The science behind PTSD

The term, post-traumatic stress disorder (PTSD) is commonly used in a nonspecific manner, often to refer to any type of emotional reaction to disturbing events. However, that type of reaction is very different from the neuropsychological process that occurs in the specific syndrome that results from exposure to severely traumatic events, such being on a field of combat.

The clinical syndrome of PTSD is best understood as an unresolved reaction of the mind and body to an experience that is of sufficient disturbance (fear and/or trauma) to cause a fight-or-flight response. The fight-or-flight response marshals all resources — neuromuscular, mental and physiological to be ready to flee a danger or fight an enemy.

{mosads}Metaphorically, the body’s energy is turned to preparing muscles to be used for fighting or fleeing as opposed to, for instance, supporting physiological processes related relaxation, digestion or even immune response. That is, if you are in acute danger, it is more important to be ready to fight or flee than to digest your last lunch or fight off a cold.

The brain goes through similar changes with the focus of attention narrowly directed toward the threat. As the brain is focusing upon reacting to the danger, normal processing of memory is of little importance at the moment and does not occur.

Using the rough analogy of a computer, normal processing of experiences first involves immediate-memory acceptance of unprocessed data; most data is then stored in short term files which retain the information only for a period of time (depending upon how important it is considered) and are then erased; most important information is sorted out and stored into “long term” memory files. The related sensory and emotional experiences are also filed, but in effect, separated into sub-directories.

For example, if asked what you ate for dinner last night, you will probably remember fairly easily and reply, “perhaps, pizza.” But you do not have the experience of smelling the aroma and tasting a pizza.  If directly asked, “Tell me what a pizza looks like, smells like and tastes like…” you would be able to access the sub-directory files and provide that information, perhaps almost re-experiencing the visual image, odor or taste — and whether or not you enjoyed the meal.

PTSD is the condition that occurs when the fight-or-flight response prevents normal processing of experience into memory. Rather, all of the data — the cognitive memory and the sensory and emotional information — are retained floating as unprocessed immediate recall. Then, when any event, interaction or experience even superficially touches upon that unprocessed data, or at times spontaneously for no evident reason, the experience floods back into consciousness, complete with the sensory and emotional information, such that the event is not remembered but actually re-experienced.

Complicating the situation, that re-experience can be re-traumatizing, again stimulating a flight-or-flight response which again interferes with normal processing of the memory.

If a person is able to retreat to a safe, supportive environment, (at times with the aid of different treatment modalities), the raw experiences can finally be processed into normal memory. However, if the trauma is repetitive or if an appropriate environment is not soon available, that processing will not occur and the re-experience continues to occur, leading to even more distress that can take different forms such as anxiety, depression, anger, paranoia, social withdrawal, and/or seeking out drugs to suppress the discomfort

Persons who have a history of emotional problems (anxiety, depression, substance abuse) or who experienced traumas earlier in their lives, will have more difficulty getting through this process.

Each individual, based upon their personality, past experiences and innate temperament, will go through the process in a unique fashion.

However, if exposed to sufficiently traumatic events, every person, no matter how emotional healthy or strong they are, will have to go through this process, usually with at least some degree of distress and disruption. Particularly for those who cannot quickly retreat to a safe, supportive environment and those who are exposed to additional or continuous trauma (such as in combat), getting through the process unscathed is almost impossible and some degree of disruptive PTSD symptomatology will emerge.

Thus, for anyone to suggest that only those who have an emotional vulnerability or who are not strong enough will develop PTSD is simply wrong — uninformed, inconsistent with scientific and medical knowledge and cruelly unfair to individuals who have been exposed to horrendous trauma.

David M. Reiss, M.D., psychiatrist, private practice, San Diego, CA

The views expressed by contributors are their own and not the views of The Hill.