Post-traumatic stress disorder, or PTSD, is a condition that can lasts months or years after a traumatic event. Although it is typically associated with combat soldiers, PTSD more often affects civilians. It may be caused by an accident, a robbery, a sexual assault, domestic abuse, the unexpected death of a loved one, witnessing violence, or a natural disaster. Someone who experiences such a trauma may relive the event in nightmares and flashbacks. People with PTSD may avoid things that remind them of the trauma, for example, being reluctant to drive after a car crash. They may be tense, easily startled, or have angry outbursts. It’s common for people with PTSD to have trouble sleeping. They may be unable to remember important aspects of the event and have excessive feelings of guilt. PTSD mainly affects three regions of the brain, the hippocampus, the amygdala, and the ventromedial prefrontal cortex. Broadly speaking, the hippocampus helps create long-term memories, the amygdala is involved in processing emotions, and the ventromedial prefrontal cortex is responsible for regulating emotions triggered by the amygdala. Perhaps the key feature of the traumatized brain is an overactive amygdala. The amygdala is responsible for emotional learning. That is, it’s what ties an event to an emotion. So when someone attacks you in a parking lot and you’re terrified, the amygdala ties together the terror, the attack, and the parking lot and creates a memory. The stronger the emotion, the stronger the memory. The amygdala also sends signals to other parts of the brain to start the fight-or-flight response. In a normally functioning brain, the amygdala is reined in by the hippocampus and the ventromedial prefrontal cortex. The hippocampus is also involved in memory formation but it’s more discriminating than the amygdala. Part of the hippocampus’s job is to compare patterns and see if a new pattern matches an old one. However, in people with PTSD, the hippocampus is underactive, and actually shrinks. It becomes less discerning. So, for example, it might decide that the parking lot behind the bar where you were attacked looks pretty much like the parking lot by your dentist’s office, and therefore you should be afraid. The ventromedial prefrontal cortex is also supposed to be a check on fear when you’re exposed to stimuli related to the trauma. However, in people with PTSD, this region is also underactive, which allows the fear response to get out of control. Basically, what happens is that the hippocampus lets through more false positives, the amygdala reacts more strongly than necessary, creating fear, and the ventromedial prefrontal cortex is unable to moderate that fear. The good news is that PTSD can often be treated effectively. Treatment often involves psychotherapy and medication. The medication is typically an antidepressant, which may reduce the activity in the amygdala. Psychotherapy typically involves either exposure therapy or cognitive restructuring. These can help desensitize the patient to stimuli related to the trauma, or strengthen the prefrontal cortex’s involvement in the fear response.
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