BRATTLEBORO—Many experiences can be stressful, Retreat Clinical Manager Susan Balaban said. Many stressful events can effect one’s mental health. But not all stress or mental health experiences lead to Post-Traumatic Stress Disorder (PTSD).
Balaban said myths exist around PTSD — like that people suffering from PTSD are violent, or that it’s easy to develop, or that it’s a life-long disease.
In very stripped-down terms, PTSD occurs when one, or many, experiences overwhelm the body’s stress-response system long-term, Balaban said. Despite how much popular culture name-drops PTSD, the diagnosis only comes after a client experiences a specific group of long-term symptoms.
All these symptoms must be present for PTSD to be present because they feed off each other, she continued.
“There’s a system to it,” she said.
It’s common for a person’s stress system to flood after a traumatic event, like a car accident, she continued. The event might even kick the person into what the psychiatric field calls acute stress disorder. Acute stress, however, still may not be PTSD.
According to Balaban, for a diagnosis, a client will have struggled with the symptoms for longer than a month. The triggering event(s) usually have a component of violence or shock. The event will also be something out of the person’s control. It’s likely they were injured or lost someone they cared about or felt responsible for.
The client’s symptoms will become intrusive and repetitive. For example, panic attacks are intense, but last maybe 10 minutes, she said. Someone experiencing PTSD might dream the same nightmare for weeks on end.
A person often feels anger, guilt, or shame, she said. Or the person will over-blame colleagues for “not having their back.”
The person might have trouble remembering parts of the event. He or she will avoid things that trigger or make them uncomfortable. For uniformed service personnel, this avoidance might be through alcohol, working long hours, or isolating themselves.
According to Balaban, with PTSD, the mind and body become caught in a hyper-adrenaline feedback loop. The mind thinks stressful thoughts, which raises adrenaline and its byproduct, cortisol.
The higher level of adrenaline changes how the brain functions, which leads to the brain operating under more stress, which leads to more adrenaline, and on and on.
As a self-protective measure, many PTSD clients avoid the things that can trigger them. Balaban warns against this as a coping mechanism and recommends professional help instead.
It might seem logical to avoid things that trigger one’s PTSD, she said. Well-intentioned family members and friends will also help a client avoid triggers.
The problem, however, is that avoiding triggers increases one’s sensitivity, Balaban said. Instead of becoming less, the stress becomes more.
When a person experiences a strong fight-or-flight response, the body produces a massive amount of adrenaline and cortisol. This can cause cell death in the limbic system of the brain, Balaban said. The limbic system helps regulate a person’s stress and emotional responses.
The brain’s limbic system is “plastic,” she continued. This means that while it is more prone to injury than other systems in the brain, it is also able to heal quickly. Avoiding triggers, however, stunts the healing process.
“That’s how that [anxiety] gets worse,” she said.
A military officer whose PTSD begins when he or she is caught in an ambush may start with avoiding crowds at public events, like parades. Then, he or she starts avoiding crowded grocery stores, and then family picnics. If left unchecked, the anxiety can spread to include things and events that weren’t part of the initial trigger, Balaban said.
Most PTSD therapies include some form of “exposure treatment” that incrementally puts the client in contact with a stressor, Balaban said.
Like building a muscle through weight lifting, the stress response becomes hardier with exposure.
Another symptom is a constant state of “hyper-arousal,” she said. The higher levels of adrenaline and cortisol in the body keeps a person on high alert. They can overestimate threats.
Sleep disorders can follow as a person’s circadian rhythm goes off kilter.
“The body is going to favor survival,” Balaban said. “[Adrenaline] is going to trump melatonin.”
According to Balaban, ancient warrior societies like those in Rome or Japan practiced a specific series of tasks — like deliberately folding one’s uniform or cleaning one’s weapons — that calmed them, brought down their adrenaline, and prepared them to return home.
There is life after a PTSD diagnosis, Balaban said. She said many of her clients go through a process of mourning the loss of their pre-PTSD life. After the grieving, however, clients have noted an increase in their awareness of what they hold dear and find a sense of meaning in their new life.