Post Traumatic Stress Disorder
PTSD is still regarded as somewhat of a medical mystery. Often described as the hidden wound, it was first defined as an illness in war veterans. It has been called different things such as Soldier’s heart, Combat disease and shell shock. It used to be associated exclusively with military experiences, but we’ve learnt it can affect any one of any age and one in thirteen of us will experience it during our lifetime.
Approximately 70% of people suffer a trauma in their lives. A trauma can be described as a very stressful, frightening or distressing event that threatens life or bodily integrity. A trauma is not purely an objective phenomenon as is determined by an individual’s personal response to that event rather than just the actual event itself, We won’t all have the same reaction to a collective experience such as a natural disaster (or a pandemic) some of us may find it traumatic, others may not. Around 20% of people who suffer a trauma go on to develop PTSD and there are risk factors associated with this development such as experiencing repeated trauma, physical pain inflicted during the event and not having an adequate support network.
People with PTSD can re-experience their trauma through nightmares or flashbacks, they may avoid anything that triggers memories or feelings about the trauma and can often feel anxious and irritable, or have trouble concentrating or sleeping.
3 facts about PTSD.
There is much about PTSD that we don’t fully understand yet but what can said with some certainty is that there is a genetic component to PTSD. This doesn’t come as a surprise as many mental health issues, such as depression, have a genetic link and the research suggests a hereditary predisposition to developing PTSD that alone can explain up to 30% of cases. There have been several studies on individuals who have experienced traumatising events going on to have offspring that suffer PTSD at a higher than usual rate. For example, a study in 2014 found that women who had been traumatised by the Rwandan Genocide had children who had a higher risk of developing PTSD symptoms, similar trends have been identified in children from Vietnam veterans and Holocaust survivors.
It is possible that a traumatising event may leave a chemical marker on our genetics and this marker can be passed down to future generations. In 2013 a study on rats supported this theory. The rats were exposed to a smell followed by an electric shock, the rats developed a fear response to the smell. The offspring of these rats had a similar fear response to the smell, despite never having been exposed to the electric shock.
The research and studies certainly suggest something is passed onto children at a genetic level. Or perhaps, as Carl Jung the founder of analytical psychology theorised, we all have a collective unconscious that we inherit from our ancestors. Another study involved a group of six-month-old babies being shown a collection of photographs. Their pupil dilation was measured as an indication of their fear response. The chemical noradrenaline is a stress chemical that we released when in danger and it increases our pupil dilation. On seeing images of flowers, the Babies’ pupils dilated 0.03mm, but the snake and spider images saw a dilation of 0.14mm. These findings suggest we are born with an inbuilt fear of certain dangers.
Women are more at risk
Women are more than twice as likely to experience PTSD than men despite men statistically experiencing more traumatic events. Ten out of one hundred women suffer from PTSD in their lives compared to four out of ten men. We must not simplify or stereotype by sex alone, but some characteristics are more common in women that in men and from a neuroscientific perspective it is interesting to look at why there might be this disparity.
One explanation is that the traumatic events men experience are more likely to be accidents, physical violence, combat, fire and disaster. Women are more likely to experience child abuse, sexual assault, and domestic violence. The type of trauma women are more likely to face may result in heightened emotional suffering. Around 50% of sexual assault survivors suffer from PTSD and this figure is even higher in child victims. During a sexual assault the victim is usually overpowered and unable to ‘flight or fight’; instead, the brain may defer to the freeze response and disassociate from the assault. This dissociation, when the mind separates itself from the experience, has a strong link with PTSD. Women who have assaulted, sexually or violently, are also more likely to be disbelieved, they often blame themselves and view themselves negatively, which can exacerbate their reactions to the trauma.
Another possible explanation is that the symptoms men are more likely to exhibit may not fit the current diagnostic criteria for PTSD. Men are less likely to report feelings of anxiety or depression but more likely to report behavioural issues, like drug abuse and violence.
We also know that Men and Women handle stressful situations differently. Men are more likely to use the ‘flight or fight’ response whilst women are more likely to rely on a ‘tend and befriend’ response. The ‘tend and befriend’ response is the process of caring for and reaching out to others to ease personal distress. Women may rely on support from others during traumatic events and if that support is not available, they are more at risk of developing PTSD.
Much more research needs to done to fully understand why women are more prone to PTSD that men, but certainly biological, environmental, and coping strategies are all factors.
When someone goes through a traumatic experience, the assumption may be that if they are going to have symptoms of PTSD, the signs will emerge quite quickly after the event. However, this is not always the case, it is now understood that up to a quarter of suffers of PTSD experience symptoms months or even years after the event. This is called delayed onset PTSD.
This delayed reaction was first identified in war veterans who experienced PTSD symptoms when they returned back home. It was theorised that this was because experiencing a stress response whilst in a combat situation could be life threatening so it only manifested when they were safely home. More recently it has been suggested that traumatising events impact an area of the brain called the hippocampus that is responsible for memories and emotions, a malfunction of this area of the brain prevents memories being processed properly and can impact how memories are stored, this could explain symptoms like flashbacks but also may make the memory less accessible to conscious thought.
We also know that memories can change over time and its possible the memory of the trauma worsens over time, and this worsening of the event can result in PTSD emerging.
PTSD is fascinating and complex, and I have only skimmed the surface. If you or anyone you know is experiencing symptoms, please seek help, visit your GP, treatment is available.
Several of us at OTH have undergone specialist training in this area and use specific techniques when a client presents with PTSD. We offer free initial consultations to anyone who would like to know more.