What Causes PTSD?

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Sadaf Akhtar.,PhD

Mental wellbeing specialist at WellQo

What causes PTSD?

Trauma responses such as shock, fear and helplessness are common reactions to unexpected threatening, or harmful events. However, while exposure to abnormal incidents, such as mental, emotional and sexual violence, is unfortunately frequent, not everyone develops post traumatic stress disorder (PTSD). Research indicates that while most people experience trauma at some point in their lives, not all suffer from chronic or debilitating symptoms. Factors such as absence of compassionate support, past and current health status at the time of the event, as well as the severity and duration of the event, explain some of these differences. However, there are other insights regarding the causes of PTSD. Understanding frameworks that explain how PTSD develops is important, particularly for purposes of making informed choices for effective treatment. The present article offers a basic introduction to some of these frameworks.

Emotional Processing Theory (EPT)

According to Emotional Processing Theory, PTSD arises from maladaptive beliefs and avoidance of distressing feelings. For instance, after a traumatic event, individuals might form inaccurate interpretations about what happened, believing the event was their fault or that it’s not safe to be around certain people or places. These distorted interpretations reinforce avoidant behaviours, maladaptive beliefs and hypervigilance across settings. It is thought that avoiding distressing feelings also hinders the integration of trauma experiences into a coherent narrative, leaving the trauma memories fragmented and unprocessed. This contributes to causing intrusive memories, flashbacks, and chronic fear responses. Therefore, EPT posits that PTSD develops when people develop unrealistic beliefs about the event(s) and avoid emotional distress.

EPT is the theoretical model underpinning many evidence-based trauma focused treatments.

Neuroscience

From a neuroscience perspective, PTSD develops when intense distress creates a trauma pathway in the brain, resulting in a chronic survival state. When a highly distressing event occurs, similar to general stress responses, the amygdala sends a distress signal to the hypothalamus, activating the hypothalamic-pituitary-adrenal axis and the sympathetic branch of the autonomic nervous system. This is the body’s adaptive alarm system that essentially aims to energise the body to fight and flee a predator. However, when escape is impossible, the body activates the freeze response, also known as tonic immobility. This survival state can manifest as not moving, speaking, collapsing or at the extreme, fainting. When the distress response is intense, it overwhelms the brain, leading to memories of the event being stored as unintegrated sensory fragments (e.g. sights, sounds, or smells). Due to suppression of the prefrontal cortex, the ability to manage difficult emotions and to think about and provide a coherent narrative of what happened is impaired. Therefore, dysregulated neurocircuitry and unconscious reactivity to reminders of the event, cause post traumatic stress symptoms.

German New Medicine (GNM)

A similar model that explains PTSD development is that of German New Medicine. According to GNM, repeated emotionally distressing events impact the left and right hemispheres of the brain, which in turn causes the brain rhythms of both sides to be out of synch or imbalanced; this results in an altered mental state and PTSD symptoms. Thus, traumatic shocks, which form trapped energy in the brain and body, inhibit the ability of both brain hemispheres to collaborate in a balanced way, causing symptoms such as re-experiencing, avoidance, persistent perceptions of threat and dissociation. These symptoms are not considered to be abnormal but rather adaptive survival mechanisms. These responses help individuals cope with unresolved emotional distress for which they have no strategy for dealing with.

Conclusion

All of these models offer valuable insight into how PTSD develops and share similarities. For instance, it is generally agreed that subjective experiences play a critical role in activating traumatic stress symptoms and associated emotional distress. EPT primarily focuses on the conscious meaning making process as causing PTSD, while neuroscience posits that intense distress alters the brains structure, causing unconscious reactivity. German New Medicine incorporates elements of both psychological and neurological models, however more specifically highlights that repeated trauma leads to hemispheric imbalances that cause PTSD. Together, these frameworks highlight the interplay of psychological, biological, and social factors in trauma development.

I hope you found this article useful. If you would like further information about PTSD development or for any other questions or queries then feel free to get in touch.

Sadaf