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  • Carolyn Hewett

Understanding PTSD

What happens to the brain after a traumatic event?

Adapted from "Healing from the Trauma of Abuse" by Copeland and Harris


If you experienced abuse, you probably developed certain symptoms in response. These symptoms may have occurred right away, or, in some cases, months or even years after the abuse. Some symptoms such as fear, anger, or sadness are obviously connected to the abuse. other symptoms, such as paranoia, dissociation, or panic attacks may have caused a bit more confusion for you. Sometimes these symptoms occur as a response to the abuse, and sometimes as a way to cope with the abuse or prevent it from occurring again. In some cases, they were ways to live in denial that the abuse happened at all so you can go on living your life.


Many signs of abuse have been mistakenly diagnosed as mental illness or biochemical brain imbalances, such as chronic depression, bipolar disorder, or schizophrenia. If you have sought treatment from health care provider as perhaps you were told your symptoms were a sign of a disease instead of being the markers of abuse. You may be given a diagnosis and medication without even being asked about your abuse history.


The brain is plastic, growing and evolving throughout life. Trauma survivors can capitalize on this plasticity to heal.

Trauma can alter brain functioning in many ways, but three of the most important changes appear to occur in the following areas: the prefrontal cortex (PFC), known as the “Thinking Center, the anterior cingulate cortex (ACC), known as the “Emotion Regulation Center”, the amygdala, known as the “Fear Center”


The PFC, or thinking center, is located near the top of your head, behind your forehead. It's responsible for abilities including rational thought, problem-solving, personality, planning, empathy, and awareness of ourselves and others. When this area of the brain is strong, we are able to think clearly, make good decisions, and be aware of ourselves and others.


The ACC, or emotion regulation center, is located next to the prefrontal cortex, but is deeper inside the brain. This area is responsible (in part) for regulating emotion, and (ideally) has a close working relationship with the thinking center. When this region is strong, we are able to manage difficult thoughts and emotions without being totally overwhelmed by them. While we might want to send a snarky email to a coworker, the emotion regulation center reminds us that this is not a good idea and helps us manage our emotions so that we don’t do things we regret.


Finally, the amygdala, a tiny structure deep inside our brain, serves as its fear center. This subcortical area is outside of our conscious awareness or control, and its primary job is to receive all incoming information—everything you see, hear, touch, smell, and taste—and answer one question: “Is this a threat?” If it detects that a dangerous threat is present, it produces fear in us. When this area is activated, we feel afraid, reactive, and vigilant.


What’s Going on in a Traumatized Brain


Traumatized brains look different from non-traumatized brains in three predictable ways:

  1. The Thinking Center is underactivated.

  2. The Emotion Regulation Center is underactivated.

  3. The Fear Center is overactivated.

What these activations indicate is that, often, a traumatized brain is "bottom-heavy," meaning that activations of lower, more primitive areas, including the fear center, are high, while higher areas of the brain (also known as cortical areas) are underactivated. In other words, if you are traumatized, you may experience chronic stress, vigilance, fear, and irritation.

You may also have a hard time feeling safe, calming down, or sleeping. These symptoms are all the result of a hyperactive amygdala.

At the same time, individuals who are traumatized may notice difficulties with concentration and attention, and often report they can’t think clearly. This, not surprisingly, is due to the thinking center being underactivated.


Finally, survivors of trauma will sometimes complain that they feel incapable of managing their emotions. For example, if someone spooks them as a prank, they may experience a rapid heart rate long after the joke is up, or may have a hard time “just letting go” of minor annoyances. Even when they want to calm down and feel better, they just can’t. This is in large part due to a weakened emotion regulation center.


What can you do about this?


Certain therapies that teach you strategies for emotion regulation, mindfulness, and thought restructuring are a great way to begin your healing process. Finding the right therapist (see previous blog post) is an important step to take in order to ensure this process can be done effectively. With the right support and a lot of patience with yourself, you can find healing from the effects of trauma and live a fulfilling life beyond.

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