Abstract
A core manifestation of post-traumatic stress disorder (PTSD) is a disconnection between physiological state and psychological or behavioral processes necessary to adequately respond to environmental demands. Patients with PTSD experience abnormal oscillations in autonomic states supporting either fight and flight behaviors or withdrawal, immobilization, and dissociation without an intervening “calm” state that would provide opportunities for positive social interactions. This defensive autonomic disposition is adaptive in dangerous and life threatening situations, but in the context of every-day life may lead to significant psychosocial distress and deteriorating social relationships. The perpetuation of these maladaptive autonomic responses may contribute to the development of comorbid mental health issues such as depression, loneliness, and hostility that further modify the nature of cardiovascular behavior in the context of internal and external stressors. Over time, changes in autonomic, endocrine, and immune function contribute to deteriorating health, which is potently expressed in brain dysfunction and cardiovascular disease. In this theoretical review paper, we present an overview of the literature on the chronic health effects of PTSD. We discuss the brain networks underlying PTSD in the context of autonomic efferent and afferent contributions and how disruption of these networks leads to poor health outcomes. Finally, we discuss treatment approaches based on our theoretical model of PTSD.
Highlights
Post-traumatic stress disorder (PTSD) is a common diagnosis following trauma exposure
In a survey of 23,936 people with trauma exposure conducted by the World Health Organization World Mental Health Surveys across 13 countries, 6.6% evidenced clinical or subclinical PTSD symptoms consistent with DSM-V criteria (McLaughlin et al, 2014)
An investigation into plasma cortisol concentrations of rape victims revealed that those who reported a history of previous sexual trauma to a new assault did not respond with the same increase in plasma cortisol that first time victims did (Resnick et al, 1995). These findings suggest a direct relationship between stress responses, autonomic nervous system behavior, the manifestation of PTSD, and a mechanism of health decline
Summary
Post-traumatic stress disorder (PTSD) is a common diagnosis following trauma exposure. PTSD AND AUTONOMIC BEHAVIOR: CHRONIC THREAT AND THE PERPETUAL STATE OF FIGHT, FLIGHT, OR IMMOBILIZATION Post-traumatic stress disorder manifests as a disorder across multiple systems in which there are atypical expressions of social engagement behaviors as well as disruptions in the regulation of emotional and cognitive processes.
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