Undoing the Adregenic Response to Treat PTSD

Post-traumatic stress disorder (PTSD) is a mental condition caused by a terrifying event. Usually seen in war veterans, this disorder can change anyone’s life forever. An individual will show generally four types of symptoms: intrusive memories, avoidance, negative changes in thinking and mood, or changes in emotional reactions. Intrusive memories consist of unwanted memories of the traumatic event such as flashbacks. Avoidance symptoms may include trying not thinking about the traumatic event. Negative changes in thinking and mood symptoms may include negative feelings about one’s self, lack of interests in activities one used to enjoy, and difficulty maintaining close relationships. Changes in emotional reaction symptoms may include angry

This paper explores post-traumatic stress and how it is seen as a disorder. Post-traumatic stress can manifest into post-traumatic stress disorder. According to Sareen (2014), Post-traumatic stress disorder is defined in the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5 as having 4 core features that are as follows. First, the person must witness or experience a stressful event. Secondly, the person or persons would re-experience symptoms of the event that include nightmares and/or flashbacks. The person or persons would also have hyper arousal symptoms, such as concentrations problems, irritability, and sleep disturbance. The final core feature dictates

At least 50% of all adults and children are exposed to a psychologically traumatic event (such as a life-threatening assault or accident, humanmade or natural disaster, or war). As many as 67% of trauma survivors experience lasting psychosocial impairment, including post-traumatic stress disorder (PTSD); panic, phobic, or generalized anxiety disorders; depression; or substance abuse.(Van der Kolk, et al, 1994) Symptoms of PTSD include persistent involuntary re-experiencing of traumatic distress, emotional numbing and detachment from other people, and hyperarousal (irritability, insomnia, fearfulness, nervous agitation). PTSD is linked to structural neurochemical changes in the central nervous system which may have a direct

Veterans suffering from PTSD are unable to integrate the memories of the trauma properly. Amnesia is likely to be caused by excessive norepinephrine (NE) or vasopressin release at the time of the trauma. Memories of the trauma can also be triggered by physiological arousal. They tend to relive the past and misinterpret innocuous stimuli as potential threats. They are also more sensitive to sounds. Neutralizing stimuli in the environment to attend to relevant tasks is very difficult. Instead they tend to shut down to compensate. This leads to decreased involvement in ordinary, everyday life (Van der Kolk, B., McFarlane, A., Weisaeth, L., 1996).

Post-Traumatic Stress Disorder (PTSD) is a psychiatric sequel to a stressful event or situation of an exceptionally threatening or catastrophic nature. It develops after a person is involved in a horrifying ordeal that involved physical maltreatment or the threat of physical harm. These events can include combat or military experience, abuse during childhood or adulthood (physical or sexual), terrorist attacks, serious accidents or natural disasters. This person may have been the one that was harmed, witnessed a harmful event or had a loved one who was harmed. It is normal for the body’s fight or flight mechanism to engage in times of danger. With a person who has PTSD, that mechanism is damaged and the person feels this even when they are not in danger. Symptoms can be categorized into four different areas – re-experiencing symptoms (flashbacks, bad dreams, frightening thoughts) , avoiding situations that remind the person of the event, negative changes in beliefs and feelings (may be fear, guilt, shame or losing interest in those activities that once were enjoyable) and hypervigilence (always feeling keyed up, trouble concentrating or sleeping). There are also feelings of hopelessness, despair, depression or anxiety, alcohol or substance abuse, physical symptoms or chronic pain and problems with employment and relationships.

PTSD can affect people in different ways due to the circumstance they went through, for example, “a young woman gets mugged and hit over the head with a pipe. Years later, she is still afraid to go out at night by herself. She has trouble making friends and she is slow to trust people. She has gotten several warnings at work for missing days; sometimes she just can’t seem to get out of bed. A former soldier, when he finally sleeps, finds himself back on the dusty roads of Afghanistan. He awakes in a panic and struggles futilely to return to sleep. Days are hardly better. The rumble of garbage trucks shatters his nerves. Flashbacks come unexpectedly, at the whiff of certain cleaning chemicals. He is imprisoned in his own mind” (Brainline,

(Rosenthal, J. Z., Grosswald, S., Ross, R., & Rosenthal, N. 2011) Veterans presenting with symptoms of PTSD will often engage in behaviors which can be dangerous for themselves, their families and socity. Lack of effective treatment can place the veteran at increased risk for drug and alcohol abuse or dependence, suicide ideations or attemps, and bouts violence toward others. (National Center for PTSD, 2010) PTSD can occur anytime anytime one has have been through the experience of a traumatic event. PTSD has been referred to by many names in past years such as post-combat disorders, shell shock, post-traumatic stress disorder, disordered or heavy heart, and war neurosis. In DSM-I PTSD was referred to as ‘‘gross stress reaction’’ this was the name of the diagnoises given to those individuals who had suffered combat exposure, and their minds had become psychologically altered. It was very helpful to have a name to the sympotms of military or civilian individual that had been exposed to combat exposure, ex-prisoners of war, and rape victims. This term had also been helpful in diagnosing Nazi Holocaust

What is PTSD? According to Goldenson, he defines Post-Traumatic Stress Disorder as “an anxiety disorder produced by an extremely stressful event(s) (e.g., assault, rape, military combat, death camp) and characterized by a number of adverse reactions: (a)re-experiencing the trauma in painful recollection or recurrent dreams; (b) diminished responsiveness (numbing), which disinterest in significant activities and with feeling of detachment and estrangement from others; and (c) symptoms such as exaggerating startle response, disturbed sleep, difficulty in concentrating or remembering, guilt about surviving when others did not, and avoidance of activates that call the traumatic event to mind” (as cited in Barnett, Miller-Perrin, & Perrin, 2011). Throughout the eras of war, we are seeing more reports of PTSD within the military. In

Throughout a lifetime, an individual is exposed to countless events that can impact their behavior and health in a noticeable way. A positive event, tends to arise happiness and contentment within the self and with those around. A negative event, on the other hand, most often produces fear, anxiety, or stress that could result in trauma. Although some individuals may show some resilience to these last events, failure to recover may result in Post Traumatic Stress Disorder (PTSD).

Post-traumatic stress disorder (PTSD) is a relatively new diagnosis that was associated with survivors of war when it was first introduced. Its diagnosis was met largely with skepticism and dismissal by the public of the validity of the illness. PTSD was only widely accepted when it was included as a diagnosis in 1980 in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) of the American Psychiatric Association. PTSD is a complex mental disorder that develops in response to exposure to a severe traumatic event that stems a cluster of symptoms. Being afflicted with the disorder is debilitating, disrupting an individual’s ability to function and perform the most basic tasks.

Individuals with PTSD persistently re-experience their traumatic event in their thoughts, perceptions, imagery, dreams, illusions, hallucinations, and flashbacks. They may experience intense physiological distress or reactivity to cues of the traumatic event. These individuals persistently avoid any stimuli associated with the traumatic event and use other mechanisms to cope with any situation or cue that recalls or contradicts their emotional or cognitive responses to the traumatic event (American Psychiatric Association [DSM-IV-TR], 2000). Individuals with PTSD also experience persistent symptoms of increased arousal, such as irritability and difficulty concentrating. These disturbances can cause significant distress in social life, the work place, and family systems. According to the American Psychiatric Association (DSM-IV-TR), in order for individuals to be diagnosed with PTSD they must experience disturbances and symptoms for more than one month (2000). Symptoms can be specified as acute (less than 3 months), chronic (3 months or more), or with delayed onset; in which onset starts 6 months after the actual stressor (DSM-IV-TR, 2000).

The amygdala is known to learn from exposure to fear and store assessment of threat–related stimuli. The prefrontal cortex is involved in extinction and the retention of fear and is connected to the amygdala. Finally, the hippocampus encodes the context during fear learning process and sends it to the amygdala. People with PTSD have hyper-activity in the amygdala, while having hypo-activity in the prefrontal cortex and there is reduction of the hippocampus volume. This reduction may limit proper evaluation and categorization of the experience. A study on Vietnam soldiers revealed that lesions in the amygdala and prefrontal cortex resulted in the absence of PTSD. To get further into the molecular level studies been done on the hormonal system. “Stress is known to contribute to the pathogenesis of a variety of disorders, including the majority of psychiatric like major depression and posttraumatic stress disorder.” (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3825244/pdf/DM30-02-343616.pdf). Research has revealed evidence that a hormonal system known as the hypothalamic-pituitary-adrenal (HPA) axis is the one that gets disrupted in people with PTSD. The hormonal system is involved in normal stress reactions, so the disruption of this system in people with PTSD creates this “false alarm”. It has been suggested by some scientist that the dysfunction of the HPA system results in hippocampal damage in people with PTSD. Damage in the hormones is caused by damage to

Seedat explains that “the disorder represents a pathological response to a traumatic event, characterized by symptoms of recurrent and intrusive distressing recollections of the event (e.g. nightmares, a sense of reliving the experience with illusions, hallucinations, or dissociative flashback episodes, intense psychological or physiological distress at exposure to cues that resemble the traumatic event)” (Seedat, 2013). Seedat also states that other symptoms could be such things as avoidance of stimuli associated with the trauma that you have experienced “(e.g. inability to recall important aspects of the trauma, loss of interest, estrangement from others)” (Seedat, 2013). Seedat mentions increased arousal as other PTSD symptom. This could include “(sleep disturbances, irritability, difficult concentrating, hypervigilance, and exaggerated startle response)” (Seedat, 2013). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) includes other symptoms that are characterized by cognition and mood of the individual. Seedat states that in order for an individual to be diagnosed

Experiencing past-life memories can result in behavioral problems, such as anger outbursts and phobias (Haraldsson, 2003). Especially the memory of dying, which is often under violent circumstances (e.g. accidents, war-related deaths, drowning, murder), when experienced repeatedly, may act as a stressor. In the ICD-10 the criteria for PTSD are: (i) the patient must have been exposed to a stressful event or situation of exceptionally threatening or catastrophic nature; (ii) there must be persistent remembering and “reliving” of the stressor in intrusive “flashbacks”, vivid memories; (iii) either inability to recall or persistent symptoms of increased psychological sensitivity and arousals shown by any two of the following: difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, hypervigilance, and exaggerated startled response. We could consider the memory of a violent death as the experience that caused PTSD symptoms. It is indisputable that dying in a violent way is a stressful event, so this corresponds to the first criterion.

Van der Kolk (1987) notes that human responses to trauma are relatively constant across various types of traumatic stimuli, where individuals have poor tolerance to arousal stimuli and may experience social and emotional withdrawal. These changes in the body’s arousal and perception prevent the continuance of “normal” life, and require help.