PTSD Science: How Trauma Changes Your Brain
Post-Traumatic Stress Disorder or PTSD is widely known as a “veterans” disease, and many of us see it as something that primarily affects people in the military. Yet, the U.S. Department of Veterans Affairs shares that 6 out of every 10 men and 5 out of every 10 women will experience at least one traumatic event in their lifetime – and every traumatic event leads to a risk of developing PTSD.
PTSD is a risk for everyone, and that means anyone, no matter what their lifestyle, is at risk of developing complications to trauma including PTSD after a traumatic event. Trauma changes the brain in many ways and PTSD continues to do so, long after the original traumatic event is over. Understanding those changes can give you insight into what PTSD is, how it affects people over the long-term, and why treatment is so important for anyone struggling with trauma after the fact.
What is PTSD?
Post-traumatic-stress disorder is a diagnosis in which trauma continues to affect the brain and the body after the trauma. In most cases, that means the side-effects of trauma have not gone away within about 2 months of a traumatic event. Not everyone exposed to trauma will develop PTSD. Instead, personal resilience, coping strategies, genetics, environment, support, and the intensity and duration of the trauma will all impact the risk of PTSD.
PTSD itself is characterized by failure to recover from a traumatic event. That often means remaining in a psychological and biological state of heightened awareness and stress response. And, that means that treatment often requires identifying pre-exposure risk factors that led to failure to recover. That’s often significantly more important to recovery than the specific reactions of the brain in PTSD.
Heightened Fear Response and the Amygdala
One of the key symptoms of PTSD is a heightened fear response. Here, you may experience situations intensely, may be on constant alert, may respond with fear or anger out of proportion to events happening, and typically experience heightened anxiety. That can translate into outbursts, feelings of anxiety and worry, fear of situations or places, avoidance, and extreme emotions.
Much of it tracks to changes in the amygdala, the almond-shaped structure in the brain widely known as being responsible for the emotional processing of fear and anger. Individuals with PTSD show hyperactivity in the amygdala, leading to that heightened fear response, hypervigilance, and emotional outburst.
Memory, Processing, and the Hippocampus
Many people describe PTSD as though they are living in a fog, as though they have a wall between them and everything going on, and as though events that happened in the past are as real or more real than things happening now. Memories of traumatic events can be as visible and as real as events happening in the present. As a result, people with PTSD can struggle to differentiate past and current memories, struggle to see safe areas as safe, and may feel that they are still experiencing a traumatic event, even years after the fact.
That’s related to shrinkage and changes in connectivity and neurotransmitters in the hippocampus. This area of the brain is responsible for memory and contextual processing. As shrinkage gets worse, so do flashbacks and memory processing symptoms of PTSD.
Emotional Regulation and the Prefrontal Cortex
PTSD often results in reduced connectivity, reduced neurotransmitter activity, and decreased electrical impulses in the brain. One of the areas of the brain most affected by this is the prefrontal cortex. This part of the brain is impactful in emotional regulation, impulse control, and decision-making. Reducing connectivity and activity in this part of the brain also means that individuals have more difficulty with emotional regulation and impulse control. For example, persons with PTSD are more likely to jump from one emotion to the next, to quickly go to emotional extremes, and to have difficulty regulating stress, anxiety, and fear. They may not have the ability to calm themselves down once stressed.
It also ties into how people with PTSD see threats. If something is a bit scary or threatening, they may not be able to regulate themselves to respond in measure to the amount of threat. Finally, reduced emotional regulation and impulse control means that impulsive behaviors like outbursts, spending money to quickly feel better, taking risks, and otherwise sensation seeking for temporary reward and feeling better all become more likely – because the person is less able to control impulses and think those decisions through.
Stress Response and the HPA Axis
The HPA Axis is only partially in the brain. However, it’s part of the body’s response to stress and to PTSD. This system regulates the stress and adrenaline responses including cortisol and adrenaline. IT’s the hypothalamic-pituitary-adrenal system. During PTSD, this system is often dysregulated, meaning that it over-produces stress hormones, leading to a constant state of stress and anxiety.
That can translate to elevated heart rate, being on edge, inability to sleep, hypervigilance and awareness, and irritability. That all makes sense because the body is producing hormones that should only occur when something is wrong.
Neurotransmitter Imbalances
PTSD often results in an imbalance of neurotransmitters throughout the brain. These include serotonin, dopamine, norepinephrine which allow the brain to send signals, to process signals, and to create reward for activities. For example, serotonin is largely known as being responsible for people feeling good after activities or when in love, dopamine is largely known for its role in providing motivation and feeling good around motivation. Reducing levels of these transmitters in the brain can have significant and meaningful impacts on the individual and their ability to recover. For example, over time, it leads to symptoms of anxiety, depression, and increased hypervigilance.
Getting Help
How do you get help for something that affects the way your brain functions? Does behavioral therapy help? The good news is that yes it does. The bad news is that it can take a long time for your brain to return to normal even with treatment. In most cases, treatment for PTSD involves a short-term course of medication to reduce the symptoms and flashbacks – so that you can benefit from treatment. From there, you’ll receive behavioral therapy like DBT, CBT, and counseling. Over time, these will allow you to reframe experiences, expose yourself to trauma, to reframe reactions, and to get emotional regulation under control. And, over time, your brain and body will heal and will return to normal.
PTSD significantly impacts the brain including the function and the structure of areas of the brain. Everyone with PTSD will see changes in neurotransmitter processing, connectivity, and activity across the brain. Those changes can mean that it’s difficult to tell what’s real and what’s not. But, with treatment, you can mitigate those symptoms and give the brain space to begin to heal.
If you or a loved one is still experiencing symptoms of trauma more than a few months after a traumatic event it’s important to reach out and get help. That means talking to your doctor and looking for a specialist that can build a custom treatment plan, identify the pre-risk factors of PTSD, and then work on helping you through the changes you need to make to recover. Full recovery will always take time, but it starts with taking steps to heal.
