In Nijenhuis’s theory of the “structural theory of dissociation and physical symptoms” that I will discuss later in this chapter, he bases his theory on what Porges (2003) proposes as the “polyvagal theory”. Porges postulates that people in crisis shows activities of autonomic nervous system which consists of three complexes as follows;
I. The ventral vagal complex: phylogenically the newest system, a mammalian signaling system for motion, emotion, and social communication.
II. The sympathetic nervous system: an adaptive mobilization system supporting fight or flight behaviors.
III. The dorsal vagal complex: a vestigial immobilization system.
According to this theory, in Lanius (2007)’s above-mentioned classification, “hypervigilance /flashbacks/ reexperiencing” state corresponds to II while his“dissociation” state is equivalent to III.
These two prototypes give us a rough idea about how trauma-induced physical symptoms can be understood as either part of PTSD symptoms or that of dissociative symptoms.
Porges, S.W. (2001) The polyvagal theory: phylogenetic substrates of a social nervous system. International Journal of Psycho-physiology 42:123~146.
Physical Manifestation of PTSD
First we examine somatic symptoms observed in PTSD. PTSD presents a real issue of how trauma-related conditions involve physical symptoms. PTSD appeared in DSM-III (1980) for the first time and it immediately gained citizenship in the psychiatric community. Since then the name and its implications have become widely accepted in the lay community as well. It consists of A criteria indicating the existence of trauma itself, and other symptoms which are described in B, C, and D criteria. This format originally seen in the 3rd edition of DSM survived despite repeated revisions all the way up to the draft of 5th edition which is currently available on the web. The criteria B, C, and D essentially describes what van der Kolk (1994) described as the “biphasic trauma response” of intrusion and numbing, originally noted by Kardiner (1941) and Lindeman (1944).
van der Kolk, B. (1994) The body keeps the score: Memory and the evolving psychobiology of posttraumatic stress, Harvard Review of Psychiatry, Jan/Feb, 1, 253-265.
Kardiner, A. (1941) The traumatic neuroses of war. Paul B. Hoeber, New York.
Lindemann, E. 1944) Symptomatology and management of acute grief. American Journal of Psychiatry, 101;141-148.
I will show a list of criterion B, C, and D in a summarized form.
B: Persistent, intrusive reexperiencing (flashbacks) of the traumatic event, in a form of recollection or nightmare, with perceptual, emotional, and physiological responses.
C: Persistent avoidance of stimuli associated with the trauma, with numbing of general responsiveness.
D: Persistent symptoms of increased arousal, with sleep disturbances, difficulty concentrating and hyperalertness.
It is clear that although PTSD is a psychiatric illness, its symptoms are not limited to the mind, it includes cardiovascular symptoms such as tachycardia and increased blood pressure, and respiratory symptoms such as hyperventilation and chest discomfort.
Moreover, the trauma-related memory has some “somatic feature”. As for ordinary memories, we can recall them whenever we like, and forget them at our will. However, trauma-related memories have very different features. Their recollection occurs suddenly and intrusively, and they may stay in our consciousness despite our effort to get distracted from them. They are often accompanied by various autonomic activities, such as tachycardia, shakiness and sweating. In a sense, trauma-related memories hijack our brain and the body, and this is what I mean by their “somatic feature”.
It was not recently that PTSD’s “somatic feature” was first noted. Let us examine the historical process of the trauma study.
History of PTSD as a physical illness
Disease notion what preceded PTSD was conceived more than a century ago. Trauma-related patients should have already existed since the beginning of human history, which was filled with battles, wars, pillage, rapes and any other atrocities. However, but it was not until in the later 19th century that the condition was recognized in a medical field. Around that time in Europe, railroad constrictions became widespread and people began to witness many train accidents and their victims in a massive order. It was Erichsen (1866) who descried the notion of “railway spine” with its symptoms he included as follows: memory impairment, poor concentration, sleep disturbance, anxiety, irritability, back stiffness and pain, headache, hearing problems, numbness of extremities, arms and hands pain.
Erichsen, J.E. (1866) On Railway and Other Injuries of the Nervous System. Walton & Maberly, London.
Cohen, M.L. (1996) The Derailment of Railway Spine: A Timely Lesson for Post-Traumatic Fibromyalgia Syndrome. Pain Reviews, 3; 181-202, 1996.
Oppenheim, H.(1889) Die Traumatiscren. The American Journal of the Medical Sciences. 97; 271-272, 1889.
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