Disturbed Sleep Connects Symptoms of Posttraumatic Stress Disorder and Somatization: A Network Analysis Approach.

Laurence Astill Wright,Eoin Mcelroy,Stanley Zammit,Kali Barawi,Neil P Roberts,Jonathan I Bisson,Natalie Simon

doi:10.1002/jts.22619

Abstract

Posttraumatic stress disorder (PTSD) and physical health problems, particularly somatic symptom disorder, are highly comorbid. Studies have only examined this co-occurrence at the disorder level rather than assessing the associations between specific symptoms. Using network analysis to identify symptoms that act as bridges between these disorders may allow for the development of interventions to specifically target this comorbidity. We examined the association between somatization and PTSD symptoms via network analysis. This included 349 trauma-exposed individuals recruited through the National Centre for Mental Health PTSD cohort who completed the Clinician-Administered PTSD Scale for DSM-5 and the Patient Health Questionnaire-15. A total of 215 (61.6%) individuals met the DSM-5 diagnostic criteria for PTSD. An exploratory graph analysis identified four clusters of densely connected symptoms within the overall network: PTSD, chronic pain, gastrointestinal issues, and more general somatic complaints. Sleep difficulties played a key role in bridging PTSD and somatic symptoms. Our network analysis demonstrates the distinct nature of PTSD and somatization symptoms, with this association connected by disturbed sleep.

Highlights

symptom disorders” (SSD) involve inflammatory or immune-related processes, and it is likely that Posttraumatic stress disorder (PTSD) affects global immune functioning through shifts in neurobiology in the hypothalamic– pituitary–adrenal (HPA) axis (Song et al, 2019), we did not assess this in the current study
The network suggests that PTSD and somatic symptoms form distinct clusters and that sleep difficulty may act as a key bridge between these domains
Sleep difficulty could be a fundamental symptom that exacerbates and maintains PTSD and somatization comorbidity, but it could be a consequence of this comorbidity, resulting in a positive correlation

Summary

Introduction

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; APA, 2013) conceptualizes medically unexplained symptoms (MUS) as “somatic symptom disorders” (SSD) and requires the presence of distressing physical health complaints in association with excessive concern or preoccupation with somatic symptoms (Afari et al, 2014) This suggests a large psychobehavioral overlay in a condition with uncertain physical pathophysiology (Henningsen, 2018), with considerable personal and societal costs (Konnopka et al, 2013). Cognitive and behavioral features of PTSD, such as insomnia, depression, substance misuse, anxiety sensitivity, avoidant coping, and negative posttraumatic cognitions may, directly and indirectly, exacerbate somatic symptoms through systemic changes in inflammatory and immune functioning (Kendall-Tackett, 2009) Negative posttraumatic cognitions, such as an individual’s negative perceptions of themselves and the world, are closely related to low levels of social support and interpersonal problems and contribute to the onset and maintenance of PTSD (AlligerHorn et al, 2017). These negative cognitions have been associated with chronic pain–related impairment (Porter et al, 2013)

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