PTSD: Causes, Impacts, and Cures

PTSD occurs to people who are exposed to or witness death, serious injury or  sexual violence. It is more common in combat veterans who survive battle situations and first responders who see the remains of murders, fires, and fatal car wrecks, than in the general population. Among civilians the precipitating event is more likely to be a rape, car crash, natural disaster, school shooting or unexpected death of a loved one. Although prior trauma is not required to develop PTSD, a substantial number of people who do were abused or neglected as children. PTSD can only be diagnosed when a person has suffered the key symptoms for more than 30 days. Onset of PTSD symptoms can be delayed, sometimes for many months or even years when symptoms are triggered by a subsequent event. Diagnosis and treatment of PTSD is often delayed due to ignorance of symptoms, stigma and shame or fear of repercussions. 

PTSD is marked by a variety of highly distressing symptoms that impair normal daily functioning. The number one symptom among vets is insomnia – 98% of vets with PTSD have insomnia vs. 28% of vets without PTSD. Only 2% of people who experience or witness trauma develop PTSD. In the ones that do the brain itself is changed. The amygdala (the brain’s fear alarm that sets off fight/flight/freeze) becomes enlarged and hypersensitive so it evaluates safe situations as being dangerous ones. The hippocampus (the place where memories are imprinted and stored) shrinks and malfunctions leaving the survivor unable to remember some key details of his trauma and more likely to remember the parts that place him at fault rather than the parts that would excuse or mitigate his conduct. The frontal lobes (the part of the brain that acts as a brake against irrational or excessive fear) is rendered much less able to reduce the heightened fear signals of the amygdala. One of the worst set of symptoms are called intrusions. These are involuntary, unwanted, and highly distressing memories of the trauma that suddenly occur during the day, nightmares replaying the trauma that cause insomnia, and flashbacks in which the survivor is suddenly torn out of the present moment and plunged back to the past where he vividly relives the trauma as if was happening now. This is a form of dissociation because it detaches the survivor from reality and puts him in a situation that no longer exists except in his mind. Other symptoms of PTSD are also distressing and impairing.

Because memories, thoughts, and feelings related to the trauma are so terrible, survivors instinctively avoid them. Avoidance can occur through alcoholism, addiction, emotional repression or steering clear of the people, places, activities, objects, and situations that remind him of the trauma. Many survivors withdraw socially and isolate themselves from others. The avoidance mechanisms only serve to prolong PTSD symptoms and worsen them, which is why PTSD is called a condition of non-recovery. The difference between people who recover from trauma naturally and those who develop PTSD lies distorted cognitions and manufactured emotions. People who recover are able to understand that bad things happen to good people and they do not blame themselves for trauma beyond their control. They are also able to experience and discharge natural emotions such as fear, sadness or anger. The people who develop PTSD are convinced they caused and are responsible for a trauma beyond their control. Because of this they suffer from the manufactured emotions of shame and guilt which stem from the distorted cognitions. Examples of these are, “I’m a bad person,” “I’m a coward,” “I didn’t deserve to live,” “the world is dangerous and I’m not safe anywhere” or “I can’t trust anyone.” PTSD survivors cling so strongly to such beliefs they are called stuck points. Successful treatment requires helping the survivor to understand the origin of his stuck points, seeing the falsity of them, releasing them, and replacing them with rational, alternative thoughts.

Survivors also experience negative changes in mood and arousal. As for mood they are no longer able to experience positive emotions and lack the ability to experience interest in or take pleasure in normal activities. This leads to emotional flatness and detachment from others. Dark mood, depression, and insomnia are common. As for changes in arousal survivors tend to be hypervigilant, meaning they are always scanning for threats and cannot feel safe or comfortable. They tend to be over-reactive to sights, sounds, and smells that remind them of their trauma, and are easily startled. Heightened arousal can produce irritability, rage, and an urge to commit violence toward self (suicide) or others. Living with PTSD drives at least 17 and as many as 22 veterans to die by suicide every day. This is a preventable tragedy. On the plus side the Veterans’ Administration and Department of Defense are very aware of the situation and putting a great deal of energy, effort, and money into research and treatment. It is important to note that not everyone is happy with their performance. There are veterans, veteran advocates, politicians, journalists, physicians, and therapists who believe the VA and DOD could be doing a whole lot better. The fact that PTSD was not named, defined or first understood in a rudimentary way until 1980 means the mental health community has a lot of catching up to do.

Treatment for PTSD are of two kinds, evidence-based and non-evidence-based. Evidence-based treatments have been empirically validated as safe and effective by a large number of gold-standard research studies that are double-blinded, placebo controlled, and carried out by highly respected institutions such as university medical centers known for highest quality research. The VA and the DOD recognize two current forms of treatment as evidence-based. These are cognitive processing therapy (CPT) and prolonged exposure therapy. Studies show that 80 plus to 90 plus percent of people who complete a full course of these treatments no longer show symptoms of PTSD. I have been trained in CPT. On average people who never enter treatment tend to remain symptomatic for at least 64 months, and in some cases much longer. In 2012 I met a veteran who was 17 years old when he was at Pearl Harbor and had to scoop bodies out of the water and stack them onboard his ship. He had been having flashbacks and nightmares for 71 years! Non evidence-based treatments can also be helpful. These include supportive counseling, group therapy, breathwork, meditation, yoga, art therapy, and movement therapy. When all treatments fail to reduce symptoms some people with PTSD will try a Stellate Ganglion Block. This involves two injections of an anesthetic into nerve bundles at the base of the neck near the head of the first rib. The purpose is to reduce the activity of the sympathetic nervous system and flight/flight. SGBs are still being researched. Medical clinics using SGBs find they work for some people and not others.