Fear conditioning and early life vulnerabilities: two distinct pathways of emotional dysregulation and brain dysfunction in PTSD

Abstract

The newly proposed criteria for posttraumatic stress disorder (PTSD) in the Diagnostic and StatisticalManual (DSM-V) include dysregulation of a variety of emotional states including fear, anger, guilt, andshame, in addition to dissociation and numbing. Consistent with these revisions, we postulate two models ofemotion dysregulation in PTSD in which fear is not the prevailing emotion but is only one of severalcomponents implicated in a dysregulated emotional system that also mediates problems regulating anger,guilt, shame, dissociation, and numbing.We discuss whether there is a relationship between fear and other emotion regulation systems that may helpfurther our understanding of PTSD and its underlying neurocircuitry. Two pathways describing therelationship between fear and other emotion regulation systems in PTSD are proposed. The first pathwaydescribes emotion dysregulation as an outcome of fear conditioning through stress sensitization and kindling.The second pathway views emotion dysregulation as a distal vulnerability factor and hypothesizes a furtherexacerbation of fear and other emotion regulatory problems, including the development of PTSD afterexposure to one or several traumatic event(s) later in life. Future research and treatment implications arediscussed.