PTSD — fear after fear

Stories of debilitating fear after trauma have been known since the Trojan Wars. In the XNUMXth century, survivors of train wrecks were diagnosed with «railroad spine», as doctors believed that patients’ hysterical states were due to compression of the vertebrae.

During the First World War, this fear was called shell shock, cardioneurosis, or overwork caused by combat conditions. They began to take him seriously only after the soldiers who returned from Vietnam showed the same symptoms: hypertonicity, involuntary scrolling in the memory of past events, nightmares.

It wasn’t until 1980 that a term was coined to cover all of these symptoms: post-traumatic stress disorder (PTSD).

The current attitude towards PTSD is very different from the approaches that were common during the Second World War, when the American General George Patton threatened military personnel suffering from overwork with a court martial. Today, researchers are rapidly learning more about the causes of the disorder and how to treat it. And this is good, because now we know how often it occurs.

Reasons for the development of the disorder

War is one of the typical causes of PTSD. A quarter of American veterans of the Vietnam War suffered from this disorder, and 10% of those who are still alive still have symptoms. Researchers who worked with Syrian refugees in Turkey last year estimated that one in three had PTSD. However, it is also common among residents of poor areas, where cases of violence are not uncommon.

PTSD occurs more often after repeated trauma than after a single event. The syndrome is more likely to occur if the person causing the injury is known to the victim. Trauma experienced in early childhood, when the brain actively explores the world and determines what to fear, makes people more vulnerable later in life.

Children who are mistreated in the family are at risk of developing post-traumatic stress syndrome. Women are twice as likely to suffer from it as men because domestic violence is a source of re-traumatization and women are much more likely to be sexually assaulted.

The development of PTSD is influenced by what happens after the traumatic event, including support from others or their distrust. Socio-economic conditions also influence. But some situations lead to the development of PTSD even in those who are not at risk.

Specificity of post-traumatic syndrome

PTSD increases the risk of other health problems such as diabetes, cardiovascular disease, depression, and addictions. Such people are much more likely to be unemployed, experience difficulties in marriage, become parents in adolescence. As in the case of other mental illnesses, an additional burden often falls on their shoulders: others consider their illness a manifestation of a bad character and do not take it seriously.

However, PTSD is fundamentally different from most mental disorders: it can be modeled on other mammals, as they experience and display fear in the same way that humans do. It is not difficult to scare a mouse with an electric shock, it is much more difficult to instill in it a negative image of itself.

While mood disorders remain a mystery, PTSD is getting clearer. According to Charles Marmar, a psychiatrist at New York University Medical Center, PTSD could be the first mental disorder «where we break into the mind-brain connection.»

How does PTSD manifest?

The brain of a healthy person, in the presence of reasons for panic, will command the body to launch various reactions, including throwing out adrenaline. The person’s heart rate will increase and he will feel a strong desire to fight or flee. When the danger has passed, the symptoms disappear, leaving only an unpleasant memory.

A woman who is attacked in a noisy bar may experience fear for several weeks at the sound of clinking glasses, but over time there will be a “fade of fear” — the positive association of this sound and parties with friends will outweigh the negative emotions. The more often people receive such reminders without a connection to the disaster, the more likely the fear will fade, which is why it is so important not to hide after the trauma.

When this mechanism fails, PTSD develops. One former soldier lost control of himself every time his wife baked pies — the smell of almonds was like the smell of explosives. People who were mistreated as children may suffer when it gets dark because they often have difficult memories associated with evening and nighttime.

Research by neurophysiologists helps to understand how people get stuck in a state of fear. The cerebellar amygdala, located in the depths of the brain, controls the feeling of fear. It reads incoming signals, such as smells and sounds, and sends messages to other parts of the brain that filter the signals before responding to them. In people with PTSD, filters have a hard time distinguishing real threats from those that can be ignored.

Twin studies also suggest that PTSD is about 30% genetic. Representatives of epigenetics, a new scientific direction that studies how external factors affect the genetic record and manifest themselves in the body, have provided the first evidence for the hypothesis that stress can be inherited.

Recently, markers have been discovered that show the difference between the brains, genes, and even blood of people with PTSD and those who don’t. When a person with PTSD sees a picture of a frightened face, their amygdala goes into overdrive. At the same time, the prefrontal cortex, which regulates fear, is suppressed. Researchers hope to isolate chemicals in blood tests that indicate the presence of PTSD in the near future.

Treatment of post-traumatic syndrome

Today, treatment is aimed at changing the response of the brain. Many patients are referred to cognitive therapy, where they are taught to think differently about what happened and deal with stress triggers.

Debra Keysen of the University of Washington says that after a dozen sessions, acute symptoms improve in about four out of five patients. Other patients undergo exposure therapy, in which they are confronted with fear stimulants.

The adult patient may be asked to describe the traumatic event in great detail until the impact wears off. Children can reenact such an event using toys. In the experiment with soldiers, virtual reality simulation methods were used. One of the therapists likened this work to the layered treatment of burns.