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What is post-traumatic stress disorder?

When our memories turn against us

We used to call it shell-shock, now it's known as post-traumatic stress disorder and it doesn't just affect soldiers at war. Anyone who has experienced or witnessed a very distressing event outside of normal everyday experience can suffer from this psychological condition.

After the initial shock of the event has passed, intense feelings of fear, horror and extreme anxiety can come flooding back, forcing the victim to relive the experience in vivid detail over and over. Post-traumatic stress disorder or PTSD can affect anyone caught up in war as well as the victims of crime, accidents, abuse and anyone who has witnessed the aftermath of these events such as members of the emergency services.

There are many symptoms of PTSD and they include severe anxiety, flashbacks (intrusive recollections of the event), sleeplessness, feelings of guilt and depression. Sufferers go out of their way to avoid anything that might relate to the original trauma: victims of a car accident may find it hard to drive, cross the street, or even listen to the sound of traffic. It can take days, weeks or months for the signs of PTSD to occur.

Not everyone is susceptible to PTSD and similar life experiences won't produce the same response. This could be due to a number of factors including variations in personality and/or brain chemistry.

As with a lot of research into the workings of the mind, scientists have gained a huge advantage from seeing how it malfunctions. The study of the brains of people with PTSD has provided insights into how we store and recall memories as well as cope with distressing events. PTSD has also highlighted the importance of forgetting.

Some of the best studied sufferers of PTSD are American veterans of the war in Vietnam. In the mid 1990s, Dr. J Douglas Bremner, a psychiatrist at a Veterans Affairs (VA) Hospital in Atlanta, Georgia, was one of the first to apply brain imaging to the study of PTSD. He focused on an area called the hippocampus which has at least two important functions. One is its role in the laying down of new memories, the other is its role in moderating emotional responses like fear.

What Bremner found was shocking. In every case, the hippocampus had shrunk or shrivelled as if the emotional trauma had literally eaten away a part of the brain that is crucial to memory and fear.

Bremner's work is one of most cited papers in PTSD research and he has since shown similar results in victims of child abuse and other non-combat related traumas. What's clear from these studies is that prolonged exposure to severe stress - and the specific brain chemistry that goes along with it - can cause major structural damage to our brains. The structural damage is probably irreversible though the sufferer may be helped with their symptoms.

PTSD - the symptoms
PTSD can affect people in different ways. Symptoms include:
Changes in sleep patterns or a lack of sleep
Flashbacks - recurrent vivid dreams about the event
Feeling or behaving as if the event were happening again
Changes in behaviour (e.g. short temper)
Changes in feelings about your self-image (e.g. feeling useless, vulnerable)
General numbed senses
Total lack of motivation and feelings of detachment.
Poor concentration
Feeling of Paranoia and guilt
Avoiding any location or activity which could spark recollections of the event
Amnesia for certain aspects of the trauma

There are several treatments for the symptoms of PTSD. They can involve one or a combination of individual or group therapy and some form of medication.

YOUR COMMENT

Zhao
I think the PTSD could be that the memories were so emotionally or traumatic that the mind suppressed it in order to maintain normality. What I want to say is the PTSD IS maybe a self protection of brain.

jane
My husband suffers from clinical depression and only works for approx 30 weeks a year. He constantly blames a recurring theme - that he left his first wife and child when she was 3 years old.He is in close contact with his daughter now 31, but is obsessed with the 'memory' of guilt that he never stuck out an unhappy marriage. When faced with the logic that he had ended the relationship with his girlfriend many months before he discoverd that she was pregnant, and only married her so that he could be an active father (she refused to allow access unless he married her).The marriage was effectively over once the child was born as his first wife admitted she did nt want the child to be ilegitimate and had no interest in him as a husband. This constant sense or memory of guilt of 'giving up'on his child has been an active part of his depression over the past 15 years, which despite cognitive behavioural therapy, counselling, psycholigical intervention etc is stronger memory now affecting him on a daily basis. I wonder if seperation/divorce can be classed as PTSD?

heather Kirchoff
I had a natural home birth without drugs at the end of which my baby died. I had chosen a home birth and was told that It was my fault he died. As I was in a heightened state of awareness during labour I remembered vividly all that happened. Every night when I lay down to sleep, the events would play and replay slowly through my head just like watching a video. I had no way of switching it off. This went on for years. I also lost my short term memory to the extent of appearing very stupid and it handicapped my every day life to a massive extent. I struggled on. I would like to say to all those suffering now that things do improve. Gradually over the years I learnt little techniques on how to compensate. And my memory would now pass as normal. But I work at it. It was 5 years before I had medication, that really helped for a long while. I am now fully functioning and drug free(thought only a little giddy - with a poor memory) but I have a full time job, kids, a degree. I now rather think that I have something akin to altzimers - different to the short term memory loss I suffered 16 years ago when my son died. Does any one know if prolonged exposure to severe stress can cause structural damage to the brain?

Jerry
I suffer PTSD as a result of workplace bullying in an office. The bully first threatened the welfare of my children. Then she recruited the personnel officer & created a situation where I was given an impossible job to do for the personnel officer in a ridiculous timescale. At the same time she complained that I had failed to attend a meeting which was nothing to do with my work. These 2 items then became the subject of a kangaroo court disciplinary hearing where the sole witness was the bully & the judge was the personnel officer. I suffered a stress breakdown. I was moved from my job as a result, to work as PA for another boss whose last PA had had to take early retirement due to stress. Within 3 years I also had to take early retirement. I suffered depression as a result of the depletion of synapse chemistry due to stress. Initially I lost the ability to read, then when I was able to re-enter employment, but this brought on flashbacks & I had to give up office-type work. A friend took me on as a part-time gardener & this gave me the opportunity to study & retrain as a counsellor/psychotherapist. I began to specialise in trauma & PTSD. Just as I was beginning to recover a little, further trauma ensued with the murder of my daughter in 1997. This became national news for a few weeks. I've realised since that had I not been behaving in a depressed manner on the evening of the murder, most probably I would have gone with her & the outcome would have been very different. Perhaps the workplace bullies are responsible for more than just the ending of my career & the breakdown of my health! In the early stages of PTSD, when I was experiencing voilent flashbacks, I'd often wondered why my flashbacks were only of the second boss, when I knew the first one was far worse. Now I realise that in PTSD, flashbacks occur only of the causal incident or sequents. This sort of information enables a therapist to pinpoint the causal incident. In fact PTSD carries with it a fascinating pathology, an expert can read a case like a crime novel. Today, I work part time in a non-office environment, enjoying a tremendous buzz from part-time voluntary work as a counsellor/therapist. If I ever had the chance to go back in time to alter anything, would I do so? You bet! I'm sure it wasn't coincidence that in the week before the murder, I'd read a book by Robin Casarijan, "Forgiveness". Casarijan explains how it is necessary to feel sorry for the person you need to forgive, before you can begin the process of really forgiving. Another book "Families & how to survive them" by Robin Skynner & John Cleese explains how each individual is damaged by their upbringing to form their personality. It is by realising how damaged workplace bullies are that I can begin to feel sorry for them, so enabling some compassion. It comes down to choice. If the painful memories won't go, all you can do is take the pain out of them. Feelings of hurt & vengefulness won't hurt the other person, but they will hurt you & diminish your quality of life. You will always live with traumatic memory, it is branded into your brain & even causes physical changes, so you're going to have to live with it. The process of forgiveness allows you to drop the feelings of hurt so that even though the memory remains, you are no longer hurt by it. When this begins to happen, the past will strengthen & empower you. I can only describe the process as one that feels like dying, but I really do believe there is hope & therefore life after PTSD.

Angie
With reference to the smaller or shrunken hippocampus - what a load of twaddle. Yes events can be traumatic & can be triggered by the slightest thing - from an evolutionary perspective this is to ensure that we do not put ourselves into that situation again. However, like the young lady who explained her situation of escaping an abusive household stated - escaping from danger can place us in further danger that we do not recognise. The recovery from an abusive situation is more to do with the use of your frontal lobes for reasoning - yes I agree this can somethimes be a painful experience as you have to acknowledge what has occurred. But by using logic, individuals will be able to overcome the trauma i.e. I did not ask for this, I was in no way responsible. Low self esteem that comes from these situations can be very inhibitory & I suggest that it is this that would also contribute to the cognitive difficuties some experience - similar effects are experienced with individuals who are depressed. As to trauma before 'Sense of Self' Freud stated [not that I'm a great advocator of his work!] that it would affect the individual more. However, if say your being abused, I would state that the 'distance' of the person who's abusing you would have more of an effect i.e. compare abuse from a 'family friend to that from a father. Unfortunately there are so many factors involved in this discussion that they cannot be attributed to one biological cause - although I'm not saying that this is not a contributory fact in SOME CASES! There must be an interaction between the individuals biological predisposition, the event & also the cognition [how they perceive it] of the individual PLUS how they are then perceived by others. A friend of mine refuse to discuss any abusive events in her life mainly because experience has taught her that people attribute innappropriate characteristics to her just because of what she has experienced

Debbie
I was diagnosed with PTSD 11 years ago, as a result of numerous childhood traumas. I have spent those 11 years, first trying to remember and then trying to forget. I say never underestimate the usefulness of forgetting a particular event. I don't mean denying it's happened, rather that I had to force myself not to continuously recall every detail, not to relate everything current in my life back to my past - AND insist that various mental health workers stop asking me about it. For me, that was a vital part of breaking the victim cycle...which is so important when overcoming trauma relating to assault/abuse. Yes, there's still a long path for me to take (for example, finding a job for the first time ever!). However, realising that I didn't have to make myself remember everything in order to overcome it has been so liberating - I'm like a different person now.

Liz
My younger sister was killed in a motorcycle accident 30 years ago and, like Karen above, I do remember certain parts of the days following her death but not others. However, the shock of her death seems to have "wiped" all my memories of our childhood together and has given me a sense of detachment, like some contributors above. Should one open the wound to try to regain the memories and "normal" involvement or feelings? Or should one leave well alone? Frightening really ...

Sharon
I was diagnosed as having post natal depression when my first child was nearly four months old. I now think having read the things about PTSD that a large part of my experience of the birth was just that, post traumatic shock. I didn't get the drugs I asked for, was told I was okay when I knew I wasn't and i had terrible flashbacks and can still feel the pain I felt then whenever someone asks about it. I'd be interested to know if there is actually a difference in brain function, chemicals involved and such, between post natal depression and PTSD, or could my experience for example be categorised as one or the other, or both concurrently.

Kanitha
I lost my focus when I got out of a bad relationship. With going to school full time and working fulltime along with two kids, I find myself beginning to forget alot. I get frustrated very easy. I have been trying to make a better living for my kids and I and it's like very hard,but at the same time I feel very stressed out. My question now is will it ever get better? Or shoud I let one go the job or school?

lorna
In 1990, Ann (b.1970) came to stay with us as part of a small group from Armenia. During her stay we discovered that she had survived the Armenian earthquake in December 1988, which killed 25,000, including the aunt and young cousin she was staying with. The 9 story apartment block was destroyed, and she was buried for five days in a very confined space. She was rescued by her father just in time, suffering from hypothermia. We visited Ann and her family in 2001, and were shown the story which Ann's younger sister Bella (b. 1979) had written in English of Ann's experience waiting to be rescued. Ann came to stay with us again in 2002, and Bella has been working in London for the past two years. She returned to Armenia on 19th July, 2006. Bella has described to us how she went about persuading her sister to recall the detail of her rescue, some years after such a traumatic event. It was a slow process and required great sensitivity. There are still situations today, 18 years after the event, which bring back the memory for her, even though she has made a full physical recovery and is now married with two daughters. Sadly, the father of Ann and Bella died suddenly in March this year while he was working in Russia. This has been a great loss for the family, as his death was unexpected, without warning, alone and a long way from home. He had visited the family in Armenia just weeks before his death and had seemed remarkably fit and well. He was the youngest of five children and the only boy. His mother had died when he was a few months old, and his eldest sister, who had been unwell, died within 24 hours of her brother, not knowing that he had died. We have read Ann's story, and find it very powerful. She has been able to recall so much detail and has been able to move on in her life, in spite of what happened to her when she was eighteen.

Judi
On Christmas Eve 1997 my husband Peter was killed in an industrial accident. There followed a long sequence of terribly stressful litigation on two fronts after this. The whole thing finally stopped about 3 years ago. Since this happened to me my ability to remember things seems markedly damaged. Could this be due to the trauma I suffered over such a long period of time?

Cathy
As a victim of childhood abuse (psycho and sexual) and neglect that lasted until I left home in my late teenage years I have experienced many forms of PTSD. Flashbacks - (short term and shocking) as well as extended, vivid and frightening nightmares, sleep paralysis, inability to sleep, extreme dislocation as if I was viewing someone else's life. Plus other problems - a brief period of anorexia, then bulimia - incredibly low self - esteem (I was taken from home to go straight into an abusive relationship with a boyfriend who raped me) I sympathise entirely with what Ruth has said about the inability to concentrate - I have studied for two years of my degree, absorbing almost no information and pushing myself to the limit. Now I have been diagnosed with Chronic Fatigue Syndrome/Myalgic Encelopathy and am chronically ill and housebound. I have been prescribed anti-depressants, beta blockers, sleeping pills, and am currently on a cocktail of medicines. Although I have attended weekly psychotherapy for three years, this has only helped me to alleviate damage in my present life - and has done little to touch upon past memories. At the age of twenty, I can only hope that with time and the care of friends I will be able to re-form myself and my life - but I am thinking in terms of years and decades into the future.

Karen
This is a both a fascinating and painful subject for me. I have had counselling for PTSD but not until 3 and a half years after losing my fiance in a motorbike accident. Although his Mum and I talk about this from time to time to keep his memory alive and to share our experiences during that time period, despite the fact that we always end up crying, what is the interesting part afterwards is that she has remembered things that I have totally forgotten and I remember things that she never knew happened, during the first fews days after the accidents and during the funeral etc. 2001-2002 for both of us seems to have been wiped out of our memories.

Veronica
I have PTSD. I function the best way I can but I wish I could overcome it. How can I explain to people that the latest bombing atrocity brings it all back into focus even when I've not been directly affected - they'd think I was just attention seeking. So I hide it all away, and struggle on, and suffer the symptoms, and when another event happens and the after effects sink in I need to take a couple of days off sick so as to hide from people and daily living. Psychotherapy just feels like a band-aid (and costs far more than I'm able to afford). I'm getting there, slowly, but I'm in my fifties now and I wish I could be happy.

Ruth
Although I do not speak as an expert, I fear that the lack of attention on the effects of childhood traumas and focus on combat induced PTSD, is due to the need to finance research. War is intrinsically linked to politics and therefore research is more likely to be conducted into the effects of this trauma as funds are more readily available. This particular attention in professional research inevitably brings only a few triggers of PTSD to the forefront of public discussion. Although there is less open discussion of childhood trauma, the fact that PTSD is being researched in any form is encouraging to me. In my own experience I have no doubt that an extended period of trauma during my early teenage years was compounded by rape at the age of 17 and symptoms of PTSD resulted. Although I have learnt to cope with some of the symptoms, I fear that the longer term effects will never go away. In addition to the classic symptoms, one thing that I have noticed is a dramatic change in my ability to retain information. I no longer seem to have the academic capability I had prior to being raped. Is this a result of PTSD? As a student reading politics and history, remembering facts is obviously a problem when it comes to revising for, and performing in exams. So as well as discussion about the memory of one particular traumatic event, or period of trauma, I am keen to know about its ongoing effects on the formation of new memories. Will I ever regain the ability I had when I did my GCSEs? Is there a wonder-drug I can take so that I can actually pass my finals next year? Or is the damage permanent?

a memory researcher
the bremner study referred to in the text has been overtaken by futher research that has shown that trauma doesn't "shrink" the hippocampus, but that people with a smaller hippocampus in the first place are more likely to develop PTSD - ie a small hippocampus is a risk factor for ptsd rather than an outcome.

julia
I am beginning to wonder if the sense of detachment I have about the extremely traumatic events of my early life, the dispassion with which I can discuss them and write about them, is actually a symptom of PTSD. I have always looked on these events as interesting, as if someone were telling me THEIR experiences, but now I feel I have lost something by processing them into the distance. I can remember in extreme, vivid detail of scene and emotion, but there are no feelings now attached.

Rosina
This is scary stuff which I'm afraid I recognise. I have recounted in 'Forgetting' how my memory was affected by the ongoing experience of a painful divorce accompnied by the need to continue full time secondary school teaching and 'refereeing' too young teenagers with the help of one of their older siblings. I felt dangled on the end of a string by both the divorce and the teaching - no control whatsoever. I left teaching in 1997 (on the advice of my children!)before the new retirement laws came into play. However, the result of those 6 years of living with a permanent knot in my solar plexus combined with a terror of waiting for the post to drop yet another bombshell, has left me with a lack of care about how I behave in public; a very short and acute temper when I see any agression against anyone else, verbal or physical (I recently broke up a street fight between two young men because one deliberately attacked the other who was walking away from him), and a sense of dislocation, apart from with my children and siblings. I also have to cope with attacks of weeping and desolation which come upon me when I am alone. I don't know whether I shall allow myself to grow much older than 70. My ex-husband was in a car crash in which his head smashed the windscreen. When I eventually persuaded him to see someone in the course of his suing me for divorce, he was diagnosed with PTSD. I believe I am suffering from the same.

chris budden
There is so much focus in discussions on event trauma like combat and result of crime etc., and little on chronic ptsd resulting from enduring events like abuse and neglect... like only 'ordinary' people and their 'normal' traumas count...don't worry you'll get back to normal...for some of us traumatic distress is 'normal'. Is it different if the trauma occurs before development of Sense of Self?

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