What is PTSD?
PTSD stands for Post-Traumatic Stress Disorder and it is a type of anxiety disorder, therefore a lot of this information will be similar to that in my “The Brain, the Body, the Behaviour – anxiety” post. However I believe that PTSD is an important mental health illness to highlight on it’s own. It is well-known for being diagnosed amongst war veterans; previously known in the two world wars as ‘shell shock’. Due to the environment and events that occur during wars, PTSD is common among veterans with at least 20% of veterans of the Afganistan and Iraq Wars and 15% of veterans of the Vietnam war living with it.
However PTSD is not specific to those in the military. PTSD can occur to anyone who has been faced by a frightening or distressing life event. Those who have been involved in serious road accidents, who have suffered from long term abuse (emotional, physical, sexual, neglect, financial, etc.), those who have been the victim of an assault (again, physical, sexual, etc.), victims of terrorist attacks and natural disasters, or witnesses to violent deaths. PTSD can develop immediately after an event, or even weeks/months/years later, depending on personal circumstances, individual levels of resiliance, and the existence of other co-morbid mental health problems.
The brain is sometimes seen as this everlasting, constant organ. However, it develops and it changes throughout an individual’s lifespan depending on what goes on in their life. Therefore following this logic, it is expected that an individuals brain may change when they have faced a traumatic life event, and that is exactly what happens. The amygdala, prefrontal cortex and hippocampus are regions of the brain that impract the stress response in all humans. Therefore after a traumatic event it is these areas that witness significant changes causing PTSD victims to suffer in their symptoms.
1. The Hippocampus – As you may remember from several of my previous blog posts, the hippocampus is mostly responsible for memory functions. It is also particuarly involved in emotional memories, those memories that give you a little twinge in your heart or cause you to smile to yourself – it works alongside the amygdala with this.
It helps an individual to distinguish between the past memories and the present. Trauma can result in the hippcampus shrinking and therefore it’s functional ability reducing.
This means that what the hippocampus usually does with the distinguishing of memories, it is now pretty shoddy at it. It means that past memories get mixed up with what is occuring in the present, and stress responses are triggered unecessarily.
2. Prefrontal cortex – The PFC is responsible for regulating emotional responses and also, like the hippocampus, works with the amygdala.
It specifically works with negative emotions, such as fear. Like the hippocampus, trauma causes this region to shrink and decrease in it’s functional ability, meaning it’s also not doing it’s job properly.
3. Amygdala – The amygdala is the centre of emotion in your brain. Every emotion you do and don’t feel is triggered by this part of the brain, or passes through this part of the brain, or is stopped by this part of the brain. So as you can imagine, with us feeling an unlimited amount of emotions every day, this part of the brain is usually very busy.
Now, because it works alongside the hippocampus and PFC, in PTSD sufferers those areas of the brain are underperforming and are therefore lacking control over the amygdala. This results in hyperactivity in response to stimuli, with this activity being triggered by the amygdala. So in this case, trauma causes an increase in activity in this region of the brain.
4. Neurotransmitters – I feel the need to mention a couple of neurotransmitters here, which I have mentioned in previous blog posts especially the one on anxiety, but they are also relevent here. In PTSD sufferers, there appears to be an increase in cortisol and norepinephrine responses. This makes sense, as these neurotransmitters are central to the stress response system in the brain.
However, there is a difference in age. If an individual develops PTSD at a young age (e.g. during child development) their resting level of cortisol and norepinephrine will be higher than the resting level of those without PTSD. If an individual develops PTSD as an adult, then their resting level of cortisol and norepinphrine will be the same as the ‘average’ adult, but when their brain responds to stress triggers then the levels of these neurotransmitters will rocket higher than that of the ‘average’ adult responding to the same stress triggers.
This is all associated with the plasticity of the brain (how much it can change) and how fragile the brain is to change during the childhood and child development years.
Physical symptoms of PTSD are all very similar to those of anxiety, as it is an anxiety disorder. They are also, like other anxiety disorders, related to the increase of neurotransmitters in response to stimuli – see my blog post on anxiety for more details, but here are examples of the physical symptoms of PTSD; panic attacks, stomach aches, headaches, muscle cramps, tightness in the chest, diarrhea. Like other anxiety disorders, consistency of these are likely to lead to ongoing health problems due to an decrease in the ability of the immune system.
As mentioned above, the hippocampus and PFC work together with the Amygdala in the regular (if there is such a thing) human brain. When the hippocampus and PFC produce hypoactivity (as in, they are not doing as much as they should) then the amygdala produced hyperactivity (doing too much compared to what it should.) This can result in several symptoms associated with emotions and memories associated with the traumatic event which triggered the PTSD in the first place.
I will be using one example of an individual who has been sexually abused and has developed PTSD. This is to help explain how the regions of the brain connect to create the symptoms that PTSD creates. There is a trigger warning here – no graphic detail about an abuse will take place, the individual and situation is totally fictional and made up on the spot, however it is possible that it may relate to a real life event that has happened to someone and for this I must apologise and insist that I’ve made this up whilst sitting in starbucks just to help explain PTSD and not to exploit anyone – thank you.
1. Hippocampus – When the hippocampus is not quite doing it’s job right, it does not distinguish between past memories and the present moment. It is also unable to interpret environmental contexts correctly. Therefore, a sexual abuse victim who was attacked in a park associated all parks with his/her abuse. Their brain is unable to interpret a park in south London as not being the park where he/she was attacked, which was actually a park in North London; all their brain interprets is a park and their brain knows that a park is where he/she was attacked. Therefore their brain triggers the stress responses, as what they are faced with is something that remotely resembles something from their traumatic past. This is due to the hippocampus being unable to interpret environmental contexts (e.g. the park) correctly (e.g. as a random park in london, not the park where the individual was attacked)
The hippoocampus underworking also means that when this individual walks past a park, they are unable to understand that they are walking on the other side of the road to the park, with a group of friends, in 2016, in broad daylight. Due to being unable to distinguish between past memories and the present time, the individual may think that they are walking through the park, on their own, in 2006 (the year they were attacked), in the middle of the night in pitch black. Their brain goes back to the time where they were attacked as it associates the park with their traumatic event – this is called a flashback.
2. Prefrontal cortex – When the PFC is not working right, it is unable to regulate emotions correctly. This generally means that an individuals are almost out of control. Therefore, when the individual walks past the random park in South London, due to his/her flashback they may feel scared, anxious, almost terrified as inside their head they are in the place, time and context of when they were attacked. This is because the PFC is underworking, and it cannot regulate the individuals emotions or control them and is also unable to let the individual know that they are feeling these emotions because of a flashback – the individual believes they are at the time and place of the traumatic event, which is untrue. Again, this is because of the hippocampus’ being unable to seperate past and present again.
3. Amygdala – Due to the PFC and hippocampus not doing their jobs right, this means the amygdala isn’t going to be doing theirs right either. In fact, trauma increases the activity here. This means that in the face of any stimuli, emotional responses are going to be heightened. Therefore, the individual walking past the park will not only feel anxious, but will feel incredibly anxious, and this is another reason why they will feel the emotions they felt at the time of the traumatic event – nothing is working well enough to tell them they are not in the past, but they are in the present, and nothing is working well enough to regulate the emotions back down to a level response to the stimuli. There is even evidence that those with PTSD have such a high fear response, that they even exhibit fear in response to photographs of other people exhibiting fear.
There is still not enough research into PTSD and into how to manage it, exactly why some people develop it and others don’t, and what exactly is going on inside the brain during the moments of flashbacks. However our knowledge of these three areas of the brain gives us enough information to help PTSD biologically make sense, and awareness to be spread that it is a silent illness and there are a lot of people who suffer from it in silence, or even suffer from it without realising that they do.
Be kind to people, who knows what they’ve been through in the past, and no two people are the same, and neither are no two peoples traumatic events – PTSD can effect anyone after trauma, and there is no true definition of trauma, it is so individual and unique to people. Someone who has been in a car accident may develop PTSD, whereas someone who served in the Iraq war may not – all mental health is individual. Therefore, PTSD is not a weakness, it is a biological response to something an individual never wanted to go through but did, and more support and research needs to go towards helping these individuals.