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August is the month when members of the armed forces celebrate several professional holidays. Many media outlets focus specifically on how the military celebrates its holidays. We would like to talk about a problem that many of them face, and for which they rarely receive qualified treatment - post-traumatic stress disorder.
Post-traumatic stress disorder (PTSD) is a psychological problem faced by people who have experienced events that are beyond normal life experience: military action, a natural disaster, a serious car or plane accident, sexual violence, cruelty.
Methods of psychological and medical assistance to people with this disorder first began to be developed in the United States after the Vietnam War. Then many men returned to the country who had lost comrades, seen death and cruelty, survived captivity, and received physical injuries. They had difficulty adapting to everyday life, their families fell apart, and they began to abuse alcohol and drugs.
Although military exposure is one of the most common causes of PTSD, there are others. The military is reluctant to share their experiences, so we are publishing the girl’s experiences - her disorder arose in response to psychological trauma, the mental disorder of loved ones. But the manifestations of PTSD in all people will be the same:
My trauma occurred a long time ago, back in childhood. I grew up in St. Petersburg with my mother and grandmother. They are both sick: my grandmother has schizophrenia, and my mother has schizoaffective disorder. At first everything was fine, but since no one treated them, over time they only got worse. Their condition greatly influenced my life, although I did not realize it: the older I got, the more the disease of my mother and grandmother progressed. My PTSD is the result of years of living with people with serious disorders.
Lyubov Melnikova, interview with Wonderzine magazine
What are the symptoms of PTSD?
Every person experiences nightmares, unpleasant thoughts, and memories of difficult events in the past. Is this PTSD?
Reliving a traumatic event
In cases of PTSD, memories, thoughts, and images come in the form of flashbacks. They feel much more real than ordinary memories - a person often perceives them as reality. Some experts classify flashbacks as episodes of confusion. They can be triggered by an event in the present tense: for example, the sound of firecrackers or the rumble of a truck can trigger a flashback to military action in a former soldier.
Many people say that PTSD is about flashbacks. It's true, and it's very unpleasant. A flashback can be caused by anything: for example, you go to the store, and something - color or light - throws you back, you stand with a pack of pasta in your hands and feel horror, having “failed” into the past. These are very vivid, rich memories, as if you are reliving a moment from the past.
Lyubov Melnikova, interview with Wonderzine magazine
Avoidance
Since flashbacks are very painful for a person, he will try to avoid events, situations, people, things that can cause them. For example, a soldier avoids crowded places. The person will also avoid obsessive thoughts about the event, for example by overburdening themselves with work and responsibilities.
In difficult times, I worked without breaks - for example, I replaced colleagues on weekends. At home I only slept, and I didn’t have a home as such - I moved around all the time. Even now, all my things fit into four boxes and a suitcase, and only now am I starting to get used to the fact that home is the place where I feel good and calm.
Lyubov Melnikova, interview with Wonderzine magazine
Negativism
Compared to how the person was before the injury, he will report that he has become more “negative.” Often people report that they have more negative thoughts or images in their minds, and they often feel emotionally worse than before. The following experiences are typical for military personnel:
- emotional deadness - what previously caused emotions now does not cause any reaction;
- shame and guilt that something happened to his colleagues that he could have prevented (from his point of view);
- anxiety and fear due to the feeling that the world and the people in it are dangerous and unreliable.
Hypersensitivity
People with PTSD are always “on guard”, do not find a place, are always waiting. This leads to problems with concentration, rapid emergence of anger and aggression, and exhaustion.
Other mental disorders
People with PTSD develop other problems: depression, alcoholism and drug addiction, self-harmful behavior, aggression towards others, and suicidal behavior.
I started taking drugs, trying to get away from the problem, then, when I stopped taking them, I drank heavily. Then there was a toxic relationship. Then there was an eating disorder. All this self-destruction was an attempt to stop thinking about the suffering that my daily life caused me.
Lyubov Melnikova, interview with Wonderzine magazine
Post-traumatic stress disorder (PTSD)
About the syndrome
Any psychiatrist, medical psychologist, or psychotherapist will instantly decipher these four letters: “pe-te-es-er,” which sound like a short burst of machine gun fire. Since 1980 , Post-traumatic stress disorder (PTSD) has been included in all editions and revisions of the International Classification of Diseases; In the DSM-I (the first version of the Diagnostic and Statistical Manual of Mental Disorders), the more general diagnosis of “Severe Stress Reaction” was included back in 1952 .
It often happens that a scientific term, defined clearly and clearly, with very specific boundaries, scope of content and scope of application, suddenly becomes extremely popular “among the broad masses.” Such a word is used (appropriately and inappropriately) in everyday speech, seems understandable, turns into the object of jokes and the topic of anecdotes - as a result, the original meaning of the term is completely emasculated. Something similar happened with the word “stress”. Today we talk about stress often, a lot, witty, carelessly, ironically. They say that our whole life is full of stress, and we need to periodically “relieve” it (to the clink of glasses, so to speak).
According to Hans Selye, the creator of the internationally recognized theory of adaptive reactions, there is no need to relieve a stressful state: this is the body’s normal response to any change in external conditions, it is an automatic mobilization of internal resources, adaptation, preservation of internal homeostasis and accumulation of new experience. But Selye distinguished between the concepts of “stress” and “distress” ; in the second case, the strength of the external stressor, physical or informational, exceeds the adaptive capabilities of the body and leads to one or another negative consequences.
The diagnosis of “post-traumatic stress disorder ,” although it has the same root, implies slightly different stresses compared to ordinary ones. PTSD is always based on severe psychotrauma, or a series of psychotraumas, or a more or less prolonged psychotraumatic situation. But it is precisely traumatic, crippling, and not mobilizing, exciting, causing the excitement of struggle or competition. There is and cannot be anything normal or useful in such stress, just as there is no benefit to the body from, say, a broken leg. Post-traumatic stress disorder has probably existed for as long as higher mental functions and higher emotions have existed in the Homo Sapiens species. In any case, the oldest written sources that have survived to this day speak about this quite definitely. For example, soldiers of the Assyrian armies showed symptoms of PTSD in the same way as patients with “Vietnamese”, “Afghan”, “Serbian” and any other similar syndrome. Those who were dishonored, mutilated, deprived of shelter and family, who went through slavery and torture - in ancient times no one counted them at all, or, in any case, did not classify them as those in need of treatment. The very fact of survival was so amazing that the rest did not matter much.
Today's world, on the one hand, is more humane, safer and calmer. On the other hand, not so much. The difference, rather, is that we started talking about problems that were of no interest to anyone at the state and international levels before (about domestic violence, for example, or child abuse, about the social stigmatization of the mentally ill, about victims of repression and war crimes, about the situation of refugees and many others); We began to voice these problems, research them, evaluate their medical and social significance, and discuss them at world and international forums. And they grabbed their heads together.
The notorious “Vietnamese syndrome” , which is generally considered to be the beginning of the detailed development of the concept of PTSD and methods of therapeutic response, has become the focus of attention of American specialists and the general public not for clinical or theoretical reasons, but for economic ones. So as not to sound so cynical, let’s put it another way: in terms of medical and social issues. The fact is that for any state (even as rich as the USA) this is simply an unaffordable loss: young, strong, physically healthy men become drunkards, become drug addicts, are treated by psychiatrists for depression, neurotic and other mental disorders, receive benefits for years, commit inexplicable and unmotivated crimes from the category of especially serious ones, commit suicide, become militants in a criminal environment or join terrorists, remain lonely and childless, cannot hold down any job if it involves contact with people.
Since the early 1990s, one of the most informative, credible and credible macroeconomic indicators has been the DALY index, which measures the annual economic burden of disease (more precisely, “the number of years of life lost or altered due to health conditions”). Regarding PTSD, the last large-scale study of this kind, at the time of writing, was carried out by WHO in 2004 . The situation with DALYs and PTSD in the 25 most populated countries in the world was studied. Things turned out to be worst in Thailand: 59 per 100,000 population. Indonesia, the Philippines and the USA are in second to fourth place (58 each). Japan is in tenth place (55). Russia in seventeenth (54) ; the same figures in France, Germany, Italy and the UK. Twenty-fifth, conditionally the best, is Brazil (45). And everywhere, in any country in the world, due to PTSD, women’s “life years” are lost twice, or even three times more than men’s.
Not only was the socio-economic burden of mental illness dramatically underestimated 50-70 years ago (did you know, say, that half of the leading causes of disability and a third of “lost” years of life according to DALYs are due to psychoneurology?); in the case of PTSD, this is also supplemented by the antisocial specificity described above.
Is PTSD treatable?
It is not worth making a diagnosis based on one description. But if most of the above symptoms are similar to what you or a loved one are experiencing, you should contact a psychologist or psychotherapist and get a specialist opinion.
Research shows that without treatment, PTSD not only does not go away, but gets worse, including due to secondary problems. Therefore, the best thing you can do is to find a qualified psychotherapist who works with this problem and enlist his support.
Psychotherapeutic (eg, prolonged exposure, EMDR, cognitive therapy) and drug approaches to rehabilitation (eg, SSRIs, the latest generation of antidepressants) have been developed.
Post-traumatic stress disorder (PTSD) - symptoms and treatment
PTSD symptoms result from an overreactive adrenaline response to a traumatic event, leaving a deep neurological imprint in the brain. These patterns can persist long after the event that triggered the stress response, making the person more sensitive to future similar situations.[3][18] During traumatic experiences, high levels of stress hormones suppress hypothalamic activity, which may be a major factor in the development of PTSD.[7]
PTSD causes biochemical changes in the brain and body that are different from other mental disorders such as depression. Individuals diagnosed with PTSD respond more strongly to the dexamethasone suppression test than individuals diagnosed with clinical depression. Most people with PTSD exhibit low cortisol secretion and high urinary catecholamine secretion.[7] High brain catecholamine levels[8] and corticotropin-releasing factor (CRF) concentrations are high.[1][2] These findings suggest an abnormality in the hypothalamic-pituitary-adrenal (HPA) axis.
Fear maintenance has been shown to involve the HPA axis and connections between the limbic system and the frontal cortex. The HPA axis, which coordinates the hormonal response to stress,[3] which activates the LC-noradrenergic system, has been linked to the excessive consolidation of memories that arise after trauma.[4] This excessive consolidation increases the likelihood of developing PTSD. The amygdala is responsible for detecting threats and the conditioned and unconditioned fear responses that occur in response to the threat.[7]
Research shows that people suffering from PTSD have chronically low levels of serotonin, which contributes to commonly associated behavioral symptoms such as anxiety, irritability, aggression, suicidality and impulsivity. Serotonin also helps stabilize glucocorticoid production.
Dopamine levels in a person with PTSD may contribute to the development of symptoms. Low dopamine levels can contribute to anhedonia, apathy, poor attention, and motor deficits. Elevated levels of dopamine can cause psychosis, agitation, and anxiety.[9]
Several studies have described elevated concentrations of the thyroid hormone triiodothyronine in PTSD.[9] This may contribute to increased sensitivity to catecholamines and other stress mediators.
There is considerable controversy within the medical community regarding the neurobiology of PTSD. In a 2012 review, there was no clear link between cortisol levels and PTSD. Most reports show that people with PTSD have elevated levels of corticotropin-releasing hormone, lower levels of basal cortisol, and increased negative feedback to the HPA axis through dexamethasone.[7][9]
Areas of the brain associated with stress and PTSD are the prefrontal cortex, amygdala, and hippocampus. Patients with PTSD have decreased brain activity in the dorsal and rostral anterior cones and the ventromedial prefrontal cortex, areas associated with experience and emotion regulation.[5]
The amygdala is actively involved in the formation of emotional memories, especially fear-related memories. During times of extreme stress, activity in the hippocampus, which is associated with placing memories in the correct context of space and time, is suppressed. One theory is that this suppression may be responsible for flashbacks that can affect people with PTSD. When someone with PTSD is exposed to stimuli similar to the traumatic event, the body perceives the event as happening again because the memory was never properly recorded.[6][7]
