INTRODUCTION:
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Severe trauma has been estimated to directly impact 60% of Americans at some point in their lifetimes (Feliciano, 2009). Psychology tells us that some trauma is severe enough to lead to changes in overall personality, and cause severe conditions such as Post-Traumatic-Stress-Disorder (PTSD). It is my aim to examine the importance of examining trauma from a neurological standpoint. I will explore how specific elements of the brain are impacted by traumatic experiences.
I view trauma as a function that modifies normal behavior through manipulation of brain chemistry. Some research questions I have to include: Why is analyzing trauma from a neurological perspective important? Does neurological research explain or contradict any observed and established psychological diagnoses? Are there any differences between PTSD-causing trauma between men and women? Altogether, it is my goal to explore this phenomenon of trauma and argue that a neurological perspective is necessary to fully examine it.
BACKGROUND:
A neurological perspective aims to explain how a process works in terms of chemical changes or reactions that take place in the human brain. In the case of this examination, I aim to explain the brain chemistry of trauma. This perspective will show how these reactions and alterations in brain chemistry can and should be used as an important method of further understanding.
Traumatic stress is something that triggers many reactions within the brain and body. In cases of extreme trauma, symptoms such as Post Traumatic Stress Disorder can occur, leading to lifelong struggle. From a psychological standpoint, PTSD is defined as “an anxiety disorder characterized by re-experiencing, avoidance, and hyperarousal symptoms that can develop after exposure to a traumatic event” (Feliciano, 2009).
In America, roughly 9% of people suffer from PTSD, which for a first-world nation, is relatively high. However, in regions experiencing more frequent civil unrest, such as terrorism, violence and governmental instability, the percentage of people experiencing PTSD can jump to as high as 30% (Feliciano, 2009). My specific research aims to treat or prevent such high rates of PTSD from occurring all across the world.
LITERATURE REVIEW:
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A large body of research has accumulated over the years in relation to PTSD and how it develops. However, the ability to analyze brain chemistry and neural activity is still relatively recent (~20 years) and therefore the body of literature as it relates to PTSD and brain function is relatively small. Despite the time constraint, Marla Mickleborough (2011), Nowotny (2010), and Goleman (1992) have all released important findings as they relate to the brain chemistry of PTSD.
Daniel Goleman is a very highly regarded psychologist, author, and brain scientist who has examined brain responses to trauma. Through the analysis of several experimental “subjects” with PTSD, with support of several external sources, he proved that the action of the noradrenaline neuron is blocked during stress, allowing more adrenaline to enter the brain (Goleman, 1992). Under extreme stress, the brain essentially turns off the system that keeps adrenaline levels from spiking in a purely survival-based evolutionary response. I will use these findings to further understand the connection between the brain and the symptoms experienced by the victims of PTSD later in my analysis.
B. Nowotny has examined a specific group of people that suffer from PTSD, (Bosnian War Refugees aged between 30-50) and drawn connections between trauma and glucose consumption by the brain. It is known that the sympathetic nervous system, as well as the hypothalmic-pituitary-adrenal axis are activated within the brain under traumatic conditions. Both of these complicated processes release hormones into the bloodstream, which ultimately results in an increased glucose consumption by the brain (Nowotny, 2010). This increase in glucose consumption was confirmed through testing and may serve as an important piece of evidence as to how PTSD develops. Glucose research is a topic of major significance in terms of trauma processing. I will analyze Nowotny’s conclusions to further strengthen my thesis in further sections.
Lastly, Marla Mickleborough, a PhD student at the University of British Columbia, recently used sophisticated fMRI medical imaging technology to map brain function of people with and without PTSD when given traumatic cues. Amazingly, people who suffer from PTSD have an altered way to process trauma (Mickleborough, 2011). I plan to use these research findings to explain the neurology of “triggers” and other observable PTSD symptoms.
ANALYSIS:
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It is clear that trauma causes changes to the homeostatic chemistry of the brain. An analysis of Goleman’s research suggests that regardless of the type of experienced trauma, the brain processes it in the same way (Goleman, 1992). This is related to one research question I aimed to answer: what is the difference between the neurology of PTSD in men and women?
I. Komarovskaya completed a research study centered around trauma patterns between men and women. Of the sample group, 95% (men and women combined) indicated that they have experienced at least one traumatic event in their lifetime. Of the 95%, only 12.5% of men developed PTSD-like symptoms as a result of their trauma. On the other hand more than 40% of women developed PTSD-like symptoms. Through regression analysis, a relationship between the trauma itself and PSTD development was drawn. It was found that the men who developed PTSD-like symptoms experienced trauma centered around “interpersonal physical trauma,” and harm “within and outside the family” (Komarovskaya, 2011). Women with similar symptoms, on the other hand, had not experienced this sort of trauma. More likely than not, women within the study had encountered some form of sexual trauma in either their childhood or adult life. It has been shown that women “get” PTSD more frequently than men do. Is it possible for neurology to explain this difference between PTSD development in men and women?
Because instances of sexual abuse related trauma are much higher for women 1 in 5 (women) vs. 1 in 71 (men) (BBC World, 2011) it is clear and somewhat obvious that more women get PTSD from rape then men. However, the question still remains, is there something unique to women, socially or otherwise that put them at greater risk for PTSD in general?
Catherine A. Simmons investigates this question within her article “Speculation as to Why Women "Get" PTSD More Often than Men.” She takes a sociological stance by arguing that the traditional roles that men and women are assigned by society play a key role in the elevated PTSD development of women (Simmons, 2007). She also touches on the possibility of genetic predisposition as a reason why women get PTSD more than men. Although hardly any research has been completed to date, Simmons poses the interesting viewpoint that perhaps a connection between the stress response system of the brain and the female reproductive system and menstrual cycles explains the relatively high PTSD rates in women (Simmons, 2007). Despite the fact that the author herself states that this connection is unlikely and lacking evidence, it is still an interesting notion that may warrant further research in the future.
Altogether, it seems as though men and women experience trauma in a similar way neurologically. Whether or not women are more at risk from a genetic standpoint is questionable, however I believe that the real point of interest comes out of societal effects on trauma processing. The fact that women get PTSD more than men is partially due to the fact that women experience more trauma, (especially sexually) and partially due to the social roles that both women fall into. One can argue that perhaps if society viewed women as dominant, controlling, and powerful (not that they aren’t) as the men of today seem to be, perhaps the instances of PTSD would diminish. Everything considered, a neurological perspective isn’t of much use in this circumstance. Instead, a more sociological or interpersonal stance should be adopted in order to explain the discontinuity between PTSD in men and women.
While neurology may not be useful in explaining the differences in PTSD between men and women, it can be used to explain many other psychological symptoms. Daniel Goleman’s conclusions seem to be reasonable, seeing that there is a direct connection between noradrenaline and the specific piece of the brain which controls the limbic system (emotional regulation system of the brain): the locus coeruleus. This part of the brain regulates not only emotion, but also 90% of the brain’s overall noradrenaline levels (Goleman, 1992). It seems to be perfectly logical that because the action of the noradrenaline neuron is altered due to trauma, and the observational data describes huge changes in emotional state, the locus coeruleus must be involved. Also, the subjects that Goleman used all were afflicted with different types of trauma, (plane crash, war-based trauma... etc.) but they all experienced similar symptoms. As a result, one may conclude that the brain turns off the noradrenaline system during extreme trauma scenarios in an attempt to stay alive, regardless of the type of trauma. This research is related to my thesis in that it shows one neurological effect trauma has on brain. Also, this study clearly confirms psychological symptoms caused by trauma in terms of alterations in brain chemistry.
B. Nowotny’s findings make sense in that because the brain uses and depletes the usable glucose from the blood during traumatic experiences, the brain’s function may alter based on glucose levels during a traumatic experience. This change in brain chemistry can lead to deterioration in hypothalamus and hippocampus function (Minor 1997) which explains some of trauma’s psychological symptoms due to the fact that the hippocampus codes for spatial and temporal memory. This study is significant to my thesis because this aspect of the neurology of trauma describes the reason why various memory-related psychological symptoms, such as flashbacks, occur in PTSD victims.
Marla Mickleborough found that, as a result of their debilitating experience, patients with PTSD exhibit different neural activity on a fundamental level, when prompted with traumatic stimuli (Mickleborough, 2011). Compared to the control group (people without PTSD), patients that do process pain in a much less intense way, which seems to suggest one of two things: that traumatic resilience, however effective, is taking place, or that emotional numbing is occurring. Either way, this study explicitly demonstrates that brain function is permanently altered, in terms of trauma processing, in people that have PTSD. This insight is vital in understanding the neurology of trauma and how it pertains to observed symptoms such as “triggers.”
I assert that a neurological understanding of trauma is important and significant because of the possibility to intervene and stop ailments like PTSD. Currently, psychological therapy is the only method of helping combat the symptoms of PTSD. At UCLA, much work is being done in order to try and change that. While curing PTSD is an immense challenge, researchers have been working to intervene between the experience of the traumatic event and the onset of PTSD. Currently, glucose research is being conducted in order to alter brain function and prevent PTSD development. Dr. Thomas Minor is heading the research group, and has shown that post-stress glucose ingestion leads to severely decreased or the elimination of PTSD-like symptoms, as well as the “learned helplessness paradigm” (Minor, 1997).
This research operates under the same notions of B. Nowotny’s, in that trauma leads to increased glucose demand from the brain. By supplying the bloodstream with excess amounts of glucose through ingestion, the brain is able to remain in working order even after a traumatic event occurs. Typically, once the brain undergoes traumatic stress, the hypothalamus and hippocampus are impaired due to lack of glucose (Minor, 2011). Because the hippocampus is responsible for the spacial temporal coding of memories, when it is impaired, the memory isn’t properly processed, causing many of the standard PTSD-like symptoms, such as the re-occurrence of memories past. Minor’s research has been focused on administering glucose to test animals before subjecting them to traumatic stress. In the animals with elevated glucose levels, they exhibit no PTSD like symptoms in post-stress testing, while the control group (animals without glucose) did show symptoms of helplessness and PTSD (Minor, 2011).
The significance of this research is immense. A human testing is in early phases through the L.A. Trauma Center, and could potentially keep people from developing the otherwise extremely debilitating symptoms of PTSD. This can impact people across the world, especially in some nations where PTSD rates are as high as 30% (Feliciano, 2009). Also, this research could be modified and implemented into the military, in order to prevent soldiers on the front lines from developing PTSD. It is clear how a neurological understanding was used in order to conclude that post-stress glucose may help alleviate PTSD-like symptoms. This, in my eyes, is the most significant reason behind the necessity to examine trauma in terms of brain chemistry.
CONCLUSION:
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Physiology normally dictates the discussion about PTSD, however, in many ways it only tells half of the very important story. The brain changes with the onset of trauma in a number of ways, including increased glucose demand, as well as restriction of noradrenaline by the locus coeruleus. These changes in brain function are uniform between both men and women, however, genetic predisposition and societal roles contribute to women getting PTSD more often then men do. Regardless, both men and women may be able to prevent the onset of PTSD through research being conducted at UCLA. An understanding of how the brain responds to stress and changes through PTSD on a neurological level, is the most effective way to learn how to combat it. Through this understanding, post-stress glucose ingestion was developed. This technique may be able to cut the ties between the traumatic event and the onset of PTSD, by ensuring the brain has enough glucose to to maintain chemical homeostasis, even under extremely stressful conditions. This may lead to a Post Traumatic Stress Disorder free future, which, I think we can all agree, can’t come too soon.
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Resources:
Feliciano, M. (2009). An overview of PTSD for the adult primary care provider. Journal For Nurse Practitioners, 5(7), 516-522. Goleman, D. (1992). Wounds that never heal: how trauma changes your brain. Psychology Today, 2562. Komarovskaya, I., Booker Loper, A., Warren, J., & Jackson, S. (2011). Exploring gender differences in trauma exposure and the emergence of symptoms of PTSD among incarcerated men and women. Journal Of Forensic Psychiatry & Psychology, 22(3), 395-410. doi:10.1080/14789949.2011.572989 Mickleborough, M. S., Daniels, J. K., Coupland, N. J., Kao, R., Williamson, P. C., Lanius, U. F., & ... Lanius, R. A. (2011). Effects of trauma-related cues on pain processing in posttraumatic stress disorder: an fMRI investigation. Journal Of Psychiatry & Neuroscience, 36(1), 6-14. doi:10.1503/jpn.080188 Minor, T. (2011, November) Personal Communication Minor, T. R., Saade S. (1997). Poststress glucose mitigates behavioral impairment in rats in the “Learned Helplessness” model of psychopathology. Biological Psychiatry, 42: 324-334. "Nearly 20% of women in the US are raped, study reveals". BBC World. 15 December 2011. Nowotny B., Cavka M., Herder C., Löffler H., Poschen U., Joksimovic L., & ... Kruse J. (2010). Effects of acute psychological stress on glucose metabolism and subclinical inflammation in patients with post-traumatic stress disorder. Horm Metab Res, 42(10), 746-53. Simmons, C. (2007). Speculation as to why women "get" PTSD more often than men. Women & Therapy, 30(1/2), 85-98. doi:10.1300/J015v30n01