinated)

Month 9

Gabapentin taper: 300mg 3x daily → 200mg 3x daily (slow, careful)
Energy: 6-7/10
Pain: 3/10 most days
IBS: 80% improved (occasional flare with stress)
IFS: the Shame Bearer exile work. The unburdening session.
“I didn’t know it was possible to feel this much without breaking apart.”
Began art expression — first drawings
Sleep improving naturally — trazodone reduction discussed

Month 12

Labs: hs-CRP 1.2 mg/L, TPO antibodies 168 IU/mL (down from 412 — dramatic reduction), TSH 1.8 mIU/L (optimized), Free T3 3.0 pg/mL (conversion improving), ferritin 62 ng/mL, Vitamin D 56 ng/mL, DHEA-S 178 mcg/dL, homocysteine 8.4 umol/L
DUTCH: cortisol curve nearly normalized. CAR at 42%. DHEA recovering.
Energy: 7/10 — “more energy than I’ve had since my twenties”
Pain: 2-3/10 on most days, 4/10 on bad days (dramatic improvement from baseline 6-7/10)
Gabapentin: successfully tapered to 100mg at bedtime only
Trazodone: tapered to 50mg (sleeping naturally for most of the night)
Sertraline: taper initiated (physician-coordinated): 100mg → 75mg
IFS: rage exile work. Processing anger at mother. Complex, messy, nonlinear, essential.
Began nature contemplation practice
Dicyclomine: discontinued (IBS resolved)
Ibuprofen: discontinued (pain managed with curcumin, PEA, LDN, acupuncture)

Month 15

Gabapentin: fully discontinued
Sertraline: 50mg (continuing gradual taper)
Trazodone: discontinued (sleep natural)
Medication list: levothyroxine + liothyronine, sertraline 50mg (tapering), LDN 4.5mg
From 7 medications to 3 (one being actively tapered)
Energy: 7-8/10
Pain: 1-2/10 baseline. Occasional flare to 3-4/10 with stress, resolving within 24-48 hours.
PCL-5 (PTSD checklist — though not formally diagnosed with PTSD, she met criteria at intake): below clinical threshold
PHQ-9: 4 (minimal depression; was 18 at intake)
GAD-7: 5 (mild anxiety; was 16 at intake)
Relationship: began dating for the first time in 3 years — chose someone “who doesn’t feel like my mother’s boyfriend. That’s new.”
Art: enrolled in a community art class
Her words: “I spent thirty years believing I was broken. It turns out I was just… carrying more than any human should have to carry. And now I’m learning to set it down.”

Month 18 (Follow-up)

Sertraline: fully tapered (with psychiatrist oversight)
Final medication list: levothyroxine + liothyronine, LDN 4.5mg
Two medications. Down from seven.
Hashimoto’s: TPO antibodies 92 IU/mL (down from 412 — 78% reduction)
Fibromyalgia: no longer meets diagnostic criteria (insufficient tender points, no widespread pain)
IBS: resolved
GERD: resolved
Depression: remission
Anxiety: managed without medication
Insomnia: resolved
The diagnoses had not changed (Hashimoto’s was still present). But the person carrying them had transformed.

Key Turning Points

Turning Point 1: The ACE Score Conversation (Intake)

When Yến was asked about her childhood — systematically, with the ACE questionnaire — and when the connection between childhood trauma and adult disease was explained to her with research, something shifted. For the first time, her illness made sense. Not as random misfortune, not as personal weakness, but as the predictable physiological consequence of what she had survived. “You mean there’s a reason for all of this?” she asked. “Yes,” the practitioner said. “And that reason also points to the treatment.”

Turning Point 2: The First Somatic Release (Month 5)

When Yến felt warmth in her legs for the first time — legs she had dissociated from since childhood — the freeze began to thaw. The body that had been a site of violation was, tentatively, becoming a place she could inhabit. This is the Serpent-Jaguar bridge: the body reconnecting to the psyche.

Turning Point 3: The Shame Unburdening (Month 9)

When the 8-year-old exile heard, from Yến’s adult Self: “It wasn’t your fault. There was never anything wrong with you” — the core belief that had organized thirty years of suffering was touched, for the first time, by its antidote. The TPO antibodies dropped dramatically in the following months. Coincidence? Perhaps. Or perhaps the immune system, which had been attacking the self as the psyche attacked the self, received a new signal.

Turning Point 4: Nature as Spiritual Ground (Month 14)

Yến could not trust God, could not trust people, could not trust institutions. But sitting under a tree in a park, feeling the sun on her skin, listening to birds — she could trust that. “This is the first thing I’ve believed in since I was a child,” she said. “Not God. Just… this. That the world has beauty, and it’s not trying to hurt me.” This was the Eagle’s gift: not faith but direct experience of the sacred in the ordinary.

Where Single-Direction Treatment Failed

This case demonstrates the failure of single-direction treatment more dramatically than any other, because Yến had received single-direction treatment for five years from seven specialists — each addressing their organ system in isolation, none treating the whole person, none asking the question that mattered most: “What happened to you?”

Levothyroxine treated the thyroid without addressing the autoimmune process attacking it
Sertraline treated the serotonin deficiency without addressing the neuroinflammation causing it
Gabapentin treated the pain signals without addressing the central sensitization generating them
Omeprazole treated the acid without addressing the gut dysbiosis and permeability causing the reflux
Dicyclomine treated the cramping without addressing the gut-brain axis dysfunction driving it
Ibuprofen treated the inflammation without addressing its source — and worsened the gut permeability that was fueling it
Trazodone treated the insomnia without addressing the cortisol dysregulation and hyperarousal causing it

Seven medications, each targeting a symptom. Zero treatments addressing the root: a traumatized body carrying thirty years of unprocessed survival.

Lessons & Principles

ACE scores predict chronic disease more reliably than genetics, lifestyle, or any other single factor. The research (Felitti et al., 1998; Dube et al., 2009) demonstrates a dose-response relationship: the higher the ACE score, the higher the risk. Every chronic disease evaluation should include ACE screening.
Autoimmune disease has emotional roots — and treating both the immune system and the emotional wound produces outcomes that neither approach achieves alone. The 78% reduction in Yến’s TPO antibodies was achieved through a combination of gut healing, nutrient repletion, immune modulation (LDN, vitamin D, selenium), AND trauma therapy. The body and the psyche are not separate systems. They are one system.
Polypharmacy without root cause treatment is a treadmill. Each specialist added a medication for their organ system without asking why that organ system was failing. The result: seven medications managing seven symptoms of one condition — unresolved childhood trauma.
The freeze response is the most overlooked dimension of trauma. Yến did not present as a “typical” trauma survivor — she was not having flashbacks, not emotionally volatile, not visibly distressed. She was numb. Flat. Dissociated. The freeze response is the body’s deepest survival mechanism, and it is invisible to approaches that look for emotional activation rather than emotional absence.
Healing from severe childhood trauma takes years, not months. The 18-month timeline presented here is actually accelerated by the simultaneous physical and emotional work. The full trajectory of healing from an ACE score of 7 may take 3-5 years of ongoing work. The body heals at the speed of biology. The psyche heals at the speed of trust. Neither can be rushed.
The therapeutic relationship is itself a treatment modality. For a patient whose primary wound is relational — abuse by a caretaker, neglect by a mother — the consistent, safe, non-exploitative therapeutic relationship provides the corrective experience that no supplement or technique can replace.

References

Afari, N., et al. (2014). Psychological trauma and functional somatic syndromes: A systematic review and meta-analysis. Psychosomatic Medicine, 76(1), 2-11.
Dube, S. R., et al. (2009). Cumulative childhood stress and autoimmune diseases in adults. Psychosomatic Medicine, 71(2), 243-250.
Felitti, V. J., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245-258.
Levine, P. A. (1997). Waking the Tiger: Healing Trauma. North Atlantic Books.
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Schwartz, R. C. (2021). No Bad Parts. Sounds True.
van der Kolk, B. (2014). The Body Keeps the Score. Viking.
Vojdani, A., et al. (2014). The prevalence of antibodies against wheat and milk proteins in blood donors and their contribution to neuroimmune reactivities. Nutrients, 6(1), 15-36.
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