What's in a name? Everything.
"Shell shocked". That is what PTSD was called after World War II and after the Korean War.
We now realize PTSD occurs after any severe traumatic event, accident or emotional stress both acute and chronic.
The symptoms of PTSD are typically categorized into four main clusters:
1. Re-experiencing Symptoms: These symptoms involve reliving the traumatic event, often through distressing memories, nightmares, or flashbacks. Individuals with PTSD may experience intense emotional or physical reactions when reminded of the trauma.
2. Avoidance Symptoms: People with PTSD may try to avoid reminders of the traumatic event. This can include avoiding specific places, people, activities, or even thoughts and feelings associated with the trauma. They might also have a reduced interest in activities they once enjoyed.
3. Negative Changes in Mood and Thoughts: PTSD can lead to significant changes in a person's thoughts and feelings. They may experience persistent negative emotions, such as fear, guilt, or shame. They might have trouble recalling specific aspects of the traumatic event, feel detached from others, or have difficulty experiencing positive emotions.
4. Arousal and Reactivity Symptoms: These symptoms involve heightened arousal and reactivity, such as irritability, anger outbursts, difficulty sleeping, and being easily startled. Individuals with PTSD may also struggle with concentration and may become hypervigilant or overly alert to potential threats.
The American Psychiatric Association (APA) added PTSD — coined in 1980 for severe, trauma-related symptoms among veterans of military engagement — to the third edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM).
While the recognition was monumentally important then, a strong case can be made to think and talk differently about the condition today. More than 40 years later, it’s clear that a shift from “disorder” to “injury” is necessary, if not overdue.
Post-Traumatic Stress Disorder (PTSD) is a complex mental health condition that can have various biochemical effects on the body. While I can provide some insights, please keep in mind that our understanding of the precise biochemical mechanisms of PTSD is still evolving. Here are some key biochemical effects and factors associated with PTSD:
PTSD or PTSI has associated biochemical dysfunction as well with the following features.
The technology can now detect physical changes in the brain following post-traumatic stress (PTS), but it was NOT available in 1980. These changes may include alterations in neural connectivity, activation patterns, or even structural changes in specific brain regions.
While it is understood, and even accepted, that terminology and conceptual frameworks within medicine often require time to adapt and incorporate advancements, like the ones mentioned above, the time has come to change the current classification/diagnosis of PTSD to PTSI. The once “invisible“ wounds of brain injury following psychological trauma can now be
1. **Hypothalamic-Pituitary-Adrenal (HPA) Axis Dysregulation:** One of the most well-documented biochemical effects of PTSD is the dysregulation of the HPA axis. This system controls the body's stress response. In individuals with PTSD, there can be alterations in the levels of stress hormones such as cortisol. Some may have elevated cortisol levels, while others may have reduced sensitivity to cortisol.
2. **Neurotransmitter Imbalances:** PTSD has been associated with disruptions in neurotransmitters, which are chemical messengers in the brain. There can be alterations in serotonin, norepinephrine, and dopamine levels. These imbalances can contribute to mood disturbances, anxiety, and other symptoms of PTSD.
3. **Inflammatory Response:** Chronic stress, which is often a part of PTSD, can lead to chronic inflammation in the body. Inflammation is associated with various physical and mental health issues. Elevated levels of inflammatory markers, such as C-reactive protein (CRP), have been observed in some individuals with PTSD.
4. **Alterations in Brain Structure and Function:** Neuroimaging studies have shown that PTSD can lead to changes in the structure and function of the brain. The amygdala, which plays a crucial role in the processing of emotions, can become hyperactive, leading to heightened emotional responses. Conversely, the prefrontal cortex, involved in emotional regulation, may show decreased activity.
5. **Epigenetic Changes:** There is emerging research suggesting that trauma, including that which leads to PTSD, can induce epigenetic changes. These changes can affect gene expression and may be passed down through generations. Epigenetic modifications can play a role in the long-lasting nature of PTSD symptoms.
6. **Sleep Disturbances:** Many individuals with PTSD experience sleep disturbances, which can further exacerbate biochemical imbalances. Sleep disruption can impact neurotransmitter function, stress hormone levels, and overall well-being.
7. **Altered Immune Function:** Prolonged stress associated with PTSD can weaken the immune system, making individuals more susceptible to infections and other health issues.
It's important to note that not all individuals with PTSD will experience the same biochemical effects, and there is significant variability in how PTSD manifests. Additionally, the relationship between biochemical changes and the development or persistence of PTSD is complex and not fully understood.
Treatment for PTSD often involves a combination of psychotherapy, medication (such as antidepressants or anti-anxiety drugs), and lifestyle changes to address these biochemical imbalances and their associated symptoms. Early intervention and a comprehensive approach to treatment are key to helping individuals with PTSD manage their condition and improve their overall well-being.
observed in the brains of people diagnosed with post-traumatic stress and, thus, should be considered “injured.”
The efficacy of diagnostic imaging, and the importance of its role in determining treatment for the injured, should not be ignored when considering the effects — and the survivors — of severe trauma. The current model of a “disorder” does not consider the latest, widely accepted neuroscience developments and, thus, renders the “D” in PTSD to be clearly outdated, from a scientific perspective.
The use of brain scans to diagnose PTS has proved inconclusive, yet there is abundant evidence for changes in the structure and function of different areas of the brain involved in fear response and anxiety, regulation of emotions, cognitive processing, and memory. For example, Michael T. Alkire, M.D. — featured in a 60 Minutes segment about the use of SGB to treat PTSD — has demonstrated over-activation of the amygdala in patients with PTS as far back as 2015 in his work for VA Long Beach Healthcare System.
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