How the Brain Is Physically Changed With PTSD | The Survival Doctor

Paratroopers from 3rd Platoon, Company B, 3rd Battalion, 509th Parachute Infantry Regiment, 4th Brigade Combat Team, 25th Infantry Division prepare to load a CH-47 Chinook Helicopter in the Bermel District of the Paktika province in eastern Afghanistan, Oct. 13, during an air-assault mission to detain a known militant. (Photo by U.S. Army Pfc. Andrya Hill, 4th Brigade Combat Team, 25th Infantry Division Public Affairs.)

by James Hubbard, MD, MPH

With Memorial Day just past, I thought I might write on a fairly common medical problem that affects many soldiers coming back from war: post-traumatic stress disorder (PTSD). The reason I find this appropriate for The Survival Doctor is soldiers are not the only ones who can be affected. This same disorder can hit anyone who has experienced a major trauma or trauma of a loved one.

Let me emphasize I do know that Memorial Day is meant to remember the men and women who have died in defense of our country. We should never forget and always honor their sacrifice, not only on Memorial Day but every day. But I think we should also not forget the permanently altered lives of the loved ones they left behind and those whose lives have been forever changed in any form from the direct horrors of war.

Why Do Some People Get PTSD and Others Don’t?

PTSD is in no way a sign of mental weakness, of some people being tougher than others, or of some just not being able to “shake it off.”  With PTSD, the events seem to actually damage the brain.

There is a part of your brain, called the amygdala, that assesses danger. If it senses a threat, it will trigger certain chemicals to be released to help you cope. This is part of the fight-or-flight response I’ve mentioned in other posts.

Another part of your brain, called the hippocampus, puts out chemicals to neutralize the fight-or-flight ones when it finds the danger is not longer a threat, or maybe that it wasn’t a threat in the first place.

One of the growing theories for PTSD is that in severe enough or prolonged situations, the hippocampus may become overworked to the point of exhaustion and damage.

MRI images in people with PTSD have shown that the hippocampus actually shrinks. It’s as much as a 20 percent smaller than the hippocampus of people who have experienced similar events but no PTSD.

In addition, there is evidence that the amygdala in people with PTSD is more sensitive and puts out more chemicals than those without PTSD, adding to the overworking of the hippocampus. So, even when all the dangers have long gone, the hippocampus is not able to neutralize the chemicals set off in everyday life.

Who’s at Risk for PTSD?

People at risk for PTSD include anyone who has:

  • Been physically abused, attacked or injured
  • Witnessed this in others
  • Been threatened with death, serious injury, or violence
  • Had a loved one who suffered or who died violently or accidentally
  • Been repeatedly exposed to trauma or stories of trauma because of their job

Causes include not only war but also childhood trauma and disasters ordinary citizens face in today’s world.

Such events alter anyone, but a person with PTSD’s brain cannot stop thinking about them. The horror essentially takes over their life.

What Are the Symptoms of PTSD?

Among the many common problems are:

  • Insomnia and nightmares
  • Horrible and vivid flashback memories, essentially reliving the event, which may occur at any time, possibly triggered by certain words, images, smells, or sounds.
  • Constant hypervigilance and hypersensitivity to things going on around them.

In truth, many if not most people who experience traumatic events go through these things, but they usually get better with time. The memories fade a bit or perhaps are tucked back in some deep recess of the mind. These people are forever altered too but are able to go on with life.

In contrast, people with PTSD don’t improve. Officially, anyone who suffers the symptoms for over one month has PTSD.

There’s also a form of delayed PTSD where some people seem OK for few months, then start having the symptoms that won’t stop.

Mayo Clinic provides a more extensive list of symptoms here.

What are the Clues That My Loved One May Have PTSD?

Sometimes the clues are obvious, but often they’re not or the affected person tries to hide the effects.

Indirect warning signs of PTSD include:

  • Being withdrawn, not talking, seemingly numb to their feelings
  • Being much more irritable or moody than they used to be
  • Being depressed
  • Drinking alcohol or taking drugs to try to self-medicate and block out the thoughts
  • The symptoms not getting better within about a month of when they start

Children may exhibit even more subtle clues, like all of a sudden start wetting the bed during sleep or acting out the events when playing.

Violence, such as incidences of spousal abuse, has been associated with a minority of people who have PTSD. (Research indicates it’s probably quite a small minority.) But much or all of this may be due to other factors, such as alcohol abuse; drug abuse; and just the fact that many current veterans are young, and their age group has a higher risk of violence anyway.

Next week we’ll talk about treatment options for PTSD.

Have you known someone with PTSD or had it yourself? How did it manifest?