1 MACP Program, Faculty of Behavioural Sciences, Yorkville University PSYC 6104 – A Biopsychosocial Approach to Counselling Comorbidities and Intersectionality: Compounding Stressors in Depression 2 I was prompted to seek counselling during a major depressive episode (MDE) by my family physician. I was assigned male at birth (AMAB) and of West-Indian descent; I identify as homosexual and gender-fluid. I was previously diagnosed with irritable bowel syndrome (IBS) and generalized anxiety disorder (GAD). I had been struggling with symptoms of MDE for 6 months before seeking help. Upon a recent move from my parents’ house to my own condo, I had started to experience persistent sadness. The move took place during COVID, so I was isolated by the lock-down and now living alone. I was plagued by fatigue, sleeping at least 10 hours in addition to multiple naps through the day. My motivation levels were at an all time low; I slept through work, missed appointments and was letting myself go. My hygiene was declining, I was missing meals; unable to keep up with the diet indicated for IBS, and had stopped exercising. 3 Biological Factors I my initial session with my therapist, they took the time to gather my background information. We got to talking about my ethno-cultural background, and they informed me that their child’s partner shared my ancestry. This self-disclosure allowed me to validate their cultural competency – essential to building respect (Audet & Everall, 2010). We talked about how much trauma my ancestry went through and how that would affect my behavior. Transgenerational epigenetics renders individual more susceptible to multiple disorders presenting as when triggered by life stressors (Jakovljevic & Borovecki, 2018). In my case these can be seen as successive comorbidities, GAD, then IBS, and now MDE. My therapist acknowledged how difficult it must be to live with IBS. IBS will often affect the creation of and metabolic pathways of neurotransmitters and thereby IBS has a high correlation with mood disorders such as MDE and GAD (Mudyanadzo et al., 2018). Currently in Canada the physiological cause of IBS is not well understood, and no cure is available, so patients are left with only tools symptom management. One such that I had been following includes a LOW-FODMAP diet that is aimed at starving bacteria that causes bloating, however those bacteria are also essential in the production serotonin and dopamine (Gearry et al., 2016). We discussed the need for in my life for “person-centered planning and care” approach (Adams & Grieder, 2004). The treatment for these comorbidities needs to be balanced and I am the expert in how they affect me and what capacity I have for the treatments. There exists a bilateral relationship between physical, inclusive of hygiene and exercise, and emotional wellness, however, I was experiencing a gap in a holistic treatment (Vreeland, 2007). As my own expert I can address that gap – they would facilitate this by engaging in open conversation about my symptoms relating to all my ailments and addressing my capacity for these treatments. 4 Psychological Factors My intersectionality leads me to be a multiple minority: queer, non-binary person of colour with invisible physical and mental disorders. LGBT-POC are more likely to experience trauma due to psychosocial dynamics (Cyrus, 2017). This trauma has a direct correlation to depressive symptoms. In my initial session I started to talk about the trauma I had gone through, but they shifted the conversation. This autobiographical account of my trauma can be intrusive and not therapeutic (Bar-Haim et al., 2021). While I was treating myself like the background of medical case, they humanized me, structuring a conversation where I was able to explore my feelings and perception of my current stressors (Slay-Westbrook, 2017). Several factors compound my feelings of isolation: discrimination from being LGBT and POC (Cyrus, 2017), the pandemic, and a move to a single occupancy home. They had me to do some diagnostic personality tests which showed I scored high in extraversion. COVID lock downs have been particularly painful to extroverts and show a direct correlation to depression as we will perceive more stress from being isolated (Bellingtier et al., 2021). This is higher stress is perceived due to this isolation – which is true for all aspects of my intersectionality as well. Depressed individuals often perceive more stress from life events than non-depressed counterparts, similarly this phenomenon can be seen with the LGBT and POC communities (Coyne & Calarco, 1995; Cyrus 2017). This heighted perception of stress has direct impacts to my behavior and can create a cyclical relationship with stress and depression. We created an emotional diary together which helped both of us have insight to how I experienced the world and my behavior when faced with a stressor (Hülsheger et al., 2015). 5 References Adams, N., & Grieder, D. M. (2004). Treatment planning for person-centered care: The road to mental health and addiction recovery. Academic Press. Audet, C. T., & Everall, R. D. (2010). Therapist self-disclosure and the therapeutic relationship: A phenomenological study from the client perspective. British Journal of Guidance & Counselling, 38(3), 327–342. https://doi.org/10.1080/03069885.2010.482450 Bar-Haim, Y., Stein, M. B., Bryant, R. A., Bliese, P. D., Ben Yehuda, A., Kringelbach, M. L., Jain, S., Dan, O., Lazarov, A., Wald, I., Levi, O., Neria, Y., & Pine, D. S. (2021). Intrusive traumatic reexperiencing: Pathognomonic of the psychological response to traumatic stress. American Journal of Psychiatry, 178(2), 119–122. https://doi.org/10.1176/appi.ajp.2020.19121231 Bellingtier, J. A., Mund, M., & Wrzus, C. (2021). The role of extraversion and neuroticism for experiencing stress during the third wave of the COVID-19 pandemic. Current Psychology. https://doi.org/10.1007/s12144-021-02600-y Coyne, J. C., & Calarco, M. M. (1995). Effects of the experience of depression: Application of Focus Group and survey methodologies. Psychiatry, 58(2), 149–163. https://doi.org/10.1080/00332747.1995.11024722 Cyrus, K. (2017). Multiple minorities as multiply marginalized: Applying the minority stress theory to LGBTQ people of color. Journal of Gay & Lesbian Mental Health, 21(3), 194– 202. https://doi.org/10.1080/19359705.2017.1320739 Gearry, R., Skidmore, P., O'Brien, L., Wilkinson, T., & Nanayakkara, W. (2016). Efficacy of the low fodmap diet for treating irritable bowel syndrome: The evidence to date. Clinical and Experimental Gastroenterology, 131. https://doi.org/10.2147/ceg.s86798 Hülsheger, U. R., Lang, J. W., Schewe, A. F., & Zijlstra, F. R. (2015). When regulating emotions at work pays off: A diary and an intervention study on emotion regulation and customer tips in service jobs. Journal of Applied Psychology, 100(2), 263–277. https://doi.org/10.1037/a0038229 Jakovljevic, M., & Borovecki, F. (2018). Epigenetics, resilience, comorbidity and treatment outcome. Psychiatria Danubina, 30(3), 242–253. https://doi.org/10.24869/psyd.2017.242 Mudyanadzo, T. A., Hauzaree, C., Yerokhina, O., Architha, N. N., & Ashqar, H. M. (2018). Irritable bowel syndrome and depression: A shared pathogenesis. Cureus. https://doi.org/10.7759/cureus.3178 Slay-Westbrook, S. (2017). Respect-focused therapy: Honoring clients through the therapeutic relationship and process. Routledge, Taylor & Francis Group. 6 Vreeland B. Bridging the gap between mental and physical health: a multidisciplinary approach. J Clin Psychiatry. 2007;68 Suppl 4:26-33. PMID: 17539697.
