Post Traumatic Stress Disorder (PTSD) is something that most people have heard of, even if they don’t know very much about it.
It has been in the media very recently, with Ariana Grande informing her fans of her diagnosis on Instagram by posting pictures of her recent brain scans, which is likely linked to the tragic MEN arena bombing on 22nd May 2017. This blog will cover PTSD and the brain – including Ariana’s brain scan – in a little more detail later on in the post.
(This post is a little different to my previous blog posts, and involves talking about different brain areas and processes, and pictures of brain scans – I hope you find it as interesting as I do!)
What is PTSD?
PTSD is an anxiety disorder that develops after frightening, stressful, or distressing events. (Source: NHS). As I have used the plural ‘events’ instead of ‘event’, this leads me on to the two different types of PTSD:
- PTSD (Type 1 Trauma) – an anxiety disorder that develops after one event
- Complex PTSD (Type 2 Trauma) – an anxiety disorder that develops after repeated trauma; such as abuse, neglect, or violence. This is often more severe if the trauma happened in early childhood.
What causes PTSD?
Traumatic events that lead to PTSD used to be thought of as a soldier’s ailment after going to war; it was deemed ‘Shell Shock’ during World War 1 long before the term PTSD was coined (as it was originally thought to be caused by soldiers being exposed to exploding shells), and it used to be considered form of cowardice. In World War 2, it was deemed combat exhaustion or combat stress.
Until relatively recently, it was a commonly held belief that only those who had experienced the horrors of war could experience PTSD. We now know that it can be caused by any type of event that causes fright or distress; and it usually involves actual or threatened death or serious injury to oneself or others. This can include (but isn’t limited to):
- Road accidents (as a victim or a witness)
- Experiencing a violent assault, such as sexual assault, beating, mugging, or robbery (as a victim or as a witness)
- Experiencing a terrorist attack (as a victim or as a witness)
- A traumatic labour/birthing experience (including partners witnessing it)
What are the symptoms of PTSD?
Symptoms usually develop approximately one month after the traumatic event, but can even develop years later. The symptoms can come in ebbs and flows – you can experience long periods without symptoms, only for them to return later. Symptoms vary between individuals, but they can include:
|Re-experiencing/re-living the traumatic event involuntarily|
This is the most common symptom that people experience.
This can be in the form of flashbacks; nightmares; intrusive, repetitive, and distressing images or sensations; or physical sensations (trembling, feeling sick, pain, or sweating).
|Being ‘hyper-alert’/feeling on-edge|
This can involve feelings that are usually associated with anxiety.
This can include: physical symptoms such as dizziness, headaches, chest pain, and stomach aches; irritability or aggressiveness, angry outbursts, trouble sleeping, difficulty concentrating, being hyper-vigilant, becoming jumpy and easily startled, panicking when reminded of the trauma, and becoming reckless or self-destructive (including self-harming or misusing alcohol or drugs).
|Emotional numbing and avoidance|
Another common symptom is trying to avoid anything that might trigger memories of the trauma, or avoiding talking about it altogether.
This can involve: keeping excessively busy; avoiding anything that reminds you of the trauma; misusing drugs or alcohol to avoid memories; feeling emotionally numb and cut off from feelings; feeling physically numb or detached from your body; not being able to express affection; being unable to remember what has happened
|Difficult feelings or beliefs|
Sometimes a person can hold feelings that are difficult are upsetting,
This can include as: feeling like nowhere is safe; feeling like nobody can be trusted; blaming yourself for the event; feeling like nobody understands; overwhelming feelings of shame, guilt, sadness, or anger.
If you are experiencing some of these symptoms and worry you may have PTSD, please make an appointment with your GP or a suitably qualified mental health professional.
PTSD and the Brain
PTSD has its roots in the brain (although you don’t necessarily need a brain scan to diagnose PTSD), due to the effect it has on certain important parts of the brain. When these parts of the brain are altered or suppressed/shut down during the stressful event, how we store our memories, and recall them in the future, is affected.
Below is a list of the affected parts of the brain spoken about below, and a description of the roles the play in the brain. (Feel free to skip this list and see if you can make sense of the images first if it seems a bit too much to read in one go! But don’t worry, there isn’t a test at the end!)
- The Amygdala is a primitive part of the brain that detects and processes emotions related to fear and survival.
- The Hippocampus is involved in memory formation and storage. It also adds ‘time stamps’ and narratives to our memories, so we know when they happened, and we can talk about them (if I had a memory of going to the shop, my hippocampus has told me that I went to the shop on Monday to buy some milk, and I can also tell other people that is what the memory is about).
- The Prefrontal Cortex plays a role in storing our memories after they have been ‘stamped’ by the hippocampus and have had a story added to them, and filing them away.
- Broca’s area is involved in language – and allows us to translate our memories into a language where we can understand and tell it to others
- The Basal Ganglia interacts with the Prefrontal Cortex, in terms of memory, and is involved in ‘non-declarative’ memory (memories that don’t require conscious thought, and are acquired through the senses) (and the structure appears to be different in those who develop PTSD after trauma versus those who don’t)
- The Anterior Cingulate Gyrus interacts with the Amygdala, Prefrontal Cortex, and Hippocampus and is the ‘gear shift’ in controlling emotional response (so if overactive it can cause traumatic memories to get stuck on a loop)
- The Thalamus receives sensory information from all of our 5 senses (so if it’s overactive when we are stressed are anxious, too much ‘gets in’ and we can’t let go of negative thoughts)
- The Hypothalamus plays a role in many important functions of the body, but in this context it’s involved in the release of adrenaline and cortisol when under stress or threatened
How are Traumatic Memories stored in the Brain?
Below are two diagrams briefly explaining the difference between how we process and store non-traumatic and traumatic memories.
In short, when the Amygdala detects a threat, it will start a process that increases the levels of adrenaline and cortisol in the body (Hypothalamus); then the other areas of the brain involved forming and storing the memory (Hippocampus) and being able to talk about it (Broca’s area) will be bypassed; and the memory won’t be ‘filed away’/stored correctly (Prefrontal Cortex). When this occurs, we can re-experience traumatic memories whereby our brain is telling is the event wasn’t in the past, “It’s happening right now”. We also can be frozen in ‘speechless terror’ when this occurs, experiencing the memory as senses in our bodies (such as sweating, increased heart rate, dizziness), rather than being able to use words to explain it.
Essentially, we go to the older and more ‘primitive’ parts of our brain when we are under threat, and can’t use the more developed ‘human’ parts of our brain as a result.
PTSD and Brain Scans
There is lots of evidence to suggest that brains of people with PTSD appear different to those without PTSD. This can be observed using different types of brain scans.
The first image below (an MRI scan) shows decreased hippocampal volumes in PTSD sufferers (the part of the brain involved in forming and storing memories) (Modified from Source)
The second image below shows a SPECT scan of a ‘normal and active’ brain, and then a brain of someone with PTSD (Source) showcasing one of the classic signs of PTSD; The ‘Diamond Plus’ pattern.
The third image below (A SPECT scan) shows increased activity in multiple areas of the brain (Source); it is also showcasing the ‘Diamond Plus’ pattern. Left is before treatment, right is after treatment.
So let’s take a look at Ariana Grande’s scan. Although it is unclear what type of scan she has had, it is likely that what is being shown is a significant amount of overactivity (shown by highlighted areas) in areas of the brain that are implicated in PTSD; along with the recognisable ‘Diamond Plus Pattern’.
Is there hope for the future?
Yes there is! There are different types of treatments and therapies available for PTSD.
Psychological therapies include Talking Therapy, Cognitive Behavioural Therapy (CBT), Eye Movement Desensitisation and Reprocessing (EMDR), The ‘Rewind’ Technique, and many more.
Some people find antidepressants or other medications help, and other people with a milder form of PTSD may find ‘watchful waiting’ helpful to see if the symptoms continue or not without treatment.
Either way, if you are worried you have PTSD it’s important to see your GP or another suitably qualified mental health professional for help and guidance.
If you’d like to book an appointment, please get in contact via the Book An Appointment page.