The science behind Post Traumatic Stress Disorder – How trauma changes the brain

After any type of trauma (from combat to car accidents, natural disasters to domestic violence, sexual assault to child abuse), the brain and body change. Every cell records memories and every embedded, trauma-related neuropathway has the opportunity to repeatedly reactivate.

Sometimes the alterations these imprints create are transitory, the small glitch of disruptive dreams and moods that subside in a few weeks. In other situations the changes evolve into readily apparent symptoms that impair function and present in ways that interfere with jobs, friendships and relationships.



What Is Post Traumatic Stress Disorder?

Posttraumatic stress disorder (PTSD) is a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape or other violent personal assault.

PTSD has been known by many names in the past, such as “shell shock” during the years of World War I and “combat fatigue” after World War II. But PTSD does not just happen to combat veterans. PTSD can occur in all people, in people of any ethnicity, nationality or culture, and any age. PTSD affects approximately 3.5 percent of U.S. adults, and an estimated one in 11 people will be diagnosed PTSD in their lifetime. Women are twice as likely as men to have PTSD.



Symptoms and Diagnosis

Symptoms of PTSD fall into four categories. Specific symptoms can vary in severity.

1. Intrusive thoughts such as repeated, involuntary memories; distressing dreams; or flashbacks of the traumatic event. Flashbacks may be so vivid that people feel they are re-living the traumatic experience or seeing it before their eyes.

2. Avoiding reminders of the traumatic event may include avoiding people, places, activities, objects and situations that bring on distressing memories. People may try to avoid remembering or thinking about the traumatic event. They may resist talking about what happened or how they feel about it.

3. Negative thoughts and feelings may include ongoing and distorted beliefs about oneself or others (e.g., “I am bad,” “No one can be trusted”); ongoing fear, horror, anger, guilt or shame; much less interest in activities previously enjoyed; or feeling detached or estranged from others.

4. Arousal and reactive symptoms may include being irritable and having angry outbursts; behaving recklessly or in a self-destructive way; being easily startled; or having problems concentrating or sleeping.

Many people who are exposed to a traumatic event experience symptoms like those described above in the days following the event. For a person to be diagnosed with PTSD, however, symptoms last for more than a month and often persist for months and sometimes years. Many individuals develop symptoms within three months of the trauma, but symptoms may appear later. For people with PTSD the symptoms cause significant distress or problems functioning. PTSD often occurs with other related conditions, such as depression, substance use, memory problems and other physical and mental health problems.

The 3-Part Brain

The Triune Brain model, introduced by physician and neuroscientist Paul D. MacLean, explains the brain in three parts:

1. Reptilian (brain stem): This innermost part of the brain is responsible for survival instincts and autonomic body processes.

2. Mammalian (limbic, midbrain): The midlevel of the brain, this part processes emotions and conveys sensory relays.

3. Neommalian (cortex, forebrain): The most highly evolved part of the brain, this area outer controls cognitive processing, decision-making, learning, memory and inhibitory functions.

During a traumatic experience, the reptilian brain takes control, shifting the body into reactive mode. Shutting down all non-essential body and mind processes, the brain stem orchestrates survival mode. During this time the sympathetic nervous system increases stress hormones and prepares the body to fight, flee or freeze.

In a normal situation, when immediate threat ceases, the parasympathetic nervous system shifts the body into restorative mode. This process reduces stress hormones and allows the brain to shift back to the normal top-down structure of control.

However, for those 20 percent of trauma survivors who go on to develop symptoms of post-traumatic stress disorder (PTSD) — an unmitigated experience of anxiety related to the past trauma — the shift from reactive to responsive mode never occurs. Instead, the reptilian brain, primed to threat and supported by dysregulated activity in significant brain structures, holds the survivor in a constant reactive state.


The Dysregulated Post-Trauma Brain

The four categories of PTSD symptoms include: intrusive thoughts (unwanted memories); mood alterations (shame, blame, persistent negativity); hypervigilance (exaggerated startle response); and avoidance (of all sensory and emotional trauma-related material). These cause confusing symptoms for survivors who don’t understand how they’ve suddenly become so out of control in their own minds and bodies.

Unexpected rage or tears, shortness of breath, increased heart rate, shaking, memory loss, concentration challenges, insomnia, nightmares and emotional numbing can hijack both an identity and a life. The problem isn’t that the survivor won’t “just get over it” but that she needs time, help and the opportunity to discover her own path to healing in order to do so.

According to scientific research, after trauma your brain goes through biological changes that it wouldn’t have experienced if there had been no trauma.


The impact of these changes are especially exacerbated by three major brain function dysregulations:


1. Overstimulated amygdala: An almond-shaped mass located deep in the brain, the amygdala is responsible for survival-related threat identification, plus tagging memories with emotion. After trauma the amygdala can get caught up in a highly alert and activated loop during which it looks for and perceives threat everywhere.

2. Underactive hippocampus: An increase in the stress hormone glucocorticoid kills cells in the hippocampus, which renders it less effective in making synaptic connections necessary for memory consolidation. This interruption keeps both the body and mind stimulated in reactive mode as neither element receives the message that the threat has transformed into the past tense.

3. Ineffective variability: The constant elevation of stress hormones interferes with the body’s ability to regulate itself. The sympathetic nervous system remains highly activated leading to fatigue of the body and many of its systems, most notably the adrenal.



How Healing Happens

While changes to the brain can seem, on the surface, disastrous and representative of permanent damage, the truth is that all of these alterations can be reversed. The amygdala can learn to relax; the hippocampus can resume proper memory consolidation; the nervous system can recommence its easy flow between reactive and restorative modes. The key to achieving a state of neutrality and then healing lies in helping to reprogram the body and mind.

While the two collaborate in a natural feedback loop, processes designed for each individually are vast. Hypnosis, neuro-linguistic programming and other brain-related modalities can teach the mind to reframe and release the grip of trauma. Likewise, approaches including somatic experiencing, tension and trauma releasing exercises and other body-centric techniques can help the body recalibrate to normalcy.

Survivors are unique; their healing will be individual. There is no one-size-fits-all or personal guarantee for what will work (and the same program will not work for everyone). However, the majority of evidence suggests that when survivors commit to a process of exploring and testing treatment options they can, over a period of time, reduce the effects of trauma and even eliminate symptoms of PTSD.


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