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August 21, 2002


Years of Research Come Together in a Book Explaining How Stress Affects the Brain

Emory University psychiatrist J. Douglas Bremner, M.D., has compiled more than ten years of research, reflection, and observations as a clinical psychiatrist in a book that explains how stress-induced changes in the brain may account for some psychiatric disorders, including Post-traumatic Stress Disorder (PTSD), dissociative disorders, borderline personality disorder, adjustment disorder, depression, and anxiety.

The book "Does Stress Damage the Brain? Understanding Trauma-Related Disorders from a Neurological Perspective," outlines the theory that there is a biological basis for trauma-related disorders which can be essential in diagnosing and treating such disorders. This view of trauma spectrum disorders, as Bremner calls them, is a departure from the widely held view in psychiatry that psychiatric disorders are completely different from one another, and have different causes.

The idea of trauma spectrum disorders came out of research conducted by Bremner and colleagues when he was a young psychiatry resident at West Haven, VA Hospital and Yale University Hospital, During an experience in the wee hours of the morning with a Vietnam War combat veteran who was trapped in the middle of a post-traumatic "flashback," Dr. Bremner was struck by the seemingly reflexive and uncontrollable nature of the symptoms, which were similar to those of patients having seizures. Dr. Bremner wondered if the flashbacks represented a neurological rather than a psychological condition, as they were considered to be at that time.

"When patients are having flashbacks, as my veteran was, they are unaware of what is going on in the present," said Dr. Bremner. "Patients often describe flashbacks as if a movie were playing in front of their eyes, complete with visual images, sounds and smells." Dr. Bremner theorized that the flashbacks could involve the same brain areas that are affected by seizures, most importantly the hippocampus, which is affected in 80% of epilepsy cases. Subsequent PET (positron emission tomography) studies with trauma victims showed a significant and direct link between a reduction in the volume of the hippocampus and PTSD.

Bremner emphasizes in his book that all bodily functions are linked in one way or another to the brain. In a stressful situation, the brain automatically sends signals that release hormones, including cortisol and adrenaline. The heart pumps faster; blood pressure goes up; and blood flow shifts to parts of the body that need it the most such as the brain and muscles so we can think fast and fight or run. If the brain overcharges for a prolonged period of time in response to stressful stimuli, the body does not have a chance to recuperate and the results can be deadly. "If stress has effects on the brain and neurological function, then stress has effects on all parts of the body including the heart, blood vessels, the immune system, and the digestive system," says Bremner. "The long list of damaging effects can include heart disease, memory impairment, depression, and even increased susceptibility to stroke and cancer."

"Knowledge is power." Dr. Bremner adds. "Our patients will benefit from a greater knowledge of the potential effects of stress on mind, body and spirit. It is essential that physicians talk to their patients and determine what is going on in their lives before making a diagnosis."

Dr. Bremner's background includes degrees in both psychiatry and neuroradiology, fueled by an intense fascination with the link between trauma and its biological effects. With the help of advanced PET technology, Bremner and his team of Emory researchers continue to peer into the brains of individuals with PTSD hoping to further determine the relationship between trauma and functionality, so that future victims can be cured. At Emory, he is director of the Center for Positron Emission Tomography and assistant professor of psychiatry and behavioral sciences. He also serves as director of mental health research at the Atlanta Veterans Administration Medical Center.

"Understanding of the human brain is more important now than ever " said Bremner. "One thing I can say from my clinical experience is that people in our country will be sorting out their response to the tragic events of September 11 for many years to come. There are many patterns of response to that tragedy that can be compared to other traumatic events from prior history. However, in many respects this particular event was unprecedented. The constant threat of terrorist activity is an anomaly."

Dr. Bremner's book is available from W. W. Norton & Company, 1/800-433-2830.

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