As therapists, we’re trained to explore the psychological roots of emotional distress. We dig into trauma histories, family systems, attachment wounds, and patterns of regulation and dysregulation. We learn to validate complexity, especially with clients navigating dissociative identity disorder or posttraumatic stress disorder. And yet, the Mental health field still struggles to address these conditions holistically.

But what happens when the emotional storms we’re treating are being fueled by an undiagnosed medical condition? I ask this not only as a psychologist but as a spouse.

A Shift No One Could Explain

My partner lives with dissociative identity disorder and PTSD stemming from prolonged, severe trauma. She spent years doing deep therapeutic work: building inner communication, learning to recognize and support her parts, and developing regulation tools. For a time, those efforts brought growth and stability. But then, something changed. Her symptoms didn’t shift in structure they intensified. Rage episodes became uncharacteristically explosive. Brain fog consumed entire afternoons. Sensory sensitivity spiked. Despair deepened. And the tools that once helped? They stopped working. She chalked it up to dissociation. So did her providers. But this wasn’t resistance; her brain was inflamed.

The Diagnosis That Changed Everything

The missing piece turned out to be chronic inflammatory response syndrome, CIRS, a neuroimmune condition triggered by exposure to mold and other biotoxins, often found in water-damaged buildings. This condition causes systemic inflammation, disrupting brain function, immune regulation, and hormonal balance.

In the brain specifically, CIRS affects regions responsible for memory, executive function, and emotional regulation. For someone already living with trauma-based conditions, this kind of inflammation doesn’t cause the trauma but it amplifies it. It fragments memory, worsens dissociation, and distorts internal communication. It hijacks the brain.

She Needed Help Years Ago But No One Looked Deeper

My spouse spent years living in poverty in the United Kingdom, at times unhoused, always trying to survive in a system not built for people with complex trauma. She reached out for help repeatedly. But what she received was often invalidating or harmful focused narrowly on behavioral Coping strategies rather than holistic healing. No one asked about her housing conditions. No one questioned the chronic sinus infections or the musty smells in her flat. No one wondered why she got worse in certain buildings. No one connected her physiological decline to the environment she was in. By the time she was diagnosed with CIRS, she had already lost so much: relationships, memories, time, energy, and hope. Even now, as she begins treatment, the damage of being unseen for so long still lingers.

What Therapists May Be Missing and Why It Matters

We can’t diagnose medical conditions but we can recognize when something doesn’t add up. When clients stop improving. When tools stop working. When emotional symptoms feel biologically fueled.

We need to be attuned to red flags that suggest an underlying medical root:

• Worsening brain fog, fatigue, or memory loss
• Cyclical or sudden surges of rage, panic, or despair
• Symptoms that shift based on environment (buildings, rooms, weather)
• Increased light, sound, or chemical sensitivity
• Frequent infections or chronic illness
• History of living in mold-prone or water-damaged spaces

In clients with dissociative identity disorder, where internal regulation is already delicate, unrecognized medical conditions can disrupt system cohesion, increase fragmentation, and erode internal trust. If therapy isn’t working, it may not be a psychological block. It may be inflammation.

What We Can Do Differently

• Ask about environmental exposure as part of your intake process.
• Partner with integrative providers who specialize in environmental and neuroimmune conditions.
• Believe your clients when they say a building, room, or climate makes them feel worse.
• Refer for medical evaluation when symptoms persist outside a trauma framework.

Healing from trauma isn’t just psychological it’s physiological. And when we miss the role of the body, we risk retraumatizing the very people we’re trying to help.

She Didn’t Need More Coping Skills She Needed to Be Believed

• My spouse didn’t need more breathing techniques. She needed someone to say, “This isn’t just in your head. Your body is under siege.”
• She needed safe housing. A treatment protocol. And the dignity of being seen not as broken but as sick.
• Her system is still fragile, and the road ahead is long. But we now have something we didn’t before: a map. And that map changes everything.

Final Reflections for Clinicians

Mental health is not separate from physical health. If we want to be truly trauma-informed, we must also be body-informed. Sometimes, the breakthrough doesn’t come from talking it comes from treating a brain that’s on fire. If you’re unsure about your client’s physical health, refer them for a full medical evaluation. Collaborate with their care team. The missing link may not be CIRS but it could be. Or it could be another underlying condition that, if left untreated, continues to drive distress. Our ethical codes urge us to rule out medical and substance-related causes before rendering a psychological diagnosis.

Don’t miss it. Their life may be depending on it.