u/kelcamer

• PMID: 39241806
• DOI: 10.1093/humrep/deae207

Study question: Are there neurobiological changes induced by endometriosis?

Summary answer: Women with endometriosis demonstrate specific neurobiological changes distinct from those in patients with chronic pelvic pain (CPP) in the absence of endometriosis.

What is known already: Endometriosis is a chronic disease affecting women of reproductive age that presents with pain and infertility often accompanied by comorbid mental disorders. Only one study with a number of limitations has investigated changes in gray matter volumes and functional connectivity in a small group of patients with endometriosis.

Study design, size, duration: This prospective study recruited 53 women undergoing a laparoscopy due to suspicion of symptomatic endometriosis and 25 healthy, pain-free women. Clinical and psychological characteristics, thermal pain perception, and voxel- and surface-based morphology were assessed in all study participants. Thereafter, the patients underwent a laparoscopy, where endometriosis was either histologically confirmed and removed, or ruled out. Correspondingly, patients were assigned into the group with endometriosis (n = 27) or with endometriosis-independent CPP (n = 26) and compared to the pain-free controls.

Participants/materials, setting, methods: The study groups were generally representative for the population of women with endometriosis. Sociodemographic, medical, clinical, and psychological characteristics were collected using various questionnaires and a structured clinical interview. Thermal pain perception and voxel- and surface-based morphometry were assessed using thermode and MRI, respectively.

Main results and the role of chance: Despite comparable pain intensity and burden of mental disorders, both patient groups demonstrated distinct neurobiological patterns. Women with endometriosis exhibited increased gray matter volume (GMV) in the left cerebellum, lingual gyrus and calcarine gyrus, compared to those with endometriosis-independent CPP. Patients with CPP had decreased GMV in the right cerebellum as compared to controls. Dysmenorrhoea severity correlated positively with GMV in the left inferior parietal lobule, whereas depressive symptoms were associated with decreased GMV in the right superior medial gyrus across patient groups. Dyspareunia correlated negatively with cortical thickness in the left inferior temporal gyrus and left middle temporal gyrus.

Limitations, reasons for caution: The study groups differed in a few baseline-characteristics, including educational levels, smoking and BMI. While measuring pain perception thresholds, we did not attempt to mimic CPP by placement of the thermode on the abdominal wall.

Wider implications of the findings: Changes in gray matter volume associated with endometriosis differ from those observed in women with endometriosis-independent CPP. Our results underline an involvement of the cerebellum in pain perception and the pathogenesis of pain associated with endometriosis.

Study funding/competing interest(s): This work was funded by the START Program of the Faculty of Medicine, RWTH Aachen, Germany, and supported by the International Research Training Group (IRTG 2150) of the German Research Foundation (DFG)-269953372/GRK2150, Germany. S.T. was supported by postdoctoral fellowship of the Faculty of Medicine, RWTH Aachen, Germany. There are no conflicts of interest.

Trial registration number: DRKS00021236.

Keywords: MRI; cerebellum; chronic pelvic pain; endometriosis; voxel-based morphometry.

Do you notice the data within a message?
Do you consciously (or subconsciously) disregard that data based on the way it is presented?

If you read something that does not 'feel native' to you, do you reject the data, or do you explore it with curiosity?

If you reject it, is it because you see the presentation of that data as more crucially important than the data's correctness, or is there a different reason?

Do you believe there is 'only one correct way' that data could be presented?

If someone shares raw data with you about a particular topic; are you happy that they have provided all the necessary information to fully and completely understand the topic, or does it trigger a feeling of resentment or rage that you think that they are somehow positioning themselves as the 'knower of the information' above you?

I would love to know your answers very much! And I appreciate all of you for the extensive conversations on these deeply fascinating topics.

My goal:
I'm trying to figure out if the default response when someone shares a lot of information is one of curiosity, or one of overwhelm and rejection.

And if the presentation of the data matters more to you than the data itself, wouldn't that mean you might be easily swayed by common marketing tactics, or do you have some other automatic response which would protect you from that?

What is the default assumption?

Can anything be truly worded neutrally, or will it always be perceived through the lens of projection itself?

Is there any way to free other people from viewing interactions through their own negative lens, or must we accept that we can only control our own projections and responses?

If a social situation is unclear; to where do you default?

Oh yeah and assume it is a stranger, someone you do not already know

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One disconnect I frequently observe is, someone will ask a neutral-information requesting question,

And others respond with things like, character attacks for example.

What I'm wondering in my question is:
How does someone benefit from assuming negative intent? And why might someone assume that a neutral clarifying question is a gotcha?

If someone expects that literal-based questions are a gotcha, is it because if they were trying to trigger a 'gotcha' that they would become increasingly more literal? Like, is it their projection?

Would NT people become increasingly more literal if they were trying to 'trap' another person in conversation?

I'd really love to understand the mechanics behind why and how literal communication so frequently is projected to be negative, or have negative intent.

Like if a topic was
Xyz causes abc

and someone said
How does xyz cause abc?

And then people might assume the person asking is asking in bad faith, and start insulting their character, just for asking.
For some reason. And I don't know why they would assume that.

Is it because the individual assumes that people asking for more information about the topic they mentioned automatically means a status challenge is happening?

Is that what causes people to assume bad faith?

For NTs, is a direct clarification question perceived as an attack on identity, or is this mostly only a subset of NTs?

I'm still trying to figure out exactly HOW and why this works, and if anyone knows and can explain it in a simple way, please tell me,

But:
- coffee and tea normally blocks iron absorption due to tannins and polyphenols

BUT APPARENTLY taking vitamin C with the iron negates that effect.

(Unfortunately, vitamin C does NOT negate the effect of calcium)

Knowing this makes it a hell of a lot easier to plan the supplement into my schedule; because I used to think I had to wait 2-3 hours after every coffee and tea time, and as someone who loves coffee in the morning and tea in the afternoon, this was rough

Nope! Apparently, I never needed to wait. Vitamin C negates that effect! So as long as you take vitamin C WITH the iron, you do not even need to worry about how close to coffee and tea you're taking it.

(But you do have to make sure you don't take it close to calcium, because vit C cannot touch that)

I'm trying to figure this out, here.

Throughout my life (and I'm sure throughout many of your lives also)

People would continually assume that symptoms of iron deficiency or anemia somehow reflected my character.

Fundamental attribution error is assuming a character flaw without considering other possible causes.

What I don't understand, and want to understand:
What do people actually get out of that?

What do people get out of making false assumptions that if someone forgets to do something that it means they want to forget?

What do they get out of assuming that if someone faints that they want to faint?

In general, my question applies across all symptoms really. What is it that people are getting out of these harmful assumptions? Is it oxytocin? Is it dopamine? Maybe they are getting the dopamine that extremely iron deficient individuals can't get (iron and ferritin being a necessary cofactor for dopamine)

Or is it because they're afraid that if they admit that there can be biological factors outside of what they perceive as 'character flaws' that it makes people become aware of their own mortality?

What is the angle here? I'd really love your take on this community, because I would personally love to dismantle fundamental attribution bias particularly in regards to iron deficiency anemia, but I do not know if this is plausible or viable because I do not know what they're getting out of it.

Do you believe that people have to consistently practice analyzing like Jung did in order for it to 'stick' or is the ability to do this within us, innate?

"Individuals on the autism spectrum or with elevated autistic traits have shown difficulty in recognizing people’s facial emotions. They also tend to gravitate toward anime, a highly visual medium featuring animated characters whose facial emotions may be easier to distinguish. Because autistic traits overlap with alexithymia, or difficulty in identifying and describing feelings, alexithymia might explain the association between elevated autistic traits and difficulty with facial emotion recognition. The present study used a computerized task to first examine whether elevated autistic traits in a community sample of 247 adults were associated with less accurate emotion recognition of human but not anime faces. Results showed that individuals higher in autistic traits performed significantly worse on the human facial emotion recognition task, but no better or worse on the anime version. After controlling for alexithymia and other potentially confounding variables, autistic traits were no longer associated with performance on the facial emotion recognition tasks. However, alexithymia remained a significant predictor and fully mediated the relationship between autistic traits and emotion recognition of both human and anime faces. Findings suggest that interventions designed to help individuals on the autism spectrum with facial emotion recognition might benefit from targeting alexithymia and employing anime characters."

https://www.cambridge.org/core/journals/development-and-psychopathology/article/autistic-traits-alexithymia-and-emotion-recognition-of-human-and-anime-faces/1177F5EC58FF0C00CC3C6F28BE5E4183

If someone asks you something, or you ask them something, are you primarily perceiving the information as irrelevant, and focusing exclusively on what the asking or answering means for your status?

I'm trying to understand here, this is not my native framework, and I'm curious if this is how most people experience reality.

Put simply:

1. Does the act of someone asking you for information itself reduce your status?

2. is the information contained within the interaction viewed as structurally irrelevant?

3. Is stating "I don't know" a status drop?

Dad, I've been in therapy every week for the last six months and a lot of the three years before it.

The little kid inner child part of me just feels sad that remembering being really hurt from something my dad did to me. She just wishes he could really hear my pain and not call me schizophrenic for accurately remembering it.

Being hurt taught me to tell the truth. And I finally did tell it.

It's been six months since he said it, and the memories still hurt. It's hard, dealing with EMDR, knowing I can never have closure, knowing my reality to him will always be invalidated. It's hard, knowing he can never truly hear me. It's hard to look at the idea that he can only see the image of me, but not who I am.

I miss the times when I was very little and he would ask me where it hurts and give me a hug, instead of me needing to prove my pain, needing to have witnesses for any of it to matter, instead of it being seen as an attack on someone's image instead of me fighting the CPTSD within.

He says money and other good times are supposed to cancel out everything else.

But I told him what honestly happened because I learned to tell the truth from that memory. I told him because I thought maybe he could validate, because I got so used to having validating friends and a validating marriage.

I miss the version of him that didn't rely on alcohol to numb pain, but the thing is this version only ever existed in my inner-child-mind or during some good years.

I'd like to believe that love outside of protecting a particular self-image exists. I'd like to give it to myself.

But dad, I don't know how. I had some examples as a kid. I learned a lot from different people. But....it doesn't make it hurt less.

What would you do, Dad?
How do I grieve the knowledge that, no matter how many ways I express my pain, that it can't be heard by him?
How did you learn to love and validate yourself? How do I grieve the pain that he will always suffer with the same?