Kolkata; 5 January:
Trapped in Trauma: Understanding the Neuroscience of PTSD and the Urgency of Early Treatment*
*By Dr. Koushik Dutta, Consultant Neurology, Manipal Hospital, Dhakuria
As evident from the name, Post Traumatic Stress Disorder (PTSD) is born out of (severe or repeated) trauma, which may be in the form of being exposed to life-threatening situations, or witnessing such an event or listening to such events related to near ones, or being subjected to severe physical injury or sexual violence. Living with PTSD is traumatic. It is like living through the trauma again and again, in some cases every day. Treating the disorder is a necessity, a challenge and a reward for both the doctor and the patient.
PTSD is a severe psychological illness that can severely interfere with daily living, it is more than being depressed or anxious. PTSD individuals can experience flashbacks or nightmares, reliving the traumatic event. They are always on the lookout, anxious, and cannot sleep or focus. They tend to avoid people, places, or activities that bring back memories of the trauma, or be distant and numb with others. There is a constant feeling of guilt or being ashamed, and the symptoms can seriously affect working, relationships, and general health.
PTSD alters thinking, feeling, and responding to the world by physically altering the brain. Amygdala, which happens to be the brain's fear center, is overactive, one is always feeling dangerous or on guard. Shrinking of the hippocampus, which assists in organizing memory, causes confusion between the past and the present by leading to flashbacks.
Relaxation or clear thinking becomes progressively more difficult as the prefrontal cortex, which assists in controlling emotions and rational thinking, shrinks. The body is also in a constant state of "survival mode," mood-controlling chemicals diminish, stress chemicals such as cortisol increase, and brain chemicals become out of balance.
Why People Avoid and Numb Out
Individuals who have PTSD usually attempt to stay away from everything that reminds them of the traumatic experience, it may be a location, an individual, a scent, a noise, or even a recollection. Avoidance may seem like a coping mechanism, but it continues to keep fear and anxiety present by not enabling the brain to process and recover from the trauma. Emotional numbing is another typical response, where one feels detached from others and themselves. This occurs since the brain is attempting to safeguard itself against being overpowered by hurtful feelings. Psychologists describe how this action is usually caused by classical conditioning when something that is neutral turns into a stimulus just because it is linked with the trauma. Negative reinforcement is involved as well—because staying away from triggers provides temporary relief, the brain begins to depend on it. This causes a cycle that hinders healing over time. Additionally, individuals with PTSD also experience distorted thinking, such as blaming themselves, thinking they were weak, or thinking they were somehow deserving of what happened. These distortions cause more feelings of guilt and shame, making recovery even more difficult.
Sleep disruption is another serious issue. Most people with PTSD have nightmares, difficulty with sleep onset or maintenance, or waking up in the morning feeling tired. It occurs because the brain does not shut down, even when sleeping. The amygdala that regulates the fear response becomes overactive, whereas the hippocampus, which is responsible for memory processing, does not function normally. The prefrontal cortex that also aids in emotion regulation and logic reasoning becomes impaired. This disequilibrium makes it more difficult for the brain to distinguish between traumatic memories and other material at night, resulting in chronic distress and inadequate sleep.
Diagnosis and Brain Changes:
Although PTSD is mainly diagnosed based on symptoms reported by the patient, medical research has shown that the disorder creates actual physical changes in the brain and body. MRI scans often show shrinkage in the hippocampus and prefrontal cortex areas responsible for memory, decision-making, and emotional control. Functional MRI (fMRI) reveals an overactive amygdala and poor communication between different brain regions, especially those involved in calming the body. PET scans detect abnormal brain activity and changes in neurotransmitter function. EEG studies sometimes show heightened brain arousal, which explains why people with PTSD are easily startled or on edge. Heart rate variability (HRV) is also often lower in PTSD patients, meaning their bodies don’t respond well to stress. Startle response tests show that people with PTSD can react much more strongly to sudden sounds or touches, which reflects how deeply the trauma has affected both mind and body.
Paths to Recovery
Various therapy can help recover, and PTSD is curable, especially if diagnosed early. Exposure therapy steadily reintroduces trauma memories in a safe, controlled environment, while trauma-focused cognitive behavioral therapy (TF-CBT) helps individuals confront and reframe their traumatic memories. Cognitive processing therapy (CPT) aims to challenge and reframe distressing thoughts such as blame or guilt. Neurofeedback trains the brain to regulate emotional responses better, and Eye Movement Desensitization and Reprocessing (EMDR) employs facilitated eye movement to help the brain process distressing memories. Transcranial magnetic stimulation (TMS) targets specific brain areas to improve emotional balance. Medication may be administered to alleviate severe anxiety or nightmares, while others, particularly SSRIs (a type of antidepressant), may reduce symptoms.
New Strategies
New drugs like ketamine and MDMA-assisted psychotherapy are promising, especially for treatment-resistant patients. Yoga, meditation, exercise, group therapy, and family therapy can also speed up recovery.
Why Early Intervention is Important
The brain is very plastic and vulnerable immediately after trauma. Under suitable and timely treatment, it heals. But without our intervention, these changes are irreversible and much harder to reverse. The sooner we intervene, the more likely we are to attain full recovery
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