PTSD Affects the Body as Well as the Mind
Dawson Church, National Institute for Integrative Healthcare
Our understanding of human development has been enriched over the past four decades by an “awful gift” in the form or research into posttraumatic stress disorder (PTSD). I have been the primary investigator in many studies of PTSD published in peer-reviewed journals, and I recently completed a scientific review entitled “Psychological Trauma: Healing Its Roots in Brain, Body, and Memory” (Church, 2015).
I’ve been struck by how comprehensively PTSD affects the body as well as the mind. I’d like to share five of the physical signs of PTSD with you, because you may recognize them in yourself, your loved ones, or your friends.
After each of the major conflicts of the past 200 years, there has been a wave of awareness about PTSD. Perhaps the first identifiable wave in the United States occurred after the Civil War ended in 1864. War had clearly changed many combatants and, for the first time, society gave their malady a name. It was called “soldier’s heart” or what we would today call PTSD.
Yet as the memory of each conflict faded in public awareness, the wave passed, and the experiences of traumatized people faded into the background of our collective consciousness.
Another wave occurred after WWI. Psychoanalyst Abram Kardiner (1941) wrote a report about the symptoms of soldiers called The Traumatic Neuroses of War. He observed that even people who had been highly functional before combat were now dissociated from their bodies and their emotions. They were also hyper vigilant, constantly scanning their surroundings for imagined threats.
He recognized that soldier’s heart, now renamed “shell shock,” was rooted in the body and not just the mind. He described it as a “physioneurosis.” By using the word “physio” in his description, he pointed to the physical basis of PTSD.
Yet the army, and society, didn’t want to deal with PTSD after the need for soldiers was over, and the wave of sympathy and attention subsided once more. The U.S. Congress had promised bonuses to WWI veterans to compensate them for wages lost while in military service. Congress and the president clashed repeatedly on how and when to pay them.
In 1932, at the depths of the Great Depression, about 20,000 destitute veterans and their family members converged on Washington DC in an effort to pressure the government into paying their long-delayed bonuses. They set up a shantytown and became increasingly insistent in their demands.
A force that included tanks and machine guns eventually dispersed them. General Douglas MacArthur led the operation, with Major Dwight Eisenhower and Major George Patton playing supporting roles. After the drama, awareness of and interest in the plight of veterans waned again. Kardiner’s book remained unpublished till after WWII had begun and a fresh wave of veterans began returning from the front.
The wave subsided after WWII and Korea. By the time of the Vietnam War, the lessons learned in the earlier wars about the profound damage done to body and psyche by combat had been forgotten. Returning veterans faced a lack of social and medical recognition. Some were spat on or assaulted by anti-war protesters.
Yet their problems could not be ignored. These included alcoholism and other addictions, domestic violence, joblessness, and mental disorders. By the mid 1980s, around half the inmates in federal prisons were Vietnam veterans. This led to a new wave of research, and a new name for their affliction: PTSD.
There are now thousands of studies of PTSD and of treatments for the condition, and they paint a disturbing yet hopeful picture. They show the profound disruption in brain and body function produced by trauma. Yet they also give us insights into normal human development by illustrating what happens when that development is interrupted by shattering events. Recent studies even show that most cases of PTSD can be cured by EMDR (Eye Movement Reprocessing and Desensitization), EFT (Emotional Freedom Techniques), and other therapies that include physical stimulation.
Among the physical characteristics of PTSD are hormonal disruption, brain remodeling, physical coordination problems, insomnia, and disease.
Hormonal Disruption. A 20-year longitudinal study of women who were sexually molested as children showed profound physical and mental changes (Trickett, Noll, & Putnam, 2011). Their hormonal cycles were disrupted and they entered puberty an average of 18 months earlier. Androstenedione and testosterone, hormones that stimulate libido, were three to five times higher than normal. When stressed, they produced less of the primary stress hormone cortisol, as their bodies had learned to adapt to ongoing stress. They had high levels of obesity, major illness, depression, dissociation, and self-mutilation.
Another study followed children for 30 years, all the way into adulthood (Sroufe, Egeland, Carlson, & Collins, 2010). The investigators found that by late adolescence, half of them had been diagnosed with mental health disorders such as anxiety, depression, and PTSD. They were unable to form healthy emotional bonds with teachers, peers, and caregivers.
Brain Remodeling. Our brains are constantly building new neural pathways, a process known as “neurogenesis.” When we’re learning to play the oboe, improve our golf swing, court a new lover, or learn French, this works to our advantage. We build new neural capacity as we practice, and we quickly improve our abilities.
Yet there’s a dark side to neurogenesis. When we’re chronically stressed, we increase the signaling capabilities of the neural circuits that carry those signals, at the expense of healthy brain function. In people suffering from PTSD, the parts of the brain responsible for activating the stress response become more efficient, while brain structures that handle memory, learning, and cognitive processing actually shrink (Vasterling & Brewin, 2005).
The eyes are extensions of the brain. During WWII, a British ophthalmologist named Harry Moss Traquair observed abnormalities in the eye movements of traumatized veterans (Traquair, 1944). Again, his work was forgotten after the war until the 1990s when new studies of EMDR demonstrated the link between eye movements and PTSD. Research shows that EMDR cures most cases of PTSD in 4-10 treatment sessions (Bisson, Roberts, Andrew, Cooper, & Lewis, 2013).
Physical Coordination Problems. Clinicians working with veterans with PTSD have been struck by their lack of physical coordination. Bessel van der Kolk, a psychiatrist formerly in charge of the physical exercise program at a Harvard hospital, found that veterans who moved with graceful assurance before combat had trouble coordinating the movement of their limbs afterward (van der Kolk, 2014). Electroencephalograph (EEG) analysis shows that the brains of veterans have difficulty coordinating information from multiple sensory channels into a coherent unified picture (Church, 2015).
Insomnia. People with PTSD have high levels of insomnia. During a randomized controlled trial of 59 veterans that I conducted with colleagues, their insomnia scores were 19 on a scale on which 15 indicates clinical levels. That’s typical, and nightmares often interrupt their sleep. After six treatment sessions using EFT, however, PTSD symptoms had normalized in 80% and their insomnia scores had dropped to 11 (Church, Hawk, et al., 2013).
Disease. Veterans need the services of doctors and hospitals much more often than average, and have high rates of cancer, heart disease, and other major illnesses.
Although we usually think of PTSD as a mental health condition, like anxiety and depression, it is actually rooted in the physical body as well as the mind. It compromises sleep, digestion, and immunity. It promotes inflammation and many different types of physical disease. Besides its immense cost in suffering, it costs a great deal of money, with the national bill for treating PTSD estimated to top a trillion dollars (Church, 2014).
Though the wave of interest in PTSD has declined after all of the previous major conflicts, I see signs that it will not abate this time around. As a society, we’re increasingly aware that many traumatized people who have never seen combat live among us. An estimated one girl in five, and one boy in 10, is sexually abused (Gorey & Leslie, 1997). Sixty percent of older children witness or experience victimization each year, half have experienced physical assault, and 25% have seen community or domestic violence (U.S. Department of Health and Human Services, 2012). Even in the absence of war, the homes in which many children grow up are a battleground.
In response to the urgent need to address this vast social problem, several successful non-drug treatments for PTSD are now available. There are many studies showing that EMDR, EFT, and other body-based therapies can rehabilitate sufferers. Neither requires a long or arduous course of treatment; both EMDR and EFT are effective in as few as four hour-long sessions (Karatzias et al., 2011).
While PTSD is an international tragedy, the “awful gift” of this new research shows that it is not an incurable condition. The physical disease, inflammation, brain rewiring, and hormonal disruption caused by PTSD can be avoided by appropriate mental health intervention. As we as a society increasingly implement these evidence-based cures, we can ensure that the current wave of concern about PTSD leads to radical and permanent changes in treatment.
- Bisson, J. I., Roberts, N. P., Andrew, M., Cooper, R., & Lewis, C. (2013). Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults (Review). Cochrane Database of Systematic Reviews, 12, CD003388.
- Church, D. (2014). Pain, depression, and anxiety after PTSD symptom remediation in veterans. Explore: The Journal of Science and Healing, 10(3), 162-169.
- Church, D. (2015). Psychological Trauma: Healing Its Roots in Brain, Body, and Memory. Santa Rosa, CA: Energy Psychology Press.
- Church, D., Hawk, C., Brooks, A., Toukolehto, O., Wren, M., Dinter, I., & Stein, P. (2013). Psychological trauma symptom improvement in veterans using EFT (Emotional Freedom Techniques): A randomized controlled trial. Journal of Nervous and Mental Disease, 201, 153-160.
- Gorey & Leslie, (1997). The prevalence of child sexual abuse: Integrative review adjustment for potential response and measurement biases. Child Abuse and Neglect, 21(4), 391-398.
- Karatzias, T., Power, K., Brown, K., McGoldrick, T., Begum, M., Young, J., Adams, S. (2011). A controlled comparison of the effectiveness and efficiency of two psychological therapies for posttraumatic stress disorder: Eye Movement Desensitization and Reprocessing vs. Emotional Freedom Techniques. Journal of Nervous and Mental Disease, 199(6), 372-378.
- Kardiner, A. (1941). The Traumatic Neuroses of War. New York, NY: P. B. Hoeber. Sroufe, L. A., Egeland, B., Carlson, E. A., & Collins, W. A. (2010). The Development of the Person: The Minnesota Study of Risk and Adaptation from Birth to Adulthood. New York, NY: Guilford.
- Traquair, H. M. (1944). An Introduction to Clinical Perimetry (4th ed.). St. Louis, MO: C. V. Mosby.
- Trickett, P. K., Noll, J. G., & Putnam, F. W. (2011). The impact of sexual abuse on female development: Lessons from a multigenerational, longitudinal research study. Development and Psychopathology, 23(02), 453-476.
- U.S. Department of Health and Human Services. (2012). Child Maltreatment 2011. Washington, DC: Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. Retrieved from http:// www.acf.hhs.gov
- Van der Kolk, B. A. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York, NY: Viking.
- Vasterling, J. J., & Brewin, C. R. (Eds.). (2005). Neuropsychology of PTSD: Biological, Cognitive, and Clinical Perspectives. New York, NY: Guilford Press.