So what is going on in the brain to cause all of this?
The Amygdala is part of the limbic system and it plays a part of in regulation of emotions, like fear, and the ability to read facial cues. It also plays an important role in maintaining memories with regard to emotional events. Studies have shown damage to the Amygdala connected to PTSD.
Douglas Bremer is known for his research on the affects of combat related PTSD on the brain. He has several published studies showing MRI images of about 8- 12% shrinkage to the Hippocampal area. Cortisol, a stress released hormone is known to damage the Hippocampus and cause the shrinkage or rather destruction of neurons. The Hippocampus is also part of the limbic system. It helps with conscious memory and establishing new memories (learning). (It is one of the first parts of the brain to be effected by Alzheimer's.) The Hippocampus also works with a part of the brain called the medial prefrontal cortex which helps regulate emotional and fear responses. Damage to the Hippocampus can also contribute to the feelings of unrealness or dissociation.
We believe that dysfunction in these medial prefrontal regions may underlie pathological emotional responses in patients with PTSD. For example, we sometimes see a failure of extinction of fear responses -- a rape victim who was raped in a dark alley will have fear reactions to dark places for years after the original event, even though there is no threat associated with a particular dark place. In a study using combat-related slides and sounds to provoke PTSD symptoms, combat veterans with PTSD had decreased blood flow in the area of the medial prefrontal cortex. Significantly, this did not occur in combat veterans without PTSD. We saw similar results when we compared women with PTSD and a history of childhood sexual abuse to women with a history of abuse but no PTSD. Bremer
Studies have also found that blood flow to the middle temporal (thought to play a role in auditory processing and language)and left inferior frontal cortex is decreased when combat related PTSD subjects were shown combat related slides meant to trigger PTSD symptoms. The frontal lobes are also called the executive function. It is the area where we "think", the area of judgment - knowing right from wrong, recognizing cause and effect, and where we analyze emotions and regulate them. The frontal lobes are that part of your brain that asks if you are over reacting to a fear stimulus. When this area is impaired, then the fear triggered memories and responses of the Amygdala and Hippocampus overwhelm.
Currently, the military is giving soldiers with PTSD antidepressants and then sending them back out to the very environments that caused the PTSD. They are giving the antidepressants because studies show that the antidepressants help the brain to repair from the damage the traumatic event(s) caused, but it does not stop the flashbacks, intrusive thoughts, etc... Some soldiers may have had abusive childhoods that have already primed their brains with PTSD triggers. The damage to the brain that is caused by childhood abuse, sexual abuse, or rape is the same as they see in combat related PTSD MRI's. If a soldier has an underlying condition or genetic propensity for say, Bipolar Disorder, the antidepressant could trigger a manic episode. Antidepressants do help in the treatment of PTSD, but they need to be used in conjunction with talk therapy and closely monitored. We would not give a rape victim antidepressant medication then send her back out into a dangerous environment that placed her in jeopardy of being raped again and then expect that she would cope. The policy and treatment of soldiers is insane. These soldiers' are not getting the services in Iraq nor at home to help them recover from the brain damage caused by PTSD. My question; does PTSD and the damage it does to the brain play a factor in war atrocities? The people of Iraq are living in a constant environment of PTSD inducing events. Other studies are showing that PTSD slows the learning ability in children.
Treatment of PTSD:
Research has shown that talk therapy helps. When we talk about and try to identify our feelings related memories we are stimulating connections between the frontal lobes and the limbic system. This process takes time, but as one proceeds one is not so overwhelmed by emotional whims caused by the flow of unconscious emotional memories from the Amygdala. Daniel Siegel, MD from the UCLA Center for Culture, Brain, and Development has stated that replicated studies are showing how meditation, no matter what form is practiced, causes the frontal lobes to repair and develop. EMDR has been used for some time now. EMDR involves having the eyes move rapidly back and forth; thereby, replicating REM sleep or some theorize that it stimulates the frontal lobes to be better able to analyze the content coming from the limbic system.
As I have said before, medication does help, but not just by itself. I have treated witnesses to murders who were experiencing extreme PTSD. The medication helped some, especially with improving sleep and having fewer nightmares, but it did not stop the episodes of flashbacks, hypervigalence, dissociation, avoidance, and grief. These symptoms took time to heal. Due to the severity of the issue I do not believe that any short-term therapy is appropriate. PTSD heals on its own schedule; it does not relate to the hurry up and find the most cost effective budget minded solution policymakers look for. It is important that we see PTSD for what it is. It is not a sign of weakness; it is a neurobiological issue. We need to address and deal with it as such.