近两个月都睡得不好的朋友，可能是身体在提醒你：创伤后应激障碍正在发生！

Many of us will experience some kind of trauma during our lifetime.

很多人都会在生命中经历某种创伤。

Sometimes, we escape with no long-term effects. But for millions of us, those experiences linger, causing symptoms like flashbacks, nightmares, and negative thoughts that interfere with everyday life. This phenomenon, called post-traumatic stress disorder, or PTSD, isn’t a personal failing; rather, it’s a treatable malfunction of certain biological mechanisms that allow us to cope with dangerous experiences.

有时，我们能毫发无伤地从中脱离，但是，成千上万的人会难以脱身，并伴有许多后遗症，像是往事突然重现，还有噩梦，以及困扰我们每天生活的负面情绪。这种现象就是创伤后应激障碍，或者PTSD，这个不是个人问题；这其实是可以治愈的生理机制失调，这种生理机制一般来说帮助我们应对危险的经历。

To understand PTSD, we first need to understand how the brain processes a wide range of ordeals, including the death of a loved one, domestic violence, injury or illness, abuse, rape, war, car accidents, and natural disasters. These events can bring on feelings of danger and helplessness, which activate the brain’s alarm system, known as the “fight-flight-freeze” response.

想要了解PTSD，我们首先要了解脑部是如何处理一系列的严酷考验，包括爱人之死、家庭暴力、受伤或是疾病、虐待、强奸、战争、车祸、以及自然灾害。这些事件都能带来危险和无助的感觉，使得激活脑部的警觉系统，这就是大家知道的“战斗、逃跑或冻结”反应。

When this alarm sounds, the hypothalamic, pituitary, and adrenal systems, known as the HPA axis, work together to send signals to the parasympathetic nervous system. That’s the network that communicates with adrenal glands and internal organs to help regulate functions like heart rate, digestion, and respiration. These signals start a chemical cascade that floods the body with several different stress hormones, causing physiological changes that prepare the body to defend itself. Our heart rate speeds up, breathing quickens, and muscles tense.

当这个警报响起时，下丘脑，脑垂体和肾上腺系统，也就是“下丘脑-垂体-肾上腺轴”，通过协同工作将信号送达副交感神经系统。就是沟通肾上腺和体内器官的网络，来帮助调节身体机能，像是心率、消化、以及呼吸。这些信号引发了化学物质的联动反应，伴随着几种不同的压力荷尔蒙流向身体，导致生理变化，使得身体进入防御准备状态。我们的心跳加速，呼吸加快，肌肉紧绷。

Even after a crisis is over, escalated levels of stress hormones may last for days, contributing to jittery feelings, nightmares, and other symptoms. For most people, these experiences disappear within a few days to two weeks as their hormone levels stabilize. But a small percentage of those who experience trauma have persistent problems —sometimes vanishing temporarily only to resurface months later.

甚至在危机结束之后，压力荷尔蒙在数日之内仍然持续保持一个高值，导致神经过敏的感觉、 噩梦、以及其它症状。对于多数人，这些体验会在几天到两周内消失，他们荷尔蒙水平慢慢趋于稳定。但是一小部分经历心理创伤的人就有着难以摆脱的问题——有时症状短暂消失，却在几个月后又重新发作。

We don’t completely understand what’s happening in the brain, but one theory is that the stress hormone cortisol may be continuously activating the “fight-flight-freeze” response while reducing overall brain functioning, leading to a number of negative symptoms. These symptoms often fall into four categories: intrusive thoughts, like dreams and flashbacks, avoiding reminders of the trauma, negative thoughts and feelings, like fear, anger, and guilt, and “reactive” symptoms like irritability and difficulty sleeping.

我们不完全知道我们的脑子里发生了什么，但是有一个理论是压力荷尔蒙皮质醇也许会持续激活 “战斗，逃跑或冻结”反应，于此同时，大脑的功能被降低，导致很多负面反应。这些症状通常被分为四类：侵入式想法，像是做梦或者闪回，逃避对于心理创伤的回忆，负面想法和感觉，像是恐惧，愤怒和负罪感，以及“反应的”症状，像是易怒以及难以入睡。

Not everyone has all these symptoms, or experiences them to the same extent and intensity. When problems last more than a month, PTSD is often diagnosed. Genetics, on-going overwhelming stress, and many risk factors like preexisting mental illnesses or lack of emotional support, likely play a role in determining who will experience PTSD. But the underlying cause is still a medical mystery.

不是每个人都有这些症状，或者有着相同程度或强度。当这些问题持续长达一个月，创伤后压力综合征就经常可以被确诊了。基因，正在经历的过度紧张，以及很多风险因素像是已经存在的心理疾病，或是缺少感情上的支持，都在引发创伤后压力综合征种扮演着角色。但是直接原因一直是一个谜团。

A major challenge of coping with PTSD is sensitivity to triggers, physical and emotional stimuli that the brain associates with the original trauma. These can be everyday sensations that aren’t inherently dangerous but prompt powerful physical and emotional reactions. For example, the smell of a campfire could evoke the memory of being trapped in a burning house. For someone with PTSD, that memory activates the same neurochemical cascade as the original event. That then stirs up the same feelings of panic and helplessness as if they’re experiencing the trauma all over again.

解决创伤后压力综合征最大的挑战是它的敏感性，当患者面临生理和心理的刺激时，大脑就把这些刺激与之前的创伤联系在一起。这些刺激其实可以是日常并不危险的的感觉，但是激起短暂而有力的生理和情绪反应。比如，闻到篝火的气味时可以唤起曾经被困在燃烧中的房子的经历。对于创伤后压力综合征患者来说，这个记忆激活了相同的神经化学反应，就跟一开始受到的创伤一样。然后，就激起了相同的慌张和无助感，就像再次经历这次创伤一样。

Trying to avoid these triggers, which are sometimes unpredictable, can lead to isolation. That can leave people feeling invalidated, ignored, or misunderstood, like a pause button has been pushed on their lives while the rest of the world continues around them.

尝试去躲避这些有时难以预测的事件，会导致与世隔绝。会让患者觉得无助、被忽视、被误解，就像是患者的人生被按了暂停键，而周围的一切却在持续地运转。

But, there are options. If you think you might be suffering from PTSD, the first step is an evaluation with a mental health professional who can direct you towards the many resources available. Psychotherapy can be very effective for PTSD, helping patients better understand their triggers. And certain medications can make symptoms more manageable, as can self- care practices, like mindfulness and regular exercise.

但是，还有别的选择。如果你认为你正在遭受创伤后压力综合征的折磨，你第一件要做的事是接受心理健康专家的评估，他们能够给你很多帮助。心理治疗对于创伤后压力综合征是十分有效的，帮助患者理解是什么引起他们的症状。有一些药物也可以使得症状更容易被控制，自我保健也能有所帮助，像是保持专注和锻炼身体。

What if you notice signs of PTSD in a friend or family member? Social support, acceptance, and empathy are key to helping and recovery. Let them know you believe their account of what they’re experiencing, and that you don’t blame them for their reactions. If they’re open to it, encourage them to seek evaluation and treatment.

如果你意识到了你的家人或朋友可能患有创伤后压力综合征该怎么办呢？社交支持，接受和同情 关怀都很有可能帮助他们的恢复。让他们知道你重视他们的经历，以及你并不会责怪他们的行为。如果他们对这个话题持开放态度，那就鼓励他们去接受评估和治疗。

PTSD has been called “the hidden wound” because it comes without outward physical signs. But even if it’s an invisible disorder, it doesn’t have to be a silent one.

创伤后压力综合征也被叫做“隐藏的伤口”，因为它不会有明显的生理症状。但是，虽然它是难以被看到的疾病，并不意味着它是该被忽视的一个。