From picking the best creamer that goes with coffee to finding the perfect pair of shoes, life revolves around decisions. Decision making is the process of gathering information and evaluating it.
Many internal and external factors influence our decision-making process. But, trauma can be detrimental to an individual's decision making and cognitive function.
Post-traumatic stress disorder, or PTSD, exposes individuals to disturbing thoughts and feelings. The complex nature of PTSD alters emotional and functional capabilities.¹ Nightmares and constant flashbacks are some of the major signs of PTSD. This can result in anger, detachment from others, and lack of acceptance.²
Decision Making and Brain Function
The amygdala and orbito-frontal cortex are essential to decision making and judgment.³ A stimulus initiates the decision-making process. These stimuli can be conditioned or unconditioned. Some of the stimuli we encounter throughout the day can encourage us to favor one option over the other.
For instance, imagine that you were bit by a dog as a kid. From that day on, every time you encounter a dog you will have a sense of fear that the dog might bite you again. You remember the pain and disturbance it caused you. This makes the dog a conditioned stimulus----something that makes you link an event to the stimulus. Depending on how you felt, the conditioned stimulus can encourage you to encounter specific emotions.
Our visual perception detects the stimulus. This information is encoded by neurons of the visual cortex. After gathering enough evidence and information, the brain will render this evidence to make a final decision. The process of enacting a decision in pursuit of action is known as the commitment point.⁴
PTSD Impaired Decision Making
Maintaining healthy executive function and decision making abilities include:
Attention and analyzing the stimuli
Working memory, manipulation, and maintenance of information
Inhibitory function in order to block autonomic function to maintain a goal-oriented attitude
Planning to develop and implement proper strategies to execute the decision
PTSD makes it difficult to regulate inhibitory function and attention. The influx of emotions manipulates the executive function of the brain. This leads to the adaptation and development of maladaptive coping mechanisms.⁵
Self-destructive traits, substance abuse, and violence are only some of the many possible outcomes of PTSD.
PTSD's biological alteration are divided by:
Malfunction of the limbic system that deals with emotion and memory
Adrenal, pituitary, and hypothalamic activities alteration due to changes in cortisol levels
Trauma and Cognitive Function
Traumatic events can cause disruption in cognitive function. The changes and challenges exposed to the brain can have negative impacts on its processing features. Cognitive error, intrusive thoughts and memories, and trauma-induced hallucinations are highly common.
Cognitive error is the misinterpretation of a situation that resembles a tragedy. This accompanies an overreaction from the individual. Imagine, one day you go out for a swim in the lake. One event leads to the other and you almost drown, but thankfully, you are able to save yourself.
This memory is now marked in the brain as a life-threatening experience. From that point on, maybe going to a small pool can trigger you and alarm you as danger.
Intrusive Thoughts and Memories
Traumatic experiences occur without any warning and leaves a shocking effect as a result. Intrusive thoughts and memories can trigger behavioral reactions. This makes it difficult for individuals to distinguish past events from present situations.
Memories lack a sense of recognition of how the reassurance of that traumatic event is low. Instability and frustration make decision making extremely hard for individuals.⁶
Auditory and visual hallucinations may be linked to post-traumatic stress disorder. The hallmark of the intrusive events can create visual imagery in PTSD. This similar concept occurs in different mental disorders as well. Considering schizophrenia, patients often see things and hear voices.
Trauma-induced hallucination can push individuals to re-experience those events. Memory-related trauma associates with psychic episodes. This interferes with information processing of the brain. Lack of proper information processing is detrimental to decision-making abilities.⁷
Our lives are dependent on making quick and accurate decisions to survive. There are many external and internal factors that can contribute to the alternation of our process of decision making. PTSD can be extremely debilitating and leave deep scars. You can always seek help to ease your pain and gradually overcome your fears. You should not let the past rule your future and limit you.
Bechara, A., Damasio, H., & Damasio, A. R. (2006). Role of the Amygdala in Decision-Making. Annals of the New York Academy of Sciences, 985(1), 356-369. doi:10.1111/j.1749-6632.2003.tb07094.x
What Is Posttraumatic Stress Disorder? (n.d.). Retrieved from https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd
Bechara, A., Damasio, H., & Damasio, A. R. (2006, January 24). NYAS Publications. Retrieved from https://nyaspubs.onlinelibrary.wiley.com/doi/abs/10.1111/j.1749-6632.2003.tb07094.x
Shadlen, M. N., & Roskies, A. L. (2012, March 30). The Neurobiology of Decision-Making and Responsibility: Reconciling Mechanism and Mindedness. Retrieved from https://www.frontiersin.org/articles/10.3389/fnins.2012.00056/full
Aupperle, R. L., Melrose, A. J., Stein, M. B., & Paulus, M. P. (2011, February 22). Executive function and PTSD: Disengaging from trauma. Retrieved from https://www.sciencedirect.com/science/article/pii/S0028390811000785
Choi, K. W., Sikkema, K. J., Velloza, J., Marais, A., Jose, C., Stein, D. J., . . . Joska, J. A. (2015, October). Maladaptive coping mediates the influence of childhood trauma on depression and PTSD among pregnant women in South Africa. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4500677/#:~:text=Trauma survivors tend to use,, & Holohan, 2005).
Steel, C. (2015, September 15). Hallucinations as a trauma-based memory: Implications for psychological interventions. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4569972/
PTSD Therapy in Eugene, OR: Betts Psychiatric, PC. (2018, January 10). Retrieved from https://www.bettspsychiatric.com/ptsd-therapy/