WHAT IS POST-TRAUMATIC STRESS DISORDER (PTSD)?
PTSD is the end result of the damage to two key systems in the body, brought about by the effects of severe or prolonged trauma. The two systems are:
1. the Information Processing System in the brain (i.e., the neural network)
2. the Central Nervous System (brain and body)
The sequence of this damage is :
A. Central nervous system malfunction at the time of the traumatic event
B. Failure of the Information Processing System to process and integrate the
memories of the event, due to A.
C. Malfunction of the Information Processing System (implicit, automatic
memory intrusion into present-day functioning, due to B.)
D. Long term damage to the central nervous system due to C.
A. Malfunction of the emergency stress response system at the time of the traumatic event
The onset of stress triggers a natural and protective hormonal response in animals and humans, controlled by the endocrine system in response to signals from the amygdala.
The Stress Response, often referred to as the “fight-or-flight” reaction, is your body’s rapid and automatic switch into “high gear.” It’s easy to imagine how this reaction helps you deal with a physical threat. You need the energy, speed, concentration and agility either to protect yourself or to run as fast as possible.
When you encounter such a threat, the hypothalamus, a tiny region at the base of your brain, sets off an alarm system in your body. Through a combination of nerve and hormonal signals, the sympathetic nervous system prompts your adrenal glands, situated atop your kidneys, to release a surge of hormones — the most abundant being adrenaline and cortisol.
Adrenaline increases your heart rate, elevates your blood pressure and boosts energy supplies. Cortisol, the primary stress hormone, increases sugars (glucose) in the bloodstream, enhances the brain’s use of glucose and increases the availability of substances that repair tissues.
The complex alarm system also communicates with regions of the brain that control mood, motivation and fear (limbic system).
When the emergency is past, the parasympathetic nervous system decreases hormone levels and enables your body to return to normal. As levels of the hormones in your bloodstream decline, your heart rate and blood pressure return to normal, and other systems resume their regular activities.
Hormones involved in stress responses and readjustments :
to activate flight or fight response : catecholamines (epinephrine, norepinephrine), glucocorticoids, cortisol.
To adjust back to normal : the same cortisols – epinephrine, norepinephrine, as well as the ‘feel good’ hormones – vasopressin, oxytocin and endogenous opioids.
In the case of an event of overwhelming terror, shock or stress, especially one from which there is no ability to escape, the mind responds by dissociating. Without some degree of focussed attention, the memories of the event cannot be successfully processed and the normal functioning of the amygdala, the hippocampus and the frontal cortex (higher brain) is suppressed.
B. Failure of the Information Processing System to process and integrate incoming stimuli
The failure of the central nervous system to integrate an overwhelming experience is due to the effect of extremely heightened emotions on the amygdala. The amygdala helps to assign importance and significance to incoming stimuli and communicate this to the hippocampus, which then acts to encode the experience into the short term memory system, and later, into the long term memory. Once the memory is encoded into permanent memory it is free of the hippocampus and is mediated by the neocortex. In other words, it has been moved across the corpus collosum to the left hemisphere, either during REM sleep or through therapeutic processing, and has been consolidated into the permanent, explicit memory system.
If the amygdala is flooded with cortisols through extreme stress, its messages to the hippocampus are interrupted, as the hippocampus goes offline. Instead of going through the usual routes from short term to long term memory via the hippocampus, the memories are shunted into the implicit memory system, and are no longer available to the cognitive systems in the cortex that would normally assess them, sort them out and discard what is not useful and file the relevant information for future benefit. Another way of putting this is that the ‘implicit’ elements of the experience – sensory perception, bodily responses, emotion and behavioural responses – would normally be stored as context-dependent memory associated with the autobiographical, narrative memories of the same event. Under traumatic conditions, only the context-dependent elements are stored in the automatic memory system, while the consciously retrievable elements (the linear narrative) have failed to be successfully processed and stored.
C. Intrusion of Implicit memories and reliving of the trauma (Acute Stress Disorder)
As described in the ‘evolution of the stress response system’, the information processing system of the brain continues to seek a resolution to the original event in order to achieve both satisfactory learning and closure. But many of the memories are now stored in the implicit system. The mind feels as if it is locked in a repeating loop, playing the implicit feelings, images and sensations over and over again. Unlike the functional evolutionary system of learning from experience, there is no forward movement or ability to make sense of the experience, because the experience is now ‘remembered’ as sensory flashbacks and emotion – overwhelmingly frightening, distressing, unjust, often guilt-ridden or rage-filled. But most of all, and these two consequences represent the bottom line of the psychological aspect of trauma – the survivor is overwhelmed by the sense of loss of personal power and control, and loss of safety.
The loss of these two aspects of a secure sense of self is a key ingredient in the ensuing build up of anxiety and tension.
D. Long-term damage to the Central Nervous System (PTSD)
For people who are exposed to overwhelming situations which their brains fail to adequately integrate, the result can be continual reliving of the trauma as described above. The resulting anxiety keeps their stress response system at high alert over a period of time. Eventually this chronic state of stress alters the balance of the endocrine system. The system begins to produce LESS cortisol in response to stressful reactions, which has the effect that the body cannot return to a correct and normal baseline or homeostasis.
The new baseline of the traumatically stressed individual is HIGHER than normal. In other words, their normal condition is to be slightly stressed. Ongoing stressors (due to the Acute Stress Disorder) gradually push that baseline higher and higher, as the body produces less cortisol, until they enter a permanent anxiety condition – post-traumatic stress disorder. By this time, most people have come to believe that their anxiety state is in response to actual stressors in the present, combined with continual reliving of their trauma. In fact, all the present-day stressors are secondary and their significance is falsely exaggerated. The real cause of the anxiety state is the damage to the brain’s emergency stress-response system.
What this then implies, is that the treatment for anxiety-ridden PTSD sufferers is to learn how to help the endocrine system to heal as much as is possible. They need to begin to see the problem as physiological, rather than psychological. Physiological treatments are ones that allow body and mind to discharge the traumatic memories. Where psychology plays a role in treatment, is to teach cognitive-behavioural techniques to assist the repair of the damaged physical systems by decreasing and bringing under control the run-away fear of danger and disempowerment.
THE THREE SYMPTOM CLUSTERS OF PTSD
Usual symptom description:
- Repeated intrusion & reliving of memories of traumatic experience
- Automatic & uncontrollable avoidance of reminders of the trauma
- Increased arousal and hypervigilence
My preferred ordering of symptoms:
- Intrusion & reliving of memories
- Increased arousal & hypervigilence
- Automatic avoidance and numbing
- Repeated Intrusion & Reliving of Memories of the Traumatic Experience
- Sensory memory (ie, without visual or narrative element)
- Emotional memory, disconnected to any factual memory
- Narrative memory (there may be some factual memory)
- Extreme physiological and psychological distress
- Or numbness and absence of appropriate emotional response
- (Can be spontaneous –
- Or triggered by real or symbolic stimuli)
- Intensity of recall does not diminish with time
- Recall feels as if it is happening in the present
- (Why these symptoms? Because the memory of the trauma is stored in the implicit memory system)
- Increased ‘Arousal’
(ie, Extreme Hypersensitivity to External Events)
- Hypervigilance
- Irritability
- Memory and concentration problems
- Sleep disturbance
- Exaggerated startle response
- (Why these symptoms? Due to damage to the emergency stress response system/cortisol levels/raised homeostatic baseline)
- Automatic and Uncontrollable Avoidance
of Reminders of Trauma
- Dissociation (spacing out, fuzzy and disconnected to reality)
- Numbing
- Detachment
- Emotional blunting
- Difficulty in experiencing joy and pleasure
- Withdrawal from engagement with life
- Fear and avoidance of many situations
- (Why these symptoms? These are the automatic attempts to deal with the intrusions and the hypersensitivity of 1. and 2. )
THE PHYSICAL / MEDICAL DANGERS of PTSD
Long-term activation of the stress-response system — and the subsequent overexposure to cortisol and other stress hormones — can disrupt almost all of the body’s processes, increasing the risk of obesity, insomnia, digestive problems, heart disease, depression, memory impairment, physical illnesses and other complications, as described in the headed sections below.
Further information about stress and cortisols.
Digestive system
Cortisol also curbs functions that would be nonessential or detrimental in a fight-or-flight situation. It alters immune system responses and suppresses the digestive system, the reproductive system and growth processes.
It’s common to have a stomachache or diarrhea when you’re stressed. This happens because stress hormones slow the release of stomach acid and the emptying of the stomach. The same hormones also stimulate the colon, which speeds the passage of its contents. Chronic hormone-induced changes can increase your appetite and put you at risk of weight gain.
Immune system
Your immune system is a complex balancing act between components that operate as an all-purpose emergency crew and more specialized components that deal with specific disease agents. The immune system, like the hormone system, evolved so that it could quickly deal with physical threats. Indeed, cortisol is one factor that prompts the system to reprioritize its tasks.
These shifting priorities are essential for priming the immune system to respond quickly to injuries, like creating inflammation around a bite or puncture wound, but these changes are not beneficial in the long run. When you experience chronic stress, some features of your immune system may remain suppressed, making you susceptible to infections. Other features of the immune system may be permitted to run unchecked, increasing your risk of autoimmune diseases, in which your immune system attacks your body’s own healthy cells.
Nervous system
Certain byproducts of cortisol act as sedatives, which can contribute to an overall feeling of depression. If your fight-or-flight response never shuts off, the stress hormones may contribute to persistent and severe depression, as well as feelings of anxiety, helplessness and impending doom.
Such stress-induced depression often results in sleep disturbances, loss of sex drive and loss of appetite. It also may make you more vulnerable to developing certain personality or behavioral disorders.
Studies also suggest that chronic activation of stress hormones may alter the operation and structure of brain cells that are critical for memory formation and function.
Cardiovascular system
Chronic activation of stress hormones can raise your heart rate and increase your blood pressure and blood lipid (cholesterol and triglyceride) levels. These are risk factors for both heart disease and stroke.
Cortisol levels also appear to play a role in the accumulation of abdominal fat, which gives some people an “apple” shape. People with apple body shapes have a higher risk of heart disease and diabetes than do people with “pear” body shapes, in which weight is more concentrated in the hips.
Other systems
Stress worsens many skin conditions — such as psoriasis, eczema, hives and acne — and can trigger asthma attacks.
More on PTSD
Pathways Of Mine(d) 