Post-Traumatic Stress Disorder, the symptoms, the anatomy and an NLP perspective by Michael Carroll

PTSD, or Post traumatic Stress Disorder, is a psychiatric disorder

That can occur following the experience or witnessing of life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, or physical or sexual assault in adult or childhood.

Different people react differently to trauma, many will return to normal after a period of time has passed, some will continue to have stress responses that remains until a professional intervention takes place and others suffer long term PTSD.

PTSD increases the intensity in the stress response accompanied by flashbacks, nightmares, feelings of dissociation or detachment, lack of sleep and inability to concentrate (Bisson 2007). These symptoms can have a major impact on an individual’s life.

People with PTSD experience three different kinds of symptoms associated with different parts of the brain. To be diagnosed with PTSD the symptoms below will be present for at least one month and will cause significant distress in the person’s life by interfering with work or home life.

1 – The first set of symptoms involves re-living the trauma in some way such as becoming upset when confronted with a traumatic reminder or thinking about the trauma when you are trying to do something else.

2 – The second set of symptoms involves either staying away from places or people that remind you of the trauma, isolating yourself from other people, or feeling numb.

3 – The third set of symptoms includes things such as feeling on guard, irritable, or startling easily (Yehuda2002)

Changes in three areas of the brain, the amygdala, hippocampus and prefrontal cortex have been associated to PTSD (Gushen 2010)

Arousal in the amygdala

People with PTSD may feel constantly alert after the traumatic event. This is known as increased emotional arousal, and it can cause difficulty sleeping, outbursts of anger or irritability, and difficulty concentrating. (http://www.ptsd.ne.gov). They may find that they are constantly ‘on guard’ and on the lookout for signs of danger. They may also find that they get startled relatively easily.

The arousal occurs due to increased levels of activity in amygdala which is the brain’s stress evaluator and decides when to react.

When a traumatic event occurs, the amygdala will:

1 – Send out a danger signal.
2 – Initiate the “fight or flight” response.
3 – Store stimuli associated with memory such as sights, sounds, smells, etc.
4 – Produces calming thoughts when there is no longer danger.  (Gushen 2010)

The amygdala is active in storing stimuli associated with the trauma and reacting kinaesthetically to visual, auditory, olfactory or gustatory representations associated with the trauma.  In NLP terms this is called a synaesthesia.  The synaesthesia can be experienced on internally generated representations (flash backs) or input representations that resemble the traumatic event (association).

Shrinking of hippocampus influences distorted memories and flashbacks

The hippocampus is essential to memory formation. When a person develops PTSD, the hippocampus is central to the re-experiencing of the traumatic events. A traumatic memory could be involuntarily retrieved when triggered by a stimulus. These memories tend to be very strong, and the hippocampus seems to be overactive in those with PTSD. The memories come in flashbacks when awake and dreams when asleep.

When a traumatic event occurs, the hippocampus:

1 – Creates and stores the memory.
2 – Retrieves the memory.
3 – Calms the amygdala alarm circuit.

Effects after traumatic stress

1 – Confusion
2 – Disorientation
3 – Recurring thoughts, Nightmares, and/or Flashbacks
4 – Difficulty sleeping
5 – Reduced size of hippocampus leading to impaired recall (Gushen 2010)

So far in this article I have presented the amygdala as the part of the brain for storing the stimuli associated with the trauma and hippocampus is holding the memory. The reduced size hippocampus impairs the memory creating a situation where external stimuli quite different to the original events can evoke the PTSD response. So for example a soldier with PTSD hears a bang that does not resemble the original explosion that resulted in the PTSD, yet the soldier experiences a PTSD response.

What has happened is auditory external (Ae) stimuli is fast routed to the amygdala, and then traumatic memory is relived in auditory internal representation (Ai ) in the Hippocampus leading to kinaesthetic internal response in the (Ki) amygdala.  All of this is most likely to happen as an overlapping representation as an Ae/Ai/Ki synaesthesia. The disparity in recognising the current stimuli is very different from the original stimuli potentially is due the shrinkage of the hippocampus

Reduced activity in the prefrontal cortex leading to avoidance and numbness 

Avoidance symptoms are efforts people make to avoid the traumatic event. Individuals with PTSD are likely to avoid situations that trigger associations with the traumatic event. They may avoid going near places where the trauma occurred or seeing TV programmes or news reports about similar events.

They may avoid other sights, sounds, smells, or people that are reminders of the traumatic event. These are external cues that have corresponding representations in the amygdala.

Numbing symptoms are another way to avoid the traumatic event. Individuals with PTSD may feel emotionally “numb” and find it difficult to be in touch with their feelings or express emotions toward other people. In NLP the numbness is known as dissociation, in this example the dissociationoccurs to experiences where there was once a strong positive kinaesthetic representation.

So on one hand the person is experiencing numbness and lack of feelings where they once experienced pleasant feelings and on the other hand the body is flooded with intense feelings associated with the trauma.

The prefrontal cortex lies directly behind the forehead within the frontal lobes and controls behaviour, emotions, and impulses. After a traumatic event occurs, the prefrontal cortex should let the amygdala know that it is okay to calm down once the danger has dissipated. However in those with PTSD, the prefrontal cortex is less active, which likely correlates with symptoms of social withdrawal, avoidance of reminders of the trauma, and emotional numbing.

Therefore, the prefrontal cortex is unable to override the hippocampus, as it flashes the memory, so it cannot signal to the amygdala that there is no real danger

Signs and symptoms of PTSD associated with the prefrontal cortex are:

1 – Irritability
2 – Withdrawal features: numbing, avoidance, etc.
3 – Reduced activation of prefrontal cortex (Gushen 2010)

It is very common for other conditions to occur along with PTSD, such as depression, anxiety, or substance abuse. More than half of men with PTSD also have problems with alcohol. (http://www.ptsd.ne.gov) The next most common co-occurring problems in men are depression, followed by conduct disorder, and then problems with drugs. In women, the most common co-occurring problem is depression. Just under half of women with PTSD also experience depression (http://www.ptsd.ne.gov). The next most common co-occurring problems in women are specific fears, social anxiety, and then problems with alcohol.

NLP and post-traumatic stress

NLP is very clear in its assertion that people do not operate in the real world, they operate on map of the world. The map of the world is comprised of VAKOG representations which are heavily filtered versions of the external stimuli the representations are mapping.  In this article I have used the anatomy of post-traumatic stress which is well researched amongst neuro-scientists and biological psychologists and explained how different VAKOG representations as noted in NLP correlate with different parts of the brain active when PTSD is present.
Of course this article is collection of words that have drawn upon researched data in the neuro science world and we present data in NLP. I have worked with PTSD clients during a visit to the Philippines in the wake of Typhoon Yolanda as well as in the UK in my coaching practice. In the part II of this series, I will share which interventions to use with PTSD and my reasoning for how these interventions work in PTSD cases.

References

Gushen B, 2010, The Anatomy of PTSD – www.brainlinemilitary.org
What is PTSD, Nebraska Department of Veterans’ Affairs – www.ptsd.ne.gov
Yehuda, R 2002, Post Traumatic Stress Disorder – N Engl J Med, Vol. 346