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Adam Tyson Cognitive Psychology (01) 5/27/2012

The Cognitive Relation Regarding Posttraumatic Stress Disorder

Posttraumatic stress disorder is an unfortunate consequence to experiencing a severe disturbing event that affects a person’s emotional and mental stability. This disorder is classified in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) as an anxiety disorder that is developed after experiencing an interpersonal traumatic event that engages threat of injury or death. These circumstances are usually involved with events such as physical or sexual assault, active engagement in war, situations of terrorism, and natural disasters. Everyday life brings about a variety of experiences that trigger certain human emotions. These emotions can range from a feeling of happiness, sadness, anger, and fear. A specific human emotion felt by all people in a variety of situations is anxiety. It is not uncommon for situations including a student right before a test, a person struggling with a problem at work, or someone making an import decision to feel anxious, nervous, or overwhelmed. It is when anxiety begins to take over one’s life and control of their mental well-being and dramatically affect their over all mood when it becomes a psychological problem. Anxiety disorders are one of the most commonly diagnosed psychological disorders (Ruscio, Chiu, Roy-Byrne, Stang, Stein, Wittchen & Kessler, 2006). There are many kinds of anxiety disorders that consist of panic disorders, obsessive-compulsive disorder, a variety of phobias, and generalized anxiety disorder. Posttraumatic stress disorder is one of the most discussed of these disorders due to its high frequency of occurrence and unique symptoms. “Such events often include either experiencing or witnessing a severe accident or physical injury, receiving a life-threatening medical diagnosis, being the victim of kidnapping or torture, exposure to war combat or to a natural disaster, exposure to other disaster (for example, plane crash) or terrorist attack, being the victim of rape, mugging, robbery, or assault, enduring physical, sexual, emotional, or other forms of abuse, as well as involvement in civil conflict.” (Yehuda, 2002)

Risk Factor Certain factors increase the likelihood of developing posttraumatic stress disorder after the incident. The first of these is the severity and duration of the event (Lilly & Valdez, 2012). For example, a veteran who spent months over seas experiencing the horrific life threatening events of war will have a greater chance of developing PTSD than someone who was in a single car accident. Another factor that increases the chance of developing PTSD is having a weak social support (Jakupcak, Vannoy, Imel, 2010). This system would be primarily composed of family members and friends. People of poverty stricken areas who have been diagnosed with the disorder have been linked to this cause from lack of a strong support system (Chen, Keith, 2007).

Symptoms of Posttraumatic Stress Disorder Posttraumatic stress disorder has a range of effects. These effects include physical, psychological, and social factors that negatively affect the patient’s daily life and activities. One of the most common symptoms seen in patients suffering from PTSD is the act of “reliving” the traumatic event (Yehuda, 2002). For example, a war veteran who personally experienced intense and violent warfare will have repeated flashback episodes of being back in battle. This veteran will suffer from all the intense and negative emotions that come with combat while sitting safely in their own home. Patients will also suffer from upsetting nightmares and have strong, damaging reactions to common situations that remind them of their traumatic event. Another common symptom of people suffering from PTSD is the act of avoidance. Under this symptom, patients feel detached from social situations and have a feeling as though not to care about anything. This is commonly referred to as emotional “numbing”. Due to patients having negative reactions to situations that remind them of the traumatic event, they will avoid people, places, and thoughts that remind them of such event (Yehuda, 2002).

Impairments in Brain Functioning Posttraumatic stress disorder has an affect of certain portions and structures of the brain. Three of the most impacted of these structures are the prefrontal cortex, the amygdala, and the hippocampus. The prefrontal cortex is the portion of the brain that is associated with the act of planning and formulating strategies (Yehuda, 2002). Patients suffering from PTSD have a reduced responsiveness within this structure. The next structure that is impacted is the amygdala, which is a temporal lobe involved in the assessment of stimuli related to threatening situations and plays a vital role in the development of fear conditioning. The amygdala and prefrontal cortex work together in a negative feedback relationship. When a patient is suffering from PTSD this feedback situation is negatively impacted and unbalanced. This causes the amygdala to be hyper-responsive, which leads to ambiguous stimuli to more frequently be seen as threatening (Yehuda, 2002). When more stimuli are observed as threatening there is a high increase in the patients stress levels, which only sparks more ambiguous stimuli to be viewed as threatening. It becomes a violent spiral in which the patient always loses. The last brain structure that is affected by PTSD is the hippocampus. This structure is also part of the medial temporal lobe and is involved in memory and the processes surrounding it. Increased levels of arousal as a result of stressors and high level of stress hormones lower hippocampal functioning. This leads to lower levels of long-term potentiation, which decreases the amount of strengthening of nerve cells and their synapses. All of this leads to memory impairment and decreased cognitive functioning (Yehuda, 2002).

Attention and Inhibition Impairment Associated with PTSD Emotional impairment due to improper functioning of the prefrontal cortex and amygdala and memory impairment from improper hippocampus functioning aren’t the only two cognitive features affected by the disorder. Attention and inhibition are also affected by posttraumatic stress disorder. Soldiers recently returning from overseas that are diagnosed with PTSD do not immediately show signs of this decrease in attention. It is not until one year or more that these symptoms start to appear. This is due to the build up of negative experiences associated with PTSD over a prolonged period of time; these experiences include frequent flashbacks and nightmares of the horrific event. As time goes by these stressors on the neurological system cause neurobiological alterations, affecting the noradrenergetic and neuroendocrine systems. As a result, there is a damaging effect on attention and learning (Yehuda, 2002). The negative affects that PTSD has on cognitive functions can have a serious impact on an individual’s daily life and normal functioning. These impacts initially depend on age range. Soldiers, who have recently returned from the Iraq or Afghanistan war, will feel affects such as brief gaps in short term memory and mild disabilities in attention tasks. Veterans from wars included Vietnam or people who have suffered from PTSD symptoms for an extended period of time will feel more extreme effects. These include extreme memory loss from specific anxiety ridden situations, significant emotional changes towards loved ones and close friends, and attention difficulties in various tasks. Posttraumatic stress disorder will continue to be one of the most discussed and feared of the range of anxiety disorders. The effects of posttraumatic stress disorder can have an assortment of negative impacts on cognitive functions of the patients. These effects vary from emotion, memory, and attention difficulties as a result of the malfunctioning of portions and structures in the brain, as well as the general suffering from the disorder. Anxiety disorders will not simply disappear one day, their effects will continues to expand and cause negative impacts on peoples lives all over the world.

Refrences:

Chen, A. C., Keith, V. M., Leong, K. J., Airriess, C. C., Li, W. W., Chung, K. Y., & Lee, C. C. (2007). Hurricane Katrina: Prior trauma, poverty and health among Vietnamese-American survivors. International Nursing Review, 54(4), 324-331. doi:10.1111/j.1466-7657.2007.00597.x

Lilly, M. M., & Valdez, C. E. (2012). Interpersonal trauma and PTSD: The roles of gender and a lifespan perspective in predicting risk. Psychological Trauma: Theory, Research, Practice, And Policy, 4(1), 140-144. doi:10.1037/a0022947

Jakupcak, M., Vannoy, S., Imel, Z., Cook, J. W., Fontana, A., Rosenheck, R., & McFall, M. (2010). Does PTSD moderate the relationship between social support and suicide risk in Iraq and Afghanistan War Veterans seeking mental health treatment?. Depression And Anxiety, 27(11), 1001-1005. doi:10.1002/da.20722

Yehuda, R. (2002). Post-traumatic stress disorder. The New England Journal of Medicine, 346(2),

Ruscio, A., Chiu, W., Roy-Byrne, P., Stang, P., Stein, D., Wittchen, H., & Kessler, R. (2006). Broadening the definition of generalized anxiety disorders: Effects on prevalence and association with other disorders in the national comorbidity survey replication. PubMed Central, 21(5), 662-676. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2475335/