PTSD
What is Post-Traumatic Stress Disorder?
Post-traumatic stress disorder, or PTSD, is a severe form of anxiety and panic disorder. It can occur in those who have either witnessed or suffered through a traumatic event. Individuals living with PTSD often experience intrusive, intense, and disturbing thoughts related to their trauma. When a PTSD event is triggered, debilitating panic attacks are common. These are often so severe that sufferers remake their entire lives in ways to avoid triggers. This leads to limited activity, impaired job performance, and negative impacts on relationships.
How Common is Post Traumatic Stress Disorder?
According to the National Alliance on Mental Illness, 3.6% of adult Americans live with PTSD. Women are two times as likely to develop PTSD than men. Roughly 37% of people diagnosed with PTSD suffer from severe symptoms (1).
What Causes Post-Traumatic Stress Disorder?
PTSD is directly related to exposure to trauma. Exposure to trauma itself is not sufficient to cause the condition, as PTSD sufferers make up a relatively small percentage of people that have experienced trauma. There does appear to be a genetic predisposition towards PTSD. A 2017 Harvard study demonstrated that 20% of the risk of developing PTSD is related to genetic factors (2).When trauma is experienced in childhood, the likelihood of developing PTSD increases. Studies of ACEs (adverse childhood experiences) show significantly increased risks of developing mental health problems later in life, including PTSD among others (3).
What are the Symptoms of Post-Traumatic Stress Disorder?
Symptoms of PTSD generally involve the following:
Re-experiencing symptoms can include flashbacks, intrusive thoughts, recurrent nightmares, and negative memories associated with the traumatic event.
Avoidance becomes a common strategy, as sufferers become aware of their triggers and take steps to prevent exposure. This withdrawal strategy can lead to a profound negative impact on quality of life.
Cognitive and mood symptoms include depression, anxiety, feeling emotionally numb, memory impairment, difficulty with concentration, and a sensation of unreality known as derealization. These often lead to a progressive loss of self-esteem.
Arousal symptoms include agitation and hypervigilance. The increased sympathetic nervous system activity seen in PTSD leads to elevated startle responses, enhanced “fight or flight” reflexes, poor sleep, and an impaired ability to relax. The inability to control strong negative emotions is common, often leading to outbursts of anger and rage (1)
Intense and disturbing thoughts or feelings that are related to a traumatic experience can last longer than the event itself did. The traumatic incident may be experienced again through flashbacks or nightmares for those with PTSD. This can also bring on feelings of sadness, fear, anger, and detachment. Being sensitive to sound or touch and having strong negative responses to them may also be signs of PTSD.
What are the Consequences of Post-Traumatic Stress Disorder?
It is estimated that up to 80% of PTSD patients have a comorbid disorder, with the most common comorbidities being depression, anxiety, alcohol addiction, and substance abuse.
Hypertension, and insomnia are common comorbid disorders. Neurocognitive disorders also frequently accompany PTSD. Chronic migraines, back pain, stomach aches, and body pain are all extremely common with PTSD. nPTSD has been associated with bone and joint disease, neurological conditions, cardiovascular conditions, respiratory conditions, and metabolic diseases.
What Happens in the Brain with Post Traumatic Stress Disorder?
There are a number of critical brain circuits involved in the development of PTSD. The amygdala functions as the brain’s threat detector, and ascribes an emotional valence to all forms of experience. The amygdala has direct connections to the midbrain reticular activating system, which excites the frontal lobe for brain arousal. The prefrontal cortex is involved in cognition, executive function, emotional regulation and goal-oriented behavior. It gives rise to the ventral frontostriatal circuit, which helps to modulate the emotional structures of the brain.
The prefrontal cortex has been shown to have decreased blood flow in PTSD, and thus decreased function. This leads to a loss of the ability to regulate stress responses, and decreased capacity to shut off the anterior cingulate cortex. The ACC has been shown to increase activity in PTSD, resulting unfortunately in profound, unmodulated suffering (4).
The ultimate consequence of all of this is increased output of the hypothalamic-pituitary axis. This results in elevated levels of circulating stress hormones such as cortisol and adrenaline, and all of the negative consequences associated with these. Increased cortisol has been shown to lead to weight gain, depression and anxiety. It has also been demonstrated to lead to greater degeneration of the hippocampus and prefrontal cortex, making the problem progressively worse over time. Research implies that PTSD may involve permanent sensitization of the HPA axis (5).
How is Post Traumatic Stress Disorder Usually Treated?
Common treatments for PTSD include therapy, medications, group therapy, acupuncture, and animal-assisted therapy (7). These can be successful to one degree or another in managing the symptoms of PTSD, but they do little to ameliorate the underlying problems creating the disorder.
TMS Treatment
Forms of neurostimulation have been shown to be effective for the treatment of PTSD. Transcranial Magnetic Stimulation is one such therapy, where an MRI-strength magnet is used to apply a focused beam of electromagnetic energy through the skull and directly to the prefrontal cortex. This treatment is safe, comfortable, with minimal rare side effects. More importantly, it is extremely effective for restoring normal function of the prefrontal and frontostriatal circuits involved in PTSD, as current literature demonstrates (6).
Your Next Best Step:
Living with PTSD is extraordinarily challenging, but there is hope for recovery and freedom from this condition. To see if TMS is right for you, contact our front desk and schedule a free consultation with Shauna Hahn, PMHNP.
And remember, it’s never too late to start getting better.
References:
1. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Posttraumatic-Stress-Disorder
2. https://www.nature.com/articles/mp201777
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860395/
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6695947/
5. https://pubmed.ncbi.nlm.nih.gov/23786690/