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Biological Theories and Models of Posttraumatic Stress Disorder

At the center of the danger and threat of traumatic stressors is the human body. After all, it is the body that is at risk of death or injury. The body has to run, fight, or freeze when threatened. Energy needs to be mobilized by the brain and the heart to get the muscles moving. The lungs need to get oxygen to the heart, and the heart needs to get blood out to the periphery.

The biological approaches to understanding PTSD discussed in this chapter focus on the brain and body's protective responses to danger and threat of death or substantial injury. Although the physiology of danger and threat responding involves many organs and body systems, such as the lungs and heart, the focus on the biological understanding of PTSD is on the brain and central nervous system. Biological models of PTSD necessitate an understanding of the brain. The basis for a biological understanding of PTSD depends on the idea that the normal brain processes and mechanisms involved in danger and threat responding, self-preservation behavior, and protection behavior become dysfunctional, thus producing the various core symptoms of the syndrome. At the center of this dysfunction or malfunction is the process of learning. In PTSD (from a biological perspective at least), the hallmark of the disorder is continuing fear and danger responding in the absence of danger. The underlying brain systems are working when they shouldn't be. Essentially, individuals with PTSD have been biologically trained to respond to danger when no credible danger exists.

Before we go on, let's quickly address this issue of protection behavior. We know from Chapter 1 that someone can develop PTSD even if they are not the direct target of a threat and are only witnesses. Why? A discussion of this is an entire book in and of itself. However, simply put, witnessing trauma can stimulate fear for oneself in a physical sense ("I might be next," "An airplane might crash into my building," etc.) and in a very profound psychological sense ("I can't live without my wife," "My children are my life," etc.). Keep in mind that the psychoanalytic and psychodynamic models of PTSD spend a great deal of time on the issue of psychic or psychological threat. Even when we are not the specific targets of danger, our danger response behaviors can be activated and employed. This is probably most obvious in maternal or parental protection behavior where we are protecting our genetic investment in our offspring.

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