PTSD: An Overview by Jennifer Newton

Introduction:

            Posttraumatic Stress Disorder, or PTSD, is a trauma or stress related disorder that can be caused from direct or indirect exposure to life threatening situations.  Adaptations or alternative versions of cognitive psychotherapy for posttraumatic stress disorder (PTSD) are needed because even the most efficacious cognitive or cognitive-behavioral psychotherapies for PTSD do not retain or achieve sustained clinically significant benefits for a majority of recipients (Ford, 2015).  This disorder consumes the lives of many Americans and controls their metacognition on a daily basis.  Posttraumatic stress disorder has arguably become a silent killer amongst American veterans and continues to grow statistically.  The more we can understand about the effects of the brain PTSD has, the more we will know how to help combat the disorder.

            To understand just exactly how PTSD effects the brain, it is important to rely on different studies to come to a conclusion.  A study conducted by Wuihui Li found that individuals with PTSD have a diminished amount of grey matter in their prefrontal lobe, occipital lobe, and parietal lobe.  Though the grey matter damage can be reduced over time, it never fully recovers back to its original brain volume (Bergland, 2013).  Grey matter is important to the mental health of individuals for the amount of gray matter in your brain affects its thought process and the ability to assess rewards or consequences (elementsbehaviorhealth.com, 2016).

            The neuroscience of PTSD also suggests that this disorder is arguably a neurological disorder.  A Neurological disorder is any disorder of the nervous system.  Posttraumatic stress disorder has been associated with a heightened autonomic nervous system (ANS) arousal and sleep disturbances.  Heightened ANS arousal may be what is unique to PTSD and has the potential to cause cardiovascular issues in the future of the individual (Kobayashi, 2014). 

            In another study, veterans were put through brain scans through fMRI machines.  The activity in their brain had extra activity in the area that are involved in reacting to threats or other outside problems.  This is a sign of an “endless loop” of hypervigilance in individuals with PTSD (Neuroscience News, 2016). 

            Furthermore, it is important to recognize that PTSD is often co-morbid with other psychiatric disorders, especially depressive illness and other anxiety disorders such as panic

disorder, which can further confound the clinical presentation of the somatic complaints.   This can be classified as a psychological disorder; which is referred to as mental disorders.  Survivors may hold back feelings of their trauma which can lead to anxiety disorders.  Furthermore, it can snowball into an effect of drug addiction. 

Another psychological disorder often seen in individuals with PTSD is the notion to numb their feelings through drugs and/or alcohol for their emotions may be overwhelming.  Another psychological disorder individual’s may face is self-mutilation (ptsd.va.gov).  They need a way to release their pain, or feel something different, thus their need to self-harm.  This can also be the reaction to self-guilt that some may feel, or the notion of feeling different than other persons around them. 

Posttraumatic stress disorder can also effect the central and peripheral nervous system.  This is called neuropsychological.  Endorphin withdrawal plays a part in the use of alcohol or drugs to control PTSD. When an individual experiences a traumatic event, his or her brain produces endorphins, neurotransmitters that reduce pain and create a sense of well-being, as a way of coping with the stress of the moment. When the event is over, the body experiences an endorphin withdrawal, which has some of the same symptoms as withdrawal from drugs and alcohol.  This can be any of the following: anxiety, depression, emotional distress, physical pain, or increased craving for drugs and alcohol (dueldiagnosis.org). 

Because of this, veterans are often prescribed medication for central nervous system (CNS) depressants.  Multimorbidity of mental disorders and traumatic brain injury was strongly associated with CNS polypharmacy.  According to the Army Institute of Public Health, 46% of veterans prescribed a CNS depressant successfully committed suicide within the year the medication was first prescribed (Collett, 2016).

Before any kinds of medicine can be prescribed or any kind of treatment can be administered for PTSD, a thorough assessment is completed by a professional.  According to the U.S. Department of Veteran Affairs, diagnostic criteria for PTSD include a history of exposure to a traumatic event that meets specific stipulations and symptoms from each of four symptom clusters: intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity.  The sixth criterion concerns duration of symptoms; the seventh assess functioning; and the eighth criterion clarifies symptoms as not attributable to a substance or co-occurring medical condition (ptsd.va.gov). 

More specifically, the DSM requires diagnostics to compose of a few factors.  The first factor is exposure.  The individual must be exposed to a traumatic event, or witnessed a traumatic event.  He or she could learn of a traumatic event that has happened to a loved one or repeatedly is around traumatic events.  Furthermore, the individual must have one or more symptom; this includes: reliving experiences, have upsetting dreams of event, experiencing flashbacks of event, experience ongoing or severe emotional distress or physical symptoms if something reminds you of the traumatic event (Mayoclinic.org, 2014).

In addition to these criteria for diagnosis, the individual may experience for one month or more: avoidance of events, memory loss of the event, view self and others negatively, detached from friends, family, and things that were once enjoyable, emotional numbness, angry outbursts, feel irritable, engage in dangerous or self-destructive behavior, constantly on guard, and/or have trouble sleeping (mayoclinic.org, 2014).  Another characteristic that is watched for is if the symptoms cause significant distress in life and causes interference in the ability to complete daily tasks. 

These symptoms effect many on a daily basis.  Some individuals do not realize that they may have PTSD, while family and friends, are confused as to what is going with those that do in fact have PTSD.  It is a silent killer, arguably.  On average, 22 American veterans successfully commit suicide on a daily basis, according to Veteran Affairs.  However, I would suspect that statistic is increasing due to the amount of individuals coming home with no after war treatment, and because of those being prescribed medications instead of psychologist working with the individual to get to the depths of the disease. 

My family has been greatly affected by the consequences of PTSD.  We are a military family, with lots of military friends whom we hold close to our hearts.  We have lost friends in combat, to drug addictions, and to suicide.  Life becomes changed because the reality of how serious PTSD can be to others, and it becomes the reality of the life we live.

Posttraumatic stress disorder does not discriminate its host.  Men and women are both susceptible to PTSD whom have been in combat, have been in life threatening situations, and/or witnessed friends and family in life threatening situations.  Children whom are abused physically and sexually are also at risk of developing PTSD.  The likelihood of developing PTSD increases as intensity and physical proximity to the event increase.  Recent immigrants from countries where there is considerable social unrest and civil conflict may have elevated rates of PTSD.  This disorder may occur at any age, furthermore, women are more likely to develop PTSD than men (Piotrowski and Range, 2016). 

II. Discussion

            Posttraumatic stress disorder is also known as shell shock, combat neurosis, and battle fatigue.  It is a trauma and stress related disorder resulting from direct or indirect exposure to actual or threatened death, serious injury, or sexual violence.  It is characterized by difficulties that negatively affect an individual’s social interactions, including work and other areas of functioning. 

            Signs and symptoms of PTSD include thoughts of the incident that has caused the disorder and that are reoccurring, involuntary, and/or are intrusive.  Other signs and symptoms consist of: flashbacks, prolonged and/or intense psychological distress, disturbing dreams or nightmares, sleep difficulty, irritability, outbursts of anger, aggression, self-destruction, distorted sense of blame of self or others, detachment from others, diminished interest in activities, difficulty concentrating, hypervigilance, exaggerated startled response. 

            Those that have suffered a traumatic event of any nature, is susceptible to form PTSD.  The individual can be a man, woman, or child, and of any nationality.  Individuals living in a high crime neighborhood, who are constantly living in fear, also have the ability to come down with symptoms of PTSD.  It is very common to experience anxiety disorders, stress disorders, addiction and depression as a result of PTSD, as well. 

            After WWI, many soldiers were acting out and had intense anxiety reactions.  During the 1960’s, it was diagnosed as an anxiety based personality disorder amongst Vietnam veterans.  Now it is no longer considered a personality disorder and is seen as a trauma or stress related disorder.  It is still seen throughout some Vietnam veterans as well as current veterans of the Iraqi and Afghanistan wars. 

            With treatment, posttraumatic stress disorder has the potential to stay under control.  Individuals can assess different situations with a clearer thought, and it can help those function better in social situations.  Psychologist see a decrease in symptoms.  However, without treatment, the disorder can lead the individual to a deeper state of depression, isolation, and anxiety.  Furthermore, it can cause the effected to be closed off towards others while isolating themselves; all which can lead to addiction, violence, and unfortunately, suicide. 

            Treatment is necessary to start the healing process of PTSD.  To initially be diagnosed with posttraumatic stress, individuals will first have to address a professional whom will assess the patient to determine if they do in fact, have PTSD by guidelines of the DSM-V.   From there, the best treatment as described by the professional will be addressed.  Ongoing management for the patient diagnosed with PTSD will also be addressed and followed up by professionals in this field.  This can be a physical exam, imaging and/or laboratory testing, special studies, psychological evaluation, or psychometric testing. 

            Professional will also take into consideration the different risk factors associated between the patient and PTSD.  It is suggested that genetics may play a role in the likely hood to develop this disorder.  Dr. Geonjian, whom is a psychiatrist affiliated with the UCLA/Duke University National Center for Child Traumatic Stress, concluded that 40% of the people who experienced PTSD after the earthquake did so because of genetic factors (ptsdtraumatreatment.org).  Those with a genetic tendency for anxiety disorders are more likely to experience PTSD after a traumatic event. 

            Other risk factors include the individual’s lifestyle and environment.  Living in a high stress area that has a high risk of crime, could produce symptoms of PTSD.  If a person has been shot at in their neighborhood, or is in constant fear for their lives every day, they are likely to have anxiety or paranoia.  Children that do not quite understand the reason for the violence also have a higher risk of being diagnosed with PTSD because their life is always threatened.  It is the same if they are living with guardians whom express physical or sexual abuse towards the child. 

            Active duty military also live a risk factor life for PTSD.  At any given moment they can be sent to battle.  Their life depends on their training and the training of others.  It is how they react that determines their homecoming success rate.  Terrorist attacks against their home bases can also be a risk factor.  They sleep on these bases and view it as their home for the duration of their deployment.  They live their days out knowing that a terrorist attack can happen at any time directed at them, and that they can go into battle at a drop of a dime (Master Sergeant Newton, USMC). 

            Civilians in countries of war can also be at risk of PTSD for natural disasters can play a great risk factor (brainline.org).  It is not just war, but those that have face natural disasters.  There have been reported cases of PTSD in Japan from the tsunami.  More than half of the 241 subjects studied in Japan by a Bringam Young University professor had symptoms of PTSD a year after the devastating tsunami that claimed of 5,000 lives (Hadfield, 2014).

            While these factors play a huge role in the factor for increasing the chances of getting PTSD, it is important to note that this disorder is not independently factorial based.  The hippocampus, which is the temporal lobe that helps with memory, contains multiple NE receptors that can contribute to long term memory reoccurrence during stressful situations.  There are central nervous system specific modifications in neurotransmitter activity and expression in response to predator exposure/psychosocial stress (Wilson, 2014). 

            The hypothalamic-pituitary-adrenal (HPA) axis is the central coordinator of the mammalian neuroendocrine stress response systems.  In short, the HPA axis is made up of endocrine hypothalamic components, including the anterior pituitary, as well as an effector organ, the adrenal glands. When exposed to stress, neurons in the hypothalamic paraventricular nucleus (PVN) secrete corticotrophin-releasing hormone (CRH) from nerve terminals in the median eminence into the hypothalamo-hypophyscal portal circulation, which stimulates the production and release of adrenocorticotropic (ACTH) from the anterior pituitary. ACTH in turn stimulates the release of glucocorticoids from the adrenal cortex. Glucocorticoids modulate metabolism as well as immune and brain function, thereby, orchestrating physiological and organismal behavior to manage stressors (Sherin and Nemeroff, 2011).

            Although stressors as a general rule can activate the HPA axis, studies in combat veterans with PTSD demonstrate decreases in Cortisol concentrations, as detected in urine or blood, compared with healthy controls and other groups.  In context, those that have low cortisol levels at the time of traumatic event exposure, may be at a higher risk to develop PTSD (Sherin and Nemeroff, 2011).

            It is important to know the neuroscience behind disorders and diseases for if cognition is altered, administering the wrong treatment option could have devastating results.  A third of all active duty service members are prescribed central nervous system (CSN) depressants, and in this ratio, 90% of those who attempted suicide, and 46% of those who successfully committed suicide, were administered the prescription within the past year. 

            Fortunately, there are other treatment options than medicines for posttraumatic stress disorder.   There are therapies such as individual therapy, group therapy, psychotherapy, imagery rehearsal therapy, therapy dogs, and EMDR (Eye Movement Desensitizing and Reprocessing) therapy.  There are trained professionals and psychologist that specialize in the therapy of PTSD.  In these cases, the therapy is an outpatient setting, however, sometimes, in severe cases, hospitalization or entrance to a treatment facility can be recommended. 

            Therapy with a psychiatrist is good for individuals going through stress because it gives them a chance to speak about experiences they are uncomfortable telling their family and friends in fear of looking weak.  Group therapies produce the same results for others going through the same thing are able to offer understanding and compassion.  In context, EMDR is a type of therapy that focuses on trauma while focusing on an external stimulus.  Three studies have shown that 77-90% of individuals going through this treatment have successfully overcome posttraumatic stress disorder (emdr.com).

            Though there is still research that is needed to help with the recovery of PTSD, there is current areas of research that are aiding.  NIMH-funded researchers are exploring trauma patients in acute care settings to better understand the changes that occur in individuals whose symptoms improve naturally.  There are other areas of research as well; such as research looking at how fear memories are affected by learning, changes in the body, or even sleep; research on preventing the development of PTSD soon after trauma.  Furthermore, 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, scientist 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 (nimh.nih.gov).

III. Conclusion

The first step to recovery is to ask for help.  Posttraumatic stress disorder is, arguably, a silent killer because a lot of military personnel do not want to address the issue to others in fear of looking weak, or incapable of completing their task.  Statistics show that 50% of those with PTSD do not seek treatment (veteransandptsd.com).  Treatment for this disorder is critical to a successful life, for it may cause anxiety and social isolation.  It can affect personal relationships and lead to addiction.  Family members should also be involved in treatment so they have a better understanding of what exactly those effected go through, neurologically and emotionally. 

Through the different treatment options available, from therapy to help emotionally to others that help neurologically, researchers continue to learn a lot about combatting trauma and the effects of trauma.  They have found deficiencies in cortisol and issues in the hippocampus that aid in understanding what PTSD can do to the brain.  Researchers have also used techniques that have proven to work, such as group and other therapies, and EMDR therapies.  Though there is still a lot to learn about the disorder, copious amounts of information have started the process in understanding the effects and effective treatment options.  Researchers are leading the way to recovery so that our veterans suffering from PTSD will no longer be a statistic.

 

 

 

 

 

 

 

 

 

 

 

                                                                  Reference

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ptsd.va.gov. (2016). PTSD. Retrieved from http://www.ptsd.va.gov/professional/PTSD-overview/complex-ptsd.asp

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Veteranandptsd.com. (2015) Veteran Statistics Retrieved from http://www.veteransandptsd.com/PTSD-statistics.html