April | 2018 | She Soars psychiatry, LLC

In my office I practice functional medicine. Functional medicine aims to identify root causes of health concerns and in doing so, supports treatment solutions that are long-lasting and sustainable. Given my specialty in mental health, the intersection between your hormones and emotional is a “root” that cannot be dismissed. Your hormones are intimately connected with your mood in a bidirectional, dynamic relationship and one of the major players in this relationship is your thyroid.

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Your thyroid is a butterfly shaped gland that sits in the lower part of your neck. It has many important roles including growth & development, metabolism, temperature regulation, and neurotransmitter production among others.

Thyroid dysfunction is on the rise these days. This may be due to the thyroid being particularly susceptible to potentially damaging effects of synthetic, hormone disrupting chemicals that have increased exponentially the past 40-50 years finding their way into the air, water, and food supply. It is estimated that worldwide up to 25 percent of the population have some degree of thyroid dysfunction. Therefore, when I evaluate someone for depression, anxiety, poor motivation, and poor focus among other symptoms, it is imperative that thyroid function be assessed.

Thyroid imbalances can trend in two directions. Most commonly, thyroid function and hormones associated with the thyroid create a state of hypothyroidism. Symptoms associated with hypothyroidism may include fatigue, depression, brain fog, memory loss, cold intolerance, weight gain, muscle pain, and dry skin. Alternatively, hyperthyroidism can be associated with restlessness, anxiety, weight loss, insomnia, rapid heart rate, irritability, and heat intolerance.

Thyroid dysfunction may be the consequence of an autoimmune disorder. Hashimoto’s disease is the autoimmune state more commonly associated with hypothyroidism while Grave’s disease is more commonly associated with hyperthyroidism.

Women have seen the highest increases in thyroid dysfunction especially during pregnancy, postpartum, and postmenopausal states. In fact, it is estimated that up to 80 percent of postpartum depression may be associated with thyroid dysfunction.

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It is important to recognize that somebody with undiagnosed thyroid dysfunction may present to a mental health clinician and meet criteria for a number of psychiatric diagnoses such as major depression, generalized anxiety, panic, or attention deficit disorder. Therefore, while your symptoms may qualify you for a psychiatric diagnosis, the foundation of these symptoms may be hormonal, which often demands treatment approaches beyond psychotropic medications.

In my opinion, truly assessing thyroid function necessitates looking at multiple pieces of the puzzle. Too often many of these pieces are neglected leaving an incomplete picture of what your thyroid is doing or not doing. At a minimum I recommend the following lab tests to assess thyroid function:

TSH (Thyroid Stimulating Hormone, regulates secretion of T3 & T4)
Free T3 (active form of thyroid hormone)
Free T4 (inactive thyroid hormone, requires conversion to T3)
Thyroid Antibody Test (this is important to rule out an autoimmune disease)
Liver Function Test (your liver is very important for activating thyroid hormone)
Ferritin (required for T3, your active thyroid hormone to work at the cellular level)

Stress, diet, nutrient deficiency, lack of physical activity, oral contraceptives, heavy metals, pesticide exposure, chronic illness, and compromised liver or kidney function can all be contributors to thyroid dysfunction. Thus, treating thyroid dysfunction demands a personalized approach that considers these multiple factors. There is not a one-size fits all solution. The good news that with a combination of hormonal support, lifestyle changes, and close monitoring, significant improvement is possible.

Ultimately, it is important that mental health symptoms are not seen in a box and that we take a broad approach in investigating what their origins may be. Acknowledging the power of your thyroid and other possible root causes is paramount to finding sustainable solutions.

Stay healthy everyone.

2017-09-09 Audry VanHouweling Headshots (2 of 2)

With gratitude,

Audry Van Houweling, PMHNP-BC, Owner She Soars Psychiatry, LLC

www.shesoarspsych.com

I always ask my clients to rate their self-esteem 0-10. The vast majority of my clients rate themselves below 5. If my client happens to be female, complaints about her body almost always dominate the list of why. Intellect, character, performance, and achievement are often never mentioned.

It is altogether disheartening how many of us associate value and worth with size, the number on the scale, and measurements that are idealized by a social concept that is both unrealistic and, in many cases, impossible.

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Every woman has her own story about body shame. Like most women, memories of my own body shame are all too vivid. I remember the early days of elementary school playing follow the leader on the playground and not being able to fit through small spaces that seemed so effortless for my peers. I remember my portions and food choices being scrutinized by family members. I remember seeing the school counselor and being told I eat too much. I remember starting at my young body in the mirror- loathing what I saw and wishing I could switch bodies with the Disney princesses or Barbies I idolized. In dismay I would compare the size of my legs, my arms, my stomach compared to my peers…and this was all before middle school.

Rather quickly my body seemed to lengthen rather than widen. I stretched to nearly 5’10” by the seventh grade and the dynamic of attention and commentary shifted. Yet seemingly too tall for pre-pubescent boys my own age, suddenly there were comments from men- sometimes much older men. Cat calls, innuendos, and crass remarks on my physical form that still seemed so new and foreign to my budding mind. Soaking in what seemed to be validation, I aimed to maintain the streak of physical affirmation sometimes by means of extremes. Food restriction and excessive exercise became a pattern. Negative self-talk was the driver. I could not let myself be satisfied. I was terrified of regressing. body image2

Our society promotes a sustained hypervigilance around body image and while I have made progress, I am not out of the woods. Most of us are actually still pretty deep in the woods so to speak. Women & girls are often ridden with trauma regarding their bodies. Whether it be a collection of accumulated comments and encounters or events of blatant harassment or abuse, we are taught from a very young age that the form of our bodies defines our worth and, in some cases, even our survival. Other elements of our being and soul are minimized, disregarded, and suppressed. As the inevitable shifting and ultimate decline of our physical bodies occurs, we are confronted by shame and guilt as the form of our body may drift farther away from the social ideal. Social media further reinforces our shame as edited and filtered comparisons are only one click away.

So make a point to praise your daughter, partner, spouse, or family member on attributes other than her physicality. Support her in creating a legacy of inner beauty and confidence. Ladies- we can be our own worst enemies. Let’s try to refrain from objectifying one another. Let’s honor each other’s accomplishments outside of what happens in the gym or on a scale. Modest or immodest, let’s realize we are all marvelously complex despite our exterior. Let’s celebrate our diversity and be unafraid to call out unrealistic and harmful stereotypes and ideals.

Character, compassion, intellectualism, humor, empathy, and mindfulness resonate far more than the number on a scale. After all, I have yet to see anything about weight loss or dress size on somebody’s tombstone. On that note, give your body grace. It will fail standards again and again, but your value is far more unconditional.

Be kind to yourself.

With gratitude,

2017-09-09 Audry VanHouweling Headshots (2 of 2)

Audry Van Houweling, PMHNP-BC, Owner She Soars Psychiatry, LLC

She Soars psychiatry, LLC

Audry Van Houweling, PMHNP-BC

Month: April 2018

Thyroid Function & Your Mood

Confronting Body Shame