We all are aware of the human toll in our country taken by the Coronavirus 19 pandemic. We have over 1.6 million cases and over 100,000 deaths as of this writing. The traumatic nature of this pandemic for so many people has high likelihood of resulting in an increase in diagnoses of Post Traumatic Stress Disorder (PTSD). According to Dr. Daniel Amen in a post titled “The next wave of the pandemic: PTSD”, the human brain is wired to remember traumatic experiences. In some people, this biological reality may lead to post-traumatic stress disorder (PTSD). In fact, mental health experts anticipate that PTSD, which currently affects over 8 million American adults, could become the next healthcare crisis.
So who is at risk for PTSD during this pandemic? Some groups are more at risk than others. Dr. Amen noted the following groups:
COVID-19 SURVIVORS Fearing that you may die is traumatic. A 2018 study showed that being critically ill can lead to symptoms of PTSD in as many as 27% of patients surviving a stay in the intensive care unit (ICU). For people with COVID-19 who survive an ICU stay, risk is even higher. I noted in another post that a 2020 study of more than 700 COVID-19 patients in China found that a very high 96% had symptoms of PTSD during quarantine. Because COVID-19 is so contagious, people in ICUs couldn’t see family or friends, leaving them completely alone during this frightening time.
PEOPLE WHO HAVE LOST A LOVED ONE Suffering the death of someone you care about can trigger devastating long-term psychological consequences. Dr. Amen cited research in The American Journal of Psychiatry showing that the unexpected loss of a loved one increased the chances of the onset of PTSD, as well as other mental health issues, such as depression and panic disorders.
HEALTHCARE WORKERS We certainly have heard much about our heroes, healthcare workers. Physicians, nurses, EMTs, and other frontline responders put themselves in harm’s way by caring for those who are sick and dying. It is likely they soon will confront another risk—PTSD. Dr. Amen cited a 2020 report in the journal Psychological Medicine which called PTSD the “second tsunami” of the COVID-19 pandemic and noted that healthcare workers are in occupations that are already at risk for the condition. Research in the Canadian Journal of Psychiatry on the SARS outbreak in 2003 showed that 10% of healthcare workers experienced high levels of PTSD following that pandemic.
PEOPLE WITH A HISTORY OF TRAUMA OR OTHER MENTAL HEALTH ISSUES If you have suffered trauma in your childhood or as an adult, the psychological distress of the pandemic may compound the effects and lead to PTSD. Dr. Amen observed that people who already struggle with anxiety, depression, bipolar disorder, or other mental health conditions may be more vulnerable to developing PTSD.
ANYONE WHO PRACTICED SELF-ISOLATION A 2013 study in Disaster Medicine and Public Health Preparedness investigated the psychosocial responses of children and their parents to quarantine and isolation measures in a pandemic. The researchers found that 30% of children in quarantine met the criteria for PTSD as did 25% of their parents. Considering that most of the nation was encouraged to self-isolate during the pandemic, this could translate into millions of people experiencing PTSD in the wake of the coronavirus pandemic.
So what is PTSD? PTSD is a pathological disorder resulting after exposure to a traumatic event. An estimated 8% of the U.S. adult population matches the criteria for PTSD with women more likely to develop symptoms than men. While PTSD cases commonly involve combat or assault experiences, there is a wide range of events capable of triggering PTSD symptoms. Trauma events frequently associated with the development of PTSD include the following: Physical, emotional, or sexual abuse; Combat experiences; Terrorist attacks; Natural disasters such as tornados, floods, earthquakes, or fires; Life-threatening accidents, such as automobile accidents, airplane crashes, or boating accidents both experienced or witnessed; Violent crimes, both experienced or witnessed.
What are common symptoms of PTSD? Dr. Amen noted that there are many signs and symptoms associated with PTSD. Common symptoms include anxiety, distressing memories and flashbacks, nightmares, trouble sleeping, hypervigilance, being easily startled, and difficulties concentrating. Also, avoiding people, places, or things that are reminders of the trauma is also common among those with PTSD. Suffering from PTSD also makes people more likely to have suicidal thoughts and behaviors.
What happens in the brains of people with PTSD? Suffice it to say, there is no use telling them to get over it because PTSD changes the brain's structure. Extensive neuroimaging studies on the brains of PTSD patients show that several regions differ structurally and functionally from those of healthy individuals. The amygdala, the hippocampus, and the ventromedial prefrontal cortex play roles in triggering the symptoms of PTSD. Together, these regions impact the stress response mechanism in humans. Consequently, the PTSD victim, long after their experiences, continues to perceive and respond to stress differently than someone who does not suffer the results of trauma. The most significant neurological impact of trauma is seen in the hippocampus. PTSD patients show a significant reduction in the volume of the hippocampus. This area of the brain is responsible for memory functions. It helps us record new memories and retrieve them later. The hippocampus also helps us distinguish between past and present memories. PTSD patients with reduced hippocampal volumes lose the ability to discriminate between past and present experiences. They have extreme stress responses when facing situations that only slightly resemble something from their traumatic past. I have treated numerous patients who were victimized by physical and/or sexual abuse whose responses were overdetermined to current situations, often benign, as though the current situation was the one which had traumatized them initially. This can occur decades after the initial traumatic event. Most recently, I have been working with victims of severe wild fires for whom intrusive reminders occur regularly and elicit emotional overreaction. Severe emotional trauma causes lasting changes in the ventromedial prefrontal cortical region of the brain. This area is responsible for regulating emotional responses triggered by the amygdala. Specifically, this region regulates negative emotions like fear. PTSD patients show a marked decrease in the volume of ventromedial prefrontal cortex. This explains why people suffering from PTSD tend to exhibit fear, anxiety, and extreme stress responses even when faced with situations not connected, or only remotely so, to their experiences from the past. Traumatic events appear to increase activity in the amygdala. This region of the brain helps us process emotions and is also linked to fear responses. PTSD patients show hyperactivity in the amygdala in response to stimuli that are somehow connected to their traumatic experiences. Sometimes, they show hyperactivity even to stimuli not associated with their trauma. Hyperactivity of the amygdala is positively related to the severity of PTSD symptoms. To a large extent, this is a result of the hypoactivity of the hippocampus and the dysfunction in the ventromedial prefrontal cortex in controlling the amygdala. The amygdala signals fear and threat, the prefrontal cortex can not control it. The excessive reactivity of the amygdala helps explain some of the major signs of PTSD - startle responses to the most harmless of stimuli and frequent flashbacks or intrusive recollections.
However, there is some hope as well as promising treatments for PTSD and these treatments have been shown in some studies to correlate with brain changes. We certainly now know that the brain can regenerate more than we thought in the past. Some drugs and behavioral therapies have been shown to increase the volume of the hippocampus in PTSD patients. Enhancing overall brain health can make a big improvement, as can some forms of psychotherapy (cognitive processing therapy, prolonged exposure therapy), some virtual reality therapies, as well as EMDR (Eye Movement Desensitization and Reprocessing) therapy.
Realize that there are treatments available for PTSD. Second, consider the above and whether you or someone you know might be suffering from such a problem. Depression and anxiety are common occurrences with PTSD and can affect well being in life and at work. Stress is a common factor in PTSD. For more information about stress management, please see our book (I Can’t Take It Anymore: How to Manage Stress so It Doesn’t Manage You; Paul G. Longobardi, Ph.D., and Janice B. Longobardi, R.N., B.S.N., P.H.N.), available on Amazon at https://www.amazon.com/dp/1542458056. For additional information about the book, authors, and stress, please visit our website at www.manageyourhealthandstress.com.
Good luck on your journey.
Dr. Paul Longobardi
For information on these and related topics, please visit my website at www.successandmindset.com