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Implications for PTSD Related Disorders.
When there is trauma in the presence of helplessness there is a freeze response that is the equivalence of dissociation
(detachment, numbness, confusion). It is a suppression of instinctual behavior resulting in the imprinting of the traumatic
experience in unconscious memory and arousal systems of the brain. Until that act of flight or self-defense has been completed,
the survival brain (limbic system) may continue to perceive that the threat continues to exist and is unable to relegate it
to memory as a past experience. Instead of becoming explicit memory it becomes implicit memory. Plasticity of selected
brain centers implies that sensory input specific to those centers changes their anatomical structure and can induce neurochemical
change. The term kindling was developed from the description of spontaneous combustion of materials reaching a certain critical
temperature. Kindling causes a permanent change in the excitability to neuronal networks within the kindled part of their
brain. The brain region most susceptible to kindling is the amygdala.
Threat-related information generated both by internal memory and external experiential cues would routinely activate the
amygdala that in turn would interpret resulting emotion-based memories as threatening, resulting in the triggering of arousal
once again. In individuals with significant prior unresolved traumatic stress experiences, modulation of the organized response
to threat could be diminished, leading to impaired regulation of arousal/memory mechanisms.
Chronic and prolonged exposure to unremitting life stress, generated by kindling and external stress is associated with
a cluster of vascular, hormonal, immunological, neuronal and degenerative diseases mainly attributable to exposure to abnormal
amounts of Epinephrine/ Norepinethrine. Many studies document the association between childhood physical and sexual abuse
and chronic pain. It is common for survivors of childhood abuse to suffer from Fibromylagia and Chronic Fatigue Syndrome.
Both of these are characterized by symptoms of soft tissue pain, poor and nonrestorative sleep, chronic fatigue, stiffness,
headaches, anxiety and cognitive dysfunction.
Trauma reenactment unfortunately creates a scenario of trauma as a self-fulfilling prophecy. Every time the Vietnam veteran
experiences the epinephrine/endorphin arousal/reward response of the combat-related stimulus, that response is reinforced.
Every time the abused spouse completes the abuse/reconciliation cycle, it ensures that this cycle will inevitably be repeated
between the couple. The brain/biochemistry link in this behavior is analogous to the brain biochemistry of narcotic addiction
that substitutes synthetic morphine derivatives for the natural endorphins in the brain. Reenactment therefore constitutes
a powerful system of reward and reinforcement and one that basically is conditioning and self-perpetuating. Thus, the release
of epinephrine and endorphins in the face of threat to survival may be associated not only with feelings of anxiety and fear,
but also with excitement and exhilaration. This disparity could be explained by the relative balance of epinephrine and endorphin
release with the specific experience.
Intrinsic autonomic instability and other neurochemical and neurophysiological changes intrinsic to dissociation and PTSD
often are associated with pharmacological intolerance. Headache and myofascial pain is often intractable, and may respond
only to narcotics, which present a problem because narcotics, with their enhancement of endorphinergic tone, may potentiate
dissociation.
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