Maladaptive DIMs

What are DIMs?

Have you ever wondered why pain can stick around long after an injury has healed? One of the most helpful things you can understand about pain is that it’s not always the result of injury. Instead, it is the brain’s assessment of how much protection you need.

In the absence of an active injury, discomfort often continues because your brain thinks you are still in danger. Think of it as an alarm that continues to blare even after the threat has passed.

The triggers for this discomfort are called DIMs (Danger-In-Me), and they are an indication that your brain is afraid. When your brain experiences fear, it perceives danger and triggers pain to protect you. When it produces pain, it typically wants you to be mindful of what you are doing, stop, or check everything out to ensure you are okay.

Adaptive & Maladaptive DIMs

There are two primary types of DIMs: adaptive and maladaptive.

An adaptive DIM reflects a credible threat. This is a reasonable expectation that you are injured or about to be injured. A maladaptive DIM, on the other hand, is not credible; the danger is no longer present.

An example of an adaptive DIM is stepping on a nail; a maladaptive DIM is feeling that same pain in your foot a year later. 

Adaptive DIMs help you avoid injury. Maladaptive DIMs restrict your mobility and reduce your quality of life.

In Discovering Safety Within, you learn how to identify maladaptive DIMs and replace them with credible evidence of safety (SIMs). In doing so, you train your brain to offer protection only when it is truly needed. 

Common Maladaptive DIMs

Movement and Body-Related

Maladaptive DIMs of this nature are typically addressed on the Chronic Pain Support Path.

• Pain associated with proprioception or movement.
• Pain that appears when bending over forward, months or years after a back injury has healed.
• Feeling pain in a previously injured knee when walking on flat, safe ground.
• Guarding or bracing a shoulder long after the tissue has recovered.
• Pain that shows up simply from thinking about a movement that once hurt.

Sensory and Environmental

Maladaptive DIMs of this nature are typically addressed on the Chronic Pain Support Path.

• Discomfort triggered by light touch, clothing, or a gentle breeze on an area that is no longer injured.
• Pain that increases in certain weather.
• Sensitivity to normal everyday sounds or busy environments that the nervous system now treats as threatening.

Thoughts, Emotions and Context

Maladaptive DIMs of this nature are typically addressed on the Flare-Up & Stress Support Path.

• Pain that flares when you feel stressed, anxious, or overwhelmed.
• Discomfort that appears when you see someone else move in a way that once injured you.
• Pain linked to specific places, times of day, or activities associated with a past injury.
• The belief “I shouldn’t do that or I’ll re-injure myself” even when the body is capable and safe.

After Healing

Maladaptive DIMs of this nature are typically addressed on the Short-Term Pain & Relief Path.

• Ongoing pain in a surgical site long after medical clearance.
• Foot or ankle pain that persists a year after a sprain has fully resolved.
• Neck or back pain that continues despite normal imaging and healed tissues.