A Trauma is not an Event

This is the most important information you need to integrate if you want to understand clearly what is a trauma. Let's repeat it : a trauma is not en event. A trauma is the consequence of an (many) event(s) on our whole nervous system. It is the process, inside our nervous system, that don't stop, since the event.

Take a look at the Trauma Timeline picture just below, to make it more concrete. You can see that after an event, we sometimes have to adapt to integrate it into our system. EMDR therapy founder Francine Shapiro postulated that a system exists to digest those informations : the Adaptative Information Processing, or AIP. And for her, sometimes it fails, creating a Trauma inside the individual system.

Either we process it, we integrate this bad experience(s) as a part of our past life, and we can fulfill our life.

Either we don't, and we stay in this traumatised states, sometimes for decades. This is when we need some help in integrative psychotherapies, to process all those informations from the past, that feel like present.

Whatever the pathway we are in, the events are over. They are in the past. They can't come back, even we feel like it. And most important : we survived. We are still here to witness the Present. This is over. We can go back to life, and leave survival.

4MajorsFactors impacting PTSD's consequences

What Is Trauma ?

TraumaTimeline to understand PTSD & CPTSD

A Family Of Traumas

In the Family of Traumas, the most famous are PTSD, Complex PTSD, and PTSD with dissociative subtype. They are related, but distinct diagnoses, describing different forms of Traumatised States.

Here are some of the differences between these conditions:

1. PTSD: PTSD is characterized by the re-experiencing of a traumatic event through intrusive memories, nightmares, or flashbacks, avoidance of trauma-related cues, negative changes in mood and cognition, and hyperarousal. PTSD typically arises from a single traumatic event.

2. Complex PTSD (C-PTSD): C-PTSD is a subtype of PTSD that arises from prolonged exposure to trauma, such as childhood abuse, neglect, or captivity and torture. In addition to the symptoms of PTSD, C-PTSD includes symptoms of emotional dysregulation, interpersonal difficulties, and negative self-concept.

3. PTSD with dissociative subtype : This subtype of PTSD is characterized by the additional presence of dissociative symptoms, such as depersonalization, derealization, or dissociative amnesia. These symptoms involve a sense of detachment from oneself or one's surroundings, and can interfere with daily functioning.

Overall, the differences between these diagnoses lies in the type of trauma exposure, the severity and chronicity of symptoms, and the presence of dissociative symptoms.

What Is Trauma ?

4Major Factors impacting PTSD's consequences

The Whole Nervous System is Impacted

PTSD is now known to affect not only the brain but also the entire nervous system. The experience of trauma can trigger a range of physiological responses, including changes in the autonomic nervous system, the hypothalamic-pituitary-adrenal (HPA) axis, the immune system, our ability to move and balance.

These changes can have wide-ranging effects on the body and can contribute to a large range of physical health problems.

One of the primary ways that PTSD affects the nervous system is through dysregulation of the autonomic nervous system. The autonomic nervous system is responsible for regulating bodily functions such as heart rate, blood pressure, and breathing. In individuals with PTSD, the autonomic nervous system can become dysregulated, leading to a range of physical symptoms such as palpitations, sweating, and gastrointestinal distress.

PTSD can also affect the HPA axis, which is responsible for regulating the body's stress response. In individuals with PTSD, the HPA axis can become dysregulated, leading to chronic activation of the stress response and increased levels of stress hormones such as cortisol. This chronic stress response can contribute to a range of physical health problems, including cardiovascular disease, metabolic disorders, and immune dysfunction.

In addition to these effects on the autonomic nervous system and HPA axis, PTSD can also have an impact on the immune system. Individuals with PTSD may experience alterations in immune function, including increased inflammation and decreased immune response to pathogens. These changes in immune function can contribute to a range of physical health problems, including chronic pain, autoimmune disorders, and increased susceptibility to infectious diseases.

Impact on the movement is critical too (cf Masgutova).

NSInCorporer, impacted baby PTSD & CPTSD

How The Brain is Impacted

Research has shown that PTSD have a significant impact on the brain, affecting its structure, function, and connectivity. Here are some of the main findings:

1.Hippocampus: The hippocampus, a brain region involved in memory and emotion regulation, is often smaller in individuals with PTSD. This shrinkage has been linked to the severity and chronicity of PTSD symptoms.

2. Amygdala: The amygdala, a brain region involved in fear processing, is often hyperactive in individuals with PTSD. This hyperactivity may contribute to the exaggerated fear responses and hypervigilance seen in PTSD.

3. Prefrontal cortex: The prefrontal cortex, a brain region involved in emotion regulation and cognitive control, may be less active in individuals with PTSD. This may contribute to the difficulty in regulating emotions and controlling intrusive thoughts seen in PTSD.

4. Default mode network: The default mode network, a set of brain regions involved in self-referential thinking, is often disrupted in individuals with PTSD. This disruption may contribute to the feelings of detachment and depersonalization seen in PTSD.

5. Connectivity: alterations in the connectivity between brain regions in individuals with PTSD have been observed, leading to difficulties in information processing and integration.

Hippocampus: Bremner, J. D. (2006). The relationship between cognitive and brain changes in posttraumatic stress disorder. Annals of the New York Academy of Sciences, 1071(1), 80-86.
Amygdala: Shin, L. M., & Liberzon, I. (2010). The neurocircuitry of fear, stress, and anxiety disorders. Neuropsychopharmacology, 35(1), 169-191.
Prefrontal cortex: Lanius, R. A., Bluhm, R. L., Coupland, N. J., Hegadoren, K. M., Rowe, B., Théberge, J., ... & Brimson, M. (2010). Default mode network connectivity as a predictor of post‐traumatic stress disorder symptom severity in acutely traumatized subjects. Acta Psychiatrica Scandinavica, 121(1), 33-40.
Default mode network: Bluhm, R. L., Williamson, P. C., Osuch, E. A., Frewen, P. A., Stevens, T. K., Boksman, K., & Lanius, R. A. (2009). Alterations in default network connectivity in posttraumatic stress disorder related to early-life trauma. Journal of Psychiatry and Neuroscience, 34(3), 187.
Connectivity: Patel, R., Spreng, R. N., Shin, L. M., & Girard, T. A. (2012). Neurocircuitry models of posttraumatic stress disorder and beyond: A meta-analysis of functional neuroimaging studies. Neuroscience & Biobehavioral Reviews, 36(9), 2130-2142.

PTSD & Comorbidity

Because PTSD and all other forms of traumas impact so much our nervous systems, it makes a lot of sense that it impacts many aspects of our lives, and creates many forms of adaptations, expressed in many types of symptoms.

In medicine, comorbidity refers to the simultaneous presence of two or more medical conditions in a patient ; often co-occurring (that is, concomitant or concurrent) with a primary condition.

In psychiatry, psychology, and mental health counseling, comorbidity refers to the presence of more than one diagnosis occurring in an individual at the same time.

That doesn't necessarily mean that they are caused by the primary condition. But it appears that, in PTSD, when you treat them, many of the comorbids symptoms decrease and/or disappear.

Here are several recent meta-analyses that examine the comorbidity of PTSD with other mental health issues :

"Comorbidity between PTSD and major depressive disorder (MDD): A systematic review and meta-analysis" by de Araujo et al. (2022). This meta-analysis found that individuals with PTSD are at increased risk of also having major depressive disorder (MDD), and that the comorbidity between these two disorders is bidirectional.
"Comorbidity of PTSD and depression: Associations with trauma exposure, symptom severity, and functional impairment in a nationally representative sample" by Kessler et al. (2021). This meta-analysis found that PTSD and depression are highly comorbid, and that the severity of trauma exposure is associated with increased risk for both disorders.
"Comorbidity between PTSD and alcohol use disorder (AUD): A meta-analysis" by Pietrzak et al. (2021). This meta-analysis found that PTSD is strongly associated with an increased risk of developing alcohol use disorder, and that the two disorders interact in complex ways.
"Comorbidity of PTSD and substance use disorder: A meta-analytic review" by Brady et al. (2016). This meta-analysis found that individuals with PTSD are at increased risk for developing substance use disorder, and that the comorbidity between these disorders is associated with greater functional impairment and worse treatment outcomes.
"Comorbidity of PTSD and eating disorders: A meta-analysis" by Mitchison et al. (2021). This meta-analysis found that PTSD is associated with an increased risk of developing eating disorders, particularly bulimia nervosa, and that the comorbidity between these disorders is associated with greater functional impairment and poorer treatment outcomes.
"Comorbidity of PTSD with anxiety : A meta-analytic review" by Karatzias et al. (2019). This meta-analysis found that PTSD is highly comorbid with both anxiety and depressive disorders, and that the comorbidity between these disorders is associated with more severe symptoms and worse treatment outcomes.
"Comorbidity of posttraumatic stress disorder and borderline personality disorder: A meta-analytic review" by Bornovalova et al. (2013). This meta-analysis found a high degree of comorbidity between PTSD and borderline personality disorder (BPD), with individuals who have both disorders experiencing greater functional impairment and poorer treatment outcomes.
"Comorbidity between posttraumatic stress disorder and obsessive-compulsive disorder: A systematic review and meta-analysis" by Hou et al. (2019). This meta-analysis found that individuals with PTSD are at increased risk of also having obsessive-compulsive disorder (OCD), and that the two disorders are associated with greater symptom severity and functional impairment.
"Comorbidity of PTSD and dissociative disorders: A meta-analytic review" by Wolf et al. (2018). This meta-analysis found that PTSD is highly comorbid with dissociative disorders, and that the presence of dissociative symptoms is associated with greater functional impairment and worse treatment outcomes.

PTSD can have a significant impact on relationships, both romantic and non-romantic. Here are a few recent articles on the topic:

"Posttraumatic stress disorder and relationship functioning: A comprehensive review and meta-analysis" by Monson et al. (2021). This meta-analysis found that individuals with PTSD experience more relationship problems, such as conflict, communication difficulties, and lower relationship satisfaction. They also found that PTSD symptoms predict poorer relationship outcomes over time.
"Posttraumatic stress disorder and relationship functioning: The influence of partner support" by Overall et al. (2019). This study found that partner support can play a protective role in mitigating the negative impact of PTSD symptoms on relationship functioning. The study highlights the importance of addressing relationship issues in PTSD treatment.
"Partner communication moderates the relation between PTSD symptoms and partner mental health" by Williamson et al. (2020). This study found that the quality of communication between partners can moderate the impact of PTSD symptoms on the mental health of the non-PTSD partner. Effective communication can help to reduce the negative impact of PTSD symptoms on the relationship.

PTSD & Financial Impact

According to the healthcare systems of the countries, PTSD can be highly ignored, and impact their populations in several levels. Post-traumatic stress disorder (PTSD) have significant financial consequences globally, both for individuals and society as a whole.

For individuals, PTSD can result in increased healthcare costs, lost productivity at work, and reduced earning potential. People with PTSD may require expensive and ongoing mental health treatment, including therapy and medication. Additionally, individuals with PTSD may have difficulties maintaining employment, which can result in reduced income and job insecurity.

In terms of the broader societal impact, PTSD lead to increased healthcare costs and decreased economic productivity. According to a report by the World Health Organization (WHO), mental health conditions, including PTSD, cost the global economy more than $1 trillion annually in lost productivity. The report also estimates that mental health conditions will cost the global economy $16 trillion by 2030, highlighting the significant economic impact of mental health conditions.

Furthermore, PTSD can also have a significant impact on the healthcare system globally. The increased demand for PTSD treatment strain the healthcare system and lead to longer wait times for treatment. The costs of PTSD treatment may also divert resources away from other healthcare priorities.

The World Health Organization (WHO) report "Investing in mental health: Evidence for action" was published in 2013. However, the estimates on the global economic impact of mental health conditions, including PTSD, are still widely cited in research and reports.

According to a study published in the European Journal of Psychotraumatology, the annual economic burden of PTSD in Europe was estimated to be between €69 billion and €85 billion. This includes direct healthcare costs, lost productivity, and social welfare expenditures.

A report by the Mental Health Europe states that mental health disorders, including PTSD, are estimated to cost the European economy over 4% of GDP, equivalent to approximately €600 billion annually.

Moreover, a report by the European Parliament's Committee on Employment and Social Affairs highlights that mental health conditions, including PTSD, are a major contributor to work absence, early retirement, and reduced work productivity. The report estimates that mental health conditions cost the European economy up to €240 billion annually in lost productivity and increased healthcare costs.

It is important to note that specific numbers may vary depending on the source and methodology used to estimate the economic impact of PTSD in Europe.

Post-Traumatic Stress Disorder (PTSD) have a significant economic impact on the United States in various ways. Here are some potential economic impacts:

Healthcare costs: PTSD can result in significant healthcare costs for both individuals and the healthcare system as a whole. Treatment for PTSD can be long-term and involve medication, psychotherapy, and other interventions. According to a study published in the Journal of Traumatic Stress in 2018, the estimated annual cost of treating PTSD in the United States was approximately $48 billion.
Lost productivity: PTSD can impact an individual's ability to work, leading to lost productivity and decreased earnings. This can affect the overall economy by reducing the size of the workforce and lowering the gross domestic product (GDP). According to a report by the National Center for PTSD, veterans with PTSD are more likely to experience unemployment, and those who are employed may earn less than their peers without PTSD.
Disability payments: In cases where individuals with PTSD are unable to work due to the severity of their symptoms, they may be eligible for disability payments from the government. These payments can place a strain on government resources and may impact the overall budget.
Social costs: PTSD can have social costs as well, including increased crime rates, family and relationship problems, and homelessness. These social costs can result in additional economic burdens, such as increased spending on law enforcement and social welfare programs.

"The economic burden of post-traumatic stress disorder in Europe: a systematic review," was published in the European Journal of Psychotraumatology in 2020.

Of course, we don't forget that estimating the economic impact of PTSD is challenging due to the complexity of the disorder and the wide range of ways it can impact individuals and society.