A Preliminary Synthesis in Polyvagal Acupuncture® and Polyvagal Massage™
Dr. Jennifer Moffitt, DTCM, DNCCAOM, L.Ac. Certified Primitive Reflex Clinical Specialist (CPRCS)
This document is a preliminary clinical synthesis. It draws on established neuroscience, clinical observation, and integrative reasoning across multiple disciplines. The mechanistic reasoning is grounded in established neuroanatomy, autonomic physiology, mitochondrial bioenergetics, and developmental neuropsychology. The clinical frameworks, techniques, and synthesis presented in this series were developed over 25 years of clinical practice, years of post-graduate education and personal recovery. Practitioners are encouraged to evaluate it against their own clinical experience The opinions expressed here are mine. ©Polyvagal Acupuncture® and Dr.Jennifer Moffitt. This work is registered with the Library of Congress.
Spoke 7: Mitochondrial Function and the Cost of Chronic Defense
Every physiological system described so far depends on cellular energy. During fight or flight, the autonomic nervous system redistributes blood flow, oxygen, and metabolic resources toward immediate survival and away from functions that are not essential in the moment. In chronic dysregulation, that redistribution never resolves. Systems throughout the body continue to function, but they do so with progressively less oxygen and less energy available for normal repair, maintenance, and recovery. Mitochondria determine in part how efficiently remaining energy is converted into ATP. (McEwen, 2007; Lei et al., 2024).
Mitochondrial oxidative phosphorylation produces theoretically 36 ATP molecules per molecule of glucose. (More precise modern measurements, accounting for the electron shuttle pathway, put the figure between 30 and 32 ATP. This piece uses 36, the textbook figure, because it is the number most clinical readers will recognize.) Cytoplasmic glycolysis, without the subsequent mitochondrial processing of pyruvate, produces 2 ATP per glucose.
When this emergency response fails to switch off, persistent fight-flight physiology locks cells into what should have remained a brief emergency adaptation. The cell now runs on impulse power: enough ATP to maintain essential functions, but not enough to sustain normal function. Its warp drive, mitochondrial oxidative phosphorylation, no longer produces ATP at normal capacity. This leaves glycolysis as a low output backup that keeps the cell alive but cannot meet its full energy demands. Over time, this metabolic stress promotes several of these mechanisms, progressively reducing mitochondrial capacity across multiple organ systems. (Lei et al., 2024; McEwen, 2007)
Mitochondrial DNA and the Inheritance Pathway
Mitochondrial DNA (mtDNA) is inherited almost entirely from the mother. The sperm’s mitochondria are destroyed after fertilization, so all mitochondria come from the egg. If the mother’s mitochondria are damaged by stress or illness, the child receives a mitochondrial population with reduced energy capacity. This is a direct, biological way trauma or disease risk can be passed from mother to child, independent of behavior. The mitochondrial inheritance pathway is the cleanest of these mechanisms in that it can be characterized at the level of cellular biology rather than at the level of behavioral transmission. (Lei et al., 2024).
Trauma can also be inherited through changes in the HPA axis. Children of trauma survivors often show altered stress hormone regulation and receptor sensitivity, linked to epigenetic changes. (Heim et al., 2008; McEwen, 2007) Studies of Holocaust survivors and their children show that a parent’s trauma can shape a child’s stress response, even if the child didn’t experience the trauma directly. (Yehuda et al., 2016).
This is why exercise and diet-based approaches often fail in dysregulated patients: the cellular machinery lacks the reserve needed to respond. Degradation is proportional to the insult, not all or nothing. Two ATP per glucose is the glycolytic floor and thirty-six is the oxidative ceiling, with most compromised cells operating somewhere in between. In dorsal freeze states, downregulation is even more severe. (Porges, 2011) Forcing physical activity on these clients leads to further depletion, not recovery. Restoration of autonomic regulation is needed first; only then can mitochondrial recovery and improved cellular energetics follow. (Moffitt, 2025).
Spoke 8: The Cognitive and Sensory Spoke — Interoceptive Shutdown and the Inhabited Body
The Cost of Sustained Threat to Afferent Processing
The consequences of chronic dysautonomia extend beyond the body’s physiology to the way the brain processes information from both the body and the external world. Neuroplasticity cannot happen in a sustained fight, flight, or freeze response. (McEwen, 2007). When this state is sustained, as across chronic dysautonomia and most severely in developmental trauma, the nervous system narrows both perception and cognition to what is necessary for immediate survival. Information unrelated to the threat receives less processing, while higher-order functions such as reflection, empathy, complex problem solving, and flexible decision making give way to defensive responses. (Schore, 2012) The brain adapts by reducing its processing of internal bodily signals and the sensory information it uses to organize and respond to its environment. (McEwen, 2007).
Interoceptive afferents carry information about the body’s internal state to the brainstem and insular cortex. (Porges, 2011). In a regulated nervous system these signals are continuously processed into the felt sense of being embodied. (Schore, 2012). When the afferent stream consistently reports threat states that the regulatory system cannot address, the brain adapts by diminishing its processing of that input. The afferent pathways remain physically intact, but the cortical processing of their input is suppressed. (Porges, 2011; Schore, 2012).
The Robot Presentation
The clinical expression of interoceptive suppression is the patient who does not feel their body from the inside. They can locate pain when asked and identify obvious somatic complaints, but the continuous interoceptive sense of being present in the body is reduced or absent. (Schore, 2012). The body is operated rather than inhabited. The clinical literature names this experience as dissociation in its broader form, but the more specific neurological description is interoceptive shutdown. (van der Kolk, 2014).
Interoceptive shutdown is what makes the high-functioning camouflage possible. Complex cognitive and professional work can be performed precisely because the body underneath is not being felt. Many occupations and life circumstances temporarily require this capacity. Parents of young children, first responders, military personnel, and healthcare workers often suppress bodily signals to meet immediate demands. (Schore, 2012). The difference is that a regulated nervous system returns to normal interoceptive processing once the demand has passed. (Porges, 2011). The cost of the solution is that the person has a markedly reduced felt sense of the body. (van der Kolk, 2014).
Most patients do not realize this has happened. The loss of interoceptive awareness develops gradually and often begins in childhood, so it feels normal to them. (Schore, 2012). They can think, work, analyze, and talk about their experiences without recognizing that the body’s contribution to those experiences is largely absent. (van der Kolk, 2005, 2014).
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