Post-traumatic stress disorder (PTSD) is a neuropsychological disorder that gained attention over the years due to soldiers returning from war with what use to be called “shell shock.” Post-traumatic stress disorder, however, is not solely associated with soldiers returning from war. In fact, the vast majority of people who suffer from PTSD is found in another population; adult women who suffered from childhood sexual abuse. The research for how childhood trauma, especially abuse by one’s caregiver, affects the brain is still a relatively new field, but evidence has revealed that it can change one’s brain, and thereby, change how a person responses to trauma in the future. Researchers also know that early victims are more likely to be re-victimized in the future; increasing one’s chances of developing PTSD. In this paper, I will discuss the effects of PTSD on the adult brain of a childhood sexual abuse survivor.
Post-Traumatic Stress Disorder
Post Traumatic Stress Disorder (PTSD) is a neuropsychological disorder that is caused by exposure to extreme trauma and stress. These incidences; sexual assault; unexpected death of a loved one; threatened death to one’s self or a loved one; obtaining or being threatened with serious bodily harm; or witnessing traumatic events such as a serious car accident (such as in the case of first responders); living through a natural disaster; and experiencing war; can cause a person to have vivid, intrusive, reoccurring flashbacks, nightmares, thoughts, or emotional or physical reactions to either internal or external cues that remind one of the incident (DSM 5, 2013). In response to these intrusive memories, individuals will often employ some type of avoidance behavior; they will avoid talking about or being reminded of the event(s) in any way.
In addition, patients will experience a wide range of emotions that are negative in nature, and they must experience at least two of the following symptoms, in addition to the above symptoms, to be diagnosed with PTSD (DSM 5, 2013). Shortly following the event the patient may be unable to recall details of the incident; they may have overtly negative thoughts about themselves and/or the world; they may have an exaggerated sense of blame for either themselves or someone else for causing the incident; they may experience negative affect (an overwhelmingly negative view of the world); they may experience a decreased interest in participating in life or activities that once interested them; they may have extreme feelings of isolation; and they may have difficulty experiencing positive affect (DSM 5, 2013).
After a traumatic event, individuals with PTSD will experience at least two of the following reactivity symptoms; they may become extremely irritable or aggressive; they may partake in risky or dangerous behavior; they may become hypervigilant (meaning that they may be always “on their guard” or “ready to run” at any time); they may have a heightened startle response; and they may experience difficulty with sleeping and/or concentrating (DSM 5, 2013). The symptoms must also have a duration of at least one month, they must cause significant distress or functional impairment in the patient’s life, and they must not be due to substance use or another psychological disorder (DSM 5, 2013).
The National Comorbidity Survey Replication, conducted between February 2001, and April 2003, found that a diagnoses of PTSD, within the adult American population, was a remarkable 6.7 percent. Among men that percentage was 3.6 percent, and among women that percentage was at an astounding 9.7 percent of the population (Gradus, 2017). Women are almost twice as likely as men to experience PTSD in their lifetime, and this is mostly due to either childhood sexual abuse and/or, sexual assault as an adult.
Long term trauma, trauma in which the victim is under complete control of the perpetrator and cannot escape, such as childhood physical or sexual abuse, causes additional symptoms in the victims that may not manifest until later in life, and/or, they can or have, become chronic; causing severe dysfunction in the victim’s life and in their interpersonal relationships. Although it is not listed in the DSM 5, Complex PTSD, is a subtype of PTSD that only effects victims of long term trauma. Survivors of long term trauma will often display issues with emotional regulation, consciousness, and self-perception; they may have a distorted perception of the perpetrator, often attributing total power to the perpetrator, or becoming preoccupied with revenge; survivors may experience a plethora of problems in their interpersonal relationships, including being unable to trust anyone, repeatedly looking for a “rescuer,” promiscuity may be a problem, or they may take the opposite route and never date anyone; and often survivors are plagued with a feeling of unworthiness, hopelessness, and despair (National Center for PTSD, 2016). Often survivors of childhood sexual abuse have relationships with people who continue to abuse them, or their children. Breaking the cycle of abuse, becomes a major aspect in treatment for these patients.
I started this paper with the belief that not too much research had been done regarding PTSD on victims of childhood sexual abuse, but I found plenty of research. I chose this topic because I am one of the many survivors of childhood sexual abuse, and I plan on targeting trauma, stress, and anxiety related disorders after I complete my doctorate in psychology; I want to know how to help survivors cope with the abuse they suffered through, how to heal from the past, and how to have a quality relationship with a partner in the present.
Natural History of PTSD
Almost everyone experiences some sort of traumatic event at least once in their life, but not everyone develops PTSD. Not everyone with PTSD has been through a dangerous situation either. Symptoms usually start occurring within three months of the incident, but they may not develop until years later. The course of PTSD varies, some patients recover within six months of treatment, but for some patients the condition may last much longer, or it may become chronic. It is important that people who do suffer from PTSD seek professional assistance as soon as possible. Treatment usually consist of psychotherapy and medication, and with treatment, a patient has an increased likelihood of recovering from PTSD. Without treatment a patient may go on to experience additional life problems to include; drug or alcohol abuse, depression or anxiety, physical symptoms of chronic pain, employment problems, and/or, relationships problems (National Center for PTSD, 2016).
Methods used to Diagnose PTSD
Psychologists have a variety of assessments available to them to diagnose PTSD. Some, such as the Beck Anxiety Inventory – Primary Care (BAI-PC), are self-reports, that the patients fill out on their own and then gives to a physician. The BAI-PC is a seven item self-report assessment that screens for anxiety, depression and PTSD, as well as other disorders that are highly co-morbid with PTSD, such as drug or alcohol abuse (Mori, 2003). A positive score of five indicates the patient may suffer from PTSD, but will need to be screened again by a professional.
Other assessments are designed for use in a primary care setting. The Primary Care PTSD Screen for DSM – 5 (PC-PTSD-5) is a five item screen that was designed for use in a primary care setting and is used to determine those patients with probable PTSD (National Center for PTSD, 2017). However, a positive indicator on this assessment means that the patient should undergo a structured interview by a psychologist who specializes in trauma and stress related disorders. If a psychologist determines that a patient has PTSD, the use of medication may be required, but cognitive behavioral therapy and exposure therapy are two recommended treatments for PTSD (National Institute of Mental Health, 2016).
While anyone can experience a traumatic event that results in a diagnosis of PTSD at any time, and at any age, there are certain risk factors involved in developing PTSD. People who have experienced long term trauma, or have a genetic predisposition to the disorder are more prone than others to developing PTSD after a traumatic experience. However, most people will not develop PTSD due to high resilience factors.
Some things that may increase one’s chances of developing PTSD include, living through dangerous events and traumas to include natural disasters; getting hurt; seeing another person hurt, or seeing a dead body; childhood trauma; feeling extreme fear; having little or no social support after the event; dealing with additional stress, such as the loss of a loved one, loss of a job or home, and being injured due to, or after the event (National Institute of Mental Health, 2016).
Some things that may make a person more resilient against PTSD include, seeking out assistance and social support, friends, family, and a local support group are all good ideas; learning to feel good about one’s own actions during and following the traumatic experience; and having a positive coping strategy after the event (National Institute of Mental Health, 2016). Research is ongoing about the effects of PTSD on the central and peripheral nervous systems, however, some remarkable discoveries have already been discovered, and may assist in the diagnosis and treatment of PTSD in the future.
Neurological and Biological Systems Involved in PTSD
Women who have suffered and lived through prolonged childhood sexual abuse make up anywhere from eight to thirty-three percent of the American population, depending on how pervasive the abuse was (Steine et al., 2017). They are more likely to develop intimate relationships with abusers, and the abuse continues into adulthood. The patients who develop PTSD report multiple types of abuse, physical, mental, emotional, sexual, and neglect (Steine et al., 2017). PTSD effects these patients differently than it does patients who have PTSD but did not suffer childhood sexual abuse (Binder, 2013). Post-traumatic stress disorder effects many parts of the brain, and those are some of the very parts of the brain affected by childhood sexual abuse (Blanco et al., 2015).
PTSD is an extremely complicated disorder, and its effect on the brain and hormones in the body are many and varied. The locus coeruleus, a nucleus located at the base of the brain stem, which is responsible for the bodies response to stress, among other things such as cognition and memory, releases increased amounts of norepinephrine (a hormone) into the body in response to stress. This makes the person more aware of their surroundings, and activates the sympathetic nervous system (flight, fight or freeze system). In patients with PTSD, norepinephrine is released in increased amounts; a patient may have a minor event that reminds them of a past traumatic experience, such as a combination of words, or the way a person touches them, that makes them over-react to the stimulus (Wilson, 2013).
Repeat exposure to trauma, such as in the case of childhood sexual abuse survivors, changes the hypothalamic-pituitary-adrenal (HPA) and endocrine response to stress, as well as its function in metabolic and immune systems of the body (McGowan, 2013). The HPA plays an important role in maintaining allostasis, or the body’s ability to maintain stability amongst challenging environmental circumstances.
The decreased size of the hippocampus shown in most patients with PTSD is related to an increase in the activity of the hormone called cortisol. Cortisol is released in relation to stress and the prolonged exposure to the hippocampus of this hormone has been shown to cause atrophy in the hippocampus, the area of the brain responsible for episodic memory creation. Decreased amounts of cortisol release during the initial event may lead to a chronic over-reaction to stress in patients who later develop PTSD (Sherin, & Nemeroff, 2011). In addition, functional imaging studies have shown a decrease in response of the prefrontal cortex, and an increase in response from the amygdala in patients with PTSD, leading some scientists to believe that stimulators of the limbic stress system prevail over inhibitors (Malejko, et al., 2017). Since, in PTSD, individuals associate neutral cues with the traumatic event(s), it has been suggested that the interaction between the hippocampus and amygdala, as two regions of the brain that play a role in consolidating memories, may contribute to the intense recollection of trauma experienced by patients with PTSD (Malejko, et al., 2017).
The biological and neurological systems that are involved in, and affected by, PTSD are numerous and varied. Interactions between the stress response system and the threat response systems of patients with PTSD may explain the avoidance and emotional reactivity aspects of PTSD. Reduced connections between the amygdala and cingulate cortex imply a decreased ability to cope with fear vigilance and reactions to threats (Wilson, 2013). Research is underway in regards to genetic factors that may make a person more predisposed to develop PTSD. Recent research has revealed a relationship between the SLC6A4 serotonin transporter genotype and elevated PTSD symptoms (Wilson, 2013). Future studies hope to reveal the interconnectedness between all the neural pathways involved in PTSD.
Diverse pharmacological and psychological treatments have been used for the treatment of PTSD. Pharmacological treatment doesn’t erase the traumatic memory of the incident(s), instead it aims to control such symptoms as anxiety, depression, and/or alcohol and drug related disorders, all common co-morbid diagnosis with PTSD. Medication to help with sleep disorders and/or nightmares may be prescribed as well (National Institute of Mental Health, 2016). Antidepressants, anti-anxiety, and sleep medications are common symptoms control treatments for PTSD. However, the best therapy for PTSD is psychotherapy.
Psychotherapy, also known as “talk therapy,” is the best know treatment for PTSD, and there are various forms of psychotherapy. The two best known treatments for PTSD are cognitive behavioral therapy, and exposure therapy. Both types of therapy should only be attempted with a psychologist who specialized in trauma and stress related disorders.
Cognitive behavioral therapy helps patients to question and then alter their dysfunctional perceptions and reactions to trauma by confronting traumatic memories, and retraining the patient in responding to those memories (Malejko, et al., 2017). Sometimes patients remember the event differently than it happened and in that case psychologists will help the patient remember it the correct way, or help them to make sense of the bad memory. Sometimes the patient may feel blame or guilt for something that is not their fault, and the psychologist will assist the patient in placing blame where it belongs (National Institute of Mental Health, 2016).
Exposure therapy involves slowly introducing aspects, such as tactile, visual, auditory, and olfactory cues that remind the patient of the traumatic event(s) (Malejko, et al., 2017). Occasionally, if possible, the psychologist may take the patient to the place the traumatic incident(s) occurred. This helps patients with PTSD learn to face and control their fear. By slowing introducing the patient to the traumatic event in a safe environment, psychiatrists help the patient cope with his or her feelings (National Institute of Mental Health, 2016). The main theme of treatment appears to be the confronting and restructuring of memories related to the traumatic experience(s).
Psychotherapy helps patients by teaching them about trauma and its effects on the body and brain. It teaches patients how to manage and control their anger, as well as techniques to relax, and calm down. Patients should learn about how to sleep, exercise, and eat better; learning the effects of how these things can effect responses in the nervous system. In addition, psychotherapy is designed to teach patients how to identify and cope with feelings of shame, guilt, disgust, revenge, and how to have a healthy relationship with oneself and with others (National Institute of Mental Health, 2016). In regard to patients with PTSD who also experienced childhood sexual abuse, it is important the doctor imparts to the patient, over and over again, that the abuse is not his or her fault.
Patients are highly encouraged to help themselves as well. Some ways that patients can help themselves recover from PTSD include; taking the first step by talking to their doctor; engage in physical activity every day; break up large tasks into smaller steps, and set realistic goals for oneself. Patients are especially encouraged to engage socially, either with trusted family and friends, or with a support group (National Institute of Mental Health, 2016). Talking about the event gives it less and less power, and patients are encouraged to talk about the event(s), and triggers to people they trust. Patients should be aware that symptoms will improve gradually over time, not immediately. Patients are highly encouraged to seek professional help in an outpatient facility, such as their local mental health center (National Institute of Mental Health, 2016).
Research is still underway on PTSD, but recent research has encouraged scientists and helped them to narrow their focus on different areas and functions of the brain, as well as possible genetic predispositions to the disorder (Sherin, & Nemeroff, 2011). Some research is looking at trauma victims in acute care settings to try to better understand how the symptoms improve in those patients who heal naturally. Some research currently underway include looking at how fear memories are effected by learning, changes in the body, and sleep. Preventative treatment measures are also underway; scientists are currently looking into how to prevent PTSD following a traumatic experience. Research into trying to predict how a patient will respond to one intervention or another better is also currently underway. With technology improving every year, one-day scientist may be able to pinpoint the exact gene and part of the brain in which PTSD starts to develop (National Institute of Mental Health, 2016).
PTSD is a debilitating disorder that activates the bodies sympathetic nervous system causing the patients to experience a heightened response to stress and trauma, and minor cues of both internal and external stimuli that results in an over exaggerated startle reflex, and intrusive memories of the incident(s). Neurological studies have shown an extensive connection between the stress and fear response in the body’s central and peripheral nervous systems. Long term exposure to trauma, such as in the case of survivors of childhood sexual abuse, shows an increased probability of developing PTSD if one is exposed to trauma as an adult. Unfortunately, survivors of childhood sexual abuse are more likely to engage in unsafe activities and relationships that often result in exposure to more trauma. Psychologists should focus treatment on confronting and reshaping behaviors toward bad memories and traumatic experiences. PTSD is a curable disorder under the direction of a specialists who exposes the patient to the traumatic experience in a safe environment over a long term period. Patient can sometimes expect to see improvement in as little as six months, but, depending on the type of trauma one is exposed to, and its duration, symptoms may become chronic, but manageable. Patients must be willing to take the first step in talking to their primary care provider. “Trauma creates change you don’t choose. Healing creates change you do choose” (Michelle Rosenthal). One must choose to heal by taking away the power of the traumatic experience by talking about it, and remembering that you are not alone.