Permanent Effects PTSD Has on the Brain

Post-traumatic stress disorder is a disorder characterized by the inability to fully recover

mentally after experiencing or witnessing a traumatic event (Lillis, 2018). When this disorder

was known exclusively as a military disorder, much of the public assumed their situation was

witnessing the drastic amount of death or tragedy such as their teammates getting injured as a result of bomb explosions or injury to themselves, but there is much more than just those few examples (Lillis, 2018). Post-traumatic stress disorder became more known during the Vietnam War era due in part to the severity of the war, the mass number of soldiers that had similar symptoms, and the increased suicide rate (Lillis, 2018). Researchers and historians began analyzing what each of these soldiers had in common aside from being in the war, thus including life experiences and/or experiences while deployed (Shen, 2019). In addition to the common discoveries, the results showed that many of the soldiers felt the weight of the world on their shoulders, the gravity of the situation for which they are responsible, encountering hostages as well as they themselves becoming taken hostage, and false hope (Shen, 2019). In addition, when looking back to previous wars and interviewing some veterans who served in World War II and the Korean War, researchers saw a history of a similar trend that was overlooked until then (Lillis, 2018). This went back further than what many people realized and perhaps could have saved many soldiers from suicide or lifelong psychological pain (Lillis, 2018). The number of veterans with post-traumatic stress disorder that went undiagnosed for decades were staggering (Shen, 2019).

Over time, the symptoms became more experienced by civilians in addition to military

personnel (Jubb, 2017). Through research and communication, it was found that civilians

experienced or witnessed death or great bodily injury to the same severity as those in the service (Jubb, 2017). This new information led to the conclusion that this disorder is more expansive than what professionals actually and previously thought. As the field of psychology started to expand in terms of an increase in research, specificity, and adage of diagnoses, it has become a more popular subject to study. Students started exploring this field while offered and taught in high school class settings and continued post high school. The world improved in erasing mental health stigmas and accepting mental diversity. Society became more aware, sympathetic, and accepting of people who have been through difficult circumstances (Jubb, 2017). Simultaneously, the world has evolved in the last fifty years or even the last decade whereby there has been an up-surge in the four major categories but are not limited to those conditions that contribute to post-traumatic stress disorder: military, crime, vehicular accidents, and natural disasters. Military PTSD experiences are witnessing or experiencing the following: IED explosions, shootings, becoming prisoners of war.

Next, crime involves rape, abuses, violence, mass shootings, and kidnapping. Deaths

and/or severe physical injury regarding vehicular accidents contribute to PTSD. Examples of

natural disasters are earthquakes, tornadoes, hurricanes, flooding, and most recently tsunamis where damage occurs to houses, property, and causes physical harm. All the above contribute to the causation of the increase rate of this diagnosis (Lillis, 2018). The rates of post-traumatic stress disorder have drastically increased over the last several years, due to the increase in crime and in conjunction with the lack of people willing to be treated or seek medical treatment for their physical and mental conditions after any of these traumatic events (Engle, 2022). There is a commonality between which traumatic events have been occurring more often based on criminal and police records on the community, county, state levels (Engle, 2022). For the victims who were willing to seek medical treatment immediately post traumatic event and continued followed up care for years, they have discovered that seeking and receiving one or both psychological and/or medical treatment has significantly lessened the effects of impairment and permanent damage to the clients (Engle, 2022). In comparison to those who were affected by a traumatic event and did not seek any medical professional for years to psychological impairment (Engle, 2022). However, there was actual brain damage in one of two possible areas of the brain, the hippocampus and/or the amygdala which therefore causes and effects that part of the brain’s function (Engle, 2022). Further studies are still being conducted to determine how it is possible for this to occur when there was no traumatic brain injury. Most of the long-term damage of post-traumatic stress disorder can be avoided by obtaining immediate treatment. (Lillis, 2019).

One of the most common traumatic events that occurs more often than what is recorded is

physical or sexual abuse (Engle, 2022). This includes anything from domestic abuse to

harassment or anything of a threatening nature to rape. This sort of abuse leads many of the

victims to not only develop medical issues but also moderate to severe long term psychological impairment (Engle, 2022). Many of the people who are affected by a situation like this not only develop anxiety, stress, and/or depression but as well as developing fears and trust issues toward other people affecting relationships of all kinds such as personal, romantic, professionally, among others (Engle, 2022). The reason why abuse affects the victim in a psychological way is because trust issues develop which often comes with comorbidities like anxiety and depression when similar situations arise due to the infringement of privacy, violation, and lack of respect for others (Engle, 2022). This is often seen in greater statistics if left untreated. While in most cases, this is usually an isolated incident, however, one said event can evoke a response that is forever impactful in the victim’s life (Engle, 2022). The data collected shows that these individuals significantly benefit from treatment at an early-stage post event and can go on to live a normal, unaffected life (Engle, 2022). There can be triggers that occur throughout life that are reminders of that event such as physical and/or unwanted touching, vocal volume, intimacy, or partner isolation.

Automobile accidents are another frequent traumatic event that is a common root cause of post-traumatic stress disorder (Sessa, 2017). Regardless of how severe the accident was, if you were the passenger, the driver, the one that caused the accident, or the one on the receiving end of the accident, this is a traumatic event for everyone involved and can certainly affect one’s thoughts towards driving or being a passenger in a car for a very long-time post event (Sessa, 2017). Many people who have sought any form of treatment following a car accident have been reluctant to get back into a vehicle. For the driver, getting behind the wheel following an accident, it is difficult since it is a constant reminder (Sessa, 2017). Studies, however, have shown that with the assistance of therapy and taking small steps towards getting back in a car again at the preferred pace of the individual, this is possible (Sessa, 2017). Individuals who were affected by this traumatic event do realize as time progresses from the accident that there is a necessity to get back into a vehicle for logistics purposes of daily living (Sessa, 2017). Fear, panic, depression, and anxiety are just a few of the common psychological disturbances that have been reported (Sessa, 2017). Furthermore, the symptoms are common in the minor cases of automobile related accidents post-traumatic stress disorder (Lillis, 2018). There were reports of traumatic brain injuries, severe anxiety, depression, leading to suicidal thoughts and actions as well as physical injuries in more severe cases (Sessa, 2017). Physical injuries, described as a broken bone, chronic pain, the need for surgery, and a scar from stitches are permanent reminders that can trigger emotional, psychological, and physiological responses that can spark an episode of anxiety, depression, and panic from simply looking at something as minimal as a scar (Sessa, 2017). Since everyone uses a vehicle as a mode of transportation at a minimum of

once a day; getting in a car is a trigger that needs to be able to be managed so it is a not constant negative, emotional reinforcer of emotions (Lillis, 2018).

Society has their own beliefs and thoughts about the laws related to vehicle safety, i.e.,

the effectiveness of seatbelts and the question as to the prevention of or injury in emergency

situations and secondly, should helmets be required when riding on a motorcycle are a few of the debates circulating (Lillis, 2018). These are common, current debates that are occurring in the public about safety on the road that can also be triggers to individuals following accidents (Lillis, 2018). The severe nature of this could lead to suicidal actions or thoughts because of the violent nature of this experience. The loss of a family member or friend is a void that can never be filled (Lillis, 2018). By losing someone in a traumatic way who happened to be traveling in the same vehicle can be quite traumatic and influence other areas of your life (Sessa, 2017). The results showed that while taking everything into consideration, therapy and medication are still the most common treatments with high success rates (Sessa, 2017).

As one can see from the previous mentioned scenarios, psychological impairment is almost inevitable in every traumatic event that one experiences to some degree or another

(Dobryakov, 2012). To skeptics, it is difficult for them to understand how one can experience

anxiety about a car accident and how or why that anxiety carries over into other unrelated areas of that person’s life that has nothing to do with the incident at hand (Dobryakov, 2012). There are several reasons why this occurs. First, the anxiety is probably not properly managed or overseen by a medical professional (Sessa, 2017). That could include anything from regular therapy sessions with a therapist, taking medication to help control it, or not having the appropriate coping skills to manage how it effects one’s daily life (Dobrayakov, 2012). The other reason why it could start effecting other areas of their life is because anxiety is oftentimes used as a defense mechanism that the individual uses to protect himself and his emotions from the anticipation of further disaster, trauma, and surprise (Dobrayakov, 2012). In some ways, anxiety could be triggered by a fight or flight response. For example, if someone were to mention a triggering word relating to a car, accident, or anything along those lines, or if you were re-exposed to a similar environment, those could trigger a fight or flight response igniting anxiety or other feelings of psychological distress (Dobrayakov, 2012). As one becomes comfortable with this, they tend to use this in other areas of their life without consciously knowing what they are doing (Sessa, 2017).

Memory was a common theme throughout all literature used in this thesis (Friedman, 2018). A frequent symptom or complaint that many therapists encounter during their therapy sessions when treating clients with post-traumatic stress disorder is either an observation and/or the client voluntarily expressing how their memory seems to be affected by the traumatic event they were a part of (Friedman, 2018). First, it is not uncommon for one’s memory of the specific details of the event to be a bit cloudy or distorted (Dolcos, 2013). When someone witnesses or experiences a tragedy, usually once that individual has time to collect or process their thoughts post event, they will start to remember more details about what happened (Friedman, 2018). This is due in part to a few factors (Dolcos, 2013). Traumatic events like these that cause post-traumatic stress disorder to occur at a fast pace but usually only last a few minutes at most, thus causing the victim to disengage, omit actions or not clearly remember the series of events that occurred (Friedman, 2018). It is not until the victim has had a chance to regain their composure that they realize what has happened and perhaps have some blank pieces of time in between certain memories (Dolcos, 2013). This can be due in part to our innate fight or flight response or what many people know as survival mode kicking in where they are just trying to make it through the event (Friedman, 2018). In addition, studies show that selective memory, suppression of thoughts, or blocking out of certain memories are also typical innate responses that our physical or mental status may not allow one to remember the actual incident to protect

themself (Friedman, 2018). It should not seep over into other areas of your life despite the above statement (Dolcos, 2013). For example, it would not be uncommon for pieces of the tragedy to be repressed when retelling the story or series of events. In most cases, the pieces will come back over time (Friedman, 2018). Should the memory loss start effecting other areas of one’s life such as personal and professional, then it could indicate a more serious problem like brain damage (Friedman, 2018).

Traumatic memories are difficult to overcome to some degree (Dolcos, 2013). As much as you prepare yourself or train your brain to combat the memories when they appear, it is easy

to let them overwhelm you (Friedman, 2018). Due to how difficult this is, people often suppress the memory or cope in unhealthy ways as a quick way to ease the mental pain (Friedman, 2018). Unhealthy ways include but are not limited to using substances like alcohol and drugs of any kind, self-harming, restricted eating, smoking, among others (Dolcos, 2013). Many who employ any of these self-destructive methods think that these tactics will only be done on a “once-and-done” basis or occasionally. Unfortunately, anxiety, depression, and stress are persistent feelings that occur often and therefore the thought to be rare usage quickly becomes an addiction (Friedman, 2018). Avoidance is a temporary solution that becomes permanent overtime because it is the most comfortable coping mechanism for the people who have sought this self-medicating option (Dolcos, 2013). However, the patient may see some relief from using methods like these, but they do not overcome these feelings on a long-term time basis (Friedman, 2018). Using substances are sometimes viewed as buying time mentally, nonetheless, it easily becomes a habit to reduce the amount of stress and anxiety of anticipation that is difficult to break the longer these habits are followed (Dolcos, 2013). The hippocampus is the part of the brain responsible for memory and since brain damage is a commonality with severe cases of post-traumatic stress disorder, the ability to sustain memory is likely altered (Dolcos, 2013). This could be seen by a lack of memory about specific topics, short-term, long-term memories, or overall memory can be altered (Friedman, 2018). If one has a lack of memory from the traumatic event, some people feel like that is a good defect because it should help relieve some of the negative feelings (Freidman, 2018). For many, this would be looked at as indirectly positive so they would not

have to relive the tragedy. It is possible to presume that the memory is also affecting other areas of their life, thus changing that opinion (Friedman, 2018).

Studies showed that someone with post-traumatic stress disorder can have brain damage in the hippocampus and amygdala without having a traumatic brain injury or suffering a head

injury (Friedman, 2018). The hippocampus’s main functions are, responsible for memory, the

other function is learning. In correlation with the hippocampus, the amygdala is known for

processing and sending signals to respond to fear and threatening stimuli (Dolcos, 2013). This includes anything that is fearful to each individual and what one person may consider a fear may not be thought of the same by another (Friedman, 2018). One or both areas of the brain can receive damage which would alter anything in the realm of one’s memory, increase fear, and heighten a psychological response (Dolcos, 2013). Damage to those areas of the brain does not mean that there is no function at all but rather altered functions that could result in confusion rather than no memory at all or changes in fear as opposed to no fear at all (Dolcos, 2013). Researchers and medical professionals have ongoing studies to determine how this type of brain damage occurs with post-traumatic stress disorder and why those two areas of the brain seem to be the most targeted with no history of trauma to the head (Dolcos, 2013).

Even though impaired memory is an unknowingly common side effect from a traumatic

experience, it is very common to have memories from the event come back to one’s mind or be triggered by other stimuli randomly throughout one’s day to day life (Yusufi, 2021). Memories from the traumatic event can be shown in various forms at spontaneous moments. With post-traumatic stress disorder, flashbacks and night terrors are familiar feelings for the patients (Apperle, 2018). While flashbacks can occur at any time in a day, the time that many people find themselves in the most distress is at night, lying in bed, when the mind is at rest and not functioning at its peak as it does throughout the day (Yusufi, 2021). We dream during REM sleep and night terrors that are somewhat like flashbacks which are seen during this time (Aupperle, 2018). Flashbacks are vivid memories of the traumatic event that the individual experienced and can be triggered by small daily occurrences such as the popping noises from a firecracker or fireworks. They can spark memories of guns firing or a smell that could remind one of gun powder among others mental images (Yusufi, 2021). It is very difficult to bring these symptoms under control, especially when one refuses to receive immediate medical and/or psychological attention (Yusufi, 2021). The longer the symptoms go untreated, the more difficult it is to remedy them due to the controlling nature of the feelings which often leads one down a path of depression and suicide (Aupperle, 2018). The psychological toll that these aggressive symptoms take on the patient become permanent over time and especially if left untreated (Yusufi, 2021).

Substance abuse is often used as a coping mechanism for post-traumatic stress disorder

for a variety of reasons (Najavitis, 2012). This can be an issue prior to the onset of this disorder and becomes more common when individuals try to self-medicate themselves with abusing substances like alcohol, tobacco, and drugs (Shen, 2019). For the individuals who do not want to seek help or do not realize they have an issue, they take matters into their own hands by abusing unhealthy methods that appeal to them in efforts of feeling mentally better (Najavitis, 2012). It has been proven that this leads to the usage of those substances in larger quantities and more frequently as one becomes dependent on it (Shen, 2019). If the individual was not previously pre-supposed to abusing substances, it is also very common for clients who see psychiatrists and are prescribed medications to abuse them in efforts of having a quicker relief (Najavitis, 2012). Unintentional overdoses occur because humans are overall impatient and naturally want to feel relief quickly when experiencing pain (Shen, 2019). Many have the pre-conceived thought that by taking more than the recommended dose of medication seems to help alleviate symptoms faster. Not only is this not the case but contributes to permanent damage in the brain and other organs in the body (Najavitis, 2012).

In severe cases of post-traumatic stress disorder when clients have brain damage in the

hippocampus and amygdala regions, stimulation is a great option under the advisement of their doctor (Lillis, 2015). Coping mechanisms are viable techniques that are easy to teach your clients how to use them in moments of urgency (Lillis, 2015). Upon initial approach, these methods may sound insignificant or something that is geared towards children however, usually any age is receptive to most of these methods being that people tend to want that instant gratification (Ullman, 2015). Studies have shown that it is beneficial to constantly adapt and change coping mechanisms from time to time when clients may notice that they are no longer as effective as they were initially (Lillis, 2018). It is not uncommon for a client to become immune to certain therapies once the novelty wears off (Ullman, 2015). Switching it up or providing clients with a few or multiple options to use allows them to see if one works better in one area versus another (Lillis, 2018). A goal of many of the therapists is to provide their clients with ways that they can become aware of their triggers, feelings, and as a result, they can de-escalate themselves when they are in certain situations (Lillis, 2018). Assisting the client in ways to help them realize their own mental health tendencies as opposed to telling them the answer is beneficial for them. It affords them the opportunity to become aware of their body and what messages it is giving off both of which is key in counseling (Lillis, 2018). The end goal of this treatment is that the individual can successfully re-enter the once traumatic situation and be able to work through the emotions to complete the task as they once did (Lillis, 2018).