The psychology of posttraumatic stress disorder Joelle Rabow Maletis
Many of us will experience some kind
of trauma during our lifetime.
Sometimes, we escape
with no long-term effects.
But for millions of us,
those experiences linger,
causing symptoms like flashbacks,
nightmares,
and negative thoughts
that interfere with everyday life.
This phenomenon,
called post-traumatic stress disorder,
or PTSD,
isn’t a personal failing;
rather, it’s a treatable malfunction
of certain biological mechanisms
that allow us to cope
with dangerous experiences.
To understand PTSD,
we first need to understand how the brain
processes a wide range of ordeals,
including the death of a loved one,
domestic violence,
injury or illness,
abuse,
rape,
war,
car accidents,
and natural disasters.
These events can bring on feelings
of danger and helplessness,
which activate the brain’s alarm system,
known as
the “fight-flight-freeze” response.
When this alarm sounds,
the hypothalamic, pituitary,
and adrenal systems,
known as the HPA axis,
work together to send signals
to the autonomic nervous system.
That’s the network that communicates
with adrenal glands and internal organs
to help regulate functions like
heart rate,
digestion, and respiration.
These signals start a chemical cascade
that floods the body with several
different stress hormones,
causing physiological changes
that prepare the body to defend itself.
Our heart rate speeds up,
breathing quickens,
and muscles tense.
Even after a crisis is over,
escalated levels of stress hormones
may last for days,
contributing to jittery feelings,
nightmares,
and other symptoms.
For most people, these experiences
disappear within a few days to two weeks
as their hormone levels stabilize.
But a small percentage of those
who experience trauma
have persistent problems
—sometimes vanishing temporarily
only to resurface months later.
We don’t completely understand
what’s happening in the brain,
but one theory is that
the stress hormone cortisol
may be continuously activating
the “fight-flight-freeze” response
while reducing overall brain functioning,
leading to a number of negative symptoms.
These symptoms often fall
into four categories:
intrusive thoughts,
like dreams and flashbacks,
avoiding reminders of the trauma,
negative thoughts and feelings,
like fear, anger, and guilt,
and “reactive” symptoms like irritability
and difficulty sleeping.
Not everyone has all these symptoms,
or experiences them to the same extent
and intensity.
When problems last more than a month,
PTSD is often diagnosed.
Genetics,
on-going overwhelming stress,
and many risk factors
like preexisting mental illnesses
or lack of emotional support,
likely play a role in determining
who will experience PTSD.
But the underlying cause
is still a medical mystery.
A major challenge of coping
with PTSD is sensitivity to triggers,
physical and emotional stimuli
that the brain associates
with the original trauma.
These can be everyday sensations
that aren’t inherently dangerous
but prompt powerful physical
and emotional reactions.
For example, the smell of a campfire
could evoke the memory of being trapped
in a burning house.
For someone with PTSD,
that memory activates the same
neurochemical cascade
as the original event.
That then stirs up the same feelings
of panic and helplessness
as if they’re experiencing
the trauma all over again.
Trying to avoid these triggers,
which are sometimes unpredictable,
can lead to isolation.
That can leave people feeling invalidated,
ignored,
or misunderstood,
like a pause button has been
pushed on their lives
while the rest of the world
continues around them.
But, there are options.
If you think you might
be suffering from PTSD,
the first step is an evaluation
with a mental health professional
who can direct you towards
the many resources available.
Psychotherapy can
be very effective for PTSD,
helping patients better
understand their triggers.
And certain medications
can make symptoms more manageable,
as can self- care practices,
like mindfulness and regular exercise.
What if you notice signs of PTSD
in a friend or family member?
Social support, acceptance, and
empathy are key to helping and recovery.
Let them know you believe their
account of what they’re experiencing,
and that you don’t blame them
for their reactions.
If they’re open to it,
encourage them to seek evaluation
and treatment.
PTSD has been called “the hidden wound”
because it comes
without outward physical signs.
But even if it’s an invisible disorder,
it doesn’t have to be a silent one.