Understanding Spatial Disorientation And PTSD

Post-traumatic stress disorder (PTSD) is a debilitating psychological condition that develops in some people after they experience trauma. Many types of trauma can lead to PTSD, including witnessing or experiencing war, interpersonal violence, psychological abuse, car accidents, or natural disasters. 

Statistics¹ show that roughly 5 to 10% of the US population will develop PTSD at some point in their lives, with women being twice as likely as men to develop the condition.

What are the symptoms of PTSD?

It’s completely normal to feel upset or uneasy after a traumatic event, but if you feel exceptionally troubled, and the feeling persists for more than a month and interferes with your daily functioning, you might have PTSD. Symptoms of PTSD include:

• Upsetting thoughts, flashbacks, or nightmares about the event

• An urge to avoid places, sensory input, or people who remind you of the trauma

• Negative feelings, such as shame or guilt, depressed mood, or emotional numbness

• Increased irritability and hypervigilance, which may lead to sleep issues

While these symptoms are commonly associated with PTSD, the condition is as unique as you are, and PTSD affects people differently. If something feels off, it’s a good idea to see a healthcare provider, regardless of whether or not you’re experiencing the specific symptoms outlined above. 

Spatial disorientation is a condition that often occurs alongside PTSD. A study² of military veterans with PTSD found evidence that participants with increased PTSD symptoms were more likely to experience some type of spatial orientation issue, such as dizziness, disorientation, or postural imbalance (or a combination of these) in bustling spaces, such as shopping malls.

What is spatial disorientation?

Your body’s sense of orientation relies on input from your eyes, ears, muscles, and skin. In some cases, if something happens too slowly or too quickly, or if there’s a mismatch between the information processed through two or more senses, the confusion may trigger an unusual response from your sensory apparatus, and your mind and body may struggle to figure out what’s happening.

Interestingly, when airplane pilots or divers are surrounded by the vastness of the sky or sea without many other visual cues, they sometimes experience spatial disorientation.³ In those situations, they may struggle to determine the position of their body relative to their surroundings. Their sensory system is so accustomed to processing many stimuli at once that their body doesn’t know how to respond when everything else is removed, and there’s nothing to stimulate the visual system.

Therefore, a lack of information to be processed by the senses may affect the body the same way an overload of information can.

Disorientation and PTSD

The disorientation affecting people living with PTSD differs from the spatial disorientation described above, and its causes aren’t fully understood. One theory is that the symptoms are triggered by anxiety, which leads people to feel panicked and become disoriented.

In contrast, some researchers believe that the disorientation linked to PTSD may be caused by changes in the body’s balance apparatus, the vestibular system, which is located in the inner ear and helps the body interpret and adapt motions, position, and balance.

Abnormalities within the vestibular system are known to cause spatial orientation problems, including dizziness, poor balance, and disorientation, so there’s a solid basis for this theory.

Research⁴ conducted with participants who don’t have PTSD shows that people who have problems within the vestibular system may experience elevated levels of stress and anxiety, and the relationship is bilateral — people who are stressed or have anxiety may be more likely to develop vestibular dysfunction. This connection may help explain why people with PTSD are more likely to experience disorientation symptoms.

Any or all of these theories may be correct, but regardless of the mechanism, the connections between PTSD and disorientation are undeniable. 

Spatial processing and PTSD

There are two types of spatial processing:

• Allocentric: how you interpret the locations of objects in an environment relative to other objects in the environment, e.g., the distance between a bicycle and a car

• Egocentric:  how you interpret the positioning of objects in the environment relative to yourself, e.g., the distance between you and another person when you’re walking on a sidewalk

A study⁵ comparing allocentric and egocentric processing found that people with PTSD performed significantly worse on allocentric spatial processing tasks than the trauma-exposed control group who didn’t suffer from PTSD. However, their performance was typical on tasks that required egocentric processing.

The outcomes of this study may indicate that people with PTSD have a problem with a part of the brain called the hippocampus, which plays a key role in spatial memory. People with damage to the hippocampus⁶ may struggle with remembering where objects are located once they’ve walked around a space and changed their perspective.

This finding further validates that a connection between the hippocampus and spatial processing likely exists.

Cortisol, the body’s stress hormone, is elevated (long-term) in people with PTSD. The brain cells located in the hippocampus are particularly sensitive to cortisol and may sustain damage (or die) if cortisol levels are high for an extended period. This could help to explain why people with PTSD are susceptible to spatial disorientation. 

The lowdown

People living with PTSD sometimes experience symptoms related to spatial orientation, such as dizziness, disorientation or confusion, and postural imbalance. The causes of these symptoms are not yet fully understood, but anxiety-related changes in some regions of the brain, including the vestibular system and the hippocampus, likely play a role.

Evidence also suggests that people with PTSD have difficulties with allocentric spatial processing, which may make it challenging to understand and remember how objects in the environment are positioned in relation to each other. This can lead to disorientation, particularly in an unfamiliar setting.