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dougbremner
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for permission information see the print copy of You Can’t Just Snap Out of It

MRI of the hippocampus in PTSD
Figure 1. Hippocampal volume measured with magnetic resonance imaging (MRI). There is a visible reduction in the hippocampus (outlined in red) in a patient with PTSD compared to non-PTSD (reused with permission).
Diagram of the human brain showing the amygdala and hippocampus.
Figure 2. Diagram of the human brain showing the amygdala (red) and hippocampus (blue). The frontal lobe (front part of the brain) is to the left of the diagram. The hippocampus and amygdala are on both the left and right sides of the brain (Source: Wikipedia).
Figure 3. The cerebrum, or cerebral cortex, is at the outer part of the
brain, and includes frontal and temporal lobes and other
areas. The frontal lobe is involved in thought and emotion
and suppression of fear reactions from the amygdala. The
olfactory cortex, that processes smell, is in the orbitofrontal
cortex at the bottom part of the frontal lobe. The
somatomotor cortex controls movement of the body. The
somatosensory cortex processes feelings of touch. The
visual cortex that processes what we see is in the occipital
lobe, which is at the back of the brain. Auditory cortex
(sound) is in the temporal lobe. The brain stem, which
controls basic processes like breathing or sleep, is the pink
area, and includes medulla oblongata and spinal cord.(Source: Wikipedia)
Figure 4. Neurohormonal Responses to Stress. Each of the body glands produces and releases
hormones into the blood-stream. The arrow shows
the hypothalamic-pituitary-adrenal (HPA) axis,
which controls release of the stress hormone,cortisol. Used with permission.
Figure 5. Diagram of a neuron, the basic cell of the brain. Long processes called axons release neurotransmitters into the space between neurons, called the synapse, where they travel to the next neurons. SSRIs work by blocking the reuptake of serotonin thus effectively increasing the amount of neurotransmitter available to the next neuron.
Figure 6. Brain activation in PTSD. The yellow area shows greater activation in veterans without PTSD in the medial prefrontal cortex (PFC), Brodmann’s area (BA) 35 and 32 and anterior cingulate (AC) compared to veterans with PTSD with exposure to combat-related slides and sounds. A failure to activate this area underlies a failure to extinguish fear reactions with trauma triggers (used with permission).
The need to escape.
Figure 7. The need to escape.
Figure 8. Trauma Spectrum Disorders. Trauma leads to a range of symptoms and the symptoms of trauma-related mental disorders often overlap with each other. For instance, in the diagram above, everything the line over “depression” are symptoms of depression, those above the line over “PTSD” are symptoms of PTSD. As can be seen, the PTSD symptom of feeling
cut off from others can be reframed as the depression symptom of flat affect, and so on. This demonstrates that trauma-related mental disorders are not discrete disorders, but rather a spectrum of symptoms with some traumatized persons exhibiting more of one core of symptoms than another. Adapted from figure in Does Stress Damage the Brain?
DSM criteria for depression.
DSM criteria for PTSD
DSM Criteria for PTSD
Figure 11. Stages of grief.
Figure 12. Antidepressants and mood stabilizers: Uses and risks.
Figure 13. Antipsychotic medications: Uses and risks.
Figure 14. Insomnia medications: Uses and risks.
Figure 15. Finding the sources of stress.
Figure 16. Mediterranean Diet. The diet is high in olive oil, fish, nuts, and breads, and low in red meat. Figure courtesy of Oldways Preservation and Exchange Trust. http://oldwayspt.org/resources/heritagepyramids/mediterranean-diet-pyramid Copyright © 2012
Oldways Preservation and Exchange Trust, used withpermission.



Figure 18. Building trust.
Figure 19. Changing the conversation.
Figure 20. Combat deployment can take a heavy toll on the soldier and the family.
Figure 21. Increased suicide rates in soldiers who returned from Iraq and Afghanistan. Chart shows suicides across the military since 2008.
Figure 22. The soldier returns home.
Figure 23. The Callaway Homecoming Initiative (CHI) Program for soldiers returning from deployment and their families. Copyright Callaway Gardens, used by permission.