Inner City Residents and Anxiety

innerCityDid you know low-income, inner-city residents suffer from PTSD as much as or more than combat vets? And did you know about 30% to 40% of the risk for PTSD is inherited? Also, traumatized parents may increase their children’s likelihood of developing symptoms environmentally, through psychological and parenting processes.

The new science of epigenetics has discovered a mother’s stress could alter some of her genes, which she could then pass down to her child. Experiences in one generation could affect how genes are expressed in the next generation.

This blog is based on an article, The Anatomy of Fear: Understanding the biological underpinnings of anxiety, phobias, and PTSD by Martha McKenzie in the spring 2014 Emory Medicine Magazine.

A frightening stimulus can produce racing heart, heavy breathing, startle response, and sweating. Anxiety disorders are one of the most common mental illnesses, with nearly one-third of Americans experiencing symptoms at least once. These fear-related disorders include panic disorders, phobias, and post-traumatic stress disorder (PTSD). PTSD includes intrusive thoughts, memories, nightmares, and startle responses, and the concept of avoidance, which may extend to other areas of the individual’s life.

Psychiatrist and researcher Kerry Ressler investigates the psychology, genetics, and biology of PTSD at Grady Hospital. Through the Grady Trauma Project he draws attention to the problem of inner city intergenerational violence. “There’s a patient I’ve seen who was attacked in a dark alley,” Ressler shared on the Charlie Rose show. “Initially it just felt dangerous to go out at night, but after a while she grew afraid of men and couldn’t go to that part of town. Then she couldn’t leave her house, and finally, her bedroom. The world got more and more dangerous.”

Ressler and collaborators gave patients admitted to the ER following a trauma—a car wreck, gunshot wound, rape—imaginal exposure therapy. “We asked them to talk about what happened in a therapeutic way. We know this type of cognitive behavior therapy works well for people with chronic PTSD. Here we were applying the same technique before the fear memory was consolidated.” Three months after their trauma, PTSD incidence in patients who received the intervention was half that of patients who did not.

Ressler and his team collect blood samples from trauma victims in the ER and search for genes and other biomarkers that would identify people who are at increased risk for developing PTSD following trauma. “We get blood from people right after they come into the ED and look for biomarkers that are predictive, within the first hours after suffering a trauma, of later development of PTSD. The vision would be to develop the equivalent of a stroke protocol or a heart attack protocol in the ED for psychological trauma.” With early pharmacological or psychological therapeutic intervention, possibly even in the emergency department, preventing PTSD might be possible.

“One of the reasons we created the Grady Trauma Project… is to shine light on an extremely underserved and underappreciated problem, civilian inner-city trauma,” says Ressler. “Within the Grady Hospital population, we’ve found that 80% to 90% have experienced a severe trauma, and 30% to 35% have gone on to develop PTSD. That rate is higher than for combat vets, yet most people are not aware of it. We think it is an epidemic problem, and we believe that the inner-city cycle of violence and poverty can be explained in part through the effects of trauma on residents’ brains.”

Ressler says, “Practicing medicine reminds us of why the research we do is so important for our patients, who are suffering every day. And if we find ways to treat these adults, it may very well help their children and grandchildren as well.

Please read about my new book, The Enneagram for Teens.



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