Is PTSD a Disorder or an Injury?

Photo by: Jessica Lee Photography

I don’t believe that labeling PTSD as an injury (PTS-I, post-traumatic stress injury) helps us in extinguishing the stigma that our fire colleagues experience when dealing with mental wellness struggles. Indeed, our push to only accept PTSD as a viable diagnosis for a disorder that is linked exclusively (which I also believe to be misguided) to what we do in our careers separates us from everyone else. And, then while isolated, we further isolate ourselves by ousting our brothers and sisters who develop anxiety, depression, an addiction issue or any other number of life-altering struggles. We in effect say, “Sorry, PTSD is the only acceptable diagnosis.”  I wager that we will see an upsurge in diagnosis as our struggling folks shop clinicians in order to receive that diagnosis.

And, I don’t blame them.

Tradition continues to trump common sense here.

With my bias known to you, dear reader, I hope to approach this dichotomy as best I can in a fact-based, balanced approach to allow you to make your own mind up.

A popular social media pictograph reads in bold letters, “PTSD IS NOT A MENTAL ILLNESS – IT IS A PSYCHOLOGICAL INJURY” and, it then goes on to address and I believe accurately, the physical structure decline that occurs. Here is what it outlines (the claims are in quotes, the rest is my input):

“The hippocampus shrinks” – the hippocampus is a structure important in memory. As part of a larger system, information passed through the hippocampus, in general terms, is said to be important for the consolidation of information to create “long-term” memories. Though, some researchers are suggesting that, while crucial in memory, it’s uncertain exactly what parts of memory exclusively. It is thought to be utilized in the episodic memory (memory for specific events within a temporal and spatial nature) (Eldrige et al., 2000).

“Increased activity in the amygdala” – The amygdala is our emotion center. If you have seen Inside Out (Pixar) with your kids, its “control center” they were in. Increased activity here may indicate a heightened emotional response – but also necessary in fear responses (Rosen, 2004). It is implicated in memory creation and consolidation and may be implicated in the heightened fear response, a known symptom of PTSD (Roozendaal, McEwen, Chattarji, 2009).

“Ventromedial Prefrontal Cortex Shrinks” – Your hand can do a great job of mimicking the structure of the brain. If you close your hand into a fist, your fingers hugging your thumb, the Ventromedial Prefrontal area would be close to the two knuckles above your fingernails on your ring and middle fingers. This area is the “control center” of the rest of your brain with major decision making and judgment impaired when this structure is damaged (Fellows & Farah, 2007). The idea of a shrinking cortical structure here is linked with its connection with being able to navigate negative emotions (Urry et al., 2006).

Let’s take a look at all these claims. Firstly, each has research to suggest their accuracy. In fact, the original image doesn’t have citations for the research consulted at all; therefore, all the research that you see above to confirm the claims is research that I sought out. Not research included in the pictogram.

But, there are some important factors to consider. And, on the face, we have a research-backed claim. They certainly are not stretching the truth, or purposely skewing the research in order to push a terminological change. And, I wish to be perfectly clear that, as far as I can tell, these things are occurring in folks experiencing PTSD. Those of us interested, however, may begin to ask ourselves a few questions. The first and most important, do any of these mechanisms occur in other disorders?

Hippocampal shrinkage – Schizophrenia (Nelson et al., 1998); Schizophrenia and psychosis (Velakoulis et al., 1999); Alzheimer’s Disease (Stepan-Buksakowska et al., 2014) Depression (Sheline, Gado, & Kraemer, 2003); Obsessive-Compulsive Disorder (Kwon et al., 2003)

Our Shop is Getting Awesome!

Increased Activity in the Amygdala – Anxiety (Stein et al., 2007); Depression (Sheline et al., 2001; Young et al., 2015) Insomnia (Baglioni et al., 2014)
(In my search for research, I stumbled across a study that suggests that individuals with Internet Gaming Disorder actual have shrinkage in their amygdala, analogous to the hippocampus above (Ko et al., 2014)

Ventromedial Prefrontal Cortex Shrinkage – Depression (Dusi et al., 2018), Stress (though it’s the medial prefrontal cortex generally, not specific to the Ventro location, (Czeh et al., 2008); Schizophrenia (Zhang et al., 2015) Obesiety ( Geha et al., 2016).

This is by no means exhaustive, in fact, these studies were found rapidly using Google Scholar, and most were free for access studies.

We seem to be confronted that, as we said above, despite the evidence that suggests all those changes occur in PTSD – we now see that they also occur in other disorders as well.

The research suggests that these claims are not exclusive to PTSD. Indeed, various disorders show real, actual, cortical change, too. Your brain ACTUALLY changes. And, alarmingly, these disorders are not making your brain any bigger, it’s literally chewing away at it. So, is depression, anxiety, obesity, video game playing or schizophrenia an injury? Or, are these disorders simply injurious to the brain. We need to suggest that these disorders too, need to be considered injuries in order for it to make theoretical sense. But, perhaps that’s my own myopic view.

Back to my bias:

If we are looking at re-naming an entire disorder because of our service has gotten a hold of it, we need to really be clear with what we are saying. Which, to my estimation, is that for First Responders PTSD is an injury – separated, of course, from those who may experience dreadful things that go on to develop disorders. Chipping away, striping down to the bare exposing tenant – PTSD is different because it’s us; civilians are different because it’s them. I see no other way to explore why we seem to be so cultishly driven toward needing this to be accepted.

Our quest towards definitive domination with this is, unfortunately, harming others in the process. I’ve personally treated individuals who explain that PTSD brought them through the door. Within a short period of time, though, it is clear that the symptomology that they are experiencing is not PTSD. That isn’t to say that it isn’t any scarier, damaging, life-altering, uncomfortable, or isolatingly hard to deal with. It is.

And, this is what my final rub is.

We cheapen our brothers and sister with bona fide PTSD diagnosis, who’ve lived the real hell when we suggest that everything is PTSD that we experience. And, we oust our brothers and sisters who don’t, yet, have clinical-threshold symptoms to be diagnosed with PTSD, by telling them it isn’t serious or not. Disturbing is not traumatic. Not on its own anyway.