PTSD: POST TRAUMATIC STRESS DISORDER

PTSD (Post-Traumatic Stress Disorder) is defined by NIMH (National Institute for Mental Health) as: An anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat.

Medline writes: "Posttraumatic stress disorder (PTSD) is a highly disabling condition that is associated with intrusive recollections of a traumatic event, hyperarousal, avoidance of clues associated with the trauma, and psychological numbing. The field of neuroimaging has made tremendous advances in the past decade and has contributed greatly to our understanding of the physiology of fear and the pathophysiology of PTSD. Neuroimaging studies have demonstrated significant neurobiologic changes in PTSD. There appear to be 3 areas of the brain that are different in patients with PTSD compared with those in control subjects: the hippocampus, the amygdala, and the medial frontal cortex. The amygdala appears to be hyperreactive to trauma-related stimuli. The hallmark symptoms of PTSD, including exaggerated startle response and flashbacks, may be related to a failure of higher brain regions (i.e., the hippocampus and the medial frontal cortex) to dampen the exaggerated symptoms of arousal and distress that are mediated through the amygdala in response to reminders of the traumatic event. The findings of structural and functional neuroimaging studies of PTSD are reviewed as they relate to our current understanding of the pathophysiology of this disorder."

Having seen PTSD patients clinically, it has struck me that people are being treated much as a 'one size fits all'. Admittedly, I may not current with all the therapies being used but I have not heard that all patients are given brain imaging to find the extent of their brain changes through time. Nor am I aware that treatment programs are different as relates to the extent of those brain changes. It makes me question whether a Korean War or Viet Nam War veteran will have more brain change than a more recent veteran of Iraq, for example. Obviously there are physical and chemical brain changes that stress imposes on one's body. Stress hormones wreak their own havoc. The length of time they work on a brain and body must influence the degree of damage which is evidenced both physically and psychologically. Working with someone who has suffered the trauma many years ago is impressive in that logic plays little importance in the thought content of their view of the world and relationships around them. Assuming the singular, trauma, is even accurate. What about those individuals who suffered repeated traumas, many of different kinds of assaults, for years?

Much effort is being put into researching PTSD, especially since it is now being recognized in troops returning from the Middle East. We must not forget that years of incest or domestic physical or emotional abuse can produce all the same symptoms. It is a concern of mine that research is not focusing (at least that I am aware of) on the difference in treatment responses in those who are fairly new to PTSD versus those for whom it has been part of most their lives and resulted brain change. In treating patients, I have often seen that they cannot retain images or explanations that are different than those they have held for years. Their seriously damaged self-images, wounded egos and sense of worth, their feeling responsible for all that befell them, their total acceptance that nothing can change how feel, is all encompassing. Medication, psychotherapy, cognitive behavior therapy, patience, and new and positive life experiences are only part of the some of the treatments.

If I were given a single wish, it might be to see that PTSD research address the differences in PTSD patients...the length of suffering post-trauma, the nature of the trauma and its being taken as a reflection of some fault of the patient, the brain and hormonal changes, levels of neurotransmitters, memory loss (as well as repression and denial), coping mechanisms, and so much more. I would want to know if there are differences reflected by gender difference since chemistry is such a variable between them.

In a perfect world, some of these questions would be answered. But, alas, the world is not yet perfect.