Assessing the structure and meaningfulness of the dissociative subtype of PTSD

Purpose

Studies conducted in the USA, Canada and Denmark have supported the existence of the dissociative PTSD subtype, characterized primarily by symptoms of depersonalization and derealization. The current study aimed to examine the dissociative PTSD subtype in an Eastern European, predominantly female (83.16%) sample, using an extended set of dissociative symptoms.

Methods

A latent profile analysis was applied to the PTSD and dissociation data from 689 trauma-exposed university students from Slovakia.

Results

Four latent profiles of varying PTSD and dissociation symptomatology were uncovered. They were named non-symptomatic, moderate PTSD, high PTSD and dissociative PTSD. The dissociative PTSD profile showed elevations on depersonalization and derealization, but also the alternative dissociative indicators of gaps in awareness and memory, sensory misperceptions and cognitive and behavioural re-experiencing. The core PTSD symptoms of ‘memory impairment’ and ‘reckless or self-destructive behaviour’ were also significantly elevated in the dissociative PTSD profile. Moreover, anxiety and anger predicted membership in the dissociative PTSD profile.

Conclusion

The results provide support for the proposal that the dissociative PTSD subtype can be characterized by a variety of dissociative symptoms.

     

The DSM-5 dissociative-PTSD subtype: Can levels of depression,anxiety, hostility,and sleeping difficulties differentiate between dissociative-PTSD and PTSD in rape and sexual assault victims?

The DSM-5 currently includes a dissociative-PTSD subtype within its nomenclature. Several studies have confirmed the dissociative-PTSD subtype in both American Veteran and American civilian samples. Studies have begun to assess specific factors which differentiate between dissociative vs. non-dissociative PTSD. The current study takes a novel approach to investigating the presence of a dissociative-PTSD subtype in its use of European victims of sexual assault and rape (N = 351). Utilizing Latent Profile Analyses, we hypothesized that a discrete group of individuals would represent a dissociative-PTSD subtype. We additionally hypothesized that levels of depression, anger, hostility, and sleeping difficulties would differentiate dissociative-PTSD from a similarly severe form of PTSD in the absence of dissociation. Results concluded that there were four discrete groups termed baseline, moderate PTSD, high PTSD, and dissociative-PTSD. The dissociative-PTSD group encompassed 13.1% of the sample and evidenced significantly higher mean scores on measures of depression, anxiety, hostility, and sleeping difficulties. Implications are discussed in relation to both treatment planning and the newly published DSM-5.     

Analysis of the longitudinal course of PTSD in 716 survivors of 10 disasters

Purpose

Identification of consistent predictors of the temporal course of PTSD has been hampered by non-uniform definitions of onset and remission. Onset and remission of PTSD based on different definitions were examined in a large database of systematically assessed disaster survivors.

Methods

Directly exposed survivors of 10 disasters were studied within approximately 3 months of the disasters and again 1–3 years later, using consistent methods including full diagnostic assessment, allowing aggregation of data from different disasters into a unified database of 716 survivors.

Results

Application of existing definitions of PTSD onset and remission uncovered problems with definitions based on diagnostic threshold as well as onset/remission of symptoms. Few predictors of timing of onset and PTSD remission were identified. Regardless, PTSD symptom group C was found to be pivotal to processes involved in both onset and remission of the disorder.

Conclusions

Research findings related to the onset and remission of PTSD are highly dependent on the definition used. Both symptom-based and diagnostic threshold-based definitions are problematic. Definitions of the onset and remission of PTSD might be more effectively based on the onset and remission of group C symptoms.     

Trauma and current symptoms of PTSD in a South East London community

Purpose

This study aimed to estimate the prevalence of symptoms of post-traumatic stress disorder (PTSD) and its association with traumatic events in a representative sample of an inner city population in the UK.

Methods

A representative community sample of 1,698 adults, aged 16 years and over, from two south London boroughs were interviewed face to face with structured survey questionnaires.

Results

The prevalence of current symptoms of PTSD was 5.5 %. Women were more likely to screen positive (6.4 %) than men (3.6 %), and symptoms of PTSD were high in the unemployed (12.5 %), in those not working because of health reasons (18.2 %) and in the lowest household income group (14.8 %). Most (78.2 %) of the study population had lifetime trauma and more than a third (39.7 %) reported childhood trauma. There was an independent association between childhood as well as lifetime trauma and current symptoms of PTSD and a gradient association between an increase in cumulative traumatic events and the likelihood of reporting symptoms of current PTSD (OR 1.8, 95 % CI (1.6–2.1)). Although we observed the highest prevalence of current symptoms of PTSD in those migrated for asylum or political reason (13.6 %), compared to the non-migrants, the prevalence of exposure to most traumatic life events was higher in the non-migrant group.

Conclusion

The present study demonstrates the high prevalence of exposure to trauma in a South East London community and the cumulative effect on current symptoms of PTSD. As PTSD is a condition which is associated with disability and co-morbidity, the association of current PTSD with common adversities in the community should be noted.     

Association of Acute Coronary Syndrome-Induced Posttraumatic Stress Disorder Symptoms with Self-Reported Sleep

Background

Symptoms of posttraumatic stress disorder (PTSD) after acute coronary syndrome (ACS) are associated with recurrent ACS events and mortality. Poor sleep may be a mechanism, but the association between PTSD and sleep after ACS is unknown.

Purpose

This study aims to estimate the association between ACS-induced PTSD symptoms and self-reported sleep.

Methods

ACS-induced PTSD symptoms were assessed 1-month post-ACS in 188 adults using the Impact of Events Scale-Revised. Sleep was assessed using the Pittsburgh Sleep Quality Index. Linear and logistic regression models were used to determine whether PTSD symptoms were associated with self-reported sleep, independent of sociodemographic and clinical covariates.

Results

In adjusted models, ACS-induced PTSD symptoms were associated with worse overall sleep (β?=?0.22, p?=?0.003) and greater impairment in six of seven components of sleep (all p values <0.05).

Conclusions

ACS-induced PTSD symptoms may be associated with poor sleep, which may explain why PTSD confers increased cardiovascular risk after ACS.     

Women convicted for violent offenses: Adverse childhood experiences, low level of education and poor mental health

Background

Topiramate might be effective in the treatment of posttraumatic stress disorder (PTSD) because of its antikindling effect and its action in both inhibitory and excitatory neurotransmitters. Open-label studies and few controlled trials have suggested that this anticonvulsant may have therapeutic potential in PTSD. This 12-week randomized, double-blind, placebo-controlled clinical trial will compare the efficacy of topiramate with placebo and study the tolerability of topiramate in the treatment of PTSD.

Methods and design

Seventy-two adult outpatients with DSM-IV-diagnosed PTSD will be recruited from the violence program of Federal University of São Paulo Hospital (UNIFESP). After informed consent, screening, and a one week period of wash out, subjects will be randomized to either placebo or topiramate for 12 weeks. The primary efficacy endpoint will be the change in the Clinician-administered PTSD scale (CAPS) total score from baseline to the final visit at 12 weeks.

Discussion

The development of treatments for PTSD is challenging due to the complexity of the symptoms and psychiatric comorbidities. The selective serotonin reuptake inhibitors (SSRIs) are the mainstream treatment for PTSD, but many patients do not have a satisfactory response to antidepressants. Although there are limited clinical studies available to assess the efficacy of topiramate for PTSD, the findings of prior trials suggest this anticonvulsant may be promising in the management of these patients.

Trial Registration

NCT 00725920     

Longitudinal patterns of PTSD symptom classes among US National Guard service members during reintegration

Purpose

The purpose of this study was to identify posttraumatic stress disorder (PTSD) symptom groups and assess their longitudinal progression during their first year of reintegration among United States (US) National Guard (NG) service members.

Methods

A cohort of NG service members (n?=?886) completed surveys at 6 and 12 months following their return from deployment to Iraq or Afghanistan. Latent class analysis (LCA) and latent transition analysis (LTA) were used to empirically derive groups based on their PTSD symptoms and examine their longitudinal course, respectively.

Results

The best fitting model at both assessments was the four-class model, comprising an asymptomatic class (6 months?=?54%; 12 months?=?55%), a mild symptom class with elevated hyperarousal symptoms (6 months?=?22%; 12 months?=?17%), a moderate symptom class (6 months?=?15%; 12 months?=?15%), and a severe symptom class (6 months?=?10%; 12 months?=?13%). Based on LTA, stability of class membership at the two assessments was 0.797 for the asymptomatic class, 0.453 for the mild class, 0.560 for the moderate class, and 0.580 for the severe class. Estimated transition probabilities were greater with respect to transitioning to less severe, rather than more severe, classes over time.

Conclusions

The four latent PTSD classes were distinguished primarily by severity; however, the mild symptom class was characterized by higher levels of hyperarousal than other symptoms. Although the absolute number of individuals within classes remained fairly constant between 6 and 12 months, there was movement between severity classes. Most NG service members without symptoms continued to do well during the first year, with only an estimated 7% moving to the moderate or severe class.

     

Trauma exposure and PTSD among older adolescents in foster care

Purpose

Youth in foster care represent a highly traumatized population. However, trauma research on this population has focused primarily on maltreatment rather than the full spectrum of trauma experiences identified within the DSM-IV. The current study aims to fill this gap by reporting the prevalence of exposure to specific types of traumatic events for a large sample of youth with foster care experience. The study also reports the likelihood of lifetime PTSD diagnoses associated with each specific type of trauma.

Method

Data are from a longitudinal panel study of 732 adolescents aged 17 and 18 who were in foster care. Lifetime trauma exposure and PTSD diagnosis were assessed using the Composite International Diagnostic Interview. Statistical comparisons were made using logistic regressions.

Results

The majority of respondents had experienced at least one trauma in their lifetime. While overall trauma prevalence did not differ by gender, males were more likely to experience interpersonal violence and environmental trauma, while females were more likely to experience sexual trauma. Caucasian participants reported higher rates of trauma exposure than African-American participants did. The types of trauma associated with the highest probability of a lifetime PTSD diagnosis were rape, being tortured or a victim of terrorists, and molestation.

Conclusions

Youth in foster care are a highly traumatized population and meet diagnostic criteria for PTSD at higher rates than general youth populations. The ongoing impact of trauma may be particularly problematic for these young people given their abrupt transition to independence.     

Lifetime traumatic experiences and their impact on PTSD: a general population study

Objective

Exploring the relationship of exposure to a traumatic event and the subsequent onset of posttraumatic stress disorder (PTSD) in the population.

Methods

Posttraumatic stress disorder was assessed using the Impact of Event Scale (IES), Posttraumatic Diagnostic Scale (PDS) and interview data. Logistic regression analyses with sex, age, marital status, educational level and traumatic event characteristics were performed. Prevalences were standardised to the sex and age distribution of the German population.

Results

A total of 41 % of the subjects reported exposure to a trauma, leading to full PTSD in 1.7 % and to partial PTSD in 8.8 % of the participants. Logistic regression revealed accidents (OR 2.5, 95 % CI 1.3–4.7), nonsexual assault by known assailants (4.5, 2.1–9.8), combat/war experiences (5.9, 2.0–17.4), life-threatening illness (4.9, 2.7–8.9) and interpersonal conflicts (15.5, 2.5–96.0) as risk factors for full PTSD; risk factors for partial PTSD were accidents (3.2, 2.4–4.3), sexual (4.6, 2.2–9.6) or nonsexual (2.3, 1.4–3.8) assault by known assailants, life-threatening illness (6.2, 4.6–8.3), death of relatives (5.0, 3.2–7.8) and interpersonal conflicts (22.0, 8.3–58.1).

Conclusions

Of subjects exposed to traumatic events, only a minority developed PTSD indicating a relationship between characteristics of the exposure and the individual and the onset of PTSD.     

Posttraumatic stress disorder: An exploratory study examining rates of trauma and PTSD and its effect on client outcomes in community mental health

Background

Rates of trauma and Posttraumatic Stress Disorder (PTSD) were examined in order to compare the profile in clients of an Australian Public Mental Health Service with that reported in the international literature for clients with major mental illness and to explore the effect of this on client health outcomes. Potential factors contributing to increased levels of trauma/PTSD in this group of clients and the issue of causality between PTSD and subsequent mental illness was also explored.

Methods

A convenience sample of 29 clients was screened for trauma and PTSD using the Posttraumatic Stress Diagnostic Scale? (PDS) and selected outcome measures. Paired and independent samples t-test and ANOVA were applied to the data.

Results

High levels of undocumented trauma and PTSD were found. Twenty clients, (74%) reported exposure to multiple traumatic events; 33.3% (9) met DSM IV diagnostic criteria for PTSD. Significant difference was found for PTSD symptomatology, severity and impairment and for client and clinician-rated scores of Quality of Life (QOL) outcomes in the PTSD group. No effect for PTSD symptomatology on the Working Alliance (WA) was found. Factors that may influence higher rates of PTSD in this group were identified and included issues associated with the population studied, the predominance of assaultive violence found, and vulnerability and risks factors associated with re-traumatisation within the social and treating environments.

Conclusion

A similar trauma and PTSD profile to that reported in the international literature, including greater levels of trauma and PTSD and a poorer QOL, was found in this small sample of clients. It is postulated that the increased levels of trauma/PTSD as reported for persons with major mental illness, including those found in the current study, are primarily related to the characteristics of the population that access public mainstream psychiatric services and that these factors have specific implications for service delivery, and raise issues of efficiency and effectiveness of resource use in achieving successful outcomes in public mental health services for clients with co-morbid PTSD. Further research with a more rigorous design is needed to test these preliminary findings within Australian Community Mental Health Services.     

A systematic review of the comorbidity between PTSD and alcohol misuse

Purpose

This systematic review aimed to assess (1) the level of comorbidity of post-traumatic stress disorder (PTSD) and alcohol misuse reported in research studies since 2007 and (2) any associations found between specific PTSD symptom clusters and alcohol misuse.

Methods

A literature search was carried out to capture any papers published from 2007 to the end of July 2012. Six hundred and twenty abstracts were identified and reviewed, and 42 papers were included in the final review after applying inclusion and exclusion criteria.

Results

The prevalence of comorbid alcohol misuse in those with PTSD ranged from 9.8 to 61.3 %. The prevalence of comorbid PTSD in those with alcohol misuse ranged from 2.0 to 63.0 %, and the majority of prevalence rates were over 10.0 %. Almost all of the odds ratios representing the strength of association between the conditions across a variety of populations were significant, and those ranged from 1.1 to 4.87. Of the different PTSD symptom clusters, this review found most evidence for associations between alcohol misuse and both avoidance/numbing symptoms and hyperarousal symptoms.

Conclusions

Given that comorbidity appears to be common, the evidence from this systematic review supports the use of routine screening for comorbidity in populations who are known to have PTSD or alcohol misuse.     

Neighborhood social cohesion and posttraumatic stress disorder in a community-based sample: findings from the Detroit Neighborhood Health Study

Purpose

Posttraumatic stress disorder (PTSD) is common and debilitating. Although research has identified individual-level risk factors for PTSD, the role of macro-social factors in PTSD etiology remains unknown. This study tests whether perceived neighborhood social cohesion (NSC), measured at the both the individual and neighborhood levels, plays a role in determining past-year risk of PTSD among those exposed to trauma.

Methods

Data (n?=?1,221) were obtained from an ongoing prospective epidemiologic study in the city of Detroit. Assessment of traumatic event exposure and PTSD was consistent with DSM-IV criteria. Generalized estimating equations (GEE) and logistic regression models were used to estimate the association of neighborhood-level perceived NSC with the risk of PTSD, adjusting for individual-level perceptions of NSC and other covariates.

Results

The odds of past-year PTSD were significantly higher among those residing in a neighborhood with low social cohesion compared to high (OR?=?2.44, 95?% CI: 1.58, 3.78), independent of individual sociodemographic characteristics, number of traumas, and individual-level perceptions of NSC. The odds of past-year PTSD were not significantly associated with individual-level perceptions of NSC.

Conclusions

These results demonstrate that social context shapes risk of PTSD and suggest that changing the social context may shift vulnerability to this disorder.     

Rescuers at risk: a systematic review and meta-regression analysis of the worldwide current prevalence and correlates of PTSD in rescue workers

Purpose

We sought to estimate the pooled current prevalence of posttraumatic stress disorder (PTSD) among rescue workers and to determine the variables implicated in the heterogeneity observed among the prevalences of individual studies.

Methods

A systematic review covering studies reporting on the PTSD prevalence in rescue teams was conducted following four sequential steps: (1) research in specialized online databases, (2) review of abstracts and selection of studies, (3) review of reference list, and (4) contact with authors and experts. Prevalence data from all studies were pooled using random effects model. Multivariate meta-regression models were fitted to identify variables related to the prevalences heterogeneity.

Results

A total of 28 studies, reporting on 40 samples with 20,424 rescuers, were selected. The worldwide pooled current prevalence was 10%. Meta-regression modeling in studies carried out in the Asian continent had, on average, higher estimated prevalences than those from Europe, but not higher than the North American estimates. Studies of ambulance personnel also showed higher estimated PTSD prevalence than studies with firefighters and police officers.

Conclusions

Rescue workers in general have a pooled current prevalence of PTSD that is much higher than that of the general population. Ambulance personnel and rescuers from Asia may be more susceptible to PTSD. These results indicate the need for improving pre-employment strategies to select the most resilient individuals for rescue work, to implement continuous preventive measures for personnel, and to promote educational campaigns about PTSD and its therapeutic possibilities.     

Responses to conflict,family loss and flight: posttraumatic stress disorder among unaccompanied refugee minors from Africa

Objective

To investigate African unaccompanied refugee minors (URMs) living in Austria for posttraumatic stress disorder (PTSD) prevalence and related symptoms, comorbidity, demographics and coping strategies.

Method

“UCLA PTSD Index and inventories” and “Scales for Children Afflicted by War and Persecution (SCWP)” were used to assess 41 African URMs.

Results

The study revealed lower PTSD rates than measured among URMs in previous studies. Girls were more likely to develop PTSD. PTSD was significantly correlated with single war-related traumatic events. The depression score for the sample was above the clinical cut-off value.

Conclusions

Trauma-specific psychopathology was less severe than reported in other studies. These findings could be explained by concepts of resilience. Other implications, such as response bias, are discussed.     

Recent Genetics and Epigenetics Approaches to PTSD

Purpose of Review

Following a life-threatening traumatic exposure, about 10% of those exposed are at considerable risk for developing posttraumatic stress disorder (PTSD), a severe and disabling syndrome characterized by uncontrollable intrusive memories, nightmares, avoidance behaviors, and hyperarousal in addition to impaired cognition and negative emotion symptoms. This review will explore recent genetic and epigenetic approaches to PTSD that explain some of the differential risk following trauma exposure.

Recent Findings

A substantial portion of the variance explaining differential risk responses to trauma exposure may be explained by differential inherited and acquired genetic and epigenetic risk. This biological risk is complemented by alterations in the functional regulation of genes via environmentally induced epigenetic changes, including prior childhood and adult trauma exposure.

Summary

This review will cover recent findings from large-scale genome-wide association studies as well as newer epigenome-wide studies. We will also discuss future “phenome-wide” studies utilizing electronic medical records as well as targeted genetic studies focusing on mechanistic ways in which specific genetic or epigenetic alterations regulate the biological risk for PTSD.

     

Recent Advancements in Treating Sleep Disorders in Co-Occurring PTSD

Purpose of Review

Comorbidity of posttraumatic stress disorder (PTSD) and insomnia, nightmares, and obstructive sleep apnea (OSA) is high. We review recent research on psychotherapeutic and pharmacological interventions for sleep disorders in PTSD.

Recent Findings

PTSD treatments decrease PTSD severity and nightmare frequency, but do not resolve OSA or insomnia. Research on whether insomnia hinders PTSD treatment shows mixed results; untreated OSA does interfere with PTSD treatment. Cognitive behavioral therapy for insomnia is the recommended treatment for insomnia; however, optimal ordering with PTSD treatment is unclear. PTSD treatment may be most useful for PTSD-related nightmares. CPAP therapy is recommended for OSA but adherence can be low.

Summary

Targeted treatment of sleep disorders in the context of PTSD offers a unique and underutilized opportunity to advance clinical care and research. Research is needed to create screening protocols, determine optimal order of treatment, and elucidate mechanisms between sleep and PTSD treatments.

     

Group cognitive behavior therapy for Japanese patients with social anxiety disorder: preliminary outcomes and their predictors

Background

The present study was designed to evaluate the efficacy of an internet-based therapy (Interapy) for Posttraumatic Stress Disorder (PTSD) in a German speaking population. Also, the quality of the online therapeutic relationship, its development and its relevance as potential moderator of the treatment effects was investigated.

Method

Ninety-six patients with posttraumatic stress reactions were allocated at random to ten sessions of Internet-based cognitive behavioural therapy (CBT) conducted over a 5-week period or a waiting list control group. Severity of PTSD was the primary outcome. Secondary outcome variables were depression, anxiety, dissociation and physical health. Follow-up assessments were conducted at the end of treatment and 3 months after treatment.

Results

From baseline to post-treatment assessment, PTSD severity and other psychopathological symptoms were significantly improved for the treatment group (intent-to-treat group × time interaction effect size d = 1.40). Additionally, patients of the treatment condition showed significantly greater reduction of co-morbid depression and anxiety as compared to the waiting list condition. These effects were sustained during the 3-months follow-up period. High ratings of the therapeutic alliance and low drop-out rates indicated that a positive and stable therapeutic relationship could be established online. Significant improvement of the online working alliance in the course of treatment and a substantial correlation between the quality of the online relationship at the end of treatment and treatment outcome emerged.

Conclusion

Interapy proved to be a viable treatment alternative for PTSD with large effect sizes and sustained treatment effects. A stable and positive online therapeutic relationship can be established through the Internet which improved during the treatment process.

Trial registration

Australian Clinical Trials Registry ACTRN012606000401550     

PTSD and Physical Health

Purpose of Review

We review evidence linking PTSD to physical health symptoms and specific disorders, highlighting areas with multiple studies and objective measures of disease states when available. We also examine evidence for biological, behavioral, and psychosocial mechanisms underlying these associations and discuss the clinical implications of recent research.

Recent Findings

Recent meta-analyses have found that evidence is particularly strong for increased risk of cardiovascular, metabolic, and musculoskeletal disorders among patients with PTSD. Numerous studies have found alterations in the hypothalamic-pituitary-adrenal axis, sympathetic nervous system, inflammation, and health behaviors that could increase risk of illness, but few studies have simultaneously incorporated measures of mechanisms and disease outcomes.

Summary

Future research should focus on expanding the diversity of populations studied, particularly with respect to underrepresented racial and ethnic groups. Longitudinal studies that incorporate repeated measures of PTSD, pathogenic mechanisms of disease, and physical health outcomes and the addition of physical health outcomes to PTSD treatment trials will be most informative for the field.

     

Variation in post-traumatic response: the role of trauma type in predicting ICD-11 PTSD and CPTSD symptoms

Purpose

The World Health Organization’s 11th revision to the International Classification of Diseases manual (ICD-11) will differentiate between two stress-related disorders: PTSD and Complex PTSD (CPTSD). ICD-11 proposals suggest that trauma exposure which is prolonged and/or repeated, or consists of multiple forms, that also occurs under circumstances where escape from the trauma is difficult or impossible (e.g., childhood abuse) will confer greater risk for CPTSD as compared to PTSD. The primary objective of the current study was to provide an empirical assessment of this proposal.

Methods

A stratified, random probability sample of a Danish birth cohort (aged 24) was interviewed by the Danish National Centre for Social Research (N?=?2980) in 2008–2009. Data from this interview were used to generate an ICD-11 symptom-based classification of PTSD and CPTSD.

Results

The majority of the sample (87.1%) experienced at least one of eight traumatic events spanning childhood and early adulthood. There was some indication that being female increased the risk for both PTSD and CPTSD classification. Multinomial logistic regression results found that childhood sexual abuse (OR?=?4.98) and unemployment status (OR?=?4.20) significantly increased risk of CPTSD classification as compared to PTSD. A dose–response relationship was observed between exposure to multiple forms of childhood interpersonal trauma and risk of CPTSD classification, as compared to PTSD.

Conclusions

Results provide empirical support for the ICD-11 proposals that childhood interpersonal traumatic exposure increases risk of CPTSD symptom development.

     

Trauma,PTSD, and the Developing Brain

Purpose of Review

PTSD in youth is common and debilitating. In contrast to adult PTSD, relatively little is known about the neurobiology of pediatric PTSD, nor how neurodevelopment may be altered. This review summarizes recent neuroimaging studies in pediatric PTSD and discusses implications for future study.

Recent Findings

Pediatric PTSD is characterized by abnormal structure and function in neural circuitry supporting threat processing and emotion regulation. Furthermore, cross-sectional studies suggest that youth with PTSD have abnormal frontolimbic development compared to typically developing youth. Examples include declining hippocampal volume, increasing amygdala reactivity, and declining amygdala-prefrontal coupling with age.

Summary

Pediatric PTSD is characterized by both overt and developmental abnormalities in frontolimbic circuitry. Notably, abnormal frontolimbic development may contribute to increasing threat reactivity and weaker emotion regulation as youth age. Longitudinal studies of pediatric PTSD are needed to characterize individual outcomes and determine whether current treatments are capable of restoring healthy neurodevelopment.