Sometimes there is not an obvious, stand-alone cause of posttraumatic stress disorder (PTSD).  An accumulation of small “t” traumas can also result in PTSD such witnessing an accident or domestic violence, having an illness with a long recovery time, experiencing mental abuse at home, school, or work, being in a relationship with an unfaithful partner, the death of a beloved pet, severe sibling rivalry, being abandoned, being humiliated in public, undergoing a series not life-threatening but nevertheless threatening situations, financial problems that risk the loss of home, or getting a diagnosis for a serious disease to name a few. Because of the dramatic effect on the brain and body, undergoing a series of these ordeals changes brain and body functioning. As stress tolerance decreases, vulnerability to PTSD increases. However, this PTSD may be unrecognized as such because there was no major trauma, or large “T” event, hence it is hidden.

PTSD symptoms are grouped into three categories, re-experiencing, avoiding, and hyperarousal. Re-experiencing symptoms occur because our brains are hardwired to complete an experience. If we have unresolved issues, our brain will find a way to keep bringing it up. The subconscious wants to complete the cycle of experience to resolution to remove the perceived danger.

Re-experiencing symptoms include:

• intrusive, distressing recollections
• flashbacks
• repeated distressing dreams
• distress in reaction to internal or external cues
• physiological reactions to these cues

Avoidance symptoms of PTSD occur due to hardwiring in our brain as well. Avoidance is an instinctual response that programs us to keep away from danger, even “dangerous” emotions such as fear and anger that trigger a cascade of physiological reactions in our brain and body, many detrimental such as suppression of the immune system.

Avoidance symptoms include:

• avoidance of feelings, thoughts, conversations concerning the event
• avoidance of people, places, or activities that recall the event
• a marked loss of interest in activities that use to be fulfilling
• inability to recall an important feature of the event
• feeling detached or isolated from others
• unable to feel love or other strong emotions
• believes that life will be unfulfilling

Hyperarousal symptoms of PTSD occur because our brain remains on low-level activation to guard against future unknown threat after a trauma.  We may have never seen the actual traumatic experience coming in the first place and our subconscious is trying to protect us from anything like that from happening again.

Hyperarousal symptoms include:

• insomnia
• angry outbursts or irritability
• poor concentration
• always watching out for potential danger, especially in an unfamiliar place
• increased startle response or jumpiness

Additional signs that you have PTSD are increased aggression, negative beliefs about self, the tendency to focus on blaming self or others for the trauma, panic attacks, self-destructive behavior, difficulty in close relationships, reluctance to trust others, and impaired problem solving and communication.

Research has shown that EMDR can help PTSD, even hidden PTSD, because the brain and body react the same to big “T” and little “t” trauma, albeit to a different degree. During EMDR the client is asked to recall a traumatic event by naming the components that compose the stored traumatic memory. In EMDR these components are called the target and include 1) some sensory impression such as an image or sound associated with the memory, 2) a negative self-evaluation, 3) associated emotions, and 4) how and where those emotions are felt in the body. The target memory is then processed to a neutral or near neutral recollection. Without the emotional punch attached, the memory is no longer threatening to think about, hence no need to re-experience or avoid it. It is just something that happened, not a threat.

Physiological changes occur in the brain during EMDR that calm the brain and stop hyperarousal. Brain scans show that our brain’s watchdog, the amygdala, shows a reduction in activity post-EMDR treatment. Reduced amygdala activity tempers high adrenaline levels and somatic responses such as increased heartrate, muscle tension, and hyper-focus on the perceived threat. Brain scans post–EMDR therapy also show an increase in hippocampal volume. The hippocampus is instrumental in long-term memory and the ability to differentiate between what is past and what is present.  When the hippocampus is working properly, the past trauma no longer feels like a present threat. These and other changes in the brain during EMDR reduce the perceived need for vigilance, thus reducing hyperarousal.