The psychology of post-traumatic stress disorder - Joelle Rabow Maletis

Many people experience trauma during their lifetime. While some escape without long-term effects, millions suffer from symptoms such as flashbacks, nightmares, and negative thoughts that disrupt daily life. This condition, known as post-traumatic stress disorder (PTSD), is a treatable malfunction of certain biological mechanisms. PTSD is not a personal failing but a condition that requires understanding and treatment.

To understand PTSD, we must first understand how the brain processes traumatic events such as the death of a loved one, domestic violence, injury, illness, abuse, rape, war, car accidents, and natural disasters. These events trigger feelings of danger and helplessness, activating the brain's 'fight-flight-freeze' response. The HPA axis sends signals to the autonomic nervous system, causing physiological changes that prepare the body to defend itself.

During a crisis, the body releases stress hormones that cause changes such as increased heart rate, quickened breathing, and muscle tension. These elevated stress hormone levels can persist for days after the crisis, leading to jittery feelings, nightmares, and other symptoms. Most people recover within a few days to two weeks, but a small percentage experience prolonged problems.

In some cases, trauma causes persistent problems, sometimes disappearing temporarily and resurfacing months later. One theory suggests that the stress hormone cortisol continuously activates the 'fight-flight-freeze' response, reducing overall brain functioning. PTSD symptoms fall into four categories: intrusive thoughts, avoiding reminders, negative thoughts and feelings, and reactive symptoms like irritability and difficulty sleeping. When these problems last more than a month, PTSD is often diagnosed.

Genetics, ongoing overwhelming stress, and various risk factors such as preexisting mental illnesses and lack of emotional support play roles in determining who will develop PTSD. However, the underlying cause remains a medical mystery.

A major challenge in coping with PTSD is sensitivity to triggers—stimuli the brain associates with the original trauma. These can be everyday sensations that provoke strong reactions, such as the smell of a campfire triggering the memory of being trapped in a burning house. Such triggers can cause individuals to relive their trauma, leading to isolation and feelings of being invalidated or misunderstood.

For those suffering from PTSD, the first step is to seek evaluation from a mental health professional. Psychotherapy and certain medications can be effective, along with self-care practices like mindfulness and regular exercise. Social support, acceptance, and empathy are crucial for those experiencing PTSD, as is encouraging them to seek evaluation and treatment.

PTSD is often called the 'hidden wound' because it lacks outward physical signs. However, it doesn't have to be a silent disorder. Acknowledging and addressing PTSD is essential for recovery and support.