PTSD (post-traumatic stress disorder) spectrum conditions

Clearly most people with PTSD are not in real immediate mortal danger. But that cognitive knowledge does not change the response of the body or affect the anxiety that comes from the body to affect the mind. So the body - and then the mind - react as if they are in mortal danger.

My experience during two decades of practice is that PTSD-type conditions are far more common than is realised. They are a major factor in almost all "difficult to treat" physical conditions and in cases where injuries do not heal properly or parts of the body are chronically too tight or too weak for no apparent reason. In a general sense, the body heals itself best when we are fully and consciously present in it. Simply put, full conscious presence is not possible in PTSD states.

Of course, there are grades of PTSD from minor shock through to major trauma; just as there are grades of injury from a small bruise through to being hit by a speeding train. Unlike a bruise, PTSD only starts 2-3 weeks after an event as a result of us still not feeling safe. By definition, PTSD is a type of physiological (i.e. NOT primarily psychological) adaptation that has not resolved and instead has become chronic. The fact that it is run by the physiological part of the brain - the Autonomic Nervous System (ANS), trauma can also result in physical symptoms and illnesses - called somatisations. The trauma is experienced as psychological because it also generates a kind of anxiety which affects the state of mind.

...the body heals itself best when we are fully and consciously present in it...

All PTSD is locked into the body by a state of overwhelm and dissociation. So the key to treatment is to address the dissociation. This is not simple, and dissociation does NOT usually respond to being treated directly. So efficient, quick and effective treatment requires that we divert slightly, build resilience and stabilise personal boundaries. This vital preparatory phase makes the dissociation - and the trauma/PTSD - relatively easy to treat.

Developmental and Generational Trauma

It must be remembered that everyone has a very different internal experience of events, and so their reaction to the same events can be very different. Some people appear to be bomb-proof even as babies, whereas others go into overwhelm almost immediately. This is not anybody's fault, but is a function of the way that the central nervous system has been set up to deal with threat.

If you do experience memories from a very early stage of life during treatment, this is quite normal. Usually these memories are not verbal - they are shapes, emotions, movements, gestures, feelings. They are often accompanied by overwhelm and grief because those were the conditions that made them get stuck in the first place. Our task is to acknowledge them, BUT at the same time make sure that the memory of overwhelm does not flood your body and mind. When we can keep most of your awareness in the present moment, so that you know you are safe, then the memory of overwhelm will "process" and the trauma will dissipate. This is a delicate task that requires respect and patience; and which is possible because we work together - rather than me just "doing something" that "treats" you.

...We now understand that trauma's imprint is both psychological and physiological and somatic. Memories are stored somatically (relating to or affecting the body) in the nervous system. Long after the events are over, the body continues to respond as if danger were ever present...
(Janina Fisher)

TRAUMA (PTSD) vs STRESS vs AROUSAL :
A simple comparative explanation...

Arousal is an increase in the energy availability in your body. That can be from an invigourating walk, or sexual arousal, or some kind of threat, or your body pumping more blood round because the temperature is a bit cold, etc etc. Any kind of arousal is considered "regulated" if it appropriate and proportional to the context. Of course, "appropriate and proportionate" themselves are subjective to some extent. Someone who is hyper-aroused (they expect threat or danger) will have a different sense of what is reasonable compared to someone who comes to a situation already calm/chilled (i.e. "well regulated"). In other words, ALL responses are potentially appropriate and a sign of good physiological and emotional regulation - given they match the corresponding context.

Arousal is a type of "adaptation" because the body has adapted by upping its ready availability of energy above the normal baseline. Once there is any kind of adaptation, there is automatically less adaptive capacity to handle something else. If an aroused response continues well after the demand for it has ceased then it is out of context and is considered to be "dysregulated". There is always a decompression time of minutes to maybe hours or days or weeks depending on the extremity of a high stress event, so I'm talking about arousal that persists well past that point.

It's the way that an adaptive response gets jammed on and does not reset that causes dysregulation and chronic hyper/hypo-arousal. PTSD is a chronically jammed state of overwhelm that also contains some degree of hyperarousal. i.e. it contains both deflated low energy states and high adrenaline states. Some people are only aware of one of these, and some people are aware of both. I think it's fairly accurate to say that many cases of adult PTSD are founded on dysregulation / prior adaptation that started very early in life - and therefore prior loss of adaptive capacity. Of course there are lots of other symptoms, but these are variable depending on what caused the PTSD and the individual's previous life history.

From there, what most people call "stress" is actually an over-reaction because they are already adapted to the hilt and in overwhelm due to the dysfunctional aspects of our culture and society, media, politics, economic system, etc etc. Different people respond differently because their history of accumulated adaptation is different. Stress may be measured via blood pressure (BP), blood cortisol and heart rate variability (HRV) (etc), but that only really measures the secondary physiological effects (q.v. Scaer "The body bears the burden") and says nothing about the underlying primary adaptations. Most/many primary (mal)adaptations are a result of inadequate or inappropriate or social/relational contact or inadequate support in early life.

PTSD comes in a spectrum from invisible to extreme, and its incidence is measured against a clinically detectable threshold. The threshold is defined against the mental-emotional health of he general population; and since the general population are chronically adapted, the diagnostic threshold is actually quite high.