Introduction and Background
In modern society there should be no place for Post-Traumatic Stress Disorder (PTSD). But here we are, seemingly surrounded by it. At this moment there is around a quarter of a billion people suffering from some form of PTSD in the world. Indeed, there are different levels of this illness, however everyone with PTSD suffers. Whether it be a product of war, sexual harassment, a natural disaster, or any traumatic experience, PTSD takes a hold of its victims and becomes a second shadow.
There are five main types of PTSD: normal stress response, acute stress disorder, uncomplicated PTSD, comorbid PTSD, and complex PTSD. However, there are four distinct behavioural symptoms that also accompany it. They are described as: re-experiencing, avoidance, negative cognitions and mood, and arousal.
Re-experiencing covers spontaneous memories of the traumatic event, recurrent dreams related to it, flashbacks or other intense or prolonged psychological distress.
Avoidance refers to distressing memories, thoughts, feelings or external reminders of the event.
Negative cognitions and mood represents myriad feelings, from a persistent and distorted sense of blame of self or others, to estrangement from others or diminished interest in activities, to an inability to remember key aspects of the event.
Finally, arousal is marked by aggressive, reckless or self-destructive behaviour, sleep disturbances, and hypervigilance.
Alongside these behavioural symptoms and different types of PTSD, there are also many ways that it can develop. Some types of events that could lead to the illness are: serious accidents, physical or sexual assault, any form of abuse, war and conflict, and serious underlying health issues. Furthermore, to solidify these facts, PTSD develops in about one in three people who experience any type of severe trauma, however it is not fully understood why some people develop the condition while others do not, but certain factors appear to make some people more vulnerable than others. If you have had depression or anxiety in the past, or do not receive much support from family and friends, you’re more susceptible to developing PTSD after any traumatic event. There may also be a genetic factor involved. For example, having a parent with any mental health problem is thought to increase the chances of also developing it.
In addition, there are some suggestions that the symptoms of PTSD are the result of an instinctive mechanism intended to help you survive further traumatic experiences.
For example, the flashbacks many people experience may force them to think about the event in detail so they’re better prepared if it happens again.
But while these responses may be intended to help them survive, they’re actually very unhelpful in reality because it is virtually impossible to process and move on from the traumatic experience.
PTSD and the brain
In order to fully understand how PTSD affects the body, we firstly need to look at the anatomy of it. The brain is what is mostly affected, so this is what I am going to focus on.
When a traumatic event occurs, the amygdala sends out a danger signal, which gives the body a rush of adrenaline. It therefore initiates what is known as the ‘flight or fight’ response. This is when the body’s sympathetic nervous system is activated due to the sudden release of hormones. Your breathing becomes quicker, as well as your heartbeat and your entire body becomes tense and ready for action. This is why, when angry, you clench your fists, it is the body’s natural reaction in preparing for a fight. Furthermore, the amygdala stores stimuli associated with memory such as sights, sounds and smells. It produces calming thoughts when the brain is certain there is no longer danger. In addition to this, there are some very clear signs and symptoms of when the Amygdala has been affected by trauma, including Hypervigilance (a state of anxiety), and the exaggerated tendency to be easily startled. Therefore, the Amygdala is known as the brain’s stress elevator and decides when to react, so when a person develops PTSD, either as a result of a single or repeated events, the Amygdala stores the sights, sounds and smells associated with the event(s). If one or more of these stimuli are encountered, the Amygdala will trigger a danger signal and prepare the body for what it believes may come.
This part of the brain is similar to the Amygdala, however, whereas the Amygdala stores senses associated with a certain event, the Hippocampus plays an important role in the consolidation of that certain event, in the short or long-term memory. When PTSD begins to become a burden on someone’s life, the Hippocampus has a central role in the re-experiencing of the traumatic event. A traumatic memory could be involuntarily retrieved when triggered by a stimulus. These memories tend to be very strong, and the hippocampus seems to be overreactive in those with PTSD. This combination makes it easy for these memories to be brought to the forefront both during times of wakefulness (a flashback) or sleep (a nightmare). Impaired sleep with frequent nightmares is among the most common and frustrating symptoms reported by people with the illness. The reason for this is because the Hippocampus is unable to calm down the amygdala because the danger perceived is real.
In the brain there are two Hippocampus. These are on the opposite sides of the brain, and together are known as the Hippocampi. Researchers have found that people who have severe chronic cases of PTSD have smaller hippocampi. This indicates that experiencing ongoing stress as a result of severe and chronic PTSD may ultimately damage both the Hippocampus, making them smaller. This process is called ‘Atrophy’. It is not only PTSD that can cause certain parts of the brain to shrink. Atrophy has long been associated with Alzheimer’s and has also been linked recently with obesity. Both these conditions are associated as abnormal shrinking of the brain naturally causes partial memory loss. Obesity alters the normal aging process by speeding it up, and the brain naturally shrinks with age, so obesity causes a rapid decrease in the size of the brain. Alzheimer’s disease more commonly affects the elderly as their brain has already shrunk in size. As neurons are injured and die throughout the brain, connections between networks of neurons may break down, and many brain regions begin to shrink. By the final stages of Alzheimer’s, atrophy is widespread, causing significant loss of brain volume and therefore memory. This is also why the symptoms of Alzheimer’s and PTSD can be very similar. For example, severe confusion and disorientation are common symptoms in any case involving damage to the brain, especially in the two cases mentioned above.
The Prefrontal Cortex
The Prefrontal Cortex lies directly behind the forehead within the frontal lobes, and controls behaviour, emotions, and impulse. After a traumatic event occurs, the prefrontal cortex should relay to the Amygdala when it is ok to calm down once the danger has dissipated. When affected by PTSD, the Prefrontal Cortex is less active, which likely correlates with symptoms of social withdrawal, the avoidance of any reminders of the trauma, and emotional numbing. Therefore, the Prefrontal Cortex is unable to override the Hippocampus, which therefore means that it cannot signal to the Amygdala that there is no real danger.
Traumatic events can be very difficult to come to terms with, but confronting the feelings and seeking professional help is often the only way of effectively treating PTSD. It is possible for it to be successfully treated many years after the traumatic event or events occurred, which means it’s never too late to seek help.
Before having treatment for PTSD, a detailed assessment of symptoms will be carried out to ensure treatment is tailored to individual needs.
GPs often carry out an initial assessment prior to referring patients to a mental health specialist for further assessment and treatment if symptoms of PTSD have been present for more than four weeks or if the symptoms are severe. There are also a number of mental health specialists available, such as a psychologist, community psychiatric nurse or psychiatrist.
There are some people who experience mild symptoms of PTSD but can get better within a few weeks without treatment. However this is usually quite rare, and people who experience this are considered very lucky.
For those not considered to be one of the ‘Lucky ones’, and for whom treatment is necessary, psychological therapies are recommended first. A combination of a psychological therapy and medication may be recommended for severe or persistent PTSD.
There are also many benefits from exercise and nature. When doing exercise the body releases endorphins, which interact with the opiate receptors in the brain to reduce our perception of pain. Just being in the fresh air can be very therapeutic, and outdoor exercise can also be prescribed as treatment.
Finally, group therapy is also a highly recommended form of treatment. Many people with the condition find it helpful to speak about their experiences with other people who also have PTSD. Group therapy can help to find ways to manage the symptoms and understand it. There are also a number of charities that provide counselling and support groups.
Antidepressants such as paroxetine, sertraline, mirtazapine or phenelzine, are sometimes used to treat PTSD in adults. Of these medications, only paroxetine and sertraline are licensed specifically for the treatment of PTSD. However mirtazapine, amitriptyline and phenelzine have also been found to be effective.
Antidepressants are not usually prescribed to anyone under the age of eighteen unless recommended by a specialist.
Although so many forms of treatment are available, those with PTSD cannot be fully cured. Of course, it can be managed so it becomes easier to live with, but once it has developed, it does not go away. Doctors and scientists are still working incredibly hard to understand the full effect of the condition, and to try and develop a cure for
This is why I understand how seriously PTSD is treated. If it continues to be treated effectively and efficiently. Then I believe the rate of suicides would drop significantly, as many people who commit suicide have underlying mental health issues; including PTSD. The depression and anxiety that people feel can be treated if found early. Now, as depression is the reason for most suicidal thoughts ( source – Psychology Today), if treatment is more widely available to everyone who actually need it, then more antidepressants can be legitimately prescribed, therefore less people suffering with depression, and less suicide attempts. However antidepressants can become very addictive, so the doctors can’t prescribe the drugs unless they are actually needed, and will benefit the patient. They have to be sure that the patients have the mental strength to withhold from getting addicted. If too many pills are taken they can become the exact opposite of what they are made to do.
PTSD: Examples in modern life
I’d like to talk about a man called Daniel Biddle. Mr Biddle is the most seriously injured survivor from the terrorist attacks in London on the 7th July 2005. As a result of that day, Daniel suffered horrific life-changing injuries including the loss of both his legs, his left eye, his spleen, and a catalogue of other life-threatening injuries.
Standing just two feet away from the suicide bomber, he has a very clear recollection of everything that happened, from the moment the bomb went off, to the horrific aftermath whilst trapped in the London underground tunnel of Edgware road.
At hospital he suffered three cardiac arrests, and was pronounced dead each time. He was in surgery for 19 hours on the first day, spent 51 weeks in hospital, and underwent a total of 60 operations. He was also told multiple times that he may not survive. Since that day, he has suffered from extremely severe complex Post Traumatic Stress Disorder. Daniel once said “The physical injuries are a lot harder to deal with than the mental trauma. I suffer from complex-post-traumatic stress disorder, which has resulted in three suicide attempts.”
After nine years of being haunted by the bombing, Daniels’s PTSD treatment was not helping him anymore. So he made a conscious decision to return to the same place in the same tunnel where the bomb had gone off. This helped him immensely, and after this he did not feel as shackled by it anymore. For him, it was a moment of closure.
His complex PTSD, affects him in many ways. He has explained that wherever he goes, he sees the bomber, seconds before detonating the bomb; almost like a ghost. Furthermore, his 3 suicide attempts do not make him different to many others suffering from severe complex PTSD, as regular suicidal feelings are not uncommon in people with the condition. This does not take away from the fact that this is still extremely worrying. In addition, Mr Biddle was having flashbacks multiple times each day. They would involve him being back on that train, the aftermath of the bombing, and any trauma in the past. The reason he was getting flashbacks from previous trauma was because his hippocampus had been severely damaged in the bombing, therefore any stimuli that related even slightly to the bombing, would be pounced upon and hie would therefore re-experience any traumatic event from the past. This furthered the depression and anxiety that Daniel had to face. While dealing with his PTSD, he had many nervous breakdowns, which were results of the lack of support and understanding from people around him.
Although we will never understand the severity of everything Daniel has had to endure for the past 15 years, we can sympathise with him, as there are many others going through exactly what he is.
As Daniel Biddle is one of the most extreme cases of PTSD and other mental and physical injuries, I’d like to also consider something completely different to what he faced.
On 11th March the World Health Organisation (WHO) declared COVID-19 ( a mutated form of the common coronavirus) a pandemic. It has hit with such force, that we are beginning to forget what life was like before it. This is because, as of 23rd March, we have been in lockdown, confined to our homes, and only allowed to leave for essentials such as: basic necessities such as food and medication, 1 form of exercise per day, and to commute to work if we cannot work from home.
Whereas Dan Biddle’s experience was so violently horrific, COVID-19 is horrific in a different way. It has become an invisible enemy, maybe more dangerous than any bomb could ever be. It has spread across the world extremely efficiently, working it’s way through person after person. Healthcare services in all countries affected are at breaking point, with too many patients to deal with and an immense number of deaths. In the UK, NHS staff on the front line fighting the pandemic have been informed that there is a high risk of them developing anxiety, burnout, or PTSD.
The British Psychological Society have said that psychological first aid should be provided as the UK runs the risk of a “future mental health crisis”.
In a letter, MP’s call for management in front-line organisations to put in place preventative measures such as: regular breaks, encouraging people to look after themselves, and to tell people that it is “OK to not be OK”.
Front-line staff in the coronavirus crisis are routinely exposed to events the general population would never encounter – loss of patients, illness and death of colleagues, extremely high levels of stress, lack of resources to treat patients, having to make choices about not treating some patients and increased exposure to the virus themselves. The trauma that these brave men and women may be experiencing can leave some with insomnia, disorientation, a sense of guilt, or even physical symptoms like shaking, headache, loss of appetite and aches and pains. Many of these symptoms above could see a deterioration of their physical and mental health, with some developing anxiety or PTSD.
If sufferers felt at ease talking about their troubles early on, then there would be less people having to go through the pain of PTSD and other mental illness. Because of the COVID-19 outbreak, a £5 million grant has also been made available to mental health charities to fund additional services for people struggling, to help prevent them from even getting close to developing some sort of mental illness.
Dr Andrew Molodynski, a consultant psychiatrist and mental health lead for the British Medical Association, has said: “Health workers are used to seeing death, but we aren’t used to seeing lots and lots of people die when we can’t do anything about it. That will cause a lot of symptoms of anxiety, depression and trauma. I’m already seeing that in my hospital – staff are anxious and some are already off work because of the impact that has had on their mental health”.
This quote alone shows how not so dissimilar the COVID-19 pandemic and the 7/7 bombings were to people’s mental health. They both have had such an effect but just in different ways. Yes, a bombing can force terror into people’s hearts, but so can a virus; an invisible assassin.
So to finish, I’d like to refer back to the question at hand. ‘What are the effects of PTSD, and can it be treated?’
PTSD can have multiple effects on the brain, body, and social life. All this however stems from one thing, trauma. In short, PTSD develops after an experience that traumatised someone, shattering their mental health. Furthermore, as a modern day society, if people felt comfortable talking about their emotions, then we would begin to take control of PTSD, rather than it controlling us. This would solidify the fact that PTSD should have no place in our society today.