MOSCOW, January 27, Tatyana Pichugina. Scientists have revealed the characteristics of terrible memories in PTSD — post-traumatic stress disorder. It turned out that the negative information that causes it changes the functioning of some parts of the brain. together with experts, we figured out how it manifests itself and how it is treated.
Soldier's heart
Medicine has accumulated knowledge about the impact of traumatic experiences for centuries. Herodotus also has a story about the Athenian warrior Epizelus, who lost his sight during the Battle of Marathon — not from a wound, only from stress. Victims of the great fire in London in the 17th century were tormented by nightmares: in their dreams everything was repeated all over again.
In the 19th century, doctors discovered that eyewitnesses of disasters and accidents exhibited psychopathological symptoms — depression, lethargy, isolation, and irascibility. The condition caused by strong emotional shocks was called fire neurosis by the German psychiatrist Emil Kraepelin.
During the American Civil War, cardiac problems were observed in the military — tachycardia, chest pain. These disorders were called irritated, or soldier's, heart. Experts assumed that the reason was the hardships of military service, excessive physical exertion, lack of time for adaptation among recruits, homesickness, and a discrepancy between expectations and reality. The term “traumatic neurosis” appeared.
After the First and Second World Wars, many descriptions of neurological and psychiatric consequences among combatants have survived. The “old sergeant syndrome” has become known, when an experienced soldier experiences severe stress with a constant threat to his life. Veterans reported heart failure, tremors, tics, weakness, memory loss, insomnia, nightmares, and inability to concentrate. However, in those days, psychological problems took a back seat to the high mortality rate from disease, injury and infection. Only after the Vietnam War did the United States come to grips with the psychological state of the military. “Battle fatigue” was recognized as an independent disease in 1980 — PTSD.
March 30, 2023, 14:00
The brain in PTSD
In psychiatry, PTSD is a fairly unique condition because it occurs in response to a specific traumatic event. Such, for example, as a military episode, natural or man-made disaster, torture, rape, or other personal tragedy. Moreover, it does not affect a person immediately, but after weeks and months.
PTSD manifests itself in two to a maximum of ten percent of people who have experienced difficult experiences. Why this happens is still unclear to scientists. Perhaps past head injuries, mental illness, heredity are to blame.
Research has shown that traumatic memories deeply affect the brain. Thus, radiologists from the United States compared brain scans of earthquake victims with and without PTSD. The first ones showed changes in gray and white matter. It has been proven that such patients have a reduced volume and impaired functioning of the hippocampus, a key part of the brain for memory. The amygdala, which is responsible for emotional memory, also plays a role in the formation of PTSD.
A hypothesis has emerged that traumatic memories cannot be considered among ordinary unpleasant episodes — they are somehow recorded differently by neurons. However, this has not yet been proven. The first step in this direction was recently taken by scientists from the USA. They showed 28 volunteers with PTSD audio clips containing negative facts from the past. During this time, their brains were scanned using fMRI.
The authors of the work suggested that the brains of different people should react similarly to semantically similar unpleasant memories. If the events that caused PTSD are just one of the facts of the biography, then there should be no differences in the scans. However, the experiment showed the opposite: the participants' brains reacted differently to similar descriptions of traumatic episodes. This means that they are controlled by some other neural mechanism. This opens up a new way to treat PTSD — rewriting traumatic memories as normal, scientists write.
The prevalence of PTSD may be much wider. Thus, British researchers believe that online bullying causes many symptoms similar to post-traumatic stress disorder in both the victim and the offender. A survey of teenagers showed that they are most often visited by obsessive thoughts and avoidant behavior. And scientists from Italy identified symptoms of PTSD months later in a third of COVID-19 survivors. The most vulnerable were women suffering from mental illness.
According to some estimates, approximately seven percent of US adults have experienced PTSD at least once during their lifetime.
How does PTSD manifest?
“With PTSD, certain changes occur in the brain that try to protect the person from further damage by stress factors. The structures that are mainly affected are the hippocampus (formation and structure of memory), the amygdala (emotions of fear) and the prefrontal cortex (complex behavioral reactions). Essentially “, “anesthesia” occurs of the brain structures responsible for emotional attachments simultaneously with increased sensitivity to fear and potentially dangerous events,” says Natalia Gavrilova, a neurologist at the N. I. Pirogov Clinic of High Medical Technologies of St. Petersburg State University, assistant at the Department of Faculty Therapy of St. Petersburg State University.
According to the specialist, for PTSD to develop in response to a traumatic event, there needs to be an unfortunate coincidence of individual sensitivity, the intensity and suddenness of the injury, as well as a lack of social support. Repetitive injuries of the same type are especially dangerous, Gavrilova points out.
The disease manifests itself in intrusive memories of the traumatic event, avoidant behavior, hyperarousal, changes in mood and emotions. Increased anxiety or withdrawal occurs.
“We once observed a case where a patient with PTSD did not talk to others for many years, but was otherwise completely social and prosperous,” continues the specialist.
“PTSD is characterized by a constant return to a situation of severe stress in the past, insomnia, obsessive thoughts, feelings of fear, helplessness, apathy for more than one month after the event,” adds cognitive psychologist Ulyana Timoshenko.
Experts note that PTSD is difficult to treat, although there are methods with proven effectiveness.
«They usually use cognitive behavioral therapy, acceptance and responsibility therapy, body-oriented therapy, drugs,» Gavrilova lists.
«When When working with PTSD, it is necessary to create motivation in a person, teach him to track thoughts, work with negative attitudes and anxiety, including “rewriting” the history of his experience, working with frightening images,” explains Timoshenko.
Experts emphasize that the disease is necessary identify as early as possible. And it is very important that the patient is supported by loved ones.