This is the fourth part in the series on PTSD. The first three articles dealt with the physical and chemical parts of the Limbic System. The safety mechanisms built into this system get hijacked in PTSD, causing a mental disorder that is becoming more common as more of our men and women return from war.
The causes of PTSD range from traumatic childhoods and spousal abuse to wartime combat and crime survival. The effects can be devastating and debilitating to careers, relationships, and life. The nurse needs to have a full understanding of the complex mechanisms that cause the symptoms and the therapies used to treat and help these patients recover their lives.
The symptoms vary, but there are almost always “triggers” that contribute to their manifestation. Common symptoms include insomnia, intrusive thoughts, hyperarousal, nightmares, night sweats, irritability, substance abuse, and avoidance. The brain is attempting to organize and process the traumatic event, and the memories are kept “alive” by the limbic system until this is done. The brain, through the senses, re-experiences the memory of the event. Small fragments of a memory brought on by sensory input cause the memory to resurface, sometimes so real that the patient can not tell the difference between reality and memory. This is terrifying and causes more confusion to the limbic system.
One therapy is to assist the brain to let go of those memories by helping it to process and store the memory properly. Journaling or talking with a professional can help the brain to accomplish this by giving the patient a safe way to work through the memory without experiencing judgment or danger. It is important to recognize that every time the memory is discussed, the patient is vulnerable. Another therapeutic help is to teach the patient to reality test. The patient learns to identify triggers by being self aware. Once the triggers are noted, instead of avoidance, there should be an active dialogue to ferret out the true danger. For example, if the patient has a trigger of the sound of a tractor trailer while driving, the patient should identify what he/she fears the sounds means, then ask themselves if this is a true danger. If there is no danger present, the patient needs to self talk the dialogue that they are safe. This helps the brain relearn those emotions into new, less threatening memories. This takes time, so it is important of them to know it is a process and that they have support throughout.
One of the most common side effects of PTSD is insomnia. We heal our bodies and fully relax our muscles during sleep. It is vital to our ability to function and have a sense of well being. One of the most common dangers of insomnia is substance abuse. Many people will drink alcohol before bed to help them sleep and avoid the emotions that crop up during sleep. It is better to try and get regular exercise, sunlight, and avoid caffeine. Sleep medications can be helpful if they are not abused.
Depression and anxiety are the two other serious problems with PTSD. Medications can do much to help the PTSD patient be stable enough to do the work of getting well. It should be noted that habit forming medications should be avoided. Benzodiazapines are particularly tricky for these patients. It is important to use medications as a stepping stone to wellness. Anything that alleviates the anxiety without the work is not helpful. The anxiety is a symptom of a larger issue and should be healed, not just drugged. This requires active participation by the patient, the family, and the healthcare team for as long as the patient requires it.
These patients have had their limbic system distressed, and in some cases, physically rewired. Understanding, patience, compassion, and trustworthiness are crucial to their survival and healing.