Post Traumatic Stress Disorder

If you have experienced an event in which you believed that you were due to come to severe harm or perhaps even death (some examples would be a motor vehicle accident, home invasion, physical/emotional/sexual assault, a natural disaster) these threatening experiences in which you felt out of control can leave an individual with residual symptoms.

These symptoms can include:

• A sense of general numbness and feeling of lack of involvement with the real world
• Recurrent images and thoughts about the trauma (e.g. flashbacks)
• Guilt about having survived (especially if others have not)
• Avoidance of reminders of the traumatic event
• Re-experiencing the trauma in dreams
• An exaggerated startle response
• Sleep disturbance
• Depression
• Anxiety
• Younger people may show physical symptoms including stomachache and headaches

The classic fight-or-flight response to perceived threat is a reflexive nervous phenomenon that has obvious survival advantages in evolutionary terms. However, the systems that organize the constellation of reflexive survival behaviors following exposure to perceived threat can, under some circumstances, become dysregulated in the process. Chronic dysregulation of these systems can lead to functional impairment in certain individuals who become “psychologically traumatized” and suffer from post-traumatic stress disorder (PTSD).

Psychological trauma can result from witnessing an event that is perceived to be life-threatening or to pose the potential of serious bodily injury to self or others. Such experiences, which are often accompanied by intense fear, horror, and helplessness, can lead to the development of PTSD. Reactions can be quite unpleasant and are typically characterized by phenomena that can be grouped for the most part into three primary domains:  

• Reminders of the exposure including flashbacks, intrusive thoughts, nightmares
• Activation including hyperarousal, insomnia, agitation, irritability, impulsivity, and anger
• Deactivation including numbing, avoidance, withdrawal, confusion, derealization, dissociation, and depression  

Individuals exposed to an event that either threatens serious injury/death, or is perceived as such, respond in different ways. In short, not all individuals who face potentially catastrophic trauma go on to develop PTSD. For most individuals, these reactions are self-limiting, and provoke minimal (seconds) to brief (hours) to short-term (days/weeks) functional impairment over time. However, about 10% of the population are genetically predisposed for development of PTSD. The psychological trauma brought about by the experience of profound threat leads to a longer-term syndrome termed PTSD, which is often accompanied by devastating functional impairment.

This subset of people have a genetic variant in which there is a shorter serotonin neurotransmitter transport gene, which causes overactivation of the amygdala, one of the more primitive areas of the brain involved with reflexive survival behaviors.  There is a biological basis for PTSD which includes a shift in the balance between different signaling systems in the brain.  As a result, the fear responses, which give rise to the fight or flight reaction are heightened.

Serotonin is the predominant neurotransmitter involved with PTSD.  Thus, SSRI medications are first line choices for the treatment of PTSD.  The rationale for their use is to restore the balance between serotonin and other neurotransmitter proteins.  Thereby affecting the degree to which the amygdala reacts to traumatic stimuli.

The signs and symptoms of PTSD reflect a persistent, abnormal adaptation of neurobiological systems which include certain endocrine and neurotransmitter pathways as well as a network of brain regions known to regulate fear behavior at both conscious and unconscious levels. 

What actually happens?

• The hippocampus shrinks; this area helps us distinguish between past and present memories. 
• There is increased activity in the amygdala, which helps us process emotions.  It is also linked to fear responses and learning. 
• The ventromedial prefrontal cortex shrinks; this region regulates negative emotions that occur when confronted with specific stimuli.  
• There are changes in brain chemistry within these regions.

When there are thoughts, impulses, or plans to harm oneself, or end one’s life, it is critical to get help now.  For immediate help, Dial 911 or go to the nearest Emergency Room, or call 988 for the Suicide and Crisis Hotline.