Post Traumatic Stress Disorder (PTSD) – A Primer on Neurobiology and Management
Psychological trauma involves witnessing of a traumatic or life-threatening event directly to yourself or others. The individual is likely to experience intense fear, horror, and helplessness, which can result in a permanent or transient psychological wound characterised by physical, cognitive, emotional and behavioural changes.
The trauma is acute and transient for most and results in minimal functional impairment. Psychological trauma can be classified into 4 clusters of symptoms. These include:
- Intrusion symptoms– Flashbacks, nightmares, and intrusive thoughts
- Avoidance – Avoidance of stimuli associated with trauma
- Negative Alterations in Cognitions and Mood associated with the traumatic event (s) – difficulty recalling important aspects of trauma, emotional detachment etc.
- Hyperarousal – Hypervigilance, Insomnia, agitation, irritability, impulsivity, and anger
For some, however, the syndrome persists, and this is termed post-traumatic stress disorder (PTSD). A PTSD diagnosis was originally considered a normal response to an extreme situation however the presence of symptoms for an extended period of time beyond one month is indicative of an abnormal adaptation in the brain.
The prevalence of PTSD varies across countries. It occurs in 5-10% of the population and has a 2:1 female to male ratio. The gender bias may be a result of a combination of a greater propensity to lifetime violence exposure and genetic vulnerability (variation in the ADCYAP1R1 (pituitary receptor) gene). [Yehuda et al., 2015]
In military populations, the risk is more significant. For example, 10 years after the Vietnam war the rates of current PTSD went up to 28% in those who had experienced combat exposure. A recent analysis showed that 40 years after the end of the war, 11% of Vietnam veterans are experiencing PTSD symptoms. [Yehuda et al., 2015]
In civilian population samples, the rates vary from 0.2%-3.8%. A number of factors such as social supports, trauma type, and severity affect prevalence.
Blum, K., Gondré-Lewis, M. C., Modestino, E. J., Lott, L., Baron, D., Siwicki, D., McLaughlin, T., Howeedy, A., Krengel, M. H., Oscar-Berman, M., Thanos, P. K., Elman, I., Hauser, M., Fried, L., Bowirrat, A., & Badgaiyan, R. D. (2019). Understanding the Scientific Basis of Post-traumatic Stress Disorder (PTSD): Precision Behavioral Management Overrides Stigmatization. Molecular neurobiology, 56(11), 7836–7850.
Hoskins, M. D., Bridges, J., Sinnerton, R., Nakamura, A., Underwood, J. F., Slater, A., … & Bisson, J. I. (2021). Pharmacological therapy for post-traumatic stress disorder: a systematic review and meta-analysis of monotherapy, augmentation and head-to-head approaches. European Journal of Psychotraumatology, 12(1), 1802920.
Yehuda R, Bierer LM, Pratchett LC, Lehrner A, Koch EC, Van Manen JA, Flory JD, Makotkine I, Hildebrandt T. Cortisol augmentation of a psychological treatment for warfighters with posttraumatic stress disorder: Randomized trial showing improved treatment retention and outcome. Psychoneuroendocrinology. 2015 Jan;51:589-97.