How Trauma and PTSD Impact the Brain

Table of ContentsView AllTable of ContentsAffected Parts of the BrainBrain’s Response to TraumaThe Consequences of TraumaHow to Treat PTSD

Table of ContentsView All

View All

Table of Contents

Affected Parts of the Brain

Brain’s Response to Trauma

The Consequences of Trauma

How to Treat PTSD

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Trauma can impact people in a variety of ways and can even have a lasting impact on the brain. In some cases, it can lead topost-traumatic stress disorder(PTSD), a trauma- and stressor-related disorder that results in improper processing and storage of traumatic memories.

Because of the way these memories are stored, people with PTSD exhibit symptoms such as recurrent memories regarding the event; traumatic nightmares;dissociative flashbacks;hypervigilance; engaging in risk-taking behavior; and an exaggerated startle response.

Not all people with PTSD experience the same symptoms or have the exact same pattern of brain changes. However, researchers have been able to use neuroimaging techniques to look at some of the different areas of the brain that play a role in the development of the condition.

At a Glance

Certain structures of the brain are closely related to some of thesymptoms of PTSD. These structures include:

PTSD causes the hyper-activation of some brain structures while other areas become hypoactive.

Both the amygdala and the mid-anterior cingulate cortex become over-stimulated when a person has PTSD. However, thehippocampus, right inferior frontal gyrus, ventromedial PFC, dorsolateral PFC, and orbitofrontal cortex all become hypoactive, some to the point of atrophy.

The Amygdala

The amygdala is a small, almond-shaped region of the brain that plays a role in several functions, including:

The Prefrontal Cortex (PFC)

The prefrontal cortex (PFC) is an area of the brain found in the frontal lobe. This region of the brain plays an important part in PTSD. Some of the key functions of the prefrontal cortex include:

The ventromedial PFChelps suppress negative emotions and plays a role in personal and social decision-making. It also plays a major role in the latter part of memory consolidation and regulates extinction—the weakening and eventual dissipation of a conditioned response.

The dorsolateral PFCmodulates decision-making and working memory. Working memory actively holds transitory information before it becomes part of thelong-term memoryduringmemory consolidation.

The orbitofrontal cortex, one of the least understood parts of the brain, seems to be involved in sensory integration and signaling expected rewards and/or punishments in a given situation. It also modulates emotion and decision-making.

As a whole, the prefrontal cortex is interconnected to many brain functions, including memory consolidation and regulating slow-wave sleep (non-REM sleep, referred to as “deep sleep”).

The Mid-Anterior Cingulate Cortex

The primary function of the mid-anterior cingulate cortex (ACC) is to monitor conflict. The ACC also plays a role in:

Research has found that decreases in cortical thickness in the ACC are linked to increased PTSD symptoms.

The Hippocampus

The hippocampus helps regulate smell, spatial coding, and memory. More specifically, the hippocampus helps store long-term memories, basically helping to decide what goes from being ashort-term memoryto what becomes a long-term memory. This process of turning short-term memory into long-term memory is what is referred to as memory consolidation.

Damage to the hippocampus can also release excesscortisol(a stress hormone).High cortisol levels lead to heightened alertness, stress, and fear.

The Right Inferior Frontal Gyrus

The right inferior frontal gyrus is involved in modulating risk aversion. Studies show thattranscranial magnetic stimulation(TMS) of this brain region may reduce some risk-taking behavior.

The Brain’s Response to Trauma

When your brain identifies some type of threat, the amygdala is responsible for initiating a fast, automatic reaction known as thefight-or-flight response.

The amygdala also communicates with other areas of the brain, including the hypothalamus, which then releases the stress hormone cortisol. It is the brain’s prefrontal cortex that must then assess the source of the threat and determine if the body needs to stay on high alert to deal with the threat or if the brain needs to begin calming down the body.

The prefrontal cortex acts as a braking system that helps return your body to a normal state when you realize that the threat doesn’t pose a danger or after the threat has passed.

When people have symptoms of post-traumatic stress disorder, the amygdala becomes hyperactive while the medial prefrontal cortex becomes hypoactive.

Techniques to Tame the Fight-or-Flight Response

The National Institute of Mental Health reports that an estimated 3.6% of U.S. adults had PTSD in the past year. Approximately 6.8% of all adults will experience this condition at some point in their lives.

When examining the functions of the various structures of the brain, the correlation between a change in those structures’ activity levels and some PTSD symptoms becomes clearer.

Hypervigilance

The amygdala’s overactivity presents as symptoms of hypervigilance and an exaggerated startle response. Because the amygdala overreacts, norepinephrine is released, but the prefrontal cortex does not adequately control or deal with it.

As a result, people with PTSD experience symptoms of hypervigilance. They become overly aroused and are on high alert, which can make it hard to relax and sleep. A person may feel that they are always tense, and even smalltriggerscan lead to react as if they are facing or re-experiencing their original trauma.

Distorted Recall

The hippocampus is involved in explicit memory processes and in the encoding of context during fear conditioning. When the hippocampus fails to function optimally, it impacts the way a person remembers and recalls memories, especially memories that contain a fear element—such as those related to trauma.

In terms of PTSD symptoms, this results in:

Learning Brain vs. Survival Brain: What’s the Difference?

Impulsive Behavior

Changes to the right inferior frontal gyrus help to explain why people with PTSD may suddenlyengage in high-risk activities.

Research has found that reduced cortical thickness in certain areas of the brain associated with emotional regulation and response inhibition, including the right frontal gyrus, is linked to impulse control problems in PTSD.

Treatments for PTSDcan help address some of the effects of trauma on the brain. Such treatments target many of the cognitive and emotional symptoms of PTSD, and may include psychotherapy or medication.

Types of therapy that may be used include:

The two medications that are FDA-approved for the treatment of post-traumatic stress disorder areZoloft(sertraline) andPaxil(paroxetine). Other medications that may be prescribed off-label includeProzac(fluoxetine) andEffexor(venlafaxine).

Self-care strategies such as using relaxation techniques, getting enough sleep, engaging in regular exercise, and practicing mindfulness meditation can also be helpful for managing the condition’s symptoms.

Other promising treatments includevirtual reality exposure therapy,ketamine infusion therapy, andMDMA-assisted therapy.

Takeaways

When thoroughly examining the relationship between brain function and a person’s symptoms, it becomes easier to understand many of the complex manifestations of PTSD. Although understanding the brain in this way may not provide direct symptomatic relief to someone living with PTSD, it can be helpful in understandingwhythe symptoms are happening and, in turn, help the medical community continue to develop more effective interventions.

Coping With PTSD

13 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Fitzgerald JM, DiGangi JA, Phan KL.Functional neuroanatomy of emotion and its regulation in PTSD.Harv Rev Psychiatry. 2018;26(3):116-128. doi:10.1097/HRP.0000000000000185Ben-Zion Z, Korem N, Fine NB, et al.Structural neuroimaging of hippocampus and amygdala subregions in posttraumatic stress disorder: A scoping review.Biol Psychiatry Glob Open Sci. 2023;4(1):120-134. doi:10.1016/j.bpsgos.2023.07.001Selemon LD, Young KA, Cruz DA, Williamson DE.Frontal lobe circuitry in posttraumatic stress disorder.Chronic Stress (Thousand Oaks). 2019;3:2470547019850166. doi:10.1177/2470547019850166Tüshaus L, Omlin X, Tuura RO, et al.In human non-REM sleep, more slow-wave activity leads to less blood flow in the prefrontal cortex.Sci Rep. 2017;7(1):14993. doi:10.1038/s41598-017-12890-7Li L, Zhang Y, Zhao Y, et al.Cortical thickness abnormalities in patients with post-traumatic stress disorder: A vertex-based meta-analysis.Neuroscience & Biobehavioral Reviews. 2022;134:104519. doi:10.1016/j.neubiorev.2021.104519Kim EJ, Pellman B, Kim JJ.Stress effects on the hippocampus: A critical review.Learn Mem. 2015;22(9):411–416. doi:10.1101/lm.037291.114Yang CC, Khalifa N, Völlm B.Excitatory repetitive transcranial magnetic stimulation applied to the right inferior frontal gyrus has no effect on motor or cognitive impulsivity in healthy adults.Behav Brain Res. 2018;347:1-7. doi:10.1016/j.bbr.2018.02.047National Institute of Mental Health.Post-traumatic stress disorder (PTSD).Ousdal OT, Milde AM, Hafstad GS, et al.The association of PTSD symptom severity with amygdala nuclei volumes in traumatized youths.Transl Psychiatry. 2020;10(1):288. doi:10.1038/s41398-020-00974-4Durand F, Isaac C, Januel D.Emotional memory in post-traumatic stress disorder: A systematic PRISMA review of controlled studies.Front Psychol. 2019;10:303. doi:10.3389/fpsyg.2019.00303Sadeh N, Spielberg JM, Miller MW, et al.Neurobiological indicators of disinhibition in posttraumatic stress disorder.Hum Brain Mapp. 2015;36(8):3076-3086. doi:10.1002/hbm.22829Boyd JE, Lanius RA, McKinnon MC.Mindfulness-based treatments for posttraumatic stress disorder: a review of the treatment literature and neurobiological evidence.J Psychiatry Neurosci. 2018;43(1):7-25. doi:10.1503/jpn.170021Nijdam MJ, Vermetten E.Moving forward in treatment of posttraumatic stress disorder: innovations to exposure-based therapy.Eur J Psychotraumatol. 2018;9(1):1458568. Published 2018 May 18. doi:10.1080/20008198.2018.1458568

13 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Fitzgerald JM, DiGangi JA, Phan KL.Functional neuroanatomy of emotion and its regulation in PTSD.Harv Rev Psychiatry. 2018;26(3):116-128. doi:10.1097/HRP.0000000000000185Ben-Zion Z, Korem N, Fine NB, et al.Structural neuroimaging of hippocampus and amygdala subregions in posttraumatic stress disorder: A scoping review.Biol Psychiatry Glob Open Sci. 2023;4(1):120-134. doi:10.1016/j.bpsgos.2023.07.001Selemon LD, Young KA, Cruz DA, Williamson DE.Frontal lobe circuitry in posttraumatic stress disorder.Chronic Stress (Thousand Oaks). 2019;3:2470547019850166. doi:10.1177/2470547019850166Tüshaus L, Omlin X, Tuura RO, et al.In human non-REM sleep, more slow-wave activity leads to less blood flow in the prefrontal cortex.Sci Rep. 2017;7(1):14993. doi:10.1038/s41598-017-12890-7Li L, Zhang Y, Zhao Y, et al.Cortical thickness abnormalities in patients with post-traumatic stress disorder: A vertex-based meta-analysis.Neuroscience & Biobehavioral Reviews. 2022;134:104519. doi:10.1016/j.neubiorev.2021.104519Kim EJ, Pellman B, Kim JJ.Stress effects on the hippocampus: A critical review.Learn Mem. 2015;22(9):411–416. doi:10.1101/lm.037291.114Yang CC, Khalifa N, Völlm B.Excitatory repetitive transcranial magnetic stimulation applied to the right inferior frontal gyrus has no effect on motor or cognitive impulsivity in healthy adults.Behav Brain Res. 2018;347:1-7. doi:10.1016/j.bbr.2018.02.047National Institute of Mental Health.Post-traumatic stress disorder (PTSD).Ousdal OT, Milde AM, Hafstad GS, et al.The association of PTSD symptom severity with amygdala nuclei volumes in traumatized youths.Transl Psychiatry. 2020;10(1):288. doi:10.1038/s41398-020-00974-4Durand F, Isaac C, Januel D.Emotional memory in post-traumatic stress disorder: A systematic PRISMA review of controlled studies.Front Psychol. 2019;10:303. doi:10.3389/fpsyg.2019.00303Sadeh N, Spielberg JM, Miller MW, et al.Neurobiological indicators of disinhibition in posttraumatic stress disorder.Hum Brain Mapp. 2015;36(8):3076-3086. doi:10.1002/hbm.22829Boyd JE, Lanius RA, McKinnon MC.Mindfulness-based treatments for posttraumatic stress disorder: a review of the treatment literature and neurobiological evidence.J Psychiatry Neurosci. 2018;43(1):7-25. doi:10.1503/jpn.170021Nijdam MJ, Vermetten E.Moving forward in treatment of posttraumatic stress disorder: innovations to exposure-based therapy.Eur J Psychotraumatol. 2018;9(1):1458568. Published 2018 May 18. doi:10.1080/20008198.2018.1458568

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Fitzgerald JM, DiGangi JA, Phan KL.Functional neuroanatomy of emotion and its regulation in PTSD.Harv Rev Psychiatry. 2018;26(3):116-128. doi:10.1097/HRP.0000000000000185Ben-Zion Z, Korem N, Fine NB, et al.Structural neuroimaging of hippocampus and amygdala subregions in posttraumatic stress disorder: A scoping review.Biol Psychiatry Glob Open Sci. 2023;4(1):120-134. doi:10.1016/j.bpsgos.2023.07.001Selemon LD, Young KA, Cruz DA, Williamson DE.Frontal lobe circuitry in posttraumatic stress disorder.Chronic Stress (Thousand Oaks). 2019;3:2470547019850166. doi:10.1177/2470547019850166Tüshaus L, Omlin X, Tuura RO, et al.In human non-REM sleep, more slow-wave activity leads to less blood flow in the prefrontal cortex.Sci Rep. 2017;7(1):14993. doi:10.1038/s41598-017-12890-7Li L, Zhang Y, Zhao Y, et al.Cortical thickness abnormalities in patients with post-traumatic stress disorder: A vertex-based meta-analysis.Neuroscience & Biobehavioral Reviews. 2022;134:104519. doi:10.1016/j.neubiorev.2021.104519Kim EJ, Pellman B, Kim JJ.Stress effects on the hippocampus: A critical review.Learn Mem. 2015;22(9):411–416. doi:10.1101/lm.037291.114Yang CC, Khalifa N, Völlm B.Excitatory repetitive transcranial magnetic stimulation applied to the right inferior frontal gyrus has no effect on motor or cognitive impulsivity in healthy adults.Behav Brain Res. 2018;347:1-7. doi:10.1016/j.bbr.2018.02.047National Institute of Mental Health.Post-traumatic stress disorder (PTSD).Ousdal OT, Milde AM, Hafstad GS, et al.The association of PTSD symptom severity with amygdala nuclei volumes in traumatized youths.Transl Psychiatry. 2020;10(1):288. doi:10.1038/s41398-020-00974-4Durand F, Isaac C, Januel D.Emotional memory in post-traumatic stress disorder: A systematic PRISMA review of controlled studies.Front Psychol. 2019;10:303. doi:10.3389/fpsyg.2019.00303Sadeh N, Spielberg JM, Miller MW, et al.Neurobiological indicators of disinhibition in posttraumatic stress disorder.Hum Brain Mapp. 2015;36(8):3076-3086. doi:10.1002/hbm.22829Boyd JE, Lanius RA, McKinnon MC.Mindfulness-based treatments for posttraumatic stress disorder: a review of the treatment literature and neurobiological evidence.J Psychiatry Neurosci. 2018;43(1):7-25. doi:10.1503/jpn.170021Nijdam MJ, Vermetten E.Moving forward in treatment of posttraumatic stress disorder: innovations to exposure-based therapy.Eur J Psychotraumatol. 2018;9(1):1458568. Published 2018 May 18. doi:10.1080/20008198.2018.1458568

Fitzgerald JM, DiGangi JA, Phan KL.Functional neuroanatomy of emotion and its regulation in PTSD.Harv Rev Psychiatry. 2018;26(3):116-128. doi:10.1097/HRP.0000000000000185

Ben-Zion Z, Korem N, Fine NB, et al.Structural neuroimaging of hippocampus and amygdala subregions in posttraumatic stress disorder: A scoping review.Biol Psychiatry Glob Open Sci. 2023;4(1):120-134. doi:10.1016/j.bpsgos.2023.07.001

Selemon LD, Young KA, Cruz DA, Williamson DE.Frontal lobe circuitry in posttraumatic stress disorder.Chronic Stress (Thousand Oaks). 2019;3:2470547019850166. doi:10.1177/2470547019850166

Tüshaus L, Omlin X, Tuura RO, et al.In human non-REM sleep, more slow-wave activity leads to less blood flow in the prefrontal cortex.Sci Rep. 2017;7(1):14993. doi:10.1038/s41598-017-12890-7

Li L, Zhang Y, Zhao Y, et al.Cortical thickness abnormalities in patients with post-traumatic stress disorder: A vertex-based meta-analysis.Neuroscience & Biobehavioral Reviews. 2022;134:104519. doi:10.1016/j.neubiorev.2021.104519

Kim EJ, Pellman B, Kim JJ.Stress effects on the hippocampus: A critical review.Learn Mem. 2015;22(9):411–416. doi:10.1101/lm.037291.114

Yang CC, Khalifa N, Völlm B.Excitatory repetitive transcranial magnetic stimulation applied to the right inferior frontal gyrus has no effect on motor or cognitive impulsivity in healthy adults.Behav Brain Res. 2018;347:1-7. doi:10.1016/j.bbr.2018.02.047

National Institute of Mental Health.Post-traumatic stress disorder (PTSD).

Ousdal OT, Milde AM, Hafstad GS, et al.The association of PTSD symptom severity with amygdala nuclei volumes in traumatized youths.Transl Psychiatry. 2020;10(1):288. doi:10.1038/s41398-020-00974-4

Durand F, Isaac C, Januel D.Emotional memory in post-traumatic stress disorder: A systematic PRISMA review of controlled studies.Front Psychol. 2019;10:303. doi:10.3389/fpsyg.2019.00303

Sadeh N, Spielberg JM, Miller MW, et al.Neurobiological indicators of disinhibition in posttraumatic stress disorder.Hum Brain Mapp. 2015;36(8):3076-3086. doi:10.1002/hbm.22829

Boyd JE, Lanius RA, McKinnon MC.Mindfulness-based treatments for posttraumatic stress disorder: a review of the treatment literature and neurobiological evidence.J Psychiatry Neurosci. 2018;43(1):7-25. doi:10.1503/jpn.170021

Nijdam MJ, Vermetten E.Moving forward in treatment of posttraumatic stress disorder: innovations to exposure-based therapy.Eur J Psychotraumatol. 2018;9(1):1458568. Published 2018 May 18. doi:10.1080/20008198.2018.1458568

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