by Kassandra Lamb
There are still some aspects of PTSD that we psychologists can’t fully explain, but there’s a lot that we do now understand. And our more recent discoveries about the brain, that offer those explanations, give me confidence that someday we will have all the explanations.
Here’s a short list of the most common symptoms of Post-Traumatic Stress Disorder:
- Experienced an event that involved a significant threat to the physical integrity of self or others.
- Recurrent and intrusive thoughts or images of the event and/or flashbacks (acting or feeling as if the event was reoccurring).
- Recurrent nightmares, insomnia.
- Intense distress and physiological arousal when exposed to internal or external cues (triggers) that symbolize or resemble some aspect of the event; avoidance of those triggers.
- Anxiety attacks and/or outbursts of anger.
- Hypervigilance and exaggerated startle response.
- Depression and/or irritability (an early symptom of mild to moderate depression).
- Difficulty concentrating, memory problems.
- Numbing of feelings and/or general responsiveness.
- Inability to recall important aspects of the event (dissociative amnesia).
- Feelings of detachment or estrangement from others.
PTSD is the only psychological disorder in the Diagnostic and Statistical Manual (the bible of mental health professionals) where the cause of the disorder is listed as one of its criteria for diagnosis. The person has to experience a traumatic event, and it’s not hard to figure out how something that overwhelming would cause intrusive thoughts, flashbacks and nightmares.
But why #4 and #5? Why such an intense physical and emotional reaction to some minor reminder, that can even lead to a full-blown anxiety attack? Let me repeat the definition of trauma from a previous post: an event so emotionally overwhelming that it cannot be processed emotionally or cognitively at the time that it happens.
The emotions of that event have not yet been processed. They’re stored in the brain in their raw and still quite intense form.
Also, think back to last week’s post about where things are stored in the brain and what parts of the brain are and are not easily accessed consciously. Negative emotions, mental images, and learned associations are all stored in relatively inaccessible places–in either the right hemisphere of the cerebral cortex or the cerebellum.
So it’s difficult sometimes to intentionally bring these memories and emotions back into conscious awareness so that they can be processed and put to rest. But because of learned associations with those “internal and external cues,” it’s all too easy for the intense emotions from the traumatic event to get triggered in day-to-day life.
How does this work? Let me give you an example.
One of my clients experienced a trauma during her childhood while she was standing across the room from a large fan. (For the sake of confidentiality, I won’t go into details.) Later in adulthood, she became phobic of fans. Whenever she saw a moving fan blade, she would have a full-blown, run-screaming-from-the-room anxiety attack. But she had no idea consciously why she had these attacks over something as dumb as a fan (The fan itself had nothing to do with the traumatic event; it was just present in the room.)
The memory of trauma was stored–as images and raw emotions–in her right hemisphere. The learned association (classical conditioning a la Pavlov’s slobbering dogs) between the sight of that fan and those intense emotions was stored in her cerebellum.
The neural impulses that were triggered whenever she saw a fan would look like a big V on the right side of her brain–the image of the fan in the here and now is processed in the right hemisphere, the neural impulse zips down and back to her cerebellum to the learned association, then is flung back up to the right hemisphere to stir up that old memory and its associated feelings.
Voila, anxiety attack. And with little or no awareness in the conscious mind of what was going on (because it tends to be focused mostly on left hemisphere activity, i.e. verbal thoughts).
Intense anger can also occur with PTSD. This anger is a leftover feeling from the traumatic event. Whenever we feel threatened, anger is part of our response, even if it is trumped by fear at the time. Later, when we are once again in a safe environment, that anger can surface. And it can come out in ways that make it appear (even to the person feeling it) to be about here-and-now events, when it’s really about the past. This can be very destructive to relationships.
I think #6 and #7 are fairly self-explanatory. If something really scary has taken you by surprise in the past, you’re likely to be more on guard all the time, and startle more easily. And struggling with all this would certainly be depressing.
Up to this point, we have been talking about the intrusive symptoms of PTSD–the ways that this disorder intrudes into and disrupts the person’s life. Numbers 8 through 11 refer to the dissociative symptoms.
The human psyche, like the rest of our internal systems, is designed to help us survive. If something is too emotionally overwhelming, the psyche strives to block it out of awareness.
It may do this by suppressing the feelings, but often it’s not able to just suppress the specific feelings related to the trauma. So all feelings become numbed out to some degree. In the extreme, all or part of the memory of the event may be blocked out. But again this blocking of memory may be more generalized, making it hard to concentrate and remember things in general.
I’ve had several clients who had memory and/or concentration problems that interfered with their schoolwork or jobs. But once certain traumatic events (that their minds were working overtime to suppress) had been processed, they rather suddenly went from C to A students or could now easily remember things (like people’s names) that they’d had great difficulty with in the past.
(Note: How the mind blocks out feelings and/or memories is one of those things we don’t yet have an explanation for, but lots of scientific research confirms that this does happen.)
Sometimes that numbing of feelings makes it hard for the person to connect with others. Also, the experiences they’ve had may leave them feeling irrevocably different from most people. Group therapy and support groups are particularly helpful for this symptom, as well as the others.
Besides group support, the most effective therapies for PTSD are the ones that help the person finally process the memories and feelings related to the trauma. Depending on the trauma (and the therapeutic approach used), this can take some time, and it can be painful to relive those feelings. But releasing the emotional charge on those events and putting their meaning into perspective allows the person to move from trauma survivor to getting on with living and thriving.
And here’s an interesting tidbit from the scientific research. In last week’s post, I talked about how memories are stored where they are first processed. Research has found that traumatic memories are stored in the cerebral cortex right next to the emotional parts of the brain (called the limbic system). But after therapy, when those memories have been re-processed, they are now stored further out in the cerebral cortex, away from the emotional limbic system. Concrete proof that the feelings have truly been discharged and the experience of that memory has been changed!
Any thoughts on all this? Do you know someone who suffers from PTSD, or have you struggled with this disorder?
PTSD is on my mind these days because of my new series, About a young woman who trains service dogs for PTSD sufferers. Please take a moment to check out Book 1 in the series, To Kill A Labrador.
Posted by Kassandra Lamb. Kassandra is a retired psychotherapist turned mystery writer. She is the author of the Kate Huntington psychological suspense series, set in her native Maryland, and a new series, the Marcia Banks and Buddy cozy mysteries, set in Central Florida.
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