Let me just start by saying:
PTSD is a natural response to trauma,
just as bleeding is a normal response to being stabbed.
This is a vital point actually. So often we feel like we are going crazy and some people feel a sense of shame for developing PTSD. Would you feel that same sense of shame for bleeding, though? Or breaking a leg? Same difference. This is the result of your experiences, it says nothing about you other than that you are a survivor.
In an episode of the Pint-Sized Healing Podcast, I reflected on some of the misinformation that floats around about PTSD.
I concluded that:
- PTSD does not only affect veterans
- PTSD isn’t just in your head
- PTSD is not a sign of weakness
So, now that we know what PTSD isn’t, let’s dive into what it is.
How PTSD Develops
When most people experience something traumatic, they experience what is known as an acute stress reaction. A normal, knee-jerk reaction to a shocking event. A lot of people have an acute stress reaction and then they get over it. They normalize again. Everything gets back into perspective. For sufferers of PTSD, this doesn’t happen, and the acute stress reaction develops into PTSD.
“PTSD: It’s not the person refusing to let go of the past, but the past refusing to let go of the person.”
– From HealthyPlace.com
It is important to understand that PTSD doesn’t just show up one day. It actually evolves and develops (click to tweet). It’s not an illness, it’s a psychiatric injury, and it evolves from something else. What we see in the healthcare literature, in particular, all the research, is that someone might have an acute stress reaction—or Acute Stress Disorder (those are used interchangeably), and if it’s extended longer than one month and it has certain specific characteristics, then it can be considered a new diagnosis of Post-Traumatic Stress Disorder.
What Is PTSD Exactly
You may think of PTSD as an emotional disorder, but it really isn’t. PTSD is a physical alteration of the brain, and actually influences the way it functions.
“When a trauma occurs, the reptilian brain takes over. This is the brain stem or the earliest developed part. It kicks in the “fight or flight” response. All nonessential body and mind functions shut down. When the threat ceases, the parasympathetic nervous system down-shifts and resumes those higher functions. For 20% of survivors, after effects remain, what we know as PTSD. The organ being plastic, trauma fundamentally changes how it operates” (from Been Traumatized? Here’s How PTSD Rewires the Brain on Big Think).
The remark that the brain is plastic refers to the phenomenon of neuroplasticity. This explains how our brain is able to adjust, create and cut of neuropathways in a response to our learning and experiences. This is an amazing ability, and it helps us to be adaptive.
“[Neuroplasticity] refers to the physiological changes in the brain that happen as the result of our interactions with our environment. From the time the brain begins to develop in utero until the day we die, the connections among the cells in our brains reorganize in response to our changing needs. This dynamic process allows us to learn from and adapt to different experiences.” – Celeste Campbell (n.d.).
Now, if our brain reacts to what is happening around us, and what we learn (whether true or false), it makes sense that changes occur when we are exposed to trauma. Especially, recurring and extended trauma as is often the case in abuse situations.
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How PTSD Rewires The Brain
Psychology Today describes three ways in which the traumatized brain looks different from a non-traumatized brain:
#1. – The Thinking Center Is Under-Activated
The constantly elevated level of stress hormones the trauma triggered impacts our ability to create the very neuropathways that our brain needs to make in order to heal itself. This is also a reason why -as a PTSD patient- you may struggle to remember things. Not just about the traumatic past, but in the present too.
Because the area where memories are made, the hippocampus, is so profoundly impacted by trauma it becomes difficult for PTSD sufferers to tell the difference between past and present. So, since the body is unable to determine whether the threat has passed or is ongoing, it remains in hypervigilant mode, which in turn keeps those stress hormone levels elevated. It is like the brain has gotten stuck in a survival mode feedback loop (click to tweet).
#2. – The Emotion Regulation Center Is Under-Activated
The ventromedial prefrontal cortex (vmPFC) is the area of the brain that controls how we respond to our emotions. Big Think explains that “with a limited vmPFC, victims find it harder to contain themselves or control behavior.” When we add to that the fact that the amygdala, the emotional center of the brain, is over-activated, it makes a lot of sense that PTSD patients feel utterly overwhelmed by their emotions, and can be at a loss about how to regain control of their bodies and minds.
#3. – Fear Center Is Over-Activated
As quickly mentioned above, the amygdala –the part of the brain that creates our emotions- is overstimulated. All the stress hormones that our body is creating in response to the traumatic events, kick that baby into overdrive and keep us in a state of fear.
Fear generally manifests in one of two ways. Most well-known is hypervigilance, or the fight or flight response. This may cause us to respond overly aggressive or intensely to situations in our present. Brainworks also defines another way in which our brain may respond to trauma:
“When a threat is utterly overwhelming and too much for the fight/flight system to cope with, the brain goes into a ‘Freeze’ state; a numbing or collapse response. This sort of trauma is experienced as a general shutdown, lack of vitality, emotional separation and detachment.”
This response to trauma is also known as disassociation and is quite a common symptom of PTSD.
What Are The Symptoms of PTSD?
What we may conclude from the above, is that –when we suffer from PTSD- our brain has gotten stuck on survival setting. Our nervous system is stuck in high gear, even if the stressful situation has long since passed (click to tweet).
So, how does all that manifest in our lives? Here are some of the most common symptoms of PTSD:
- Intense feelings of distress when reminded of a tragic event
- Extreme physical reactions to reminders of trauma such as nausea, sweating or a pounding heart
- Invasive, upsetting memories of a tragedy
- Flashbacks (feeling like the trauma is happening again)
- Nightmares of either frightening things or of the event
- Loss of interest in life and daily activities
- Feeling emotionally numb and detached from other people
- Sense of a not leading a normal life (not having a positive outlook of your future)
- Avoiding certain activities, feelings, thoughts or places that remind you of the tragedy
- Difficulty remembering important aspects of a tragic event
(This list of symptoms is sourced from Signs and Symptoms of PTSD by The Oak’s Treatment)
“PTSD nightmares aren’t always exact replays of the event. Sometimes they replay the emotions you felt during the event, such as fear, helplessness, and sadness.”
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What About C-PTSD?
Trauma affects all of us differently. So if you have experienced trauma, you may or may not develop PTSD. One of the contributing factors may be that the abuse was, perhaps, not a single traumatic event as much as prolonged traumatizing experiences that can last many years.
Being consistently exposed to harm or abuse may lead us not only to develop PTSD but C-PTSD—or Complex Post Traumatic Stress Disorder.
“The “Complex” in Complex Post Traumatic Disorder describes how one layer after another of trauma can interact with [others]” describes Out Of the Fog. They go on to say: “People who suffer from C-PTSD may feel un-centered and shaky as if they are likely to have an embarrassing emotional breakdown or burst into tears at any moment. They may feel unloved – or that nothing they can accomplish is ever going to be “good enough” for others. […] People who suffer from C-PTSD may feel that everything is just about to go “out the window” and that they will not be able to handle even the simplest task. They may be too distracted by what is going on at home to focus on being successful at school or in the workplace.”
Complex-PTSD is especially common in survivors of abuse since it is often related to trauma that:
- Occurs at an early age
- Lasts for a long time
- That was hard or impossible to escape
- Is made up of multiple traumatic events
- Is caused by someone close to us
One of the telltale signs of C-PTSD is the occurrence of emotional flashbacks (click to tweet). Mind explains this as “hav[ing] intense feelings that you originally felt during the trauma, such as fear, shame, sadness or despair. You might react to events in the present as if they are causing these feelings, without realizing that you are having a flashback.”
Why Does PTSD Trigger Years Later?
Like I mentioned above, PTSD is a condition that evolves and develops. So, it is possible for symptoms to show up much later. This is called Delayed-Onset PTSD (click to tweet), and its exact causes are still being debated. Very Well Mind shares that some research suggests Delayed On-Set PTSD may occur when people “are experiencing some symptoms of PTSD, but not enough to meet criteria for a PTSD diagnosis (referred to as subthreshold PTSD) after a traumatic event.” Additionally, they explain that research suggests that life stressors or additional trauma, may trigger PTSD in response to a previous traumatic experience.
I couldn’t understand why I felt like my brain wasn’t functioning – I couldn’t remember things, I couldn’t process things. It was like my brain had just slowed down and ground to a halt.
I hope this exploration of PTSD was helpful to you. I know that, when I first started reading into PTSD, it really helped me to understand what was going on. That, in turn, helped me develop coping strategies and really brought home the point that:
You’re not crazy, it’s just your brain on PTSD