Post Traumatic Stress Disorder (PTSD) is a type of anxiety disorder which may develop after direct exposure to or witnessing traumatic events, serious injury or death. This could be through events like war, natural disaster, sexual assault, serious accident or terrorist attack etc. The symptoms of PTSD do not always occur shortly after the event. Symptoms could take a few years to develop but most often they develop within 3 months. The symptoms of PTSD became more widely known following the first world war. At that time it was known as shell shock. Traumatized soldiers where returning home with tremors, uncontrollable nightmares, headaches, muscle spasms and stomach cramps to name a few of the symptoms. During that time there was a grave lack of understanding and many soldiers where not diagnosed or treated adequately. In modern times we now understand that shell shock is an acute form of PTSD which has been renamed combat stress reaction.
Trauma affects not only those who are directly exposed to it, but also those around them. Soldiers returning home from combat may frighten their families with their rages and emotional absence. The wives of men who suffer from PTSD tend to become depressed, and the children of depressed mothers are at risk of growing up insecure and anxious. Having been exposed to family violence as a child often makes it difficult to establish stable, trusting relationships as an adult. Trauma, by definition, is unbearable and intolerable. Most rape victims, combat soldiers, and children who have been molested become so upset when they think about what they experienced that they try to push it out of their minds, trying to act as if nothing happened and move on. It takes tremendous energy to keep functioning while carrying the memory of terror, and the shame of utter weakness and vulnerability.
While we all want to move beyond trauma, the part of our brain that is devoted to ensuring our survival (deep below our rational brain) is not very good at denial. Long after a traumatic experience is over, it may be reactivated at the slightest hint of danger and mobilize disturbed brain circuits and secrete massive amounts of stress hormones. This precipitates unpleasant emotions intense physical sensations, and impulsive and aggressive actions. These post-traumatic reactions feel incomprehensible and overwhelming. Feeling out of control survivors of trauma often begin to fear that they are damaged to the core and beyond redemption. - The Body Keeps The Score, Bessel Van Der Kolk
After experiencing a traumatic event most people will have some form of stress reaction. However, if the symptoms last longer than 1 month after the event then it is likely to be PTSD.
Re-experiencing the traumatic event in the form of flashbacks. Flashbacks can be visual or experience the same physical symptoms which were experienced at the event. This could be physical symptoms like a racing heart or shortness of breach. The flashbacks are often triggered by similar objects, smells or words to the traumatic event.
Difficulty sleeping and nightmares. Often very sensitive to unexpected noises which make it harder to fall asleep.
Explosive anger when faced with small frustrations. Extreme moods, loss of self-regulation and self-control.
Emotionally numb often unable to experience pleasure. A loss of imagination.
Catastrophic thoughts, imagining that the worse scenario is going to happen and replaying this in the mind. One PTSD sufferer described how after losing a newborn baby they would imagine their other children dying in catastrophic accidents whenever the children were out of sight.
Avoiding similar things, places or events to the trauma. For example not wanting to drive again after a serious accident.
Feeling tense, startling or jumping easily.
Persistent negative thoughts.
Memory blanks of the traumatic event. This is most common with childhood sexual abuse.
Withdrawn and distant from close family and friends.
The stress hormones of people suffering from PTSD will take much longer after stressful events to return back to normal levels. This is what causes irritability, attention and memory problems. Research tells us that the left side of the brain develops impaired functioning. The left side of is the logical side of the brain, which controls things like logic and reason. When it is not operating with full functioning it looses the ability to recognize a flashback as a past memory rather than a real event happening in the present moment.
Why Do Some People Get PTSD
What happened in the aftermath of a traumatic event is important here. If people do not talk about what happened and have a strong social support network they are more likely to develop PTSD. If they experience some other stressful event in the aftermath this is a contributing factor. Being unable to move or escape from the trauma for an extended period of time is another contributing factor. Childhood trauma and pre-existing mental health issues increase the likeliness of developing PTSD. Another factor is how the person felt they acted or did not act during the traumatic event and suffers can experience feelings of intense shame. A study found that soldiers who harmed prisoners of war or civilians had a much higher occurrence of developing PTSD. There are also some biological factors at play as specific genetic variants have been found to cause higher rates of PTSD.
Over the past two decades, researchers have used various kinds of imaging techniques to peer inside the brains of trauma victims. These studies report that in people with PTSD, two areas of the brain that are sensitive to stress shrink: the hippocampus, a deep region in the limbic system important for memory, and the anterior cingulate cortex (ACC), a part of the prefrontal cortex that is involved in reasoning and decision-making. Functional magnetic resonance imaging (fMRI), which tracks blood flow in the brain, has revealed that when people who have PTSD are reminded of the trauma, they tend to have an underactive prefrontal cortex and an overactive amygdala, another limbic brain region, which processes fear and emotion (see 'The signature of stress').
People who experience trauma but do not develop PTSD, on the other hand, show more activity in the prefrontal cortex. In August 1, Kerry Ressler, a neuroscientist at Emory University in Atlanta, Georgia, and his colleagues showed that these resilient individuals have stronger physical connections between the ACC and the hippocampus. This suggests that resilience depends partly on communication between the reasoning circuitry in the cortex and the emotional circuitry of the limbic system. “It's as if [resilient people] can have a very healthy response to negative stimuli,” says Dennis Charney, a psychiatrist at the Mount Sinai School of Medicine in New York, who has conducted several brain-imaging studies of rape victims, soldiers and other trauma survivors. - Stress: The Roots Of Resilience, Virginia Hughes
Effects On The Brain
Developments and research in the field of neuroscience show us how trauma actually changes the structure of the brain. Trauma causes an increase in stress hormones like cortisol. The body has a central alarm system where the brain processes sights, sounds, and other stimuli then decides if it is a life or death situation. If the brain decides that it is a life or death situation; it will tell us to fight, flight or freeze by sending various signals to parts of the body. We then might experience a racing heart, shortness of breath, sweaty palms etc. This part of the brain is often called the reptilian brain and is the oldest part of the brain which helped our ancestors survive in harsh environments. However, in modern day life, we encounter life or death situations rarely. In people suffering from trauma, the brain has changed how it processes and filters information. This causes it to mistakenly believe that it is in a fight for survival. The fight, flight or freeze system is effectively stuck on high alert. The sound of a baby crying becomes a ransacked village back in the depths of Vietnam for a veteran, a long beep of a car horn becomes the truck that lost control for a crash victim. There are also changes in the Broca's area of the brain which is the center for speech. This means PTSD suffers struggle to put into feelings and thoughts the traumatic experience. This explains why even if the traumatic event happened a long time ago, suffers can struggle to explain what happened to other people in a coherent manner. Traumatic memories are stored in a different way than normal memories meaning that the brain will remember the images of trauma longer and more vividly than a normal memory.
The region in the brain called the thalamus helps your brain distinguish between normal background noise, smells, sights and things that need your attention. However, in people with PTSD, the thalamus is not operating as well; leaving the brain in sensory overload, unable to determine what is normal background and what is a likely threat. As a coping mechanism, many will try to shut down their attention to background stimuli and intensely focus on the task they are doing. If that does not work then some use alcohol or substances to try and block out all the stimulus to feel some calm. However, closing down not only stops pain it prevents pleasure from being experienced too.
Complex PTSD is a form of PTSD which differs in that it does not occur after a single traumatic event or series of events. Rather it occurs from prolonged exposure to trauma most often during childhood, with no option to get away from the situation. This could be through severe child abuse, neglect, witnessing domestic violence, trafficking etc.
complex traumatic events and experiences can be defined as stressors that are:
(1) repetitive, prolonged, or cumulative (2 ) most often interpersonal, involving direct harm, exploitation, and maltreatment including neglect/abandonment/antipathy by primary caregivers or other ostensibly responsible adults, and (3) often occur at developmentally vulnerable times in the victim's life, especially in early childhood or adolescence, but can also occur later in life and in conditions of vulnerability associated with disability/ disempowerment/dependency/age /infirmity, and so on. - Understanding Complex Trauma, Complex Reactions, and Treatment Approaches, Christine A. Courtois, PhD
Complex PTSD Symptoms
Complex PTSD has some similar symptoms to PTSD, with the addition of the following:
Suffers do not always remember the trauma compared to normal PTSD, but do continue to act out the behavior.
Lack of physical coordination, clumsy. Trauma leads to the loss of sensation in large parts of the body.
Trouble with concentration.
Always feeling on edge, jittery or restless.
Sexual abstinence or high-risk sexual behaviors.
Gaps in memory. The memory of trauma can be repressed for years. Total loss of memory is most common with childhood sexual abuse.
Some experience depersonalization which means to dissociate, blank out or detach from thoughts and the body. Some describe it as feeling like you are in a dream or observing events from outside the body. However, blanking out blocks the sense of self from emerging with makes it difficult to find a sense of purpose or direction in adulthood. This also makes it difficult to make decisions or know what you want. Being in the present moment is difficult as to be present you need to be aware of where you are and what is going on within you. If your focus was mostly external the brain does not develop some of its internal monitoring system.
Dissociation is another major symptom of complex PTSD. This means to feel lost, abandoned or disconnected from the world. With feelings of emptiness, helplessness, and feeling trapped. This is developed as a coping mechanism by blocking out events in the mind but the body still knows that it is happening. This creates an unsafe feeling in the body which leads to an impaired sense of inner reality, self-destructive or excessive clinging behavior. Dissociation creates a lack of synchronization in the body and mind. This leads to misalignment in hearing, vision, touch and balance. For example, missing ques of shared laughter with others, missing shared emotions (also know as attunement). Crucially dissociation prevents trauma from being integrated within the memory, causing it to be relived or reenacted.
Children who grow up with supportive and emotionally intelligent parents (or caregivers) learn how to regulate their arousal while playing and interacting with peers. This means they learn how to avoid extreme highs and lows of emotion also known as emotional regulation. In contrast, children who are often pushed into over-arousal and confusion by their parent do not develop real attunement of their brain systems. This means that they will often grow up expecting that they will lose control if something upsets them. If the parents are very unpredictable in their behavior the children will learn that they have to fight for attention and will get extremely agitated when facing small frustrations. This makes the children generally anxious and nervous. They will have difficulties with concentration and attention, over sensitivity to touch and sound. Moods and feelings can shift quickly from temper tantrums to shut down dissociation. They are often misdiagnosed with behavioral problems at school, like Attention Deficit Disorder.
A secure attachment combined with the cultivation of competency builds an internal locus of control, the key factor in healthy coping throughout life. Securely attached children learn what makes them feel good; they discover what makes them (and others) feel bad, and they acquire a sense of agency: that their actions can change how they feel and how others respond. Securely attached kids learn the difference between situations they can control and situations where they need help. They learn that they can play an active role when faced with difficult situations. In contrast, children with histories of abuse and neglect learn that their terror, pleading, and crying do not register with their caregiver. Nothing they can do or say stops the beating or brings attention and help. In effect, they're being conditioned to give up when they face challenges later in life. -The Body Keeps The Score, Bessel Van Der Kolk
Repeating Patterns Of Trauma
Experiencing trauma for a prolonged period often causes trauma bonding, which is where the victim becomes addicted to the hormonal roller coaster of abuse, therefore, remaining loyal to the person that abuses them. Subconsciously the brain may seek similar people or situations so that the trauma cycle is repeated as it feels familiar. Research tells us that women with a childhood history of neglect and abuse are seven times more likely to be raped in adulthood. Trauma also makes it more difficult for people to determine if a situation is safe or dangerous. This means even the slightest misinterpreted look or word could cause a strong defensive reaction. Being stuck in this survival mode leaves no energy free for nurture, play, imagination, caring and ultimately creating close bonds.
The brain is formed in a "use dependent manner". This is another way of describing neuroplasticity, the relatively recent discovery that neurons that "fire together, wire together". When a circuit fires repeatedly, it can become a default setting - the response most likely to occur. If you feel safe and loved, your brain becomes specialized in exploration, play and cooperation; if you are frightened and unwanted, it specializes in managing feelings of fear and abandonment.- The Body Keeps The Score, Bessel Van Der Kolk
Visit your GP or Doctor - They will make a general assessment and diagnosis. With severe PTSD medication may be required alongside psychotherapy.
Psychotherapy - It is important to receive treatment from a trained psychotherapist. We know that the brain is neuroplastic which means it can learn new pathways and heal old unhealthy pathways. A therapist will create a safe environment for you to explore and process past trauma. There is a range of different therapies that are used to treat PTSD and Complex PTSD. Some of these therapies are designed to be used alongside traditional talking therapies. These are eye movement desensitization and reprocessing (EDMR), art and drama therapy, neurofeedback to name a few.
Mindfulness - The benefits of meditation are extensive and can be read further here. Yoga has also been shown as important in the treatment of PTSD as we are learning more about the effects of trauma on the physical body. Many practitioners recommend treatment that involves taking care of the mind and body. Joining self-help groups and reading books about recovery from trauma are also beneficial supplementary help.
Bessel Van Der Kolk, The Body Keeps The Score, Mind Body And Brain In The Transformation Of Trauma - 24 September 2015 - https://www.penguin.co.uk/books/259420/the-body-keeps-the-score/
Virgina Hughes, Stress: The Roots Of Resilience, Nature.com - https://www.nature.com/news/stress-the-roots-of-resilience-1.11570
Christine A. Courtois, PhD, Understanding Complex Trauma, Complex Reactions, and Treatment Approaches - http://www.giftfromwithin.org/pdf/Understanding-CPTSD.pdf