Running Head: BIOPSYCHOLOGY IN PSYCHIATRIC DISORDERS: PTSD 1

Biopsychology in Psychiatric Disorders: PTSD Mordechai Klein Walden University PSYC8226-1 Biopsychology 27 May 2011

Running Head: BIOPSYCHOLOGY IN PSYCHIATRIC DISORDERS: PTSD 2 Abstract This paper will look at PTSD in all forms and evaluate where the disorder comes from, how powerful an affect it has based on the individual and his or her bodily makeup, and how his or her life will be affected if PTSD sticks around and is not cured in a certain amount of time. Using research, this paper will give examples of PTSD case studies in the past and examine the role PTSD plays in our society today.

Running Head: BIOPSYCHOLOGY IN PSYCHIATRIC DISORDERS: PTSD 3 Biopsychology in Psychiatric Disorders: PTSD Posttraumatic Stress Disorder (PTSD) is a biological and neurological anxiety disorder which can occur after an individual experiences or witnesses an incontrollable traumatic event involving actual or potential injury, the possibility of grave danger, or imposes a severe threat to their sense of integrity (Pub Med Health, 2010). Thus in the instance of PTSD, the use of the word trauma is a narrowly defined term of a specific and horrific nature rather than the often casual usage of the expression to denote adverse life events like divorce or getting fired from a job (Mueser, Rosenberg & Rosenberg, 2009). Although the specific reasons for the onset of the disease are not known, scientific evidence points to psychological, biological, physical, and social factors as being influential in the manifestation of PTSD. This paper will define PTSD while exploring and determining the biological effects including brain changes in function and form along with the behavioral alterations expressed during physical demonstrations of the illness. What is PTSD? Posttraumatic Stress Disorder, as mentioned in the introduction, is a biological and psychological disorder which manifests itself with abnormal behavioral characteristics. Symptoms of PTSD, according to the DSM-IV, are a re-experiencing of the traumatic event, hyper-arousal (insomnia), numbing affect, avoidance symptoms, poor concentration, and difficulty explicitly recalling aspects of the traumatic event (Yufik & Simms, 2010). From this definition several themes emerge; mainly that there is a re-experiencing of the traumatic event, but that there is difficulty in recalling specific aspects of the traumatic event (Symes, 1995). It seems almost contradictory to state that someone would relive an event but not be able to recall

Running Head: BIOPSYCHOLOGY IN PSYCHIATRIC DISORDERS: PTSD 4 important aspects of it. Common sense might say that in events that are life-threatening or where someone is in a highly aroused emotional state, recollection would be superior to say what one had for dinner last evening. There is a concept in memory called flashbulb memory which is a different concept altogether (Wong, Kennedy, Marshall, & Gaillot, 2011). In a flashbulb memory there is vivid recollection of what happened during an event and details that are very specific (Wong et al, 2011). Flashbulb memories tend to occur in situations of high significance, often of national or international importance like what happened on 9/11 or the day JFK was shot. Though our initial exposure in the U.S. to PTSD was mainly brought about by controversy surrounding the U.S. Department of Veterans Affairs denial of treatment for the psychological injury suffered by Vietnam veterans, our understanding of the disease has bled into various other forms of trauma (Arnon, Maoz, Gazit, & Klein, 2011). No doubt, civilians who are an almost invisible casualty of societal war will likely suffer from the same condition as soldiers when they witness atrocities, death, and destruction firsthand in their own neighborhoods and countries (Wong et al, 2011). Today, PTSD is being diagnosed among those who have suffered childhood sexual abuse, rape, traumatic injury, other violent crimes, and extreme or prolonged neglect (Kubany, Ralston, & Hill, 2010). Mainstream Americas impression of PTSD may not be one of complete accuracy (Pars, Mills, & Edmondson, 2010). In fact, the impression one gets from the depiction of media and entertainment is a testament to the importance of inquiry. The impression one gets from films and television is that PTSD is a mood, anxiety, or stress disorder (Rademaker, van Zuiden,

Running Head: BIOPSYCHOLOGY IN PSYCHIATRIC DISORDERS: PTSD 5 &Vermetten, 2010). Characters are portrayed as stressed out and tense, moody and jumpy, anxious and even violent. While all these are true symptoms, the connection between the memories that are the cause and the symptoms one exhibits as a result, are only briefly explored, and by some sufferers accounts, inaccurate (Marshall, Schell, & Miles, 2010). But as research continues to expand into areas of the brain that are affected and some of the effects of the disorder going into old age are documented, contemporary understanding of PTSD as a memory disorder is growing (Peres, McFarlane, Nasello, & Moores, 2008). Perhaps the first documented diagnosis of post-traumatic stress was in 1864, by a man by the name of John Eric Erichsen (Mueserm Rosenberg, & Rosenberg, 2009). He was a British surgeon who was a devoted much of his professional career to physiology and anatomy. He was studying individuals who had been involved in train accidents and symptomology is almost exactly what it is today for PTSD (2009). Patients went through a re-experiencing of the trauma and exhibited hysterical symptoms, with anxiety expressed as bodily complaints with no obvious signs of physical injury (2009). The understanding of trauma on the mind was not what it is today, and as such physicians at that time believed it to be a disorder caused by the high speeds of the trains, a whopping 30 miles per hour. As it was later found to be purely psychological in origin, the diagnosis faded (2009). Veterans have always been those that are the most obvious sufferers. But as each war came and went, the disorder was known by a different name and its understanding changed. U.S soldiers that survived the Civil War who suffered emotional problems as a result of the war were diagnosed with soldiers heart which shares with PTSD many of the symptoms (Fraizer

Running Head: BIOPSYCHOLOGY IN PSYCHIATRIC DISORDERS: PTSD 6 et al, 2011). Following the Civil War, veterans of WWI who were similarly disturbed were said to have Shell Shock. And in WWII, a number of different names for the disorder came about. Battle fatigue, combat fatigue, irritable heart, war neurosis, and operational exhaustion were all phrases common to soldiers who were psychologically and emotionally distressed following combat (Fraizer et al, 2011). Despite all the historical acknowledgement of the disorder, a formal description and symptomology did not appear in the Diagnostic and Statistical Manual, the mental health professionals guide to all disorders, diseases, and conditions psychiatric in nature, until 1980 (Mueser, Rosenberg, & Rosenberg, 2009). Perhaps the greatest barrier to PTSD being recognized as a disorder that can severely inhibit ones ability to live a normal life was that it wasnt greatly understood as being associated with memory (Park, Mills, & Edmondson, 2010). Most people know PTSD as being exhibited in times where some cue elicits a memory of the traumatic event. But what wasnt known for a long time was what areas of the brain were affected; most notably the ones that are involved in memory (Rademaker, van Zuiden, Vermetten, & Geuze, 2010). What also wasnt known were what made people more at risk for getting the disorder, how to treat it, and what the long term implications were? Some questions that were raised were why some people got it and some people, who were in the same situation as the person who had PTSD, did not. As our understanding of memory and areas of the brain that are involved in long term and short term storage have increased, our understanding of this disorder as well as other disorders has grown considerably (Bremer, 2006).

Running Head: BIOPSYCHOLOGY IN PSYCHIATRIC DISORDERS: PTSD 7 So what is it about the event that brings about PTSD that is so different from an event that is conducive to a flashbulb memory? The difference can be compared to your level of involvement which is almost always correlated to the emotion that is felt (Kolassa et al, 2010). Compare the people who were direct witness to the horrors of 9/11 to those that witness it on TV. One may recall their location, the time of day, what they did in response, and who they were with as they heard the news through the radio, television, or word of mouth. But asking those who watched the planes strike from the neighboring tower or from a nearby street may not be able to give as clear and detailed a response. They can recall the emotion rather well, though. Biological Changes Within the Brain Research shows that moderate emotion, the emotion experienced by those that watch the drama from the comfort of their home, has a tendency to enhance memory. But extreme levels of emotion have the opposite effect. They have a tendency to impair it. Some researchers showed that the reasons behind this are hormonal in nature (Kolassa & Elbert, 2007). When adrenaline and corticosterone are released and the sympathetic nervous system in concert with the amygdaloid complex within the brain (a center critical to the feeling of emotion) are powerful methods the body and brain uses to ensure that the emotionally stimulating events are stored (Kolassa & Elbert, 2007). But there is also evidence that excessive amounts of stress which are associated with high levels of cortiscosterone, impairs the functioning of the hippocampus, which serves a critical function in memory (Kolassa & Elbert, 2007). From this research, two important parts of the brain stand out; the hippocampus and the amygdala. First, it is necessary to discuss these organs and their importance to memory and brain functioning, then connections can be made to PTSD. The amygdalae are two almond

Running Head: BIOPSYCHOLOGY IN PSYCHIATRIC DISORDERS: PTSD 8 shaped bundles of neurons that are located in an area of the brain known as the medial temporal lobe. Its primary function is in the formation and storage of memories associated with emotional events (Villarreal & King, 2004). Studies involving the functioning of the amygdala sometimes involve the fear response in rats. An association between an aversive event and a stimulus often results in synapses within the amygdala to react more readily. Damage to the amygdala has also been shown to impair the acquisition of fear conditioning (Kubany, Ralston, & Hill, 2010). The opposite seems to be the case among people with PTSD; their amygdale appears to be overactive (Villarreal & King, 2004). But thats not all the amygdala does. Its also involved in memory consolidation. Immediately following a learning event, its not stored into long term memory (Smid, van der Velden, Gersons, & Kleber, 2011). Rather, the information is slowly assimilated into long term storage over time. In humans, the more activity in the amygdalar region of the brain is correlated with retention of the information, depending on the emotionality of the information being presented (Villarreal & King, 2004). This information can be used to understand certain aspects of PTSD and the memory and recollection of traumatic events. It has been shown that immediately following a traumatic event, people may not have a very clear recollection of it. They may only be able to give bits and pieces of information regarding what happened. But over time their recall tends to increase (Lancaster, Melka, & Rodriguez, 2011). Theyre able to recall more and more of the event as days and even weeks go by. Perhaps this delayed recollection is an evolutionary adaptation to allow homeostasis to set back in (Villarreal & King, 2004). But it may also explain some facts about PTSD. After the

Running Head: BIOPSYCHOLOGY IN PSYCHIATRIC DISORDERS: PTSD 9 traumatic event occurs the individual may not be able to recall what happened, for good reason (Wong et al, 2011). But as time goes on they start to relive the event and are able to remember what happened. While from an evolutionary perspective this may have been beneficial in order to remind one not to approach a lioness and her cubs, it provides the individual the opportunity to attach new meaning or relive the terror that was felt at the moment it occurred. In fact, this is precisely why some researchers say that some people get PTSD and some people dont (Fraizer et al, 2011). It is hypothesized that those who do not suffer from PTSD have attached some type of contextual meaning to what they witnessed, or have modulated the memory to incorporate a meaning that is greater than simply what happened or attach a negative emotion to it (Fraizer et al, 2011). For some war veterans, it may be the difference between believing they are fighting for their country under a flag with noble cause and not knowing what theyre fighting for at all. Interestingly, new therapies have emerged that seek to capitalize on this theory of modulating memory and hope to change the way people, specifically soldiers, think of their traumatic experiences. The therapy involves stories of ancient Greek mythology concerning warriors and hopes to change the emotions that are attached to what the soldiers experience when they relive their wartime experience (Bremer, 2006). But the hippocampus and the roles that it plays must also be explored. The hippocampus, like the amygdala, is also located within the medial temporal lobe, and it also plays an important role in memory, but also in spatial navigation which well see has important implications for people with PTSD (Bremer, 2006). Damage to the hippocampus can cause anterograde amnesia, forming new memories, and retrograde amnesia, access to existing

Running Head: BIOPSYCHOLOGY IN PSYCHIATRIC DISORDERS: PTSD 10 memories (Bremer, 2006). Its primary role is in general declarative memory, or memories that can be explicitly verbalized. When subjected to chronic or severe stress, it has been shown that the hippocampus become damaged (Marshall, Schell, & Miles, 2010). And as stated previously, damage can cause certain types of amnesia. But what was also said was that the hippocampus is also important for storing and processing spatial information. Would the reduction in hippocampal volume have an effect on the ability of people suffering from PTSD to perform a visuo-spatial task? Subjects who were asked to perform a visuo-spatial task called the Virtual Morris Water Task achieved results not statistically different from normal individuals (Villarreal & King, 2004). However, upon viewing the images of the subjects brains, there was a significant difference in hippocampal activity (Villarreal & King, 2004). What does this mean? Well, the researchers gave several possible explanations. The first was that perhaps the number of participants in the experiment was not numerous enough to observe a difference (Bremer, 2006). A more interesting explanation offered involves the hippocampus relationship with the Amygdala. First, it has been shown that people with PTSD have a more active Amygdalar region (Villarreal & King 2004). It has also been shown that the activation of the amygdala inhibits the hippocampus. Perhaps the amygdala was compensating for the damage that was done to the hippocampus (Yufik & Simms, 2010). Further research is needed to offer any definitive explanation. But some other interesting points for consideration can be brought up. For example, are there certain people who are at greater risk for PTSD because of the size of their hippocampus? Interestingly, there

Running Head: BIOPSYCHOLOGY IN PSYCHIATRIC DISORDERS: PTSD 11 are known genetic variations in the size of the hippocampus from individual to individual (Villarreal & King, 2004). Many of the subjects involved in research concerning PTSD are not measured prior to trauma. So its very difficult to know precisely how much damage has been done to the hippocampus (Villarreal & King, 2004). Also, so many of those that suffer from PTSD, most notably veterans, engage in behaviors that may be self-medicating such as alcohol use. This serves to exacerbate the effects of PTSD as alcohol is known to damage the hippocampus as well Pub Med Health, 2010). So the very thing that sufferers use to seek relief may be pushing them farther into the depths of psychological damage and farther from recovery. Summary Some researchers have proposed a unique way of thinking of memory as a result of the study of those who live with PTSD. They state that there are possibly two different types of memory for trauma. One is the verbally accessible memory, or memory that can be readily retrieved and integrated with other autobiographical information and deliberately recalled (Bremer, 2006). The other type of memory situationally accessible memory, is so called due to the fact that flashbacks that are experienced are triggered by situational reminders of the trauma (Villarreal & King, 2004). Still, others propose that the brain, in recalling the traumatic event, is unable to distinguish the threat as merely a recollection or as an actual recurrence of the event (Symes, 1994). Treatment for PTSD is vital to not only the health of our veterans who put their lives on the line for citizens of this country, but it is vital to future generations of soldiers as well as

Running Head: BIOPSYCHOLOGY IN PSYCHIATRIC DISORDERS: PTSD 12 individuals who will suffer from the disorder as a result of some other traumatic event. Recently, there has been increased public attention on the outsourcing of the war. There are an estimated 200,000 contractors who are paid soldiers who have no affiliation with the military. These men and women are paid amounts of money monthly that sometimes exceed the pay that Army soldiers receive in a year. But the psychological price may be greater. It is important to realize that many of these mercenaries are not provided benefits that will afford them any type of medical coverage should they experience the symptoms of PTSD. Conclusion As we enter a period in time where new research in memory leads to strides against this and other disorders involving memory and where research with PTSD and other disorders of the memory lead to more knowledge about how memory works, it is important to categorize PTSD as a memory disorder. The current DSM-IV does not treat PTSD as such. Perhaps with more social awareness and treatments that evolve from memory research, PTSD will be treated more effectively and with more vigor. Not only can soldiers benefit, but others who have suffered traumatic events such as tsunamis, school shootings, hurricanes, tornadoes, earthquakes, floods and other natural disasters, rape, sexual abuse, physical or verbal abuse, and neglect. PTSD is an ever-growing mental disorder which affects literally millions of individuals in the U.S. alone and countless others across the globe. Procedures must be developed to properly diagnose individuals suffering from PTSD so they can begin the road to recovery and improved mental health. The possibility of collateral mental and physical damage, injury, or death to those afflicted with PTSD as well as family and friends in constant contact with the sufferer is too great to overlook.

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