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Post-Traumatic Stress Disorder

When we remember the brain’s and body’s chemical reactions to stress and threat, the symptoms of PTSD make perfect sense:

  • Hyperarousal, hypervigilance, irritability, difficulty concentrating, and difficulty sleeping are all natural functions of a sympathetic stress system that has learned to stay on alert and in “overdrive,” even when there is no immediate sign of threat (LeDoux, 1996). 
  • Exaggerated startle responses, the “kindling” of strong emotional reactions under minimal stress, inappropriate anger, and rage all seem absolutely necessary to an amygdala that considers itself always in danger and responsible for protection against all threats, seen and unseen (LeDoux, 1996).
  • Intrusive memories, nightmares, and flashbacks (experiencing the traumatic event as if it is happening now) are the amygdala’s unconscious memory fragments jumping to the surface.  At first they may be triggered by sights, sounds, smells, emotions, etc. that remind the primitive amygdala of its own “memory bites.”  But over time, they may not need any outside triggers, as the stress system itself becomes a trigger (van der Kolk, 1994).
  • Loss of conscious memory of intense past experiences, and problems forming new memories in the present, are natural results of the ways in which the dissociative parasympathetic chemicals (particularly cortisol and endorphins) interfere with the ability of the hippocampus to store and retrieve conscious memories (van der Kolk, 1994).
  • The senses of numbing, detachment, shutting down, boredom, loss of hope, loss of energy, and loss of motivation are also functions of the high levels of parasympathetic “slow down, numb out” chemicals (van der Kolk and Fisler, 1995).
  • Avoidance of things that remind one of the trauma is both a function of the high levels of parasympathetic chemicals and a logical response to the fact that these things are likely to trigger challenging sympathetic chemical reactions (van der Kolk and Fisler, 1995).

View the Diagnostic Criteris for Post-Traumatic Stress Disorder

Commonly reported sleep disturbances among people with PTSD include trouble falling asleep, restless sleep, thrashing around, frequent awakening (with trouble falling back asleep), short duration of sleep, daytime fatigue, night terrors (screaming or shaking during sleep), and nightmares and anxiety dreams.  Level of combat exposure has also been associated with the frequency of nightmares and mildly associated with difficulty falling asleep (Pillar, Malhotra, and Lavie, 2000).

These effects are all products of learning processes that were associated with survival, and so have become “hard wired” into the brain.  The prefrontal cortex can learn to calm, soothe, reason with, and “turn off” some of these functions—and can learn to understand, accept, and manage the rest (Siegal, 1999).  But it is not simply a question of realizing one is wrong and making a decision not to have these symptoms.  It takes work, support, and time to “re-program” the stress systems.

Next: Substance Use Disorders


The material on all of the Clinical Pages is taken directly from the draft version of Finding Balance After the War Zone:  Considerations in the Treatment of Post-Deployment Stress Effects, a manual under development for the Great Lakes Addiction Technology Transfer Center and Human Priorities.  This draft is copyright © 2008, Pamela Woll.  Reprint permission is universally granted, but attribution is requested.
Click here for References and Other Resources.
Click here to link to a PDF file of the current version of the clinician’s manual draft.
Click here to link to a PDF file of the accompanying booklet for veterans.

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