Trauma is any negative life event in which the brain perceives a real sense of danger, horror, and helplessness. PTSD occurs when people are directly exposed to, repeatedly exposed to, or witness horrific events, such as death, abuse, domestic violence, or war. During these events, the body’s stress response kicks into overdrive. Studies show that women are more likely to experience sexual abuse as children, whereas men are more likely to experience physical assault or witness death.

A person’s PTSD symptoms may prove indiscernible to others. When people are reliving their trauma, they sometimes stare off into space as if they are watching a movie. This is known as the “thousand-yard stare” and is typically the only observable symptom.

Prompted by the autonomic nervous system (ANS), the brain sends alert signals to prepare the body to ward off danger. This survival instinct reaction is called the hyperarousal acute stress response, or, as it’s more commonly called, the fight-flight-freeze response. This reduces overall brain functioning. PTSD is considered an anxiety-based disorder with symptoms that fall into in four categories: intrusive thoughts, like dreams and flashbacks; avoiding reminders of the trauma; negative thoughts and feelings of fear, anger, horror, shame and guilt; and “reactive” symptoms like irritability, self-destructive behaviors, physical outbursts, and difficulty sleeping. Not everyone with PTSD has all of these symptoms, and they tend to vary in form and intensity from person to person. Sometimes symptoms disappear completely and resurface years later when the traumatic event is triggered again by another stimulus. When the symptoms last for more than a month, they are chronic, and diagnosed as PTSD.

The adaptability of the hypothalamic-pituitary-adrenal (HPA) axis plays a key role in how our stress response engages when we’re exposed to a traumatic event. When the hypothalamus sends a message to the ANS, the bloodstream is flooded with several different stress hormones, such as cortisol. These hormones also release extremely high levels of natural opiates, which temporarily mask pain. A person may feel as if the event is occurring right now—their brains re-experience the traumatic event through surges of energy and intrusive thoughts. Severe anxiety can result as they experience a heightened sensitivity to potential dangers. Researchers found that people with PTSD continue to produce higher levels of stress hormones after the trauma is over, which may explain why emotional symptoms linger after the threat is gone.

Triggers are physical and emotional stimuli randomly associated with the traumatic experience. Sight, sound, smell, taste, and touch can act as triggers that cause a memory to light up the brain. Other examples of triggers include specific people, crowded places, songs, or emotions. When triggers are re-experienced, the brain sends signals to the body to prepare to defend itself against more trauma.

Because PTSD is repetitive and multilayered, triggers may cause false alarms. Some triggers are obvious to the person experiencing them and easy to understand. Others are buried in the subconscious, making it difficult to determine why the brain is overreacting. The triggered experience often causes depersonalization, which is when someone feels as if the memory is an out-of-body experience, or de-realization, when the experience feels unreal or distorted. When our warning signs are tripped, the ANS reengages our brain’s hypothalamus and the process starts over again.

People with PTSD tend to isolate themselves and can suffer from depression. In response, they avoid situations, events, and people that remind them of their trauma. Other mental illnesses can occur after experiencing a traumatic episode, such as substance abuse or panic attacks. Sufferers can be seen as “unable to cope.” Because of this, they may feel invalidated, ignored, and misunderstood.

PTSD is also known as the unseen or hidden wound. Those with PTSD say that they feel as if a pause button has been pushed on their life while the rest of the world moves on.

With social support, understanding, and empathy, people with PTSD can embrace their incredible personal strength, resiliency, and balance that they feel have been lost. Self-care, medication, mindfulness, and psychotherapy can help PTSD sufferers regain their self-esteem. Other exposure-based treatments, like cognitive behavioral therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR), group therapy, and psychotropic medication also help those experiencing PTSD.

PTSD can happen to anyone and is not a sign of weakness. With early detection, PTSD is significantly easier to treat. Know the warning signs of stress and PTSD before they feel out of control. To find out how to get help and support, click here.

In addition to being a prominent family and relationship psychotherapist and clinical director, the educator is also a published author who discusses military psychology, Behavioral Risk Threat Assessment, and wellness.

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