PTSD and Adult Health: Comorbidities, Brain Changes, and Physiological Impacts

This podcast episode delves into the extensive comorbidities between Post-Traumatic Stress Disorder (PTSD) and various adult health conditions, highlighting the broad impact of trauma beyond conventional understanding. It begins by noting the high lifetime prevalence of trauma (60% in men, 51% in women) and expands the definition of traumatic events to include not just war or violent crime, but also unexpected death, serious illness, car accidents, and even the COVID-19 pandemic. The discussion differentiates between single-incident PTSD and Complex PTSD (C-PTSD), which arises from repeated or multiple traumas and is associated with more extensive structural and functional brain abnormalities, such as the amygdala initially increasing in size then shrinking with chronic exposure.

The episode further explores the concept of intergenerational and cultural Post-Traumatic Stress (PTS), where the effects of unresolved trauma are passed down or collectively experienced within a society, exacerbated by constant media exposure. It details the strong correlation between PTSD and mood disorders like anxiety and depression, and introduces two distinct subtypes of PTSD: one characterized by emotional over-modulation and distancing (D-PTSD), and another by re-experiencing symptoms, hyperarousal, and emotional dysregulation, often resembling borderline personality disorder symptoms. The host emphasizes focusing on symptoms and their function rather than stigmatizing diagnoses, noting that many BPD-like symptoms in early addiction recovery can remit with time and empowerment.

Key personality characteristics are linked to PTSD, with symptoms positively correlating with negative emotionality, neuroticism, harm avoidance, hostility, anger, and anxiety, while negatively correlating with extroversion, conscientiousness, positive emotionality, hardiness, and optimism. Hardiness, a concept proposed by Kobasa, is broken down into commitment, control, and challenge, offering a framework for resilience that can be enhanced through cognitive-behavioral approaches. The podcast also highlights the critical role of sleep dysfunction, with 70-91% of PTSD sufferers reporting disturbances like insomnia, nightmares, and obstructive sleep apnea, which in turn exacerbate other health issues and can even precede and predict PTSD development.

Finally, the episode extensively covers the physiological mechanisms linking PTSD to autoimmune disorders, cardiovascular disease, and addiction. It explains how PTSD dysregulates the autonomic nervous system, HPA axis, and causes oxidative stress and inflammation. A significant portion is dedicated to the paradox of trauma processing in addiction recovery, illustrating how trauma mimics addictive drugs by increasing dopamine release in the nucleus accumbens, leading to similar tolerance and sensitization. The discussion underscores the importance of concurrent treatment for addiction and trauma, while cautioning about the careful timing and planning required to prevent relapse, and touches upon neuroimmune mechanisms involving the CB2 receptor and the impact of opioid pre-treatment on fear learning.

"the lifetime prevalence of trauma is 60% in men and 51% in women which we generally expect it to be flip-flopped but that's not what the data says."

"structural abnormalities in the brain seem to be more extensive than in ptsd in which there was a single trauma and brain activity in complex ptsd is also strikingly different."

"the amygdala when it's initially exposed to trauma increases in size but over over a lifetime over a time span if exposure to traumatic experiences stressful experiences continues then the amygdala actually starts to shrink."

"intergenerational pts and intergenerational aces are really a thing so it is important that we advocate for caregivers to make sure that if they're experiencing symptoms that they have a way to address them."

"media and social media unfortunately keeps that wound right in your face."

"dptsd people tend to over modulate their emotions and and they tend to distance from their emotions as opposed to patients who primarily suffer from re-experiencing symptoms."

"hardiness was proposed by Kobasa in '78 I believe and it's composed of three characteristics: commitment, control and challenge."

"insomnia may precede the trauma and predict the development of ptsd so people who had insomnia prior to the trauma are at greater risk of traumatic injury of developing ptsd."

"trauma affects the dopaminergic pathways in ways that largely mimic the effect of addictive drugs causing increased dopamine release in the nucleus accumbens."

"opioid pre-treatment robustly augments associative fear learning in the amygdala although these changes were not observed when opioids were given after the trauma."