To explain how trauma affects the brain and what happens in the brain of someone who has PTSD, I will begin with a brief explanation of the human brain and the different nervous systems the body has. This allows you to get a better understanding of how the brain works in someone struggling with PTSD.
The human brain consists of three parts:
Brains make sure, among other things, that you can communicate, move, think, use your senses and your memory. In addition, brains produce hormones, regulate blood pressure and body temperature, that you can breathe and your heart beats. These last four things are controlled by the autonomic nervous system.
The human brain, together with the spinal cord, forms the central nervous system. The central nervous system receives and processes information from the environment and the body. In addition, it connects different areas of the brain with each other and provides connection of the brain with the rest of the body. This allows the brain to communicate with the body. You can (control) the central nervous system consciously.
In addition, there is the peripheral nervous system through which the connection and communication from the brain to the body occurs. This consists of a network of nerves: cranial nerves, spinal nerves and all other nerves running through the body. Then there is the autonomic nervous system works independently and involuntarily; you cannot directly influence it. The autonomic nervous system regulates almost all unconscious functions and processes in the body. For example, in addition to heart rate, blood pressure and body temperature, think about digestion, energy production and metabolism.
The autonomic nervous system consisting of two systems: the sympathetic nervous system and the parasympathetic nervous system.
Simply put, you can say that the sympathetic nervous system provides action in your body and the parasympathetic nervous system provides rest. When your body is in action mode, and the sympathetic nervous system is active, you are able to survive. To do this, the following hormones are produced in the adrenal glands, which are part of the sympathetic nervous system: adrenaline, norepinephrine and cortisol. These hormones act as messengers to your brain, letting it know it needs to take action. The hormones cause the heart rate to increase, blood pressure to rise and you to breathe faster: your body prepares for danger. This takes a lot of energy, and it is exhausting for both the body and the brain.
Once the danger has passed, the parasympathetic nervous system comes into action. The parasympathetic nervous system makes your heart rate go down again, your blood pressure goes down and your muscles can recover from the exertion. The parasympathetic nervous system makes your body and brain calm and relaxed again; thus, you can recover from the exertion.
Your brain is equipped with an alarm system that responds when you perceive a threat. This alarm system helps you survive. In the event of a threat, all non-emergency functions in the brain and body are turned off and the focus is on survival. The amygdala (almond-shaped area in the limbic part of the brain) responds first and activates the hormone norepinephrine; this hormone speeds up your breathing, slows your heart rate and increases your blood pressure. It gets you to take action. The amygdala is the alarm bell in your brain that causes you to choose one of four survival modes: fight, flight, freeze or follow. In the first two modes, you confront or flee from danger. If you freeze, you literally cannot move; that is, you cannot flee from or fight the danger. And in the "follow" mode you tend to please the person causing the danger, to make the person feel comfortable.
The amygdala communicates with other parts of the brain, including the hypothalamus and the prefrontal cortex. The hypothalamus makes the hormone cortisol, and the prefrontal cortex assesses whether the body should stay 'on' (because the danger is still imminent) or can return to rest. The prefrontal cortex is the braking system in the brain.
Each person reacts differently to a situation involving danger. For example, one person will fight, another chooses to flee, and a third person freezes in the situation or becomes completely docile. This is not a conscious choice you make, but a primary, instinctive reaction. The autonomic nervous system reacts and determines how you act in a dangerous situation.
In someone who has PTSD, the systems are disturbed, so to speak, and work abnormally. The survival system supplied by the amygdala is very sensitively tuned; it is triggered and activated at the slightest thing. The sympathetic nervous system becomes active and the body goes into survival mode. At the same time, the prefrontal cortex does not work adequately, so the brake in the brain is no longer (fully) present. This process takes a lot of energy. This in itself is not a problem if it were short-lived, because then the body has a chance to recover afterwards.
But in people with PTSD, the body is constantly in survival mode, creating an imbalance between the sympathetic and parasympathetic nervous systems. Because the body is in action mode too often and for too long, it does not come to rest sufficiently or at all. The body no longer recovers. The body is overworked and exhausted, with physical and mental consequences.
PTSD has a profound impact on the brain and can cause structural changes in the brain. In some parts of the brain, PTSD causes hyperactivation, while other areas become less active (hypoactive). For example, the cortex cingularis anterio and the amygdala become overexcited, while the hippocampus, the right frontal gyrus inferior, the prefrontal cortex and the dorsolateral PFC become less active or sometimes show no activity at all.
The hippocampus is part of the limbic brain and plays a role in memory; the ability to store things. In addition, the hippocampus is important for spatial orientation. A larger hippocampus is more likely to increase spatial awareness. Furthermore, the hippocampus helps regulate emotions and plays an important role in exhibiting desirable social behavior.
The amygdala also belongs to the lymbic brain and is involved in stress regulation, among other things: the amygdala is able to connect an emotion to a particular stress situation. This increases the chance that you will recognize a similar stress situation in the future and exhibit different behavior to avoid the stress and associated emotion.
The prefrontal cortex (PFC) is located in the frontal lobe of the brain and plays an important role in the regulation of thoughts, actions and emotions. Examples include making choices, impulse control, (working) memory, organizing and planning, problem solving and interpreting emotions.
The cortex cingularis anterio (ACC) is located in the prefrontal cortex of the brain and is involved in various cognitive functions such as decision making, emotion processing, empathy and conflict management, among others. Furthermore, the ACC plays a role in the registration of pain in the body, emotional awareness and the regulation of blood pressure and heart rate.
The right frontal gyrus inferior is located in the prefrontal lobe of the brain and is involved in grammatical matters and risk management, among other things.
In people with PTSD, that part of the brain that triggers a survival response (fight, flight, freeze or follow) is overstimulated and reacts much more strongly than average; often too strongly in relation to the danger that is imminent. And the part that is supposed to put the brakes on the systems again, reacts just not strongly enough, so that the body does not calm down sufficiently or at all.
PTSD changes processes and functions in the brain.
For example, too much and too long the hormone norepinephrine is produced because the amygdala reacts too strongly. The result is that a person is over-alert (he is constantly "on") and cannot relax sufficiently. This leads, among other things, to sleeping problems, which prevents the body from recovering properly (this happens mainly during sleep). An additional consequence of always being ?on? is that a person reacts excessively intense in relation to what is happening in a situation; the emotional experience in the brain feels similar to that of the trauma, while in reality the situation is often less intense and far-reaching. But the brain thus experiences that the situation is as bad as that of the trauma.
The prefrontal cortex, important for reasoning and decision-making, among other things, because it is not working as well, can make it harder for a person to think rationally. The prefrontal cortex helps regulate emotions: it is able to inhibit the panic response, which is triggered by the amygdala, when it turns out that a situation is not as deceptive after all as the person initially thought. In someone with PTSD, the prefrontal cortex is not always able to do this.
Another consequence is reduced function and/or size of the hippocampus. If the hippocampus works less well or is smaller, it affects how a person stores and recalls memories. You can compare it to a computer's hard drive. The hippocampus sends information to the hard drive. This also happens in the case of trauma. Only then, because the event is so overwhelming, the information is not sent fully and correctly to the hard drive. As a result, the person may have difficulty remembering certain details of the trauma or, on the contrary, think about the trauma a lot because the hippocampus is working hard to make sense of it all. Thus, the person gets flashbacks of the traumatic experience(s) and distorting negative beliefs.
The combination of an overactive amygdala, a non- or slow-working prefrontal cortex and a faltering hippocampus creates chaos in the brain. You can compare it to the following situation: driving full throttle on the highway and then finding out that the brakes don't work. All three are involved in processes of emotions, decision-making, thinking and memory. A person with PTSD can simultaneously:
Finally, impaired functioning of the right gyrus frontalis inferior causes a person to exhibit impulsive and/or risky behavior more often.
These are just some of the changes that can occur in the brain of someone who has PTSD. PTSD, and certainly CPTSD, can be a lifelong problem for people who struggle with it, with or without (severe) brain damage. Wondering what it means for me to live with PTSD? Read here my story.
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