A number of landmark studies explain the complex neurobiologic sequelae of childhood and adult. It is now commonly assumed that the endogenous stress hormones (e. g. , catecholamines, corticosteroids, serotonin, endogenous opioids) have an effect on how memories are stored in the brain. Traumatized individuals tend to remember merely bits and pieces of an experience due to the massive secretion of these neurohormones, mainly norepinephrine. Trauma disturbs the functional integration of extensive cortical and subcortical regions, as recommended by electroencephalography, positron emission tomography, and cortical event-related potentials.
These neuroanatomic effects include decreased hippocampal volume, activation of the amygdala and its connected structures, as well as lateralization to the right hemisphere when traumatic events are remembered. Decreased activation of Broca’s area during flashbacks supports the clinical observation that traumatized persons cannot use words to explain their experience. It appears that, Broca’s area actually “switches off” when traumatic memories are activated. (Yehuda, R. 2001)
Stimulation of the amygdala interferes with hippocampal functioning, however the actual effects on brain structure are complex and difficult to unravel. Permanent changes in the limbic system as well impair cortical control and tend to be indelible. Therefore, the trauma victim is not capable to consolidate, process, and work through traumatic memories. Disruptions in the limbic structure cause an array of problems, including amnesia, exaggerated startle response, hyperarousal, and dissociation. (Yehuda, R. 2001) Patients with PTSD have decreased hippocampal volumes, leading to a loss of verbal memories.
In addition, traumatic memories are activated in the right hemisphere of the brain, which processes emotion; for this reason, the clinically observable phenomenon of traumatized patients who “suffer from speechless terror”. Apparently, in the left hemisphere, Broca’s area (which is accountable for language and communication) has diminished oxygen utilization; the right hemisphere independently recalls and facilitates emotional responses and sensory impressions based merely on fragments and unintegrated bits of information.
The patient who is reminded of traumatic events has compounded neurophysiologic susceptibility that affects her capacity to name feelings, explain what has happened, and work through trauma. (Yehuda, R. 2001) Thus the impact of domestic violence, rape, physical and sexual trauma, and natural disaster on the lives of women is astounding. Only some individuals are immune to the impact of traumatic events, for the reason that life is a high-risk proposition.
By recognizing and treating victims of abuse and posttraumatic stress, physicians can make enormous inroads toward improving the mental and physical health of women. Regardless of this massive public health problem, physicians need guidelines for patients who suffer the consequences of natural disaster, childhood abuse, adult trauma (e. g. , rape, robbery, kidnapping, bombing), or domestic violence. Several problems remain unrecognized as symptoms can be triggered months and even years after the event.
When a problem is recognized, the clinician has to be prepared to work with the patient as part of a team. Eventually, this care is extremely cost-effective. Screening and early intervention are becoming integrated into the preventive health services of some insurance and managed care plans, for the reason that the persistent health and emotional problems that abused women experience show the way to so many other physical and psychological problems. These difficulties can be reduced if effective help is offered early.