What is Post-Traumatic Stress Disorder?

Jul 28

Post-traumatic stress disorder, or PTSD, is a severe form of anxiety and panic disorder. It can occur in those who have either witnessed or suffered through a traumatic event. Individuals living with PTSD often experience intrusive, intense, and disturbing thoughts related to their trauma. When a PTSD event is triggered, debilitating panic attacks are common. These are often so severe that sufferers remake their entire lives in ways to avoid triggers. This leads to limited activity, impaired job performance, and negative impacts on relationships.

How Common is Post Traumatic Stress Disorder?

According to the National Alliance on Mental Illness, 3.6% of adult Americans live with PTSD. Women are two times as likely to develop PTSD than men. Roughly 37% of people diagnosed with PTSD suffer from severe symptoms (1).

What Causes Post-Traumatic Stress Disorder?

PTSD is directly related to exposure to trauma. Exposure to trauma itself is not sufficient to cause the condition, as PTSD sufferers make up a relatively small percentage of people that have experienced trauma.

There does appear to be a genetic predisposition towards PTSD. A 2017 Harvard study demonstrated that 20% of the risk of developing PTSD is related to genetic factors (2).

When trauma is experienced in childhood, the likelihood of developing PTSD increases. Studies of ACEs (adverse childhood experiences) show significantly increased risks of developing mental health problems later in life, including PTSD among others (3).

What are the Symptoms of Post-Traumatic Stress Disorder?

Symptoms of PTSD generally involve the following:

Re-experiencing symptoms can include flashbacks, intrusive thoughts, recurrent nightmares, and negative memories associated with the traumatic event.

Avoidance becomes a common strategy, as sufferers become aware of their triggers and take steps to prevent exposure. This withdrawal strategy can lead to a profound negative impact on quality of life.

Cognitive and mood symptoms include depression, anxiety, feeling emotionally numb, memory impairment, difficulty with concentration, and a sensation of unreality known as derealization. These often lead to a progressive loss of self-esteem.

Arousal symptoms include agitation and hypervigilance. The increased sympathetic nervous system activity seen in PTSD leads to elevated startle responses, enhanced “fight or flight” reflexes, poor sleep, and an impaired ability to relax. The inability to control strong negative emotions is common, often leading to outbursts of anger and rage (1)

Intense and disturbing thoughts or feelings that are related to a traumatic experience can last longer than the event itself did. The traumatic incident may be experienced again through flashbacks or nightmares for those with PTSD. This can also bring on feelings of sadness, fear, anger, and detachment. Being sensitive to sound or touch and having strong negative responses to them may also be signs of PTSD.

What are the Consequences of Post-Traumatic Stress Disorder?

It is estimated that up to 80% of PTSD patients have a comorbid disorder, with the most common comorbidities being depression, anxiety, alcohol addiction, and substance abuse.

Hypertension, and insomnia are common comorbid disorders. Neurocognitive disorders also frequently accompany PTSD.

Chronic migraines, back pain, stomach aches, and body pain are all extremely common with PTSD.

PTSD has been associated with bone and joint disease, neurological conditions, cardiovascular conditions, respiratory conditions, and metabolic diseases.

What Happens in the Brain with Post Traumatic Stress Disorder?

There are a number of critical brain circuits involved in the development of PTSD. The amygdala functions as the brain’s threat detector, and ascribes an emotional valence to all forms of experience. The amygdala has direct connections to the midbrain reticular activating system, which excites the frontal lobe for brain arousal. This system activates the hypothalamic-pituitary-adrenal axis, which is the output of the sympathetic nervous system and leads to global stress responses. The hippocampus is an important structure involved in memory, and in particular building context for memories. The prefrontal cortex is involved in cognition, executive function, emotional regulation and goal-oriented behavior. It gives rise to the ventral frontostriatal circuit, which helps to modulate the HPA axis and the emotional structures of the brain. The anterior cingulate cortex is an area with many functions, and is heavily involved in emotional suffering.

In PTSD, functional MRI studies show that the amygdala becomes hyperactive, leading to elevated perception of threats and an increased baseline level of general anxiety. The hippocampus has been shown to decrease in physical volume, resulting in poor ability to build an appropriate emotional context around memories (15).

The hippocampus plays an important role in regulating the balance between cortisol, a major stress hormone, and melatonin, an important hormone for sleep. Damage to the hippocampus thus leads to the sleep disruption seen in PTSD (16).

The prefrontal cortex has been shown to have decreased blood flow in PTSD, and thus decreased function. This leads to a loss of the ability to regulate stress responses, and decreased capacity to shut off the anterior cingulate cortex. The ACC has been shown to increase activity in PTSD, resulting unfortunately in profound, unmodulated suffering (4).

The ultimate consequence of all of this is increased output of the hypothalamic-pituitary axis. This results in elevated levels of circulating stress hormones such as cortisol and adrenaline, and all of the negative consequences associated with these. Increased cortisol has been shown to lead to weight gain, depression and anxiety. It has also been demonstrated to lead to greater degeneration of the hippocampus and prefrontal cortex, making the problem progressively worse over time. Research implies that PTSD may involve permanent sensitization of the HPA axis (5).

Many of the circuits involved in PTSD are very susceptible to the effects of mild traumatic brain injuries. PTSD is a common consequence of concussions and mild traumatic brain injuries. The hippocampus in particular appears to be very vulnerable to damage in mTBI. The prefrontal cortex is commonly injured, and a prefrontal cortex injury may be the hallmark of post-concussion syndrome. The frontostriatal circuit is a very midline network, and is susceptible to the rotational shearing forces that lead to concussions and mTBI. The result of all of these is damage to autonomic nervous system regulation networks, thereby increasing the frequency and severity of PTSD attacks (6).

PTSD increases levels of stress hormones such as norepinephrine. This leads to increased inflammatory chemicals circulating throughout the body. Inflammation increases susceptibility to heart disease, diabetes, arthritis, strokes, obesity, and a host of other diseases (7).

How is Post Traumatic Stress Disorder Usually Treated?

Common treatments for PTSD include therapy, medications, group therapy, acupuncture, and animal-assisted therapy (17). These can be successful to one degree or another in managing the symptoms of PTSD, but they do little to ameliorate the underlying problems creating the disorder.

How is the NeuroRescue Program Different?

We take a comprehensive functional neurological approach in the treatment of PTSD. We look for neurological systems that have been damaged, systems that are over-firing or under-firing, and find ways to stimulate and rehabilitate the involved pathways to bring your system back into balance. We attempt to directly address the neurological causes of your PTSD, rather than just manage the symptoms.

One of the main things your brain does, and maybe even the primary thing, is help you determine where you are in the world. Your brain uses inputs from your inner ear to figure out where your head is in relation to gravity and how it is moving. It uses inputs from your muscles and joints to figure out where your body is in relation to your head and what your body is doing. It uses inputs from your eyes to figure out where your body is in relation to the visual environment.

Your brain needs to put all of that together to make sense of where the world is, and where you are in relation to the world. It needs to be able to localize you effectively in the environment, in order for you to be able to respond to the environment properly.

Your brain organizes all of this information in terms of maps. There is a vestibular map from the inner ear, a proprioceptive map from muscles and joints, a vascular map of your blood flow, a visual map of the world from your eyes, and several others. Your brain needs these maps to be saying largely the same thing about where you are in the world at all times.

One often overlooked feature of PTSD is that these maps often fail to match. Your eyes, inner ear, and muscles may be creating maps that say different things about where your head is in relation to gravity, and in relation to the external world. When these maps do not match, it is difficult to unconsciously localize yourself in the world.

And when you can’t make sense of where you are in the world, the world can become a very scary place.

This is why many patients fail to fully resolve their PTSD with most forms of treatment. Without addressing the problems in these maps, the underlying dysfunction remains, and the best they can hope for is to gain some control over their symptoms. We would much rather try to address the underlying cause. The functional neurological treatment we employ as part of your NeuroRescue Program is the key to rehabilitating the underlying issues that are creating and promoting your PTSD.

Neuroscience research has shown that programs designed to address specific patterns of dysfunction in the pathways listed above can successfully treat PTSD. A 2015 study showed that two weeks of intensive functional neurological therapy was more effective at treating PTSD in combat-injured veterans than the current gold-standard traditional therapies, Citalopram and cognitive-behavioral therapy. Moreover, the more severe the PTSD, the more effective was functional neurological treatment (9). Follow-up study showed that the effects of this treatment were long-lasting, and patients continued to improve with their home exercise protocols (10). Additional studies with researchers from Harvard and Cambridge have investigated the role of specific classes of impaired eye movements in anxiety, depression, PTSD, and associated mental health conditions. Rehabilitation of the involved eye movements by functional neurological methods have been shown to significantly decrease the severity of these conditions (11, 12).

Additional forms of neurostimulation have been shown to be effective for the treatment of PTSD. Transcranial Magnetic Stimulation is one such therapy, where an MRI-strength magnet is used to apply a focused beam of electromagnetic energy through the skull and directly to the prefrontal cortex. This treatment is safe, comfortable, with minimal rare side effects. More importantly, it is extremely effective for restoring normal function of the prefrontal and frontostriatal circuits involved in PTSD, as current literature demonstrates (13). We have such great success with our TMS treatment at Northwest Functional Neurology that we installed our second TMS unit this year.

There are several other forms of electrical stimulation and neuromodulation that we employ for PTSD treatment. One of our adjunct therapies known as transcutaneous vagal nerve stimulation (tVNS) has been helpful for modulating stress responses and fight-or-flight reflexes (14). Neuromodulation in general has been shown to be very helpful in treatment of PTSD (15).

Not all of these therapies are appropriate for all individuals with PTSD, as there are many different subclasses of PTSD based on the neurological circuits involved. It is impossible to use a cookie-cutter approach to properly treat a condition as complex as PTSD. As with any serious mental health condition, it is ill-advised to treat PTSD without the involvement of licensed psychiatric professionals. At NWFN, all of our PTSD patients are seen by our skilled and experienced Psychiatric Mental Health Nurse Practitioner, Shauna Hahn. All of our providers combine their diagnostic and therapeutic skills to create your unique NeuroRescue program, to ensure that your treatment is safe, efficient, and effective.

How Does the NeuroRescue Program Work?

We design your unique NeuroRescue Program to be among the most comprehensive diagnostic and therapeutic protocols available today. We create individual NeuroRescue Programs based on a comprehensive analysis of every relevant neurological system and pathway, using gold-standard, cutting edge neurodiagnostic technologies and examination procedures and state-of-the-art therapies.

We begin with your Discovery Day, wherein we perform a comprehensive history of not only your condition, but your life on a timeline. This allows us to dive deeply into your case and see all of the factors that led to where you are now. It helps us uncover hidden problems and associated conditions that may be making it difficult for you to move your recovery forward.

Our examination allows us to identify the areas and pathways of your brain that are involved in your PTSD. We begin by precisely quantifying the function of your visual, vestibular, and proprioceptive systems through computerized analysis of your eye movements, your inner ear reflexes, and your balance in a host of different sensory conditions.

We employ technologies including Videooculography and Saccadometry to measure several classes of eye movements. We use Video Head Impulse Testing to measure the function of your inner ear, and Computerized Dynamic Posturography to assess your balance in different sensory conditions.

We use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and perception of vertical in a virtual reality environment.

We combine all of this with a comprehensive physical and neurological examination of your sensory, motor, autonomic, and cognitive systems. We review any relevant laboratory testing, radiological imaging, and prior neurodiagnostic testing, and integrate that information with our findings.

We use this information to identify which parts of your brain are working properly, which systems are struggling, and the precise point at which your systems fatigue.

We can then design a NeuroRescue Program that is unique and specific to your brain, and yours alone. Your NeuroRescue Program works to rejuvenate and reintegrate the damaged neurons and pathways in your brain. It works to improve energy, endurance, and functional capacity within your involved fragile systems.

We use our technologies and procedures to not only see what we need to address, but also when it is time to stop and let you rest. We address your impaired neurological function from multiple angles of therapy, and provide metabolic support to improve neurological recovery.

While we cannot bring back neurons that have been lost, your NeuroRescue Program allows us to take the pathways that remain and maximize their efficiency and endurance. And by focusing on the integration of systems, we can do more than just get pathways working better, we can get them working together again. This gives us our best opportunity to return you to living a healthy, vibrant, and fulfilling life.

Your Next Best Step:

Living with post-traumatic stress disorder can be extremely challenging, but there is hope for recovery and remission. To see if the NeuroRescue Program is right for you, contact one of our patient care coordinators to schedule your Discovery Day.

And remember, it’s never too late to start getting better.