Post Traumatic Stress Disorder

How does the suffering of people who have experienced a great natural disaster affect them? What is the effect of living in a place where bombs explode every day and guns do not stop, on human psychology? How can we explain that a child who escaped from the war in Syria in a video circulating on the internet recently heard the sound of an airplane, and was looking for a place to hide? How does this painful situation occur? Not only wars but also natural disasters and sexual assaults have a traumatic effect on individuals’ lives. As a result of this effect, psychological/psychiatric problems called post-traumatic stress disorder may occur.

Post-traumatic stress disorder is a psychological disorder that occurs as a state of high anxiety after a traumatic event, avoidance of stimuli related to the event, and an increase in the arousal level of the person. However, in order to be diagnosed with this disorder, the individual must experience serious trauma. For example; Exposure to and witnessing events such as threats of death, serious injuries, sexual assaults, war, natural disasters are among the most common.

According to DSM 5, the holy book of psychiatry and clinical psychology, the diagnostic criteria for post-traumatic stress disorder are grouped into 4 groups.

one- Re-experiencing of involuntary traumatic events; The person may have recurring memories of the event and have nightmares. In addition, he is highly disturbed by stimulus reminders of the event. For example, the person may feel uncomfortable in situations such as the sound of an airplane or helicopter reminiscent of the war environment, and the darkness reminiscent of the rape environment.

2- Avoidance of event-related stimuli; avoidance of any reminder of the traumatic event. For example, an earthquake survivor who was buried alive had a fear of closed areas and avoided these areas (McNally, 2003).

3- Other mood and cognitive changes after trauma;Under this group, some important parts of the event are not remembered, blame oneself or another for the event, and distance from other people.

4- Signs of increased arousal and reactivity; Among these symptoms; irritability, aggressive behavior, self-harming behavior, difficulty falling asleep and staying awake, and hypervigilance.

Post-traumatic stress disorder (PTSD) can be chronic in some cases. In a study conducted, some of the symptoms are still seen in half of the people who were diagnosed with PTSD in the interviews made after a few years. In another study conducted with 15,288 war veterans who had 30 years of service, a positive correlation was found between PTSD and death rates from medical diseases, accidents, and suicide.

neurobiology of PTSD

Of course, it would be unfair not to discuss the biology of PTSD, as we have the idea that understanding human beings cannot be independent of biology. Studies show that some brain regions and neurotransmitters are effective in the development of PTSD.

In a study, increased activity in the amygdala, which we know to be associated with fear related to PTSD, and decreased activity in the medial region of the orbitofrontal cortex, which we know to be associated with behavioral inhibition, were reported. We can say that these two regions also play a role in anxiety disorders. Unlike anxiety disorders, we know that it is related to memory processes.

The hippocampus is one of the structures involved in PTSD. In some neuroimaging studies, it has been observed that individuals diagnosed with PTSD have a smaller hippocampus compared to normal individuals. Individuals with a smaller-than-average hippocampus before diagnosis seem to be more likely to be diagnosed with PTSD.

There are changes in attention and memory processes when PTSD symptoms are looked at. It is known that the hippocampus and the mesocortical dopaminergic system play a role in “working memory”. Based on this idea, it is thought to be related to the attention and memory impairments in PTSD and the mesocortical dopaminergic system, which plays a role in working memory accordingly. It can be hypothesized that changes in dopamine systems may have an effect on the symptoms seen in people with PTSD.

Does everyone who experiences a traumatic event develop PTSD?

Not all traumatized people have PTSD. For example, 20% of American soldiers who fought in Vietnam developed PTSD, while 50% of prisoners of war were diagnosed with PTSD. In addition, 65% of the soldiers who were tasked with detecting and collecting the body parts of the dead during Iraq’s invasion of Kuwait between 1990 and 1991 were diagnosed with PTSD. In another study, the diagnosis rate of soldiers who were admitted to psychiatry clinics and served in World War II is closely related to the number of soldiers who died in their troops. All these studies show that the severity of trauma is effective in the formation of PTSD.

If we end the article with an interesting piece of information about PTSD, it is seen that the type of trauma is very important as well as the severity of the trauma. For example; rapes, wars, conflicts and abuses appear as more effective risk factors than natural disasters. It seems that trying to prevent people’s destructive effects on other people will be the most effective way to reduce the prevalence of PTSD.

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