Post Traumatic Stress Disorder (PTSD) is a mental health condition caused by extreme, prolonged or repetitive trauma. It is a normal reaction, to an abnormal situation.
Over the years, PTSD has been referenced many times in relation to soldiers returning from war. This association has led to a stigma, where people believe that Post Traumatic Stress Disorder is something that can only be developed during war and that diagnosis of this condition for anything else is not taken as seriously. In reality, PTSD can affect anyone who has experienced a traumatic event.
It is important to note that not everyone who experiences a traumatic event will develop PTSD.
It’s also important to note that the memory of a traumatic event can bury itself deep in a person’s mind and cause strange, unexplained feelings many months, or years later.
Not everyone who experiences a traumatic event will develop PTSD.
PTSD sufferers can find it difficult to discuss their feelings with friends and family, even a doctor. Someone suffering from PTSD may not know what they are experiencing and will often try to cope with the symptoms alone due to feelings of shame, fear or guilt. PTSD can look and feel a lot like depression or rage, but there are key differences and it affects all aspects of a person’s life, both at home and at work.
Following a traumatic event, the brain begins to process what has happened and the person(s) involved will usually experience some reaction. This can last around 4-6 weeks and can often include many of the same symptoms of PTSD, such as hyperarousal and dissociation. Sometimes, the brain cannot process the memories of the trauma correctly, this is what causes PTSD.
Examples of experiences that could cause PTSD are:
- serious accidents
- natural disasters
- war or conflict
- sexual assault
- physical assault
- witnessing a traumatic event, such as a serious car accident
- feeling that your life is in danger
- traumatic birth/sudden death of a child
Anyone can develop PTSD, but, for reasons that are not entirely understood, some people are at a higher risk of developing PTSD than others. Risk factors include:
- repeated trauma; living in a unsafe environment, such as a war zone.
- having suffered from a mental illness in the past such as anxiety or depression.
- a history of trauma or abuse in early childhood.
- experiencing very severe trauma
- not having enough support after experiencing trauma
- extra life stresses after the trauma; losing a job or a loved one.
- the type of traumatic event; rape, assault etc.
The most associated and typical symptom of PTSD is re-experiencing. This is when a person relives the traumatic event in the form of:
- repetitive and distressing intrusive images or sensations
- physical sensations, such as pain, sweating, feeling sick or trembling
Re-experiencing can happen at anytime and the memories appear so vividly. They can feel more like nightmares than memories and come with the accompanying feeling of fear and anxiety. Therefore, they cannot always be differentiated from reality.
What happens in the brain to cause re-experiencing?
The Hippocampus is an area of the brain where the formation of new memories occur. These new memories are then processed into long term memories at a later time and stored in other parts of the brain.
In the brain of people suffering from PTSD, the Hippocampus shrinks. Due to the role that the Hippocampus plays regarding memory, this reduction in size can cause problems with a person’s ability to record new memories and recall older ones.
If a new memory is not recorded and stored correctly in the brain, it could keep finding it’s way back into the short term memory, like a lost file in an office that keeps getting taken out of the incorrect drawer and placed on top of the filing cabinet, it keep’s coming to light even when it tries to be put away. Due to the Hippocampus being damaged, the brain has trouble distinguishing between the past and present, resulting in flashbacks.
Hypervigilance can be an issue for PTSD suffers, even in familiar surroundings and with people that they know.
It can make people highly aware of even the most subtle details that are usually taken for granted. Someone suffering from PTSD will find themselves continually assessing a person’s voice and tone, body language etc. Or be constantly scanning their environment for threats.
Hypervigilance can be mistaken for paranoia due to the constant worry that something will happen in their environment. However, unlike a person suffering with paranoia, someone suffering with Hypervigilance is aware of their symptoms. It is important to be able to make the distinction.
Some common behaviours of Hypervigilance are:
- Lack of objectivity – reading too much into situations
- An over-awareness of what people see or think about a person
- Constantly waiting for betrayal from others
- Feeling concerned about others
- Being unaware of what is obvious to others
- Over scrutinising/analysing situations
Hyperarousal is a heightened state of anxiety, often caused by the impact of trauma on a person’s brain.
The symptoms of hyperarousal include:
- Chronic anxiety
- Difficulty falling or staying asleep
- Frightening dreams
- Difficulty concentrating
- Anger and angry outbursts
- Panic attacks
- Being constantly on guard for threats (hypervigilance)
- Being easily startled (excessive startle reflex)
What happens in the brain to cause hyperarousal?
The Ventromedial Prefrontal Cortex is the area in brain that process negative emotions, such as fear.
In the brain of people suffering from PTSD, this region can shrink, resulting in a reduced ability to regulate emotions. This can cause fear, anxiety and extreme stress when the person is faced with something even slightly similar, or even unconnected to the trauma they have experienced.
Studies have shown that trauma increases activity in the Amygdala (where the brain processes emotions and fear responses).
The Amygdala uses the Hippocampus to understand the correct course of action to take in different situations. Based on the retrieval of older memories, the Amgydala can decide if the current situation is familiar, enjoyable or dangerous. If the Amygdala decides that the situation is dangerous, it will begin to release stress hormones to activate the body’s survival mode in order for it to tackle the threat (fight or flight).
However, in those suffering from PTSD, the Amygdala becomes hyperactive in response to reminders of their trauma. As the Hippocampus is also damaged, the brain will have difficulty regulating emotional responses which causes the Amygdala to associate even the safest of situations as threatening, which can activate the stress response regularly throughout the day.
The excess stress hormones including Cortisol and Norepinephrine can also cause physical symptoms in PTSD suffers. These can include skin conditions, digestive problems, chronic pain and a flare up of allergies.
Feeling suspicious is not just linked to PTSD, but Hypervigilance can result in suspicion of people and their motives. This can result in feelings of paranoia around others. A person with PTSD will often find themselves wondering “Why is this person talking to me?”, “What do they say about me when I leave the room?” “Do they even like me?”.
A person with PTSD will be constantly analysing the situation and questioning their relationship. Many sufferers don’t want to wait for something to go wrong as they may feel it is inevitable, so they end relationships with people first in order to avoid getting hurt.
PTSD can cause a person’s mind to take a situation and create an extremely negative version, leading to increased anxiety and questioning their abilities and decisions. As a result, more negative situations are created which can lead to feelings of doubt and failure. This can then exacerbate the symptoms of PTSD.
This is a relatively common and normal response to trauma.
It is thought to be an defence mechanism that automatically kicks in when a person is faced with extreme emotional or physical pain. Dissociation allows a person to block out unbearable thoughts or feelings and is therefore often experienced in cases of PTSD. There are varying types of Dissociation, with Chronic and Problematic Dissociation likely to develop where there has been a repeated threat or trauma.
As mentioned earlier, memory is a common problem for people suffering from PTSD. Concentration problems are also a common symptoms and can affect a person’s ability to stay focused during the day. This can affect daily tasks in the workplace and significantly impact on their role. Difficulty sleeping can also contribute to concentration issues.