PTSD: Not All Wounds Are Visible

PTSD6-27-13The United States Senate has designated today (June 27, 2013) as PTSD Awareness Day, while also setting aside June as “PTSD Awareness Month.” To honor this worthy intent, Mom Psych is working with the National Center for PTSD to help educate the public about the causes, symptoms and treatment of traumatic stress.

One of the most common questions people ask about post-traumatic stress disorder (PTSD) has to do with why some people “get” PTSD and others don’t.  There may not be one simple answer, but researchers are closing in on some important influences. One important consideration is our level of resilience.

What is resilience and where does it come from?  From a psychological perspective, resilience is the ability to return to a healthy emotional baseline after adversity or stress. Like most of our traits, there’s a genetic component that contributes to where we fall on the resilience scale. But that’s not all there is to it. We know that our environment plays on our genetics to help determine which genes are “expressed” or activated, and which are not. We also know that there are certain key windows for this activation.

While the brain remains malleable to a certain degree our whole lives long, there are key developmental periods for shaping its basic substrates. Whether or not we reach our full genetic potential in terms of resilience depends to a great degree on our interpersonal history, particularly during the first two years of life:

[See: Born to Connect: The Role of Secure Attachment in Resilience to Trauma]

Clearly, it’s during these early years that we’re most vulnerable to the effects of abuse. But even more so when the abuse comes from those who are supposed to protect and nurture us:

[See: Betrayed: Why All Trauma Is Not Equal]

So, even though there are complexities to the question of why some people end up with PTSD while others don’t, we are beginning to piece together a general picture:

[See: Why Some Soldiers Develop PTSD and Others Don’t

As this particular bit of research points out, pre-war vulnerability is just as important as combat-related trauma in predicting whether veterans’ symptoms of post-traumatic stress disorder (PTSD) will be long-lasting. And one of the most common problems contributing to that pre-war vulnerability is, as you might suspect by now, child abuse:

[See: Embattled Childhoods May Be the Real Trauma for Soldiers with PTSD]

All of this said, we aren’t stuck with our pre-existing resilience levels. Yes, we can work toward increasing our stores of resilience, and there are effective therapies for PTSD.

Interestingly, the most effective therapists are those who instinctively provide that interpersonal connection we need so we can use the brain of another as a scaffold to our own brain’s rebuilding process. As therapist Tom Cloyd puts it:

When you run into a rough patch and all your tools are failing, the number one fallback really is the same for child or adult: another person who is NOT a participant in your distress and is compassionate in relation to you—tolerant of your drama, understanding of the experience, interested in staying connected to you—and who follows through, etc. Because of the way feelings jump back and forth between people (it’s about mirror neurons, if you want to look up the neurology), a calm person will tend to propagate calmness to (or “infect,” if you will) a distressed person. Good parents do this all the time for children.

In addition to surrounding yourself with a good support network (including a knowledgeable therapist) there are a few practical things you can do to make the most of your own capacity for resilience.

The first key is to take care of your physical health: good nutrition, regular sleep and exercise will help give you the strength necessary to support psychological health.

But you can also apply these same concepts to your brain as you work to support neurogenesis (the birth of new neurons) and lay the groundwork for successful therapy.

  • Feed your brain with positive, health-promoting experiences such as reaching out to help others or accomplishing a task that has a clear and beneficial outcome.
  • Rest your brain through meditation or by focusing on those things that give your life meaning.
  • Exercise your brain by learning something new.  Behavioral biologist Paul Martin notes in his 2006 book Making Happy People, that learning helps us reduce unpleasant emotions like anxiety, anger and depression, as well as aches and pains (which often accompany PTSD). He suggests that this is because the knowledge and problem-solving ability we gain—and the resulting sense of mastery—liberates us from worries and concerns that would otherwise make us anxious.

It should be clear by now that there is much hope for PTSD sufferers and their loved ones. Realizing this hope begins with educating the public about this debilitating condition. And that, after all, is the point of having an “awareness day.”

For more information about causes, symptoms and therapies for PTSD, I’d like to recommend three great resources. There are more, but these are great places to begin:

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