It’s normal to be affected by a very stressful or traumatic experience, such as military combat, natural disasters, terrorists attacks, serious accidents, or physical or sexual abuse.  For example, it’s typical to be upset, on edge, experience upsetting memories, or have trouble sleeping after exposure to a traumatic event, For most people, these experiences begin to diminish and they start to feel better after a few weeks or months. However, for some distressing symptoms can persist and interfere with their daily lives. Approximately 5% of adolescents meet criteria for PTSD,  a psychiatric disorder that can develop after someone experiences or witnesses a life-threatening event, injury, or sexual violence. PTSD can also develop when someone learns of a close relative or friend who experienced an actual or near accidental or violent death.* In some cases, PTSD symptoms may not begin might away or they might wax and wane over time.

SYMPTOMS OF PTSD

Symptoms of PTSD fall into three different clusters.

1. Intrusion of thoughts or unwelcome memories of the traumatic event manifested in one or more of the following ways:

  • Memories of the trauma that keep coming back even though you don’t want them to. 

  • Nightmares related to the traumatic event. Kids may have freighting dreams that don’t center on the traumatic event.

  • Flashbacks or other dissociative reactions that make it feel like the event is happening again.

  • Intense, long-lasting emotional distress or physical reactions in response to a “trigger” or something that reminds you of the traumatic event. For example, someone who witnessed a shooting might feel terrified, start sweating, or experience racing heartrate when they hear a car backfire.

 

2. Persistent avoidance of feelings, thoughts, or things (e.g., situations, people, places, objects) related to the trauma. For example, someone who was mugged may go out of her way to avoid the street where it happened or might try not to think about it. Although it makes sense that people want to avoid thoughts, feelings, or things associated with the trauma, when avoidance becomes pervasive or extreme, it can get in the way of healing and recovery. 

  • Having trouble remembering an important aspect of what happened

  • Feeling worse about yourself, other people, or the world

  • Blaming yourself for what happened even though it wasn’t your fault

  • Feeling negative emotions (fear, anger, guilt) a lot of the time

  • Difficulty experiencing positive emotions (happiness, satisfaction, loving feelings towards others)

  • Being less interested in things you used to enjoy

  • Feeling detached or not connected to other people

 

3. How you react or respond to things may change and you may experience:

  • Anger outburst (yelling, throwing things, violence towards others)

  • Engaging in dangerous behavior like driving too fast, using drugs

  • Feeling keyed up or on edge

  • Always looking out for danger

  • Trouble concentrating

  • Trouble falling or staying sleep or sleeping restlessly. 

 

To be diagnosed with PTSD, symptoms from each of these clusters must last for a month or more and must get in the way of your relationships, school or work performance, or other important areas of your life. It is also important to note that different people may experience different symptoms of PTSD and that not everyone with PTSD has the same experiences.

Some people may not meet full criteria for PTSD for some time, which is known as “PTSD with delayed expression”. 

 

What other problems do people with PTSD tend to experience?

Many people who have PTSD also experience other mental health or physical problems, such as:

  •  Alcohol or drug Abuse

  •  Depression

  •  Thoughts of harming themselves

  •  Chronic Pain

*-American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013

 

How Our Brains Respond to Stress:

 

Our bodies come with a built-in alarm system to protect us when we are in danger. In times of great stress, the stress-response system kicks in to help the body prepare to fight, flee, or freeze. This system includes parts of the brain, organs and hormones that work together to help us respond to stress. The amygdala, located in the middle of the brain, is the threat detector and is essential to our survival. It tells the Hypothalamus-Pituitary-Adrenal (HPA) Axis, our brain’s messenger system, to responds to stressful situations by signaling the release of stress hormones, such as cortisol and adrenaline. These hormones then signals the rest of the body to respond. For example, cortisol tells your heart to pump more blood to your muscles and breathe faster to get more oxygen to help you run away when you’re faced with something dangerous. The prefrontal cortex (PFC) plays an important role in interpreting and deciding how to respond to situations. In other words, the prefrontal cortex helps determine whether a perceived threat is actually something to stress about. If so, the PFC helps decide the best way to respond and then quiets down the stress-response system once the threat goes away. If the PFC determines that there is no real stress, it then dampens or calm down the stress reaction.

(Bezdek K and Telzer E (2017) Have No Fear, the Brain is Here! How Your Brain Responds to Stress. Front. Young Minds. 5:71. doi: 10.3389/frym.2017.00071)

 

With PTSD, the alarm system is very sensitive and triggers easily. Specifically, people with PTSD tend to have very reactive amygdalas, but less active prefrontal cortexes. This can cause someone with PTSD to feel as though they are in danger, and act accordingly, even when they are not. It can also mean that it takes the body longer to recover from these situations. In some cases, everyday things can trigger the alarm system and create stress. For example, if someone develops PTSD after nearly drowning in the ocean, their body’s alarm system might kick into high-gear during a brief sun shower and it may take some time to return to baseline afterwards.

How Does PTSD Affect the Brain

 

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