Disgust and fear reactions uniquely affect intrusions and posttraumatic stress symptoms

Disgust reactions commonly occur during/following trauma and predict posttraumatic stress (PTS) symptoms. Yet, disgust is not mentioned in DSM-5 PTSD criteria. To investigate disgust’s clinical significance in PTSD, we measured the relationship between disgust (and fear) reactions to a personal trauma, and problematic intrusion characteristics (e.g., distress) and intrusion symptom severity. We focused on intrusions because they are a transdiagnostic PTSD symptom, though we also measured overall PTS symptoms to replicate prior work. Participants (N = 471) recalled their most traumatic/stressful event from the past six months. They then rated disgust and fear reactions to this event and completed the Posttraumatic Stress Disorder Checklist-5. Participants who had experienced intrusions about their event in the past month (n = 261) rated these intrusions on several characteristics (e.g., distress, vividness). We found stronger traumatic event-related disgust reactions were associated with more problematic intrusion characteristics, higher intrusion symptom severity, and higher overall PTS symptom severity. Notably, disgust reactions uniquely predicted these variables after statistically controlling for fear reactions. We conclude disgust reactions to trauma may be similarly pathological to fear reactions for intrusion and broader PTS symptoms. Therefore, PTSD diagnostic manuals and treatments should recognize disgust as a trauma-relevant emotion.     

Individual differences in trauma disclosure

Background and objectivesFindings on disclosure and adjustment following traumatic events have been mixed. Better understanding of individual differences in disclosure may help us better understand reactions following trauma exposure. In particular, studying disclosure patterns for those with and without psychopathology and for different types of emotional experiences may help clarify the relationship between disclosure, event emotionality, trauma exposure, and PTSD.MethodsIn this study, 143 men and women with (n = 67) and without (n = 43) chronic PTSD and without trauma exposure (n = 33) provided information on disclosure for a traumatic/severe life event, a negative event, and a positive event.ResultsIndividuals with PTSD reported greater difficulty disclosing their traumatic event compared to those with trauma exposure no PTSD and those with no-trauma exposure. However, individuals with PTSD reported disclosing the traumatic event a similar number of times and with similar levels of detail to those with trauma exposure but no PTSD. Both sexual and childhood trauma were associated with greater disclosure difficulty.LimitationsAlthough control event types (positive, negative) were selected to control for the passage of time and for general disclosure style, they do not control for salience of the event and results may be limited by control events that were not highly salient.ConclusionsThe present findings point to a dynamic conceptualization of disclosure, suggesting that the differential difficulty of disclosing traumatic events seen in individuals with PTSD is not simply a function of the amount of disclosure or the amount of details provided.     

Gender differences in traumatic events and rates of post-traumatic stress disorder among homeless youth

In the present report we describe patterns of traumatic events and Post-traumatic Stress Disorder (PTSD), both partial and full, among homeless youth and those at risk for homelessness, with an emphasis on gender differences. Participants were 85 homeless and at-risk youth (49% female) recruited from a drop-in center in New York City in 2000. Youth completed a structured interview lasting 1.5 h. Rates of childhood maltreatment were substantial. Further, almost all youth experienced at least one traumatic event, with most experiencing multiple types of trauma. Gender differences were found in the types, but not prevalence or magnitude, of childhood maltreatment and traumatic events experienced. Partial symptomatology of PTSD was common for females but not males. Symptoms of depression and anxiety were found to co-occur with PTSD for females, which may complicate treatment efforts. Further investigation of the impact of trauma on homeless males is needed.     

Posttraumatic stress disorder and the incidence of nicotine,alcohol, and other drug disorders in persons who have experienced trauma

BACKGROUND: We examine whether exposure to traumatic events increases the risk for nicotine dependence or alcohol or other drug use disorders, independent of posttraumatic stress disorder (PTSD). METHODS: Data come from a longitudinal epidemiologic study of young adults in southeast Michigan. Prospective data covering a 10-year period and retrospective lifetime data gathered at baseline were used to estimate the risk for onset of substance use disorders in persons with PTSD and in persons exposed to trauma without PTSD, compared with persons who have not been exposed to trauma. The National Institute of Mental Health Diagnostic Interview Schedule for DSM-III-R was used. Logistic regression was used to analyze the prospective data, and Cox proportional hazards survival analysis with time-dependent variables was applied to the lifetime data. RESULTS: The prospective and retrospective data show an increased risk for the onset of nicotine dependence and drug abuse or dependence in persons with PTSD, but no increased risk or a significantly (P =.004) lower risk (for nicotine dependence, in the prospective data) in persons exposed to trauma in the absence of PTSD, compared with unexposed persons. Exposure to trauma in either the presence or the absence of PTSD did not predict alcohol abuse or dependence. CONCLUSIONS: The findings do not support the hypothesis that exposure to traumatic events per se increases the risk for substance use disorders. A modestly elevated risk for nicotine dependence might be an exception. Posttraumatic stress disorder might be a causal risk factor for nicotine and drug use disorders or, alternatively, the co-occurrence of PTSD and these disorders might be influenced by shared risk factors other than traumatic exposure.     

Pre-trauma verbal ability at five years of age and the risk of post-traumatic stress disorder in adult males and females

Previous studies have shown that high cognitive ability, measured in childhood and prior to the experience of traumatic events, is protective of PTSD development. Our aim was to test if the association between pre-trauma verbal ability ascertained at 5 years with DSM-IV lifetime post-traumatic stress disorder (PTSD) at 21 years was subject to effect modification by gender, trauma type or prior behaviour problems. Using a prospective birth cohort of young Australians, we found that both trauma type and behaviour problems did not change the association between cognitive ability and PTSD. During multivariate analysis, testing for the interactive effect of gender revealed that verbal ability was linearly and inversely associated with PTSD in females only, with those in the lowest verbal ability quintile having strongly increased odds of PTSD (OR=3.89: 95% CI; 1.50, 10.10) compared with those in the highest quintile. A graph of the interaction revealed lower verbal ability placed females, but not males, at an increased risk of PTSD. Our results indicate that lower verbal ability in early childhood is a vulnerability factor for PTSD in females but not in males, and may constitute a gender-specific risk factor responsible for part of the increased risk of PTSD found in females compared with males.     

Trauma exposure and post-traumatic stress disorder in the general population

OBJECTIVE: To examine the lifetime prevalence of trauma experiences and post-traumatic stress disorder (PTSD). METHOD: Questionnaire-assessed PTSD, the type of traumatic event experienced, perceived trauma impact, and trauma frequency in 1824 randomly selected men and women. RESULTS: PTSD lifetime prevalence was estimated at 5.6% with a 1 : 2 male-to-female ratio, in spite of men reporting greater trauma exposure. The highest PTSD risk was associated with sexual and physical assault, robbery and multiple trauma experiences. Controlling for trauma type did not account for gender differences, while controlling for experienced distress did. CONCLUSION: The conditional probability for PTSD varied as a function of trauma type, frequency and impact of the event, with increased rates associated with prevalent trauma exposure and higher perceived distress. The latter accounted for the gender effect, suggesting that gender differences in PTSD in part represent a generally greater vulnerability to stress in women.     

Gender differences in risk factors for trauma exposure and post-traumatic stress disorder among inner-city drug abusers in and out of treatment

Over the past two decades there has been a growing awareness of the comorbidity between post-traumatic stress disorder (PTSD) and substance use disorders in the general population. The purpose of these analyses was to examine, in a population of drug users, the role of gender in (1) predicting the nature of the traumatic event and PTSD symptoms, (2) patterns of substance use disorders in relation to trauma exposure and PTSD symptoms, (3) comorbidity of other psychiatric disorders with trauma exposure and PTSD, and (4) the temporal association of substance use disorder, exposure to trauma, and PTSD. Drug abusers (n = 464) were interviewed using the Diagnostic Interview Schedule for DSM-III-R (DIS) and the Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM). Although more women than men met criteria for DSM-III-R PTSD, there were no gender differences on endorsement for a traumatic event. Adult antisocial behavior, affective disorder, schizophrenia, other anxiety disorder and polysubstance use predicted exposure to an event, whereas, only schizophrenia and other anxiety disorder predicted PTSD. In men, drug use preceded the exposure to an event, while in women, the onset age for both drug use and exposure to an event were nearly identical. This work suggests implications for gender-based education and prevention interventions.     

Determinants of postconflict symptoms in Albanian Kosovars

During the period from 1998 to 1999, more than 1 million civilians from the province of Kosovo in the Balkans were displaced as a consequence of organized violence and war. The aim of the present study was to determine the prevalence of posttraumatic stress disorder (PTSD) in a sample of the Albanian Kosovar population more than 2 years after the end of the conflict and to assess the effect of exposure to war-related events. A total of 340 households were randomly selected among 12,900 families returned from a country of asylum (Switzerland). All adults in each household were invited to participate (N = 996). The following instruments were used: the Albanian translations of the PTSD section of the Mini International Neuropsychiatric Interview and of the Medical Outcomes Study 36-Item Short Form, and a list of traumatic events adapted from the Harvard Trauma Questionnaire. The overall prevalence of PTSD was 23.5%. A strong cumulative effect of trauma was observed, with odds ratios for PTSD rising steeply with the number of events to which people were exposed. After taking into account traumatic events, multivariable analysis indicated that female gender, older age, and having left Kosovo during the conflict were significantly associated with higher frequency of PTSD, whereas significant heterogeneity among municipalities was observed. Stratified analysis for people who stayed and left the province during the war suggested that different patterns of trauma may be relevant in the two subsamples, with forced separation and isolation strongly associated with PTSD in people who stayed in Kosovo. PTSD diagnosis was also significantly associated with lower scores on all dimensions of the Medical Outcomes Study 36-Item Short Form and lower economic status. The results suggest that responding to medium-term and long-term mental health consequences of conflict is a necessary task for the global rehabilitation of health care systems in a war devastated country.     

Early childhood behavior trajectories and the likelihood of experiencing a traumatic event and PTSD by young adulthood

This study modeled children’s trajectories of teacher rated aggressive-disruptive behavior problems assessed at six time points between the ages of 6 and 11 and explored the likelihood of being exposed to DSM-IV qualifying traumatic events and posttraumatic stress disorder (PTSD) in 837 urban first graders (71% African American) followed-up for 15 years. Childhood trajectories of chronic high or increasing aggressive-disruptive behavior distinguished males more likely to be exposed to an assaultive violence event as compared to males with a constant course of low behavior problems (OR_{chronic high} = 2.8, 95% CI = 1.3, 6.1 and OR_increasing = 4.5, 95% CI = 2.3, 9.1, respectively). Among females, exposure to traumatic events and vulnerability to PTSD did not vary by behavioral trajectory. The findings illustrate that repeated assessments of disruptive classroom behavior during early school years identifies more fully males at increased risk for PTSD-level traumatic events, than a single measure at school entry does.     

Sex differences in hippocampal response to endocannabinoids after exposure to severe stress

Women are more vulnerable to stress‐related mental disorders than men and the naturally occurring fluctuation in estrogen that occur across the estrus cycle can dramatically influence the pathophysiology observed following traumatic events. It has been demonstrated that the endocannabinoid (eCB) system could represent a therapeutic target for the treatment of post‐traumatic stress disorder (PTSD) in males. The current study aimed to examine the effects of exposure to a traumatic event and acute enhancement of eCB signaling on hippocampal‐dependent learning and plasticity in male and female rats. Males and females were exposed to the single prolonged stress (SPS) model of PTSD (restraint, forced swim, and sedation) followed by acute administration of the fatty acid amide hydrolase (FAAH) inhibitor URB597 (0.3 mg/kg). Females were in diestrus during SPS exposure. SPS exposure impaired extinction and hippocampal plasticity tested a week later in males and females. Sex differences were observed in the effects of URB597 on hippocampal plasticity of SPS‐exposed rats. Also, URB597 normalized the SPS‐induced upregulation in CB1 receptor levels in the amygdala, prefrontal cortex (PFC), and hippocampus in males. In females, URB597 normalized the SPS‐induced up regulation in CB1 receptors in the amygdala and PFC, but not hippocampus. Our findings support the eCB system as a therapeutic target for the treatment of disorders associated to inefficient fear coping in males and females. There are differences in the hippocampal response of males and females to the enhancement of eCB signaling after intense stress suggesting sex differences in treatment efficacy. © 2016 Wiley Periodicals, Inc.     

Elevated plasma arginine vasopressin levels in veterans with posttraumatic stress disorder

BACKGROUND: Posttraumatic stress disorder (PTSD) is associated with altered hypothalamic-pituitary-adrenal (HPA) axis functioning. Arginine vasopressin (AVP), in conjunction with corticotrophin releasing hormone, has shown to be an important modulator of the HPA axis. In order to evaluate the effect of trauma and PTSD on central AVP secretion we assessed plasma AVP levels in equally trauma exposed veterans with and without PTSD and a non-traumatized healthy control group. METHODS: Assessment of plasma AVP in 29 male veterans with PTSD, 29 traumatized veterans without PTSD, matched for age, gender, year and region of deployment (trauma controls), and 26 age matched healthy controls. RESULTS: Plasma AVP levels were higher in PTSD patients compared to both healthy controls (p = 0.004) and trauma controls (p < 0.001). In PTSD patients without a comorbid MDD a significant correlation was observed between plasma AVP levels and symptoms of avoidance measured with the Clinician Administered PTSD Scale (CAPS). CONCLUSION: Elevated plasma AVP levels are specifically related to PTSD and not to exposure to traumatic stress during deployment. Our results indicate that AVP may play a role as an anxiogenic factor, but they do not support a role for AVP in the altered response to dexamethasone in PTSD.     

The relationship of gender and trauma characteristics to posttraumatic stress disorder in a community sample of traumatized northern plains American Indian adolescents and young adults

OBJECTIVE: Previous studies have identified a high prevalence (25%-80%) of trauma among American Indian and non-American Indian adolescents and adults. However, only a fraction of traumatized individuals develop posttraumatic stress disorder (PTSD). This article examines the relationships of gender and trauma characteristics to a diagnosis of PTSD among a community sample of traumatized American Indian adolescents and young adults. METHOD: Complete data were collected from 349 American Indians aged 15 to 24 years who participated in a cross-sectional community-based study from July 1997 to December 1999 and reported experiencing at least 1 traumatic event. Traumatic events and PTSD were assessed using a version of the Composite International Diagnostic Interview. Logistic regression determined the relationships of gender, trauma type, age at first trauma, and number of traumas to the development of PTSD. RESULTS: Forty-two participants (12.0% of those who experienced a traumatic event) met criteria for lifetime PTSD. While all 4 of the independent variables noted above demonstrated univariate associations with PTSD, multivariate logistic regression analyses indicated that only experiencing a sexual trauma (odds ratio [OR] = 4.45, 95% confidence interval [CI] = 1.76 to 11.28) and having experienced 6 or more traumas (OR = 2.53, 95% CI = 1.06 to 6.04) were independent predictors of meeting criteria for PTSD. CONCLUSION: American Indian children and adolescents who experience sexual trauma and multiple traumatic experiences may be at particularly high risk for developing PTSD.     

Risk and resilience in posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) is a fairly common psychiatric disorder that is associated with a lifetime prevalence of approximately 9% in the United States. In light of recent war and terrorist activity worldwide, it is likely that increased numbers of individuals will be exposed to severe or life-threatening trauma, and the incidence of PTSD may be even higher than previously indicated in epidemiologic studies. PTSD may develop after exposure to a traumatic event in which the individual experienced, witnessed, or was confronted by either actual or threatened loss of life or serious injury. Patients with PTSD often reexperience intrusive recollections of the event in ways that are highly distressing and may be described as reliving the memory. Not surprisingly, symptoms of avoidance are noted because individuals with PTSD often wish to escape recollections (thoughts, feelings, conversations, places) related to the trauma. Patients also experience symptoms of hyperarousal associated with difficulty concentrating or exaggerated startle response. Notably, individuals who develop PTSD represent only a subset of those exposed to trauma. It is of interest why certain individuals are at risk for development of PTSD after traumatic exposure, whereas others appear to be more resilient to the effects of trauma. Studies suggest that previous exposure to trauma and intensity of the response to acute trauma may affect the development of PTSD. In addition, however, neuroendocrine changes, such as lower cortisol levels, also may influence formation and processing of traumatic memories and may be associated with the underlying pathology of PTSD.     

White matter integrity alterations in post‐traumatic stress disorder

Post‐traumatic stress disorder (PTSD) is a debilitating condition which can develop after exposure to traumatic stressors. Seventy‐five adults were recruited from the community, 25 diagnosed with PTSD along with 25 healthy and 25 trauma‐exposed age‐ and gender‐matched controls. Participants underwent clinical assessment and magnetic resonance imaging. A previous voxel based morphometry (VBM) study using the same subject cohort identified decreased grey matter (GM) volumes within frontal/subcortical brain regions including the hippocampus, amygdala, and anterior cingulate cortex (ACC). This study examines the microstructural integrity of white matter (WM) tracts connecting the aforementioned regions/structures. Using diffusion tensor imaging, we investigated the integrity of frontal/subcortical WM tracts between all three subject groups. Trauma exposed subjects with and without PTSD diagnosis were identified to have significant disruption in WM integrity as indexed by decreased fractional anisotropy (FA) in the uncinate fasciculus (UF), cingulum cingulate gyrus (CCG), and corpus callosum (CC), when compared with healthy non‐trauma‐exposed controls. Significant negative correlations were found between total Clinician Administered PTSD scale (CAPS) lifetime clinical subscores and FA values of PTSD subjects in the right UF, CCG, CC body, and right superior longitudinal fasciculus (SLF). An analysis between UF and SLF FA values and VBM determined rostral ACC GM values found a negative correlation in PTSD subjects. Findings suggest that compromised WM integrity in important tracts connecting limbic structures such as the amygdala to frontal regions including the ACC (i.e., the UF and CCG) may contribute to impairments in threat/fear processing associated with PTSD.     

Affective lability predicts decreased habituation in posttraumatic stress symptom responding during a single laboratory session of imaginal exposure

Affective lability, or the instability of emotional states, is associated with heightened levels of trauma-related emotional responding and posttraumatic stress disorder (PTSD) symptoms. However, the impact of affective lability, specifically on habituation to idiographic trauma cues, has yet to be examined among trauma-exposed individuals. The current study examined differential response trajectories to trauma-related imaginal exposure as a function of affective lability. Specifically, 72 women with a history of sexual victimization participated in a laboratory-based study involving a single session of repeated imaginal exposures to idiographic traumatic event cues. As hypothesized, participants higher in affective lability reported less reduction in trauma-cue elicited posttraumatic stress symptoms across exposure trials. Given these results, it will be important to continue to extend these laboratory findings to better understand how elevated affective lability is related to response to trauma-focused exposure therapy among individuals with PTSD or other trauma-related psychopathology (e.g., borderline personality disorder).     

Retrieval and emotional processing of traumatic memories in posttraumatic stress disorder: peripheral and central correlates

Posttraumatic stress disorder (PTSD) is thought to be characterized by dysfunctional memory processes, i.e., the automatic re-experiencing of the traumatic event and the inability to consciously recall facts about the traumatic event, as well as altered emotional processing of trauma-relevant cues. The present study examined the cerebral mechanisms underlying the cued recall of trauma-specific memories and the emotional processing of the presented cues in 16 PTSD patients, 15 trauma-exposed subjects without PTSD and 16 healthy controls. Subjects received questions about their specific trauma as well as other disastrous and neutral events while the electroencephalogram and heart rate were measured. The PTSD patients showed no impairment in trauma-specific declarative memory compared to non-PTSD subjects but had some deficits in general declarative memory as assessed by the Wechsler Memory Scale-Revised. Compared to healthy control subjects, PTSD patients displayed increased P300 and late positive complex amplitudes to trauma-specific questions, indicating enhanced emotional processing of these cues. In line with their behavioral performance, both trauma-exposed groups showed decreased terminal contingent negative variation amplitudes to trauma-specific questions over frontal electrodes reflecting altered memory retrieval. Within-group comparisons revealed that only the PTSD group but not the other groups showed a differentiation between trauma-specific and neutral questions with respect to the LPC, tCNV and P300. Concordantly with previous studies, PTSD patients showed elevated resting heart rate compared to the healthy controls. These findings are discussed in the context of current models of the role of declarative memory in the development and maintenance of PTSD.