Post-Traumatic Stress Disorder (PTSD)

"Fight or flight” mode is a natural instinct for humans; however, in individuals with post-traumatic stress disorder, better known as PTSD, that instinct has been damaged or altered. Even in the absence of real danger, people with PTSD can experience fear and dread.  PTSD affects about 7.7 million Americans* but it is often associated with veterans because of the extreme nature of what they experience in war. It is also prevalent in victims of violent crime such as rape or kidnapping, in physical and/or sexual abuse victims, among children who observe domestic violence, accident victims, those who survived a bad car accident, and people who experience loss as a result of a natural disaster.

The causes of PTSD are actively being studied to understand why two people can experience the exact same situation, and one will develop post-traumatic stress disorder and the other will not. Genes may actually play a role in the creation of “fear memories.” Also, areas of the brain such as the amygdala are being studied to understand their relation to PTSD. So, development of PTSD may be a combination of our genes, specific areas of the brain, and our environment.  Signs of PTSD may include re-experiencing the event through flashbacks and nightmares, avoidance of places or events that may be triggers, and a tendency to be easily startled or frequently feeling on the edge. In addition, PTSD may cause feelings of  guilt, anger, or depression, substance abuse, tension, and difficulty sleeping or disrupted sleep patterns.

Treatment is often very successful with patients who are dedicated to overcoming PTSD. Treatment may include psychotherapy, medication or both. One of the most powerful forms of psychotherapy for this condition is cognitive behavioral therapy (CBT), with the VA and other therapists using a form of CBT called “Cognitive Processing Therapy.” This involves learning about your symptoms, becoming aware of your thoughts and feelings, re-experiencing some of the feelings, building learning skills to help you cope with symptoms more effectively, and changing some of your beliefs about the traumatic experience.   Another popular therapy used is called EMDR or Eye Movement Desensitization and Reprocessing.

PTSD is something that if left untreated can continue to impact one's life. We only had to watch the 70th. anniversary of D-Day to observe veterans with tears in their eyes as they remembered such a traumatic event. Do not believe the adage that "time heals all wounds." What is more appropriate is that, "wounds continue to wound until healed!"** So, if you believe you are experiencing symptoms of PTSD, we strongly encourage you to seek professional help.

* Source: National Institute of Mental Health

** Source: Michael H. LeBlond, PhD, MBA


The above summary by WebPsychology.

Understanding It

What is post-traumatic stress disorder (PTSD)?

When in danger, it’s natural to feel afraid. This fear triggers many split-second changes in the body to prepare to defend against the danger or to avoid it. This “fight-or-flight” response is a healthy reaction meant to protect a person from harm. But in post-traumatic stress disorder (PTSD), this reaction is changed or damaged. People who have PTSD may feel stressed or frightened even when they’re no longer in danger.

PTSD develops after a terrifying ordeal that involved physical harm or the threat of physical harm. The person who develops PTSD may have been the one who was harmed, the harm may have happened to a loved one, or the person may have witnessed a harmful event that happened to loved ones or strangers.

PTSD was first brought to public attention in relation to war veterans, but it can result from a variety of traumatic incidents, such as mugging, rape, torture, being kidnapped or held captive, child abuse, car accidents, train wrecks, plane crashes, bombings, or natural disasters such as floods or earthquakes.

Causes

Genes. Currently, many scientists are focusing on genes that play a role in creating fear memories. Understanding how fear memories are created may help to refine or find new interventions for reducing the symptoms of PTSD. For example, PTSD researchers have pinpointed genes that make:

Stathmin, a protein needed to form fear memories. In one study, mice that did not make stathmin were less likely than normal mice to “freeze,” a natural, protective response to danger, after being exposed to a fearful experience. They also showed less innate fear by exploring open spaces more willingly than normal mice.

GRP (gastrin-releasing peptide), a signaling chemical in the brain released during emotional events. In mice, GRP seems to help control the fear response, and lack of GRP may lead to the creation of greater and more lasting memories of fear.

Researchers have also found a version of the 5-HTTLPR gene, which controls levels of serotonin — a brain chemical related to mood-that appears to fuel the fear response. Like other mental disorders, it is likely that many genes with small effects are at work in PTSD.

Brain areas. Studying parts of the brain involved in dealing with fear and stress also helps researchers to better understand possible causes of PTSD. One such brain structure is the amygdala, known for its role in emotion, learning, and memory. The amygdala appears to be active in fear acquisition, or learning to fear an event (such as touching a hot stove), as well as in the early stages of fear extinction, or learning not to fear.

Storing extinction memories and dampening the original fear response appears to involve the prefrontal cortex (PFC) area of the brain, involved in tasks such as decision-making, problem-solving, and judgment. Certain areas of the PFC play slightly different roles. For example, when it deems a source of stress controllable, the medial PFC suppresses the amygdala, an alarm center deep in the brainstem, and controls the stress response. The ventromedial PFC helps sustain long-term extinction of fearful memories, and the size of this brain area may affect its ability to do so.

Individual differences in these genes or brain areas may only set the stage for PTSD without actually causing symptoms. Environmental factors, such as childhood trauma, head injury, or a history of mental illness, may further increase a person's risk by affecting the early growth of the brain. Also, personality and cognitive factors, such as optimism and the tendency to view challenges in a positive or negative way, as well as social factors, such as the availability and use of social support, appear to influence how people adjust to trauma. More research may show what combinations of these or perhaps other factors could be used someday to predict who will develop PTSD following a traumatic event.

The next steps for PTSD research

In the last decade, rapid progress in research on the mental and biological foundations of PTSD has led scientists to focus on prevention as a realistic and important goal.

For example, NIMH-funded researchers are exploring new and orphan medications thought to target underlying causes of PTSD in an effort to prevent the disorder. Other research is attempting to enhance cognitive, personality, and social protective factors and to minimize risk factors to ward off full-blown PTSD after trauma. Still other research is attempting to identify what factors determine whether someone with PTSD will respond well to one type of intervention or another, aiming to develop more personalized, effective and efficient treatments.

As gene research and brain imaging technologies continue to improve, scientists are more likely to be able to pinpoint when and where in the brain PTSD begins. This understanding may then lead to better targeted treatments to suit each person's own needs or even prevent the disorder before it causes harm.


Source: National Institute of Mental Health