Constitutional Factor – Nature or Nurture? Sharon Ashton

Is the Constitutional Factor (CF) of a person formed at conception or developed at some point during childhood?

Some argue that a child’s personality is present right from birth.  However, to what extent do events that occur during our early childhood contribute to the formation of our CF?

‘All of us are born with one Element which is constitutionally slightly more imbalanced than the others.  This imbalance causes us to have repetitive negative states or difficulties expressing certain emotions.’ Hicks and Hicks (1999).

According to the NeuroAffective Relational Model (NARM), there are five biologically based core needs essential to our physical and emotional wellbeing: connection, attunement, trust, autonomy and love-sexuality.

If one or more of these core needs is not met, particularly in early childhood, various psychological and physiological symptoms will occur, with the outcome being development of certain strategies or coping mechanisms.

Connection Capacity to be in touch with our body and our emotions


Capacity to be in connection with others

Attunement Capacity to attune to our needs and emotions


Capacity to recognise, reach out for, and take in physical and emotional nourishment

Trust Capacity for healthy dependence and interdependence
Autonomy Capacity to set appropriate boundaries


Capacity to say no and set limits

Capacity to speak our mind without guilt or fear

Love-Sexuality Capacity to live with an open heart


Capacity to integrate a loving relationship with a vital sexuality

NARM’s Five Core Needs and Their Associated Core Capacities (Healing Developmental Trauma – Hellier and LaPierre, 2012)

Could it be possible that our CF is formed in early childhood based upon whether or not certain needs are met?  According to NARM, the strategies a child forms if certain needs are not met, are as follows:

Connection – A survival style develops around the need for contact and the fear of it. The individual can become disconnected from physical and emotional self and have difficulty relating to others.

Attunement – A survival style develops around the conflict between having personal needs and the rejection of them. The individual may have difficulty knowing what they need and/or feel their needs do not deserve to be met.

Trust – A survival style develops around both the longing for and the fear of healthy trust and interdependence. This can lead to the individual feeling they cannot depend on anyone but themselves and may feel they have to always be in control.

Autonomy – A survival style develops around both the desire for and the fear of setting limits and expressing independence. This can lead to feeling burdened and pressured, with difficulty setting limits and saying no directly.

Love-sexuality – A survival style develops around wanting to love and be loved and the fear of vulnerability.  It also develops around the splitting of love and sexuality, possibly leading to difficulties integrating heart and sexuality, as well as affecting self-esteem based on looks and performance.

Even if we stick to the premise that we are born with our CF, it might be that if particular needs are neglected at certain stages of our development, our already-formed CF may become even more out of kilter.

Using the Five Elements to help balance constitutional factors. 

As any Five Element acupuncturist knows, by treating the Constitutional Factor of a patient, often all disharmonies can be addressed, as the CF is frequently the primary cause of all a person’s symptoms.

Could it be, that by treating a patient’s Element, we are helping to correct the imbalance formed by the early childhood trauma and furthermore aiding a person to adjust their coping mechanisms to more healthy responses to life?

As practitioners, we use the Five Elements: metal, earth, wood, fire and water to help with emotional healing.

Taking the example of a Wood CF, we can demonstrate the similarities of Five-Element treatment with that of the NARM.

Our Wood Element gives us the capacity to be appropriately assertive and to have structures and boundaries as well as the ability to make plans and decisions. The Liver and the Gall Bladder are the Organs associated with Wood.  The Liver ensures the smooth flow of Qi and therefore, if there is an imbalance in the Wood Element, this function may be impaired and our Qi may have a tendency to become stuck.

The Wood Element is a powerful force for growth and development.  If restricted in this capacity at any point, it can lead to frustration and anger as well as bitterness and resentment.

Sometimes an imbalance in the Wood element can lead to a ‘lack of anger’. A person may be unable to assert themselves and therefore avoid confrontation and become seemingly passive, over obedient and compliant.  This may have formed as a coping strategy during childhood for getting needs met.

The tendons and ligaments are the body parts for Wood, and Wood CFs can have a tendency towards tension in the neck and shoulders as a result.

The ‘Big Issues’ (Hicks & Hicks, 1999) for Wood are:

  • Power
  • Boundaries
  • Correctness
  • Growth
  • Development

The coping strategies for a Wood CF are:

  • Organising, structuring and getting things right
  • Rebelling against or being overly restricted by the rules
  • Seeking justice and fairness
  • Indirectness
  • Not planning or over planning

Comparing the traits of a Wood CF to the key features of the ‘Autonomy Survival Style’ from the NARM system, we can see there are remarkable similarities:

Core Fear

  • If people really knew me, they wouldn’t like me
  • If I show you how I really feel, you won’t love me

Compromised Core Expression

  • ‘No’
  • ‘I won’t’
  • Any expression that might evoke conflict

Shame Based Identifications

  • Angry
  • Rebellious
  • Resentful of authority
  • Enjoy disappointing expectations others have of them
  • Burdened

Pride Based Counter Identifications

  • Nice, sweet, compliant
  • Good boy/ girl
  • Fear of disappointing others
  • Pride at how much they can take on their shoulders

Coping mechanisms

  • Indirectness – not laying cards on the table
  • Passive aggression
  • Projects authority onto others
  • Procrastination

Behavioural Characteristics

  • Often complain of feeling stuck
  • Fear of losing their independence when they become intimate
  • Choosing to please others over themselves and then feel resentful
  • Fear of their own spontaneous expression
  • Superficially eager to please
  • Covertly feeling spite, negativity and anger
  • Passive-aggressive
  • Secretive about their pleasures for fear that they will be taken away
  • Forceful in defending others but not themselves
  • Projection of authority on others
  • Believe that others have an agenda for them, imagine it even when not true
  • Want to know what is expected of them so they can do the opposite
  • Pressure themselves constantly while imagining the pressure as coming from the outside
  • Continual self-judgement and self-criticism


  • High energy, contained as if in a vice
  • Compressed and dense
  • Prone to psychosomatic problems, such as neck and back problems, ulcers, colitis, high blood pressure, pinched nerves

Sharon Ashton is a Chinese medicine and practical skills teacher at the College of Integrated Chinese Medicine

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