Expression Of Posttraumatic Stress Disorder Research Articles

Exploring the impact of biological sex on intrinsic connectivity networks in PTSD: A data-driven approach

IntroductionSex as a biological variable (SABV) may help to account for the differential development and expression of post-traumatic stress disorder (PTSD) symptoms among trauma-exposed males and females. Here, we investigate the impact of SABV on PTSD-related neural alterations in resting-state functional connectivity (rsFC) within three core intrinsic connectivity networks (ICNs): the salience network (SN), central executive network (CEN), and default mode network (DMN). MethodsUsing an independent component analysis (ICA), we compared rsFC of the SN, CEN, and DMN between males and females, with and without PTSD (n = 47 females with PTSD, n = 34 males with PTSD, n = 36 healthy control females, n = 20 healthy control males) via full factorial ANCOVAs. Additionally, linear regression analyses were conducted with clinical variables (i.e., PTSD and depression symptoms, childhood trauma scores) in order to determine intrinsic network connectivity characteristics specific to SABV. Furthermore, we utilized machine learning classification models to predict the biological sex and PTSD diagnosis of individual participants based on intrinsic network activity patterns. ResultsOur findings revealed differential network connectivity patterns based on SABV and PTSD diagnosis. Males with PTSD exhibited increased intra-SN (i.e., SN-anterior insula) rsFC and increased DMN-right superior parietal lobule/precuneus/superior occipital gyrus rsFC as compared to females with PTSD. There were also differential network connectivity patterns for comparisons between the PTSD and healthy control groups for males and females, separately. We did not observe significant correlations between clinical measures of interest and brain region clusters which displayed significant between group differences as a function of biological sex, thus further reinforcing that SABV analyses are likely not confounded by these variables. Furthermore, machine learning classification models accurately predicted biological sex and PTSD diagnosis among novel/unseen participants based on ICN activation patterns. ConclusionThis study reveals groundbreaking insights surrounding the impact of SABV on PTSD-related ICN alterations using data-driven methods. Our discoveries contribute to further defining neurobiological markers of PTSD among females and males and may offer guidance for differential sex-related treatment needs.

Differences in the phenotypic expression of posttraumatic stress disorder symptoms in US military veterans with and without clinical insomnia.

The goal of this study was to examine the phenotypic expression of posttraumatic stress disorder (PTSD) symptoms in veterans with probable PTSD and clinical insomnia relative to those with probable PTSD alone. Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of 4,069 US military veterans. A total of 3.9% of the full sample screened positive for probable PTSD and clinical insomnia and 3.2% for probable PTSD alone. Relative to veterans with probable PTSD alone, those with probable PTSD and clinical insomnia reported significantly greater severity of intrusions, avoidance, and anxious and dysphoric arousal symptoms. Post hoc analyses of individual symptoms revealed that trauma-related nightmares; flashbacks; trauma-related emotional and physiological reactivity; avoidance of trauma-related thoughts, feelings, and external reminders; exaggerated startle response; concentration difficulties; and trauma-related sleep difficulties differed between groups. A multivariable logistic regression analysis further revealed that trauma-related sleep difficulties, trauma-related physiological reactivity, and exaggerated startle response independently predicted probable PTSD and clinical insomnia relative to PTSD alone. Results of this study suggest that trauma-related reactivity and arousal symptoms differentiate veterans with probable PTSD and clinical insomnia from those with probable PTSD alone. They further underscore the importance of utilizing nuanced models of PTSD symptom expression as part of assessment and treatment planning efforts in this population. DeViva JC, McCarthy E, Fischer I, Pietrzak RH. Differences in the phenotypic expression of posttraumatic stress disorder symptoms in US military veterans with and without clinical insomnia. J Clin Sleep Med. 2024;20(3):345-351.

Neurobiological mechanisms underlying delayed expression of posttraumatic stress disorder: A scoping review.

BACKGROUNDThe capacity of posttraumatic stress disorder (PTSD) to occur with delayed onset has been documented in several systematic reviews and meta-analyses. Neurobiological models of PTSD may provide insight into the mechanisms underlying the progressive increase in PTSD symptoms over time as well as into occasional occurrences of long-delayed PTSD with few prodromal symptoms. AIMTo obtain an overview of key concepts explaining and types of evidence supporting neurobiological underpinnings of delayed PTSD.METHODSA scoping review of studies reporting neurobiological findings relevant to delayed PTSD was performed, which included 38 studies in the qualitative synthesis. RESULTSNeurobiological mechanisms underlying PTSD symptoms, onset, and course involve several interconnected systems. Neural mechanisms involve the neurocircuitry of fear, comprising several structures, such as the hippocampus, amygdala, and prefrontal cortex, that are amenable to time-dependent increases in activity through sensitization and kindling. Neural network models explain generalization of the fear response. Neuroendocrine mechanisms consist of autonomic nervous system and hypothalamic-pituitary-adrenocortical axis responses, both of which may be involved in sensitization to stress. Neuroinflammatory mechanisms are characterized by immune activation, which is sometimes due to the effects of traumatic brain injury. Finally, neurobehavioral/contextual mechanisms involve the effects of intervening stressors and mental and physical disorder comorbidities, and these may be particularly relevant in cases of long-delayed PTSD. CONCLUSIONThus, delayed PTSD may result from multiple underlying neurobiological mechanisms that may influence the likelihood of developing prodromal symptoms preceding the onset of full-blown PTSD.

Saffron (Crocus sativus) aqueous extract reverses the hypothalamus-pituitary-adrenal axis activity in rat model of post-traumatic stress disorder

Crocus sativus L., Iridaceae, has been used worldwide in traditional medicinefor treatment ofsome neurological disorderssuch as depression. Post-traumatic stress disorder is a mental disorder developed in peoplewho experience stressful events. Since stress has been proposed tocause thehypothalamic-pituitary-adrenal axis malfunction in post-traumatic stress disorder patients, this study aimed at investigating the effect of saffron aqueous extract on hypothalamic-pituitary-adrenal axis activity in rats of post-traumatic stress disorder model. Here, Post-traumatic stress disorder animals received an acute electro foot shock; however, 5min before the stress session, these animals received an intra-cerebral-ventricular (10μg/rat) infusion of either saffron aqueous extract or saline. Twenty one days later, they were re-exposedto the stress box withoutinducing stress, andthen were examined for their freezing behavior. The impact of stress and saffron aqueous extract on serum corticosterone, corticotrophin releasing hormone gene expression in hypothalamus and glucocorticoid receptor gene expression in pituitary gland werethen evaluated on day 28. Intra-cerebral-ventricular injection of saffron aqueous extract resulted in an increase in serum corticosterone level and reduced symptoms of freezing behavior, and corticotrophin releasing hormone and glucocorticoid receptor gene expression in post-traumatic stress disorder groups.Saffron administration could improve the symptoms of stress-induced post-traumatic stress disorder, possiblythrough the adjustment ofhypothalamic-pituitary-adrenal axis function.

S19. Neural and Behavioral Evidence of Estradiol Modulating Fear Learning and Extinction Among Women With PTSD

Fear expression in posttraumatic stress disorder (PTSD) and anxious psychopathology is sexually dimorphic and varies with fluctuations in estrogen throughout a menstrual cycle. While estrogen is hypothesized as a mechanism of increased PTSD among women, there is a dearth of research on modulatory effects of estrogen on fear responding among women with PTSD specifically, and no data on neural outcome measures in women with PTSD.

Predictors of Treatment Access and Initiation Among Diverse, Low-Income Victims of Violence Offered a Trauma-Focused Evidence-Based Psychotherapy.

Many victims of violence may benefit from trauma-focused evidence-based psychotherapies (EBPs), but fail to utilize treatment. The current study investigated factors associated with treatment access and treatment initiation in a low-income, racially and ethnically diverse, urban population of victims of violence who were screened for EBPs. The sample consisted of 941 adults, mean age = 35.87 (SD = 12.8), who were screened for mental health treatment and offered an EBP. Overall, 55.7% of individuals accessed treatment by attending an in-person screening appointment and intake, and 79.0% of the individuals who accessed treatment then initiated treatment by attending the first EBP session. Analysis revealed higher age (odds ratio [OR] = 1.05, 95% confidence interval (CI) = [1.04, 1.09]) and lower expression of posttraumatic stress disorder (PTSD) symptoms predicted higher rates of accessing treatment (OR = 0.20, 95% CI = [0.05, 0.82]). Higher global severity of distress (OR = 3.22, 95% CI = [1.14, 9.10]), poor quality of life in the area of psychological health (OR = 0.90, 95% CI = [0.81, 1.00]), and better quality of life in the area of physical health significantly predicted initiation of treatment (OR = 1.11, 95% CI = [0.998, 1.24]). Findings suggest that low-income, ethnically and racially diverse victims of violence may effectively utilize trauma-focused EBPs offered in a community setting.

Combat and operational risk factors for post-traumatic stress disorder symptom criteria among United States air force remotely piloted aircraft “Drone” warfighters

The prevalence and expression of post-traumatic stress disorder (PTSD) symptoms among United States Air Force remotely piloted aircraft (RPA; commonly referred to as “drones”) warfighters exposed to battlefield trauma via remote, electronic warfare is relevant and critical to the effective delivery of mental health care for this population. RPA warfighters (n = 715) with real-time exposure to at least one traumatic event participated in an online survey. Measures included the PTSD Checklist for DSM-5 (PCL-5) and survey of exposure to traumatic events during the course of operational combat missions. A total of 6.15% met PTSD symptom criteria; those in the age ranges of 31–35 and 36–40 and those working 51 or more hours per week had greater odds of meeting symptom criteria. For combat-related events, the number of events in which RPA warfighters witnessed civilian bystanders being killed by enemy forces or felt shared responsibility for the injury or death of bystanders were also significant predictors, regardless of whether the risk was anticipated or unanticipated. The results of this study suggest that specific types of exposure and participation in missions with specific outcomes, albeit via electronic, remote means, are associated with an increased risk for meeting PTSD symptom criteria.

5.4 Gender and Ethno-Racial Differences in Symptom Expression of Posttraumatic Stress Disorder and Depression Among Child Trauma Victims

5.4 Gender and Ethno-Racial Differences in Symptom Expression of Posttraumatic Stress Disorder and Depression Among Child Trauma Victims

Main and Interactive Effects of Anxiety Sensitivity and Physical Distress Intolerance with Regard to PTSD Symptoms Among Trauma-Exposed Smokers

The present study examined the roles of anxiety sensitivity (AS; the tendency to misinterpret physical internal sensations of harmful) and distress tolerance (the capacity to tolerate aversive stimuli) in terms of the expression of posttraumatic stress disorder (PTSD) symptoms among a sample of trauma-exposed, treatment-seeking tobacco smokers (n = 137; Mage = 37.7 years, 48.2% female). It was hypothesized that higher AS and lower physical distress tolerance would interact to predict greater PTSD avoidance and hyperarousal symptoms. Results were partially consistent with this prediction. Specifically, there was a significant interactive effect of AS by physical distress tolerance in terms of PTSD hyperarousal symptom cluster severity. The form of the interaction was in the expected direction, with the highest levels of PTSD hyperarousal symptoms reported among smokers with higher levels of AS and a lower capacity to tolerate physical distress. Findings underscore the importance of considering AS and physical distress tolerance in terms of better understanding mechanisms underlying the expression of PTSD symptoms among trauma-exposed smokers.

Video-Based Analysis of Bodily Startle and Subsequent Emotional Facial Expression in Posttraumatic Stress Disorder.

Exaggerated startle is a core hyperarousal symptom of Posttraumatic Stress Disorder (PTSD). Observational studies on the characteristics of this response are strikingly lacking. Previous research has demonstrated that detailed video analysis of facial and bodily responses to startling stimuli enables the differentiation of an initial, primarily reflexive response and a secondary, primary emotional response. We exposed PTSD patients (n = 34) and trauma-exposed but healthy participants (TE group, n = 26) to startling electric stimuli while acquiring observational behavioral, psychophysiological, and experiential measures. Videographic results indicate that PTSD patients' initial bodily startle response was stronger than in the TE group, and their secondary facial expression was more negatively valenced, largely due to elevated anger expression. Videographic assessment of primary and secondary startle responses provides a new window into reflexive and emotional functioning of PTSD and may therefore complement existing startle measures. PTSD treatments should address bodily startle, negative symptom appraisals, and anger more specifically.

Disturbances of emotional awareness and expression in posttraumatic stress disorder: Meta-mood, emotion regulation, mindfulness, and interference of emotional expressiveness.

Demonstrations of deficient emotional awareness (EA) in posttraumatic stress disorder (PTSD) measured by alexithymia were extended to trait metamood, difficulties in emotion regulation, and trait mindfulness in 55 women with PTSD related to history of interpersonal/familial maltreatment. Perceived causes of interference of emotional expression were also identified that fully mediated the association between PTSD diagnostic status and alexithymic difficulty describing feelings, but only partially mediated the association between PTSD diagnosis and alexithymic difficulty identifying feelings. Such causes of interference of emotional expression correlated with history of childhood physical and emotional neglect. Clinical implications and future research directions are discussed.

Transcriptional control of monocyte gene expression in post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) confers an increased risk for disorders with an inflammatory etiology. PTSD-related dysregulation of the sympathetic nervous system (SNS) and hypothalamic-pituitary adrenal (HPA) axis and associated alterations in inflammatory activity may contribute to this increased risk. However, little is known about convergent SNS, HPA and inflammatory signaling at the level of the immune cell transcriptome in PTSD. To explore such signaling, we examined the prevalence of specific transcription factor binding motifs in the promoter regions of differentially expressed genes in monocytes from individuals with PTSD and matched controls. Participants included 49 men (24 PTSD+ and 25 trauma-exposed controls) and 18 women (10 PTSD+ and 8 controls). Men with PTSD showed up-regulation of target genes for the NF-κB/Rel family of transcription factors, which convey inflammatory signals, up-regulation of target genes for CREB/ATF transcription factors, which convey adrenergic signals from the SNS, and down-regulation of target genes for the glucocorticoid receptor, which conveys glucocorticoid signals from the HPA axis. Women with PTSD also showed significant up-regulation of target genes for NF-κB and non-significant down-regulation of target genes for GR, but significant down-regulation of target genes for CREB/ATF. Altered transcriptional control of monocyte gene expression could contribute to exaggerated inflammatory activity in PTSD.

Transcriptional Control of Monocyte Gene Expression in Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) confers an increased risk for disorders with an inflammatory etiology. PTSD-related dysregulation of the sympathetic nervous system (SNS) and hypothalamic-pituitary adrenal (HPA) axis and associated alterations in inflammatory activity may contribute to this increased risk. However, little is known about convergent SNS, HPA and inflammatory signaling at the level of the immune cell transcriptome in PTSD. To explore such signaling, we examined the prevalence of specific transcription factor binding motifs in the promoter regions of differentially expressed genes in monocytes from individuals with PTSD and matched controls. Participants included 49 men (24 PTSD+ and 25 trauma-exposed controls) and 18 women (10 PTSD+ and 8 controls). Men with PTSD showed up-regulation of target genes for the NF-κB/Rel family of transcription factors, which convey inflammatory signals, up-regulation of target genes for CREB/ATF transcription factors, which convey adrenergic signals from the SNS, and down-regulation of target genes for the glucocorticoid receptor, which conveys glucocorticoid signals from the HPA axis. Women with PTSD also showed significant up-regulation of target genes for NF-κB and non-significant down-regulation of target genes for GR, but significant down-regulation of target genes for CREB/ATF. Altered transcriptional control of monocyte gene expression could contribute to exaggerated inflammatory activity in PTSD.

Personality and the etiology and expression of PTSD: A three-factor model perspective.

This review provides an overview of research on the influence of personality on the development, course, and behavioral expression of posttraumatic stress disorder (PTSD). The existing literature is discussed in relation to three broad-band personality traits that have been emphasized in personality and psychopathology research: negative emotionality (NEM), positive emotionality (PEM), and constraint/inhibition (CON). The primary conclusion derived from this review is that high NEM is the primary personality risk factor for the development of PTSD whereas low CON and low PEM serve as moderating factors that influence the form and expression of the disorder through their interaction with NEM. From this standpoint, a premorbid personality characterized by high NEM combined with low PEM is thought to predispose the trauma-exposed individual towards an internalizing form of posttraumatic response characterized by marked social avoidance, anxiety, and depression. On the other hand, high NEM combined with low CON is hypothesized to predict an externalizing form of posttraumatic reaction characterized by marked impulsivity, aggression, and a propensity towards antisociality and substance abuse.

Rate of psychiatric illness 1 year after traumatic brain injury.

Neurobehavioral symptoms are not uncommon after a traumatic brain injury. However, psychiatric syndromes per se have rarely been studied in patients with such an injury. The purpose of this study was to evaluate the type and extent of psychiatric syndromes in patients with traumatic brain injury. One hundred ninety-six hospitalized adults were studied 1 year after a traumatic brain injury with the use of a two-stage psychiatric diagnostic procedure. Psychiatric diagnoses were made according to ICD-10 criteria on the basis of data from the Schedules for Clinical Assessment in Neuropsychiatry interview. Of 164 patients interviewed, 30 (18.3%) had an ICD-10 diagnosis of a psychiatric illness. Among the 120 patients who were 18-64 years old, 21.7% had a psychiatric illness, compared with 16.4% in a study of the general population. A depressive illness was present in 13.9% of the traumatic brain injury patients, compared with 2.1% of the general population, and panic disorder was present in 9.0%, compared with 0.8% of the general population. In comparison with the general population, a higher proportion of adult patients had developed psychiatric illnesses 1 year after a traumatic brain injury; the rates of depressive episode and panic disorder were significantly higher in the study group. A history of psychiatric illness, an unfavorable global outcome according to the Glasgow Outcome Scale, a lower score on the Mini-Mental State examination, and fewer years of formal education seemed to be important risk factors in the development of a psychiatric illness. Compensation claims, however, were not associated with the rate of psychiatric illness.

Post-Disaster Stress Following the Oklahoma City Bombing

This article describes a study of 472 community members to determine the nature and course of the post-disaster response to the April 19, 1995, bombing in Oklahoma City. It was hypothesized that an individual's post-disaster reaction would resemble a linear function of the degree of exposure experienced, and that this dose-response relationship could be used to differentiate the expression of post-traumatic stress disorder and victimization symptomatology within the three study groups. The respondents were divided into three groups based on their level of exposure and proximity to the event. The findings partially support the stated hypotheses. As expected, the Oklahoma City groups reported higher levels of post-disaster disturbance than the comparison sample, although only PTSD and victimization could be used to differentiate among the three groups.

Narcissistic Personality as a Mediating Variable in Manifestations of Post-Traumatic Stress Disorder

This case report serves to highlight the manner in which premorbid narcissistic personality adjustment may exacerbate the clinical expression of post-traumatic stress disorder (PTSD). Narcissistic personality may enhance vulnerability to distress at lower levels of trauma. In addition, narcissistic needs for esteem may produce atypical presentations of PTSD. The case history of a patient with both narcissistic personality disorder and PTSD is presented as a means of illustrating this phenomenon.

Symbolic expression in post-traumatic stress disorder: Vietnam combat veterans in art therapy

Symbolic expression in post-traumatic stress disorder: Vietnam combat veterans in art therapy