PTSD: How Does a Young Person’s Brain React to Trauma?

Trauma changes the brain. According to the DSM-5 classification of mental disorders, post-traumatic stress disorder (PTSD) may develop in response to being a participant in or a witness to life-threatening situations, sexual violence, or serious injuries. It is a disorder characterized by frequently reliving a traumatic event. It happens in nightmares or in the form of flashbacks, that is, short flashes of painful memories in which a person feels and even behaves as if the terrible past has returned for a while.

PTSD is dominated by strong emotional reactions – sometimes it is indifference and loss of interest in life. Some other times, suffering people may experience fright or have outbursts of anger. They begin to see the world as more dangerous and themselves as defenseless. Any elements of the environment resembling traumatic events arouse fear and panic. What remains is to avoid them at all costs.

Fortunately, PTSD does not occur very often in Poland. In the 2021 EZOP II study its prevalence in children aged 7–17 was estimated at just 0.1%. In adults, this number is higher and amounts to 2%. The data from the United States is more disturbing and shows that almost two-thirds of teenagers there have been dealing with a factor that could have caused trauma. Most often these were: the sudden death of a loved one, disaster or cataclysm and witnessing someone’s death/serious accident. 8% of these people developed PTSD throughout their lives.

PTSD in Young People: The Stress Axis

There is little research that focuses on younger people (aged from 7 to 18). Above all, it is more difficult to recognize PTSD in this group than in adults. The symptoms are not as evident and may resemble, for example, ADHD. Children often act out traumatic events during their play.

When it comes to stress response in young people, it is similar to that of adults. The main role here is played by the so-called HPA axis (named after three key structures: hypothalamus, pituitary, and adrenal). It releases cortisol into the blood, causing an acceleration of metabolism and a rise in blood glucose levels. In the short term, this helps to cope with a difficult situation, but in the long term, elevated cortisol levels can be harmful to health. Research also indicates that neglect or abuse in childhood interferes with the performance of the HPA axis, making the person more susceptible to PTSD later in life.

Intuition suggests that a child with PTSD has higher than normal levels of cortisol in the blood, which translates into stronger anxiety reactions. It turns out, however, that the level of stress hormone is lowered in this case. How is this possible? There is a scientific hypothesis saying that as a result of this phenomenon, a person is less prepared to cope with stress, more sensitive to its effects, and thus more susceptible to the occurrence of trauma.

This result was confirmed in another study, in which participants with PTSD were divided into two groups: The first group included people who had experienced traumatic events in childhood (before the age of 18), and the second group gathered those who had struggled with it in adulthood. They all had to perform a stressful task, which was to dip their hand in ice water. The subjects suffering from PTSD showed a weaker HPA axis response than the comparison group comprised of healthy people. Moreover, participants who experienced trauma as children had lower levels of cortisol than the rest both before and after the examination. In addition, for the next two hours, their bodies were unable to regulate this hormone and lower it to its initial concentration, which other subjects managed to do. The results indicate that the earlier the trauma occurs, the worse for the child.

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Stress: Not Only Cortisol

In young people with PTSD, the activity of other chemical compounds collectively called catecholamines, which include adrenaline, noradrenaline and dopamine, is also impaired. In the stress reaction, the first two play a particular role. They are the ones that prepare the body for the “fight or flight” response. They make the heart rate faster, the lungs start to demand more oxygen, and blood flows to the limbs. Studies have shown that in children with PTSD noradrenaline is produced in excess, which means they are in a state of constant arousal, and most of them suffer from tachycardia (a heart rhythm disorder). The resting heart rate of 85% of people was above 94 beats per minute (the norm at this age is 84), and of 40% was above 100.

The results were proved very simple – the child first lay for nine minutes and then stood for ten. Resting heart rate in people with PTSD was always higher than in the healthy group, but other aberrations from the norm were also observed in them. At the moment of getting up, some had a sharp increase in heart rate (up to almost 150 beats per minute). Whereas in others, the heart rate accelerated in a fairly standard way, but it took a long time for it to calm down.

 A Shattered Brain

Trauma changes not only the action of hormones but also the brain itself – especially the areas responsible for perceiving the threat. The world has become a hostile place for children with PTSD. It has been observed that their prefrontal cortex, that is, the area that plays a major role in regulating emotions and suppressing fear response, is much smaller than in a healthy population. Similarly, the functioning of another structure – the hippocampus, which is responsible for short-term memory and orientation in the context of the situation, is disturbed. 

In all this, one cannot forget about the center of human emotions, especially fear – the amygdala. In some studies, it was noted that in children with PTSD, the activity of this small area located in the temporal lobe is increased. Although the result is intuitive, it has not been confirmed in other experiments. This may stem from the fact that in the developing brain, structures are still maturing to perform certain functions.

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Help with Trauma Healing

What comes to the fore in the treatment of PTSD in children and adolescents is cognitive behavioral therapy (CBT). Meta-analyses of studies indicate that it gives the best results, both during group and individual sessions.

In this vein, meetings with young patients suffering from PTSD are usually divided into three stages. The first is to present methods that help to cope with trauma (such as relaxation or strengthening the sense of security). In the second phase, the person is gradually exposed to emotions and traumatic past, so that these events can be seen in a different light. In the end, changes are strengthened and lost trust is restored. Parents/guardians often participate in sessions, which helps children trust that they will receive support from them if something bad happens in the future.

CBT reduces the severity of symptoms, both depression and anxiety. Importantly, the results persist at least one year after the end of treatment. This raises hope that trauma can be overcome and that young people are not doomed to it for the rest of their lives.

Translation: Marcin Brański