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Trauma/PTSD

Trauma refers to the emotional, psychological, or physical response to a highly stressful event. PTSD can manifest after experiencing trauma.

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What is trauma (Leonard, 2020)?

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  • Trauma refers to the emotional, psychological, or physical response to a highly stressful event.

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  • Traumatic experiences can be isolated, repeated, or ongoing events. Common traumatic experiences include:

    • Bullying or harassment

    • Physical, psychological, or sexual abuse

    • Sexual or physical assault

    • Traffic collisions

    • Childbirth

    • Life threatening illnesses

    • Unexpected loss of a loved one

    • Being attacked or kidnapped

    • Acts of terrorism

    • Natural disasters

    • War

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  • There are several types of trauma:

    • Acute trauma – results from a single stressful or dangerous event

    • Chronic trauma – results from repeated and prolonged exposure to highly stressful events (e.g., bullying, child abuse, domestic violence, etc.)

    • Complex trauma – results from exposure to multiple traumatic events

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  • Another form of trauma is called vicarious trauma, which refers to an individual developing trauma symptoms as a result of close contact with someone who has been impacted by a traumatic event

    • Though this form of trauma is uncommon, it is commonly found in family members and mental health professionals who care for an individual who has experienced trauma

      • These symptoms mirror the symptoms of post-traumatic stress disorder (PTSD)

      • As a result of the COVID-19 pandemic, vicarious trauma amongst healthcare workers has increased significantly compared to pre-pandemic numbers (Thew, 2020)

        • Many frontline healthcare workers were significantly impacted by the overall grief, loss, trauma, and fatalities that resulted from those suffering from COVID-19 and their families

 

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Do certain factors determine how a traumatic event affects a person (Leonard, 2020)?

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  • Yes! The symptoms of trauma range from mild to severe, and there are many factors that determine how a traumatic event affects an individual. These factors include:

    • Characteristics of the individual (e.g., those who lack resiliency are more likely to be negatively affected by trauma)

    • Presence of other mental health conditions

    • Previous exposure to traumatic events

    • Type and characteristics of the event(s)

    • Individual’s background and approach to handling emotions (i.e., those with poor coping skills are more likely to develop PTSD after a traumatic event)

 

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How do I know if I am being affected by trauma (Finch, 2019)?

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  • Trauma affects an individual physically and emotionally, therefore can also impact one’s behavior. Not everyone is affected by trauma in the same way and symptoms can range from mild to severe. Some key signs of trauma are:

    • Physical symptoms such as:

      • Constant fatigue

      • Headaches and general pain in your body

      • Difficulty falling or staying asleep

      • Strange physical sensations

    • Emotional changes such as:

      • Hypersensitivity to emotional content (i.e., movie, song, book, etc.)

      • Feeling disconnected from your emotions or body

      • Feeling helpless or hopeless about the future

      • Constantly feeling angry or irritated towards others

      • Being cynical or jumping to conclusions

      • Intrusive thoughts or imagery related to the traumatic event

    • Changes in behaviors such as:

      • Avoiding going to work or planned events

      • Having little to no interest in activities or hobbies that once gave you joy

      • Changes in personal relationships (e.g., people avoiding you, you avoiding others, etc.)

      • Keeping yourself busy all the time to avoid the reminders of the trauma (e.g. no separation of personal and professional time)

      • Difficulty relating to others’ day-to-day experiences

      • Difficulty finding meaning in or relating to small talk

      • Feeling that nobody understands you

      • Being overly cautious about the well-being of others

      • Isolating yourself completely or interacting with only people who you work with or can relate to your experience(s)

 

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What is post-traumatic stress disorder (PTSD) (American Psychological Association, n.d.)?

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  • PTSD is an anxiety disorder that individuals can develop after experiencing trauma. Anxious feelings often arise as a result of the trauma which are so intense that it disrupts the individual’s life and overall functioning

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  • Symptoms of PTSD are very similar to sensations experienced at the time of the traumatic event and typically occur within a month of experiencing something traumatic. On rare occasions, symptoms can present years after the event. PTSD symptoms include:

    • Intrusive memories:

      • Recurring memories of the event

      • Flashbacks

      • Nightmares

      • Seeing, hearing, or smelling something that reminds the individual of the event, causing emotional distress

      • Intrusive memories can lead to physical symptoms such as headaches, panic attacks, or heart palpitations

    • Avoidance:

      • Avoiding people or places that remind the individual of the event

      • Some individuals isolate completely from those around them, even individuals who have no connection to the event

    • Thinking and mood changes that are sudden and occur often:

      • Hopelessness

      • Numbness

      • Guilt

      • Shame

      • Suicidal thoughts

  • PTSD symptoms look different in children than adults. Some common behaviors in children who are suffering from PTSD include (NIMH, n.d.):

    • Bed wetting, even though the child is potty trained

    • Forgetting how to, or being unable to, speak

    • Acting out the traumatic experience during play

    • Being unusually clingy

    • Developing behaviors that are disruptive, disrespectful, or destructive

 

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Does a traumatic experience always result in PTSD (NIMH, n.d.)?

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No! Not everyone who experiences a traumatic event will develop PTSD.

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  • There are many factors that play a role in the development of PTSD including:

    • Genetics

    • Gender – females are more likely to develop PTSD than males

      • Men are more likely to experience trauma such as combat, accidents, natural disasters, and disasters caused by humans, while women are more likely to experience trauma such as sexual abuse, domestic violence, and sexual assault

        • Studies show that the type of abuse women often go through takes more of a toll on an individual psychologically and emotionally which is the basis of the DSM-5 criteria for PTSD

          • Men often respond to trauma through behaviors (e.g., drug abuse, violence) instead of on a psychological or emotional level (Greenberg, 2018)

    • Living through dangerous events or trauma

    • Multiple traumatic experiences

    • Having little or no social support after the traumatic event occurs

    • Dealing with extra stress after the traumatic event

    • Having a history of other mental illnesses or substance use

 

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How is PTSD treated (National Center for PTSD, 2022)?

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  • There are many treatment options for PTSD including different types of psychotherapy (talk therapy) and medication.

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  • Common types of psychotherapy used to treat PTSD include:

    • Trauma-focused psychotherapy

      • Focuses on the memory of the traumatic event or its meaning

      • Helps the sufferer process emotions and what happened

    • Accelerated Resolution Therapy (ART)

      • Uses techniques such as rapid eye movement and image rescripting

      • Works to recondition stressful memories and alters how these memories are stored in the brain

      • Treatment typically consists of 1-5 sessions

    • Prolonged Exposure (PE)

      • Involves talking about your trauma and facing things the sufferer may be avoiding

      • Helps you gain control by facing your negative feelings

    • Cognitive Processing Therapy (CPT)

      • Reframes negatives thoughts and emotions associated with the trauma

      • Involves short assignments and speaking about your trauma with a professional

    • Eye Movement Desensitization and Reprocessing (EMDR)

      • Assists with processing and making sense of the trauma

      • Bilateral stimulation works to “overwrite” the core negative thoughts and feelings that resulted from the traumatic event

  • Medication management is also used in the treatment of PTSD

    • A large, combined treatment study conducted by Emory University showed that patients who utilized both therapy and medication management in their PTSD treatment reported a more significant decrease in symptoms as compared to those who underwent only therapy or only medication management (Psychiatric Times, 2003)

 

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What does PTSD look like in the brain?

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  • Studies show that trauma can impact memory function in addition to changing brain circuits in areas of the brain such as the hippocampus, amygdala, and medial prefrontal cortex (Bremner, 2006)

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  • The brains of individuals who have experienced trauma develop a way to keep them “safe” as a result of the trauma

    • Individuals often become-hyperaware of their surroundings their brain can perceive people, situations, events, etc. as a threat, whether the threat is real or not

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  • Depending on which stage of life the trauma occurs, the effect and change in brain development may vary (Bremner, 2006)

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  • To better understand what and where changes are occurring in the brain as a result of trauma, please refer to the following photo which points out the hippocampus, amygdala, and prefrontal cortex, which all play a significant role in in PTSD:

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What happens in the hippocampus (Logue MW, 2018)?

 

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The largest PTSD neuroimaging study to date found that those suffering from PTSD have a significantly smaller hippocampal volume, which leads researchers to believe that a smaller hippocampal volume may be an indicator for proneness to PTSD

 

  • The hippocampus, located in the medial temporal lobe, is often referred to as the brain’s “memory center”

    • The hippocampus is also responsible for memory retention and creation, helping us adjust to our surroundings, and facilitating our ability to navigate the world around us

  • After trauma occurs, the hippocampus works hard to try to remember events and to accurately make sense of the event(s)

    • Because trauma can be overwhelming, the hippocampus may not “code” things correctly and is constantly working hard to “code” these memories correctly

      • The constant “working” of the hippocampus often results in random onset of unwanted feelings and thoughts associated with the trauma

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What happens in the amygdala (Logue MW, 2018)?

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  • The amygdala is located in the frontal portion of the temporal lobes near the hippocampus. The amygdala is responsible for (Brainline, n.d.):

    • Forming and storing information related to emotional events

    • Long-term memory formation

    • Conversion and retention learning from our pleasure responses

    • Helping us recognize and determine danger or fear

  • The amygdala can be thought of as our natural “alarm system” and is wired to ensure survival

    • When experiencing a disturbing event, the amygdala sends a signal that results in a fear response in order to keep us safe

  • Those suffering from PTSD have an overactive amygdala

    • This means that the amygdala signals a fear response even though no real threat or danger is present

      • An overactive amygdala results in the constant feelings of fear, threat, and worry in those suffering from PTSD

      • Other PTSD symptoms related to the overactive amygdala are:

        • High anxiety and on high alert

        • Physical reactions to non-threatening situations

        • Avoidance (of situations that may trigger intense emotions)

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What happens in the prefrontal cortex (Logue MW, 2018)?

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  • The prefrontal cortex is responsible for decision making, regulating emotional responses triggered by the amygdala, and helps determine if something is a threat or not

    • The prefrontal cortex can be thought of as our “brake system” when it comes to determining if something is a threat

      • When we decide something that we originally thought is a threat is no longer a threat, the prefrontal cortex is at work

  • Those suffering from PTSD have an underactive prefrontal cortex

  • An underactive prefrontal cortex often presents symptoms similar to an overactive amygdala:

    • Causes conflict in determining actual threats

    • Often results in high anxiety and trauma responses such as being on-edge, unprovoked fear reactions, anxiety related to trauma, etc.

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Brief summary

  • PTSD alters the structure of our brain. With treatment, these altered brain structures can be reversed over time.

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Personal Success Story: My Story of Survival: Battling PTSD

*Trigger warning – the story below mentions sexual and physical assault, please read with discretion*

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It is a continuous challenge living with posttraumatic stress disorder (PTSD), and I've suffered from it for most of my life. I can look back now and gently laugh at all the people who thought I had the perfect life. I was young, beautiful, and talented, but unbeknownst to them, I was terrorized by an undiagnosed debilitating mental illness.

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Having been properly diagnosed with PTSD at age 35, I know that there is not one aspect of my life that has gone untouched by this mental illness. My PTSD was triggered by several traumas, including a childhood laced with physical, mental, and sexual abuse, as well as an attack at knifepoint that left me thinking I would die. I would never be the same after that attack. For me there was no safe place in the world, not even my home. I went to the police and filed a report. Rape counselors came to see me while I was in the hospital, but I declined their help, convinced that I didn't need it. This would be the most damaging decision of my life.

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For months after the attack, I couldn't close my eyes without envisioning the face of my attacker. I suffered horrific flashbacks and nightmares. For four years after the attack, I was unable to sleep alone in my house. I obsessively checked windows, doors, and locks. By age 17, I'd suffered my first panic attack. Soon I became unable to leave my apartment for weeks at a time, ending my modeling career abruptly. This just became a way of life. Years passed when I had few or no symptoms at all, and I led what I thought was a fairly normal life, just thinking I had a "panic problem."

Then another traumatic event re-triggered the PTSD. It was as if the past had evaporated, and I was back in the place of my attack, only now I had uncontrollable thoughts of someone entering my house and harming my daughter. I saw violent images every time I closed my eyes. I lost all ability to concentrate or even complete simple tasks. Normally social, I stopped trying to make friends or get involved in my community. I often felt disoriented, forgetting where, or who, I was. I would panic on the freeway and became unable to drive, again ending a career. I felt as if I had completely lost my mind. For a time, I managed to keep it together on the outside, but then I became unable to leave my house again.

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Around this time, I was diagnosed with PTSD. I cannot express to you the enormous relief I felt when I discovered my condition was real and treatable. I felt safe for the first time in 32 years. Taking medication and undergoing behavioral therapy marked the turning point in my regaining control of my life I’m rebuilding a satisfying career as an artist, and I am enjoying my life. The world is new to me and not limited by the restrictive vision of anxiety. It amazes me to think back to what my life was like only a year ago, and just how far I've come.

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For me there is no cure, no final healing. But there are things I can do to ensure that I never have to suffer as I did before being diagnosed with PTSD. I'm no longer at the mercy of my disorder and I would not be here today had I not had the proper diagnosis and treatment. The most important thing to know is that it's never too late to seek help.

 

Retrieved from: https://adaa.org/living-with-anxiety/personal-stories/my-story-survival-battling-ptsd

 

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Crisis Resources:

  • NAMI HelpLine

  • NAMI Crisis Text Line

    • Text NAMI to 741-741

  • COPE (Hennepin County)

    • Adult: 612-596-1223

    • Child: 612-348-2233

  • Ramsey County

    • Adult: 651-266-7900

    • Child: 651-266-7878

  • Text Connect (Crisis counseling via text)

    • Text “HOME” to 741741

 

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References

 

American Psychological Association. (n.d.). Post-traumatic stress disorder.

https://www.apa.org/topics/ptsd

 

Brain line. (n.d.). Interactive brain.

https://www.brainline.org/tbi-basics/interactive-   brain?gclid=EAIaIQobChMInt25k7Ln-AIVlbfICh3q-AlOEAAYAyAAEgL_jvD_BwE

 

Bremner JD. Traumatic stress: effects on the brain. Dialogues Clin Neurosci. 2006;8(4):445-61. doi:10.31887/DCNS.2006.8.4/jbremner. PMID: 17290802; PMCID: PMC3181836.

 

Bremner J. D. (2007). Neuroimaging in posttraumatic stress disorder and other stress-related

disorders. Neuroimaging clinics of North America, 17(4), 523–ix. https://doi.org/10.1016/j.nic.2007.07.003

 

Finch, J. (2019). How do I know if I’ve been affected by trauma? Centre for Clinical Psychology.

https://ccp.net.au/how-do-i-know-if-ive-been-affected-by-trauma/

 

GoodTherapy. (2018). Accelerated Resolution Therapy (ART). https://www.goodtherapy.org/learn-

about-therapy/types/accelerated-resolution-therapy 

 

Greenberg, M. (2018, September 25). Why women have higher rates of PTSD than men. Psychology Today. https://www.psychologytoday.com/us/blog/the-mindful-self-express/201809/why-women-have-higher-rates-ptsd-men

 

Leonard, J. (2020). What is Trauma? What to know. MedicalNewsToday.

https://www.medicalnewstoday.com/articles/trauma  

 

Logue MW, van Rooij SJH, Dennis EL, Davis SL, Hayes JP, Stevens JS, Densmore M, Haswell CC, Ipser J, Koch SBJ, Korgaonkar M, Lebois LAM, Peverill M, Baker JT, Boedhoe PSW, Frijling JL, Gruber SA, Harpaz-Rotem I, Jahanshad N, Koopowitz S, Levy I, Nawijn L, O'Connor L, Olff M, Salat DH, Sheridan MA, Spielberg JM, van Zuiden M, Winternitz SR, Wolff JD, Wolf EJ, Wang X, Wrocklage K, Abdallah CG, Bryant RA, Geuze E, Jovanovic T, Kaufman ML, King AP, Krystal JH, Lagopoulos J, Bennett M, Lanius R, Liberzon I, McGlinchey RE, McLaughlin KA, Milberg WP, Miller MW, Ressler KJ, Veltman DJ, Stein DJ, Thomaes K, Thompson PM, Morey RA. Smaller Hippocampal Volume in Posttraumatic Stress Disorder: A Multisite ENIGMA-PGC Study: Subcortical Volumetry Results From Posttraumatic Stress Disorder Consortia. Biol Psychiatry. 2018 Feb 1;83(3):244-253. doi: 10.1016/j.biopsych.2017.09.006. Epub 2017 Sep 20. PMID: 29217296; PMCID: PMC5951719.

 

National Center for PTSD. (2022). PTSD Treatment Basics. U.S. Department of Veterans Affairs.

https://www.ptsd.va.gov/understand_tx/tx_basics.asp

 

National Institute of Mental Health. (n.d.). Post-traumatic stress disorder.

https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-            

ptsd#:~:text=Women%20are%20more%20likely%20to,member%20experiences%20danger%20or%20harm. 

 

MedlinePlus. (n.d.). Post-traumatic stress disorder. U.S. National Library of Medicine (NIH).

https://medlineplus.gov/posttraumaticstressdisorder.html

 

Psychiatric Times. (2003, February 1). Combined therapy shows promise for PTSD. Psychiatric Times Vol. 20(2). https://www.psychiatrictimes.com/view/combined-therapy-shows-promise-ptsd

 

Thew, J. (2020, July 10). COVID-19 Creates vicarious trauma among healthcare workforce. Health Leaders. https://www.healthleadersmedia.com/nursing/covid-19-creates-vicarious-trauma-among-healthcare-workforce

 

Uniformed Services University of the Health Sciences. (2019). How PTSD affects the brain. Brainline. https://www.brainline.org/article/how-ptsd-affects-brain

 

United Brain Association. (2022). PTSD Brain Science. https://unitedbrainassociation.org/brain-

resources/ptsd/?gclid=CjwKCAjwyryUBhBSEiwAGN5OCDizwmQJr6GstmPsYuY-o3YSxQLJlkG8qaTtjNQGGWgQFIy1yJhdFRoCYesQAvD_BwE    

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