Tag Archives: post traumatic stress disorder

“What Is the Function of the Brain?” by Laura K. Kerr

29 Jan
reblogged from Trauma’s Labyrinth
If you haven’t checked out Trauma’s Labyrinth yet, DO IT.  Its curator, Laura Kerr is a psychologist specializing in trauma and her blog is a must-read for anyone in the process of recovery. Her writing is academic but accessible, a great balance of scientific evidence and artistic/literary sensibility. Go read it, please.

Based on her ethnographic study of psychiatric residency programs, anthropologist T.M. Luhrmann concluded psychiatry is “of two minds”: one “mind” emphasizes the role of neurochemistry, while the other “mind” places more importance on the context of our suffering, including relationships past and present.

Identifying the origins of mental illness likely depends on both interpretations. There is an undeniable organic component to mental illness, just as psychological and social conditions are inexorably linked to mental well-being. But like the Democrats and Republicans, these two approaches are often pitted against one another, often leading to that old, tiresome nature versus nurture debate.

Unfortunately, in a world of limited resources, including limited time, the implicit guiding question — Where should we place our focus? — naturally divides our attention. Is it helpful to explore genes and neurobiology in our efforts to reach best outcomes? Or is it better to explore the social conditions that contribute to mental disorders? Unfortunately, much like U.S. politics, the treatment of mental illness often is derailed when such questions become fodder for polarizing arguments that serves allegiances and professional agendas more than persons in the throes of mental suffering.

Instead of worrying if nature is more influential than nurture, perhaps it would be more helpful to identify what counts as optimal functioning for the brain. Perhaps we could then focus on the value of combining information, thus leading to better outcomes rather than increased competition (and often, market share). I think the significance of function often gets overlooked because we aren’t adept at looking at any issues from multiple levels. Although the term biopsychosocial was coined to address the issue of scale and focus in the treatment of mental illness, it often feels piecemeal in approach.

How might we identify the causes of mental illnesses in ways that address their biological, psychological, and social aspects without parodying the impact of any of them?  Furthermore, what stands in the way of answering such a seemingly straightforward and important question?

More than any other arena of healthcare, the mental health field is paralyzed by politics, disciplinary boundaries, and financial stakes competing to define the disorders it treats and studies. I have wondered what it would be like for all of us who either work in the field or receive treatment for a mental disorder (a Venn diagram of these two groups would show a big overlap) to restart our quest for mental health and well-being with the very simple question:

What is the function of the brain?

With this question, I think we might begin treating the brain like any other organ of the body, and not according to its current exalted status. Appropriate treatment would “simply” mean returning the brain to its optimally functioning state. I believe this question could also encapsulate the complex relationship between biology, self, and society that complicates understanding the nature of mental illness as well as identifying best treatments.

Typically, something is perceived as a disease or trauma when it interferes with an organ’s proper functioning. By knowing the function of an organ of the body, it follows that healing that organ involves returning it to its homeostatic, functional state. Thus, what counts as disease or trauma are those things that interfere with normal functioning. For example, we know the function of the heart is to repeatedly and continually pump blood through the blood vessels, and anything that interferes with this process would be identified as disease or trauma. Similarly, the functions of the stomach include storing food during a meal and breaking down food particles into molecules small enough to be absorbed by the small intestine.  Whatever interferes with these functions is treated as disease or trauma.

We can identify the functions of every major organ of the body — the lungs, the skin, the intestines, the skeleton, the immune system — and with this knowledge, both diagnose and treat the causes of disease or the effects of trauma. Whereas there may be many paths to the cure, there is nevertheless a shared understanding of how the organ is meant to function. This simple approach seems to evade the mental health sciences, and I wonder if this is because there is a lack of agreement about the function of the brain.

We know the brain is part of the central nervous system, which functions like a command center for the rest of the body as well as gathering sensory information from the environment. The neurochemical model of mental illness relies heaviest on this understanding of brain functioning, particularly given its focus on neurotransmitters. Having a well-functioning central nervous system certainly seems central to mental well-being, yet it is also likely only one contributor to mental illness, and cannot adequately account for the psychological and social impairment also associated with mental illnesses. Although this model of mental disorders is not necessarily wrong, it nevertheless is too limited in scope to grapple with the myriad phenomena we associate with mental disorders.

An alternative model of the brain has emerged with research into the neurobiology of trauma as well as research into the different regions of the brain. With this model, the brain is understood more in terms of the functions of its components and adaptation to environmental conditions, especially the environments created through our relationships with significant people in our lives. This is an important change in scope from the biochemical model of mental illness that seems to rest on the “command, control, communicate” metaphor that has dominated information systems thinking since World War II.

In contrast, the neurobiology of trauma model examines how specific areas of the brain — often depicted as three primary regions: the cortex, limbic system, and brain stem — take part in the process of gathering information from the body and the environment, synthesizing this information, and then acting in accordance with often implicit needs or desires. In particular, two dominant action tendencies are thought to organize how the brain functions, which also correlate with two dominant environmental conditions:

  • conditions of attachment and normal daily activities, and
  • conditions requiring defense (i.e., fight, flight, freeze, submit, cling).

From the perspective of the neurobiology of trauma, sociality, and the capacity to engage with others in meaningful and pleasurable ways, is inversely related to the amount of traumatic stress a person experiences. Too little of the conditions that contribute to sociality, along with too many of the conditions that activate defense responses (including low levels of chronic stress), lead to poor mental functioning. And yet both functions — surviving in states of peace and in states of defense — are necessary functions of a healthy brain. (Thus an added benefit of the neurobiology of trauma model is that it replaces notions of pathology with notions of adaptation.)

The neurobiology of trauma model of the brain can also incorporate the functions of the central nervous system associated with the biochemical model of mental disorders, especially when the primary function associated with the brain is this concept of sociality. When the brain is seen as primarily a “social” organ, it seems to have two main functions:

  1. to communicate with the rest of the body in the creation of a coördinated response to stimuli (creating an ‘internal’ society of sorts); and
  2. to communicate with the world in the creation of a self among others selves.

When the primary function of the brain is seen as sociality — both within our own psyches & bodies and with other people — mental illness could then be simplified to include

  • interference with the capacity for internal communication that contributes to authentic self-care;
  • interference with the ability to be a self among others, and thus feeling relaxed and safe in the presence of others; and
  • interference with the capacity to maintain meaningful and supportive relationships.

Just as there are many ways for the heart, stomach, or any organ to be diseased or traumatized, there are many ways for the brain to lose functionality. Impairment does sometimes result from genetic predispositions, although typically in combination with physiological stressors such as exposure to toxins, exposure to bacteria and/or viruses, poor diet, high levels of stress, and injuries that alter the physiology of the organ or impairs its normal development. Also included in these physiological environmental stressors are traumas such as adverse childhood experiences, assault, combat, and other situations where people hurt people, thus not only overly activating defense responses, but also altering the capacity to function as social beings.

Both nature and nurture are undoubtably contributing causes to mental disorders. But perhaps we should think of them as either less or more relevant depending on which lens best helps people regain functionality — both in terms of their inner and outer sociality.

Another way of thinking about this would be in terms of integration. Feeling internally integrated lessens the sense of internal fragmentation. And integration is central to mental well-being. Feeling internally fragmented demands a lot of energy and attention, and often leads to isolation and limited integration with the larger community, hence also limiting the capacity for sociality.

Lacking the capacity for sociality seems central to the suffering associated with mental disorders, irrespective of the cause. And isn’t the reason we have any type of healthcare is to help people overcome suffering? Sometimes when overloaded with competing theories, professional agendas, and the potential for large profits, we lose sight of this otherwise straightforward goal. Yet if we can agree on the primary function of the brain, I think we can also be more astute in our choices about what counts as best treatments.

“Maternal PTSD Linked to Children’s Trauma” by Kathleen Raven

12 Sep
from Reuters, reblogged from Trauma’s Labyrinth:

 

The children of mothers with posttraumatic stress disorder (PTSD) may be at high risk of being traumatized themselves, according to a small new study in urban U.S. neighborhoods.

Inner-city kids whose mothers had PTSD experienced more traumatic events – such as neighborhood shootings, domestic violence, dog bites or car accidents – before age five than kids whose mothers were depressed or had no mental health issues, researchers found.

Mothers with a combination of PTSD and depression were also more likely to report psychologically or physically abusing their child, compared to mothers with just one of those disorders.

“The main take-home message is that when parents are suffering, their children suffer, too,” said Dr. Howard Dubowitz, professor of pediatrics at University of Maryland School of Medicine in Baltimore.

“Those of us who are involved in helping to take care of kids can’t ignore what problems mothers and fathers may be struggling with,” added Dubowitz, who was not involved in the study.

Children exposed to trauma are themselves at greater risk of a mix of health challenges later on in life, such as obesity, drug and alcohol addictions, heart disease, suicide and mental health disorders, experts said.

“Everyone’s been putting the focus on depression, even though PTSD and depression run together,” said the study’s lead author Claude Chemtob, director of NYU Langone Medical Center’s family trauma research program.

He and his colleagues recruited 97 mothers with children between the ages three and five years old from Mount Sinai School of Medicine’s pediatric primary care clinics in New York City to participate in the study.

Most mothers were from ethnic minority groups and had high school diplomas. The women all completed questionnaires designed to detect depression or PTSD symptoms. They also answered questions about violent events their children had witnessed.

The majority of mothers were not clinically depressed or suffering from PTSD, Chemtob’s group reports in JAMA Pediatrics. Of the 97 mothers, 11 had diagnosable depression, six had PTSD and 10 had a combination of both.

Chemtob pointed out that the study population had slightly elevated levels of depression and PTSD diagnoses compared to national averages.

The researchers also found that mothers with PTSD and depression reported far greater parenting stress. “In short, their experience of parenting is that it is more difficult and less rewarding,” Chemtob said.

Last year the American Academy of Pediatrics urged pediatricians to take steps to reduce childhood “toxic stress” that can occur when parents or caregivers suffer from poor mental health.

In the current study, the children of mothers with PTSD witnessed an average of five traumatic events.

Their peers whose mothers were only depressed or had no mood disorder experienced an average of only one traumatic event. A third group of kids with mothers suffering both PTSD and depression experienced nearly four events.

Previous research suggests that nearly half of women with PTSD may also suffer from depression.

“We know that the effects of maternal mental health difficulties can be especially problematic in early life, from pregnancy to age 5,” Michelle Bosquet of Boston Children’s Hospital in Massachusetts told Reuters Health in an email.

Bosquet, who was not involved in the new study, added that much previous research has focused only on depression and less is known about how PTSD may influence parenting.

Researchers noted that the study is limited by its small size.

“These results have been found among certain families,” Dubowitz said. Future studies could look for the same results in different populations, such as whites, he said.

The authors encourage screening mothers for PTSD alongside depression in pediatric primary care settings. “This might be an effective way to intervene on child maltreatment,” Chemtob told Reuters Health.

In his research on child abuse, Dubowitz has created a questionnaire for parents to complete before arriving for a pediatric appointment. It contains two questions to detect depressive symptoms.

“It may be most efficient to use just two questions to identify possible depression, and, in so doing, identify parents with that condition and … help them get evaluated,” Dubowitz said.

“Aside from time, and time is very important, there is the whole challenge of changing health professionals’ practice and behavior,” he said.

SOURCE: http://bit.ly/1apSvqP JAMA Pediatrics, online September 2, 2013.

http://news.yahoo.com/maternal-ptsd-linked-childrens-trauma-153636958.html

“Posttraumatic Stress Disorder in Patients with Bipolar Disorder: A Review of Prevalence, Correlates, and Treatment Strategies” by Michael W. Otto et al

9 Aug
From PubMed:

 

Abstract

OBJECTIVES:

In this article, we review the evidence for, and implications of, a high rate of comorbid posttraumatic stress disorder (PTSD) in individuals with bipolar disorder.

METHODS:

We reviewed studies providing comorbidity data on patients with bipolar disorder, and also examined the PTSD literature for risk factors and empirically supported treatment options for PTSD.

RESULTS:

Studies of bipolar patients have documented elevated rates of PTSD. Based on our review, representing 1214 bipolar patients, the mean prevalence of PTSD in bipolar patients is 16.0% (95% CI: 14-18%), a rate that is roughly double the lifetime prevalence for PTSD in the general population. Risk factors for PTSD that are also characteristic of bipolar samples include the presence of multiple axis I disorders, greater trauma exposure, elevated neuroticism and lower extraversion, and lower social support and socio-economic status.

CONCLUSIONS:

These findings are discussed in relation to the cost of PTSD symptoms to the course of bipolar disorder. Pharmacological and cognitive-behavioral treatment options are reviewed, with discussion of modifications to current cognitive-behavioral protocols for addressing PTSD in individuals at risk for mood episodes.

 

http://www.ncbi.nlm.nih.gov/pubmed/15541062

Subduction

22 Jun

I’m afraid to go to sleep. For the last four nights, I’ve woken with the residuals of nightmares. The moods they evoke take time to dissipate. I drink coffee and will the feelings back. Numbness rushes in to fill the space.

Then yesterday I started having flashbacks, dissociating, and hyperventilating. Nothing triggered it. I haven’t had intrusive PTSD symptoms for over two months, even with the stress I’ve been under. I was in the middle of a support group meeting. It was embarrassing.

The flashbacks receded today, but the anxiety and dissociation keep creeping up on me. I can’t drive because I intermittently float out of my body. People speak to me and I can’t focus on their words; I just stare at them and do my best to feign comprehension. I dig my nails into my arm to try to keep my mind connected to my body. I breathe diaphragmatically.

These past couple of days have reminded me not to get cocky. Never turn your back on your illness. Your mind will get the better of you if you don’t keep your eye on it.

I don’t want to backslide. I’ve made a lot of progress in the past few months. I’m determined to learn to live with this and not let it control my life. Concurrently, I know that I need to be honest with myself about my limitations. It’s a balancing act.

I don’t think I’ll ever get it fully under control. Things happened to me when I was too young to articulate them and they come to the surface sometimes. I don’t try to process them. I attempted that several years ago with a therapist, desensitization therapy. It was too much all at once. My symptoms have been much more frequent and intense since then. Because I can’t clearly recall things, and because no one can fill in the gaps, it isn’t possible to examine the memories and put them in perspective. All I get are sensations, shards of visions, and waves of confusion and fear.

I have no desire to dig into that mess, so I have to contain it. I’m hoping that it will die back down after a couple of days of TLC and sustained efforts. But it will always be straining beneath the surface. All I can do is breathe and prepare for the next time.

“DSM-5 Changes: PTSD, Trauma, and Stress-related Disorders” by John M. Grohol

19 Jun

http://pro.psychcentral.com/2013/dsm-5-changes-ptsd-trauma-stress-related-disorders/004406.html

From Psych Central:



The new Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) has a number of changes to post-traumatic stress disorder (PTSD), trauma and stress-related disorders, as well as reactive attachment disorders. This article outlines some of the major changes to these conditions.

According to the American Psychiatric Association (APA), the publisher of the DSM-5, there are some significant changes in this category from the diagnostic criteria that appeared in the previous edition, DSM-IV. These include changes to PTSD criteria, acute stress disorder, adjustment disorders, and reactive attachment disorder, a childhood concern.

Posttraumatic Stress Disorder (PTSD)

Post-traumatic stress disorder undergoes some major changes in the DSM-5. For example, the first criteria is far more explicit in what constitutes a traumatic event. “Sexual assault is specifically included, for example, as is a recurring exposure that could apply to police officers or first responders,” notes the APA. “Language stipulating an individual’s response to the event — intense fear, helplessness or horror, according to DSM-IV — has been deleted because that criterion proved to have no utility in predicting the onset of PTSD.” So goodbye to the current Criterion A2 from the DSM-IV.

Instead of three major symptom clusters for PTSD, the DSM-5 now lists four clusters:

  • Re-experiencing the event — For example, spontaneous memories of the traumatic event, recurrent dreams related to it, flashbacks or other intense or prolonged psychological distress.
  • Heightened arousal — For example, aggressive, reckless or self-destructive behavior, sleep disturbances, hyper-
    vigilance or related problems.
  • Avoidance — For example, distressing memories, thoughts, feelings or external reminders of the event.
  • Negative thoughts and mood or feelings — For example, feelings may vary from a persistent and distorted sense of
    blame of self or others, to estrangement from others or markedly diminished interest in activities, to an inability to remember key aspects of the event.
PTSD Preschool Subtype

DSM-5 will include the addition of two new subtypes. The first is called PTSD Preschool Subtype, which is used to diagnose PTSD in children younger than 6 years. Post-traumatic stress disorder is also now developmentally sensitive, meaning that diagnostic thresholds have been lowered for children and adolescents.

PTSD Dissociative Subtype

The second new PTSD subtype is called PTSD Dissociative Subtype. It is chosen when PTSD is seen with prominent dissociative symptoms. These dissociative symptoms can be either experiences of feeling detached from one’s own mind or body, or experiences in which the world seems unreal, dreamlike or distorted.

Acute Stress Disorder

Acute stress disorder in the DSM-5 has been updated in ways similar to the PTSD criteria, for consistency’s sake. That means the first criteria, Criterion A, “requires being explicit as to whether qualifying traumatic events were experienced directly, witnessed, or experienced indirectly.”

Also, according to the APA, the DSM-IV Criterion A2 regarding the subjective reaction to the traumatic event (e.g., “the person’s response involved intense fear, helplessness, or horror”) has been eliminated. This criteria appeared to have little diagnostic utility.

Furthermore,

Based on evidence that acute posttraumatic reactions are very heterogeneous and that DSM-IV’s emphasis on dissociative symptoms is overly restrictive, individuals may meet diagnostic criteria in DSM-5 for acute stress disorder if they exhibit any 9 of 14 listed symptoms in these categories: intrusion, negative mood, dissociation, avoidance, and arousal.

Adjustment Disorders

Adjustment disorders are reconceptualized in the DSM-5 as a stress-response syndrome. This takes them out of their residual, catch-all category and places them into a conceptual framework that these disorders represent a simple response to some type of life stress (whether traumatic or not).

This category of disorders remains a place to diagnose a person who doesn’t otherwise meet the criteria for another disorder in the DSM-5, such as a person who doesn’t meet the full criteria for major depression. The subtypes — depressed mood, anxious symptoms, or disturbances in conduct — from the DSM-IV remain the same for the DSM-5.

Reactive Attachment Disorder

Reactive attachment disorder is subdivided into two distinct disorders in the DSM-5, based upon the DSM-IV subtypes. So we now have reactive attachment disorder which is separate from disinhibited social engagement disorder.

According to the APA, “Both of these disorders are the result of social neglect or other situations that limit a young child’s opportunity to form selective attachments. Although sharing this etiological pathway, the two disorders differ in
important ways.” The two disorders differ in many ways, including correlates, course, and response to intervention.

Reactive Attachment Disorder

The APA suggests that reactive attachment disorder more “closely resembles internalizing disorders; it is essentially equivalent to a lack of or incompletely formed preferred attachments to caregiving adults.” In reactive attachment disorder, there is a dampened positive affect — the child expresses joy or happiness in a very subdued or restrained manner.

Disinhibited Social Engagement Disorder

The APA further suggests that disinhibited social engagement disorder more closely resembles ADHD: “It may occur in children who do not necessarily lack attachments and may have established or even secure attachments.”

“The Boston Marathon Bombings: You Don’t Have to Watch the Media Coverage” by Julie Fast

18 Apr
From the blog Bipolar Happens by Julia Fast:

“Regarding the bombings at the Boston Marathon in the United States

It’s so important to remember that we don’t have to follow the news if
it upsets us. We can read about it next week- or ask others for an
update.

A 24 hour CNN stream of the aftermath of this event is detrimental if you are not doing well.

If you are upset right now, I highly suggest staying off the internet
and turning off the TV. That is what I do. Anxiety, especially OCD,
paranoia, fear, depression and worry about the future can be triggered. I
always remind myself that I can learn about a world event and then let it
go. If donations are needed, I always find it helps to support an
organization like the Red Cross.”

“What Works for PTSD” by Alexandra Carmichael

3 Apr

https://blog.23andme.com/23andme-research/what-works-for-ptsd/

From the blog 23andMe:

“Some of the most popular treatments for Post-Traumatic Stress Disorder are not necessarily the most effective, according to a new study by CureTogether, a free resource owned by 23andMe that allows people to share information about their health and treatments.

People in the study said they found some treatments without drugs — including art therapy and exercise — were the most effective. Conversely some popular treatments such as the use of antidepressants, were among the least effective, according to the study.

PTSD is an anxiety disorder that is often associated with combat veterans, but the disorder can occur in anyone who has experienced or seen a traumatic event. Finding the right treatment can be particularly difficult, so CureTogether asked people suffering from PTSD to rate the effectiveness of different treatments.

CureTogether’s study compiled responses from 531 people with PTSD, who rated the effectiveness of 31 different treatments.

Among the most helpful treatments were Cognitive Behavior Therapy, avoiding places and noises that trigger symptoms, art therapy, and exercise. Also highly effective for those in the study were having a daily routine and participating in support groups. Also on the list was the use of a clear shower curtain, which addresses the fear some have of hidden threats. In contrast people in the study said anti-depressants and Exposure Therapy were not as effective.”

 

 

 

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