PTSD caused by brain injury

A Post Traumatic Stress Disorder, PTSD can occur when someone has been exposed to a very traumatic event by which this person has been confronted with death. As a result of this he or she can react with intense fear, horror and helplessness.
It is a severe stress response to a shocking event. This is a natural reaction to a non-natural event.

 

About 14-23% of people with brain injuries have post-traumatic stress disorder (PTSD).

There is a chance that someone will also suffer PTSD while sustaining a brain injury if the cause of the brain injury was a very shocking event or if there was intense helplessness and someone looked their own death in the eye and was therefore confronted with the enormous vulnerability in this life. This is particularly known in the case of traumatic brain injury such as a brain contusion, but also after cardiac arrest or strangulation with oxygen deficiency, or after a stroke. There can be numerous causes.

 

When PTSD and brain injury coexist, it is usually difficult to distinguish what in the brain has been changed by the PTSD and what by the brain injury.
Changes in cognition may occur with both diagnoses; such as memory, attention and concentration problems. But depression, anxiety, insomnia and fatigue can also follow both diagnoses.

 

A posttraumatic stress disorder has the following characteristics:

• Extreme loss of control. People have lost their grip on daily life. Many victims feel powerless,
• Disruption: self-evident expectations no longer apply. Confidence in oneself, in other people and daily existence is
  disappeared. One is confronted with one's own vulnerability,
• Unwanted memories of the trauma that keep cropping up. The memories are too intense and too painful,
• Avoidance symptoms: withdrawal from other people, places and situations and/or sounds that remind you of the trauma,
• Feelings of detachment from people, even from loved ones. This may be accompanied by emotional insensitivity,
• Arousal symptoms: a person may be hyper-alert, as it were, permanently on the lookout for possible danger, irritable, excessive vigilance (hypervigilance),
• Chronic stress,
• Physical complaints,
• Re-experiencing the trauma - flashbacks. The person may temporarily lose contact with reality,
• Nightmares and/or night terrors,
• Shame about what happened or was done,
• Feeling of guilt towards the people who did die with the trauma,
• Fears,
• Feelings of insecurity.

 

Such a shocking event can cause a disruption of the psychobiological balance. People then remain attuned to danger. The fear or feeling of insecurity can become permanent. This condition disrupts daily life. This can make a person physically ill due to high-stress hormones such as cortisol.
When the body is exposed to stress, such as danger, it produces stress hormones. It leads to:

• (a) Alarm phase (usually called fight or flight phase),
• (b) resistance phase (focused on resisting for a long time as a way of life),
• (c) exhaustion phase. This is a dangerous phase because it involves intervention in body processes.

The associated stress of PTSD can therefore cause physical damage. This can also be due to fears and stress or due to chronic overstimulation or fear of epilepsy or dizziness caused by brain damage.

Long-term effects of the stress hormone cortisol

In the case of permanently elevated levels in the blood, the stress hormone cortisol can lead to:

• cardiovascular complaints
• stomach and intestinal complaints
• sleep problems
• autoimmune problems
• fat metabolism problems
• protein metabolism problems
• osteoporosis
• disturbed muscle functions
• depression
• burnout
• anxiety disorders

 

Cortisol inhibits the production of T helper cells and macrophages. By reducing T helper cells, the production of antibodies may be inhibited. Cortisol is in many ways an antagonist to insulin.

As a result, people can develop new physical illnesses years after a traumatic event. The body remembers the traumas that the mind has sometimes already forgotten. In that sense, PTSD could also fall under physical conditions. You cannot separate body and mind.

This situation should certainly be treated/supervised by experienced trauma practitioners/neuro-psychologists who have knowledge of both brain injury and PTSD.

They may refer you to psychiatrists for medication and specific help. PTSD can fade away (in many people) and there are various more and less effective treatments, but a trigger can suddenly and unexpectedly relive later in life.

 

Changes in the brain due to PTSD

Chronic stress can even lead to the shrinkage of certain brain structures such as the hippocampus, which is important for memory and spatial orientation, among other things.

The shrinkage of a brain structure is not always irreversible.

The volume of these brain structures may recover.

 

People who suffer from emotional trauma or PTSD can suffer from emotional scars for a long time: months, years or even for the rest of their lives. This stress even causes changes in neurochemical systems and the 'stress response' circuits in the brain.

 

The areas of the brain that are most affected and may even decrease slightly in volume due to emotional consequences are:

 

• the amygdala, especially the left amygdala,
• the hippocampus is the storage place for long-term memory and the storing of memories from long-term memory to permanent memory,
• anterior cingulate cortex ACC (the front part of the girdle gyrus/cingulate gyrus in the prefrontal cortex),
• left insula, (the island of Reil),
• the medial prefrontal cortex.

 

As mentioned earlier on this page, changes in cognition can occur with both diagnoses (PTSD and brain injury). For example, memory, attention and concentration problems. But depression, anxiety, insomnia and fatigue and other physical consequences can also occur with both diagnoses.

 

CPTSS
Complex post-traumatic stress disorder (CPTSD) is a condition that most often develops in childhood. It changes the course of life forever.
There are also exceptional circumstances in which adults develop CPTSD.

It is the response to chronic traumatization over years. In some cases this can be months.

CPTSD develops in response to repeated violence that leaves the victim feeling trapped with no hope of escape or impending death.
Because it develops in childhood, CPTSD is a developmental trauma disorder. Children lack the cognitive or emotional skills to understand what is happening to them. They have no 'words' for what is happening. The child often thinks that he or she is 'bad'. The trauma can affect the entire life, and sometimes even continue for generations afterwards.

 

Treatments

A good trauma therapist will choose from different treatment methods depending on the person with the trauma and their circumstances. Every person is different. For example, the body and that particular psyche do well with certain approaches but not with others. The person with the trauma will above all have to feel SAFE with the treatment that has been chosen.

 

EMDR therapy

EMDR therapy (Eye Movement Desensitization and Reprocessing) is one of the possible treatments for PTSD. Researchers do not yet know exactly how the brain can extinguish the pain, but they have the following theory:
With EMDR, the thalamus is calmed by the eye movements. During therapy, new connections are created in the brain between the right parietal lobe and the left insula and from there to the frontal cerebral cortex. It is not yet clear how the brain beam is involved. In any case, the sensory context of the trauma is removed. It shifts to the prefrontal cortex, so sensory triggers no longer have such an influence or no longer have such an influence.

 

Through treatment, a traumatic memory can become a normal memory that is no longer so painful. The patient can tell the trauma as an ordinary story, as one of many life events. The pain can fade away.
Little is known about the treatment of PTSD in the target group of people with brain damage.
People who, in addition to their psychotrauma, suffer from overstimulation as a result of the brain injury do not always tolerate the sounds and rapid hand movements that are common in EMDR therapy.

In case of overstimulation, the method in which the therapist taps the knees of the person with PTSD with his hands is often tolerated.

It is important to choose a highly experienced trauma therapist, not someone who just uses a trick.

 

Trauma therapist on TV

You can see and listen to the video of the episode from the Dutch TV program 'Zomergasten' with the well-known trauma therapist psychiatrist Bessel van der Kolk through this link.
Conversation with psychiatrist and trauma specialist Bessel van der Kolk about trauma and what we have learned worldwide to heal from trauma. Click here to listen via Spotify.

 

 

TIME DOES NOT HEAL ALL WOUNDS