Kasia Kozlowska

This article explores a variety of chemosensory strategies – pungent foods, ammonia salts, and essential oils – as potentially useful interventions for clinical states of dissociative shutdown (including functional/dissociative seizures); re-experiencing symptoms of posttraumatic stress disorder; and other states involving changes in arousal and a loss of balance in the neural pathways or networks crucial for the processing and integration of somatic, or body-based, sensations, as a result of stress-system dysregulation or trauma-related experiences. All of these states are common in clinical practice. Patients find them distressing as they interfere with normal daily function, quality of life, and capacity to manage the daily challenges of life. Based on the current literature we, the authors, provide an update pertaining to the current knowledge base about the neurobiology that underlies the therapeutic effects and clinical utility of these chemosensory substances. Whilst the use of chemosensory substances goes back into antiquity, our understanding of underlying neurobiological mechanisms is just beginning to emerge.

Dissociative shutdown states occur when the individual encounters inescapable stress or trauma – or memories of inescapable stress or trauma. In the therapeutic space – occupational therapy, psychotherapy, or family therapy – working with shutdown states poses a clinical challenge. The individual’s loss of full awareness of what they are doing, or their loss of capacity to feel their body, to think, or to move or act, can bring the therapeutic process to a halt. Over the last half-century, body-oriented therapists working with the felt sense of the body, therapists working with patients presenting with complex trauma, and therapists working with patients with functional/dissociative seizures have introduced the use of grounding strategies to help patients maintain their connection with the body, self, close others, and the environment. This article explores the use of pickle juice (and other pungent foods) as a useful grounding strategy for managing dissociative shutdown states. Clinical examples are provided via vignettes. Also provided are a hypothesis and neurobiological model – the homeostatic sensory-reset hypothesis – as to why pickle juice and other pungent foods, which activate special sensory receptors in the gastrointestinal tract called transient receptor potential channels, help to disrupt and alleviate dissociation shutdown states.

Background: Rehabilitation for children with functional neurological disorder (FND) requires a biopsychosocial intervention: physiotherapy, psychotherapy, pharmacotherapy, school attendance, and family work. This study documents the pharmacotherapeutic element and its rationale.Methods: Medication use was documented in 158 children with FND (41 boys, 117 girls, aged 8.50–17.58; mean 13.78) admitted into the Mind-Body Program.Results: On presentation, children with FND had high levels of functional impairment, school loss, and comorbid psychiatric, functional, and medical disorders. On admission, 63% (n=95) were on medications. During admission, 130 (82.3%) children had pharmacotherapy interventions: dose adjustment, initiation, or discontinuation. 88.6% (n=140) were discharged on medications. Pharmacotherapy targets included: antidepressants for anxiety/depression (n=111; 70.3%); antipsychotics for extreme anxiety/arousal (n=73; 46.2%); melatonin for sleep (n=64; 40.5%); α agonists and β blockers, for arousal, sleep initiation, and trauma-related nightmares (n=58; 36.7%); iron/vitamin supplementation (n=30; 19.0%); and medications for functional gut symptoms (n=28; 17.7%) and comorbid pain (n=20; 12.7%).Conclusions: Pharmacotherapy is used as an adjunct in paediatric FND to down-regulate the stress system, reset the circadian clock, manage pain, and treat comorbid disorders. Pharmacotherapy and its concomitant placebo effects scaffold the child to enable engagement in all components of the therapeutic process and return to healthy function.