The Psychophysiology of Posttraumatic Stress Disorder: A Meta-Analysis

Department of Psychology, University of Michigan, Ann Arbor, MI 48109-1109, USA.
Psychological Bulletin (Impact Factor: 14.76). 10/2007; 133(5):725-46. DOI: 10.1037/0033-2909.133.5.725
Source: PubMed


This meta-analysis of 58 resting baseline studies, 25 startle studies, 17 standardized trauma cue studies, and 22 idiographic trauma cue studies compared adults with and without posttraumatic stress disorder (PTSD) on psychophysiological variables: facial electromyography (EMG), heart rate (HR), skin conductance (SC), and blood pressure. Significant weighted mean effects of PTSD were observed for HR (r = .18) and SC (r = .08) in resting baseline studies; eyeblink EMG (r = .13), HR (r = .23), and SC habituation slope (r = .21) in startle studies; HR (r = .27) in standardized trauma cue studies; and frontalis EMG (r = .21), corrugator EMG (r = .34), HR (r = .22), and SC (r = .19) in idiographic trauma cue studies. The most robust correlates of PTSD were SC habituation slope, facial EMG during idiographic trauma cues, and HR during all study types. Overall, the results support the view that PTSD is associated with elevated psychophysiology. However, the generalizability of these findings is limited by characteristics of the published literature, including its disproportionate focus on male veterans and neglect of potential PTSD subtypes.

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    • "Our results are in agreement with studies on PTSD patients. There are two meta-analyses [14] [15] showing that PTSD patients might be characterized by higher resting SBP and DBP. Moreover, the recent analysis of data from 4008 subjects participating in the United States National Comorbidity Survey revealed that PTSD is associated with the highest rate of hypertension, independently of depression [16] [17]. "
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    ABSTRACT: Objective: It has repeatedly been found that early life traumatic events may contribute to metabolic dysregulation. Therefore, the aim of this study was to investigate the association between the history of childhood trauma and cardiovascular risk factors in first-episode schizophrenia (FES) patients. Method: The history of childhood trauma was assessed using the Early Trauma Inventory Self Report – Short Form (ETISR-SF) in 83 FES patients. Based on the ETISR-SF, patients were divided into those with positive and negative history of childhood trauma – FES(+) and FES(−) patients. Serum levels of fasting glucose lipids, homocysteine, vitamin B12 and folate, as well as anthropometric parameters, resting systolic and diastolic blood pressure (SBP and DBP) were measured. Results: The history of childhood trauma was associated with higher LDL levels, SBP and DBP after co-varying for age, gender, BMI, education and chlorpromazine equivalent. There were significant correlations between scores of distinct ETISR-SF subscales and LDL, HDL, SBP, DBP and the number of metabolic syndrome criteria. Conclusions: Results of this study indicate that traumatic events during childhood might be related to higher resting blood pressure and higher LDL levels in adult FES patients.
    General Hospital Psychiatry 03/2015; DOI:10.1016/j.genhosppsych.2015.03.017 · 2.61 Impact Factor
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    • "Basal heart rate measures: Persistently elevated HR is reported in PTSD patients (Bedi and Arora 2007; Pole 2007; van Liempt et al. 2013). Diminished HRV in individuals with PTSD has been observed in a number of studies (Cohen et al. 1997, 2000; Haley et al. 2004; Mellman et al. 2004; Jovanovic et al. 2009; Ginsberg et al. 2010; Song et al. 2011; Tan et al. 2011; Agorastos et al. 2013). "
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    ABSTRACT: Heart rate variability (HRV), determined by different methods from the fluctuation of heart rate (HR), has been used in many studies as a powerful index of autonomic function and indicator of cardiac risk. Here, we review how HRV measures in different domains such as time, frequency, and nonlinear domains have been successfully used to identify increased cardiac risk in PTSD patients. PTSD patients show high cardiac comorbidity that may have emerged for various reasons but is predominantly attributed to altered autonomic control. The deranged fear or “stress” system is implicated in affective and autonomic system dysfunctions. The underlying neurocircuitry and molecular key players of autonomic dysfunction in PTSD are still poorly understood. A malfunctioning cortical control of the downstream defense system is hypothesized to be causal for the blunted tonic vagal control and/or increased sympathetic activity that generally leads to increased HR, reduced HRV, and blunted diurnal/circadian changes compared to the healthy state. Altered serotonergic neurotransmission is likely involved in the reduced vagal function. Nonlinear approaches in combination with animal models are required to provide a better mechanistic understanding of the neural and molecular mechanisms underlying the healthy and the malfunctioning brain-heart interaction in PTSD.
    Comprehensive Guide to Post-Traumatic Stress Disorder, Edited by Colin R. Martin, Victor R. Preedy, Vinood B. Patel, 03/2015: pages 1-15; Springer International Publishing., ISBN: 978-3-319-08613-2
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    • "In humans, however, studies of adults and children with a history of trauma, including exposure to war or childhood physical and sexual abuse (Pole, 2007), have yielded inconsistent results. Some report enhanced startle suggestive of a hypersensitive defensive motivational system due to early adversity (Jovanovic et al., 2009; Pole, 2007). Others have found blunting of the startle response and argue that early adversity or/and persistent dysphoria depletes defensive responding (Klorman, Cicchetti, Thatcher, & Ison, 2003; McTeague et al., 2010; Reichmann-Decker, DePrince, & McIntosh, 2009). "
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    ABSTRACT: This study tested the effect of early neglect on defensive and appetitive physiology during puberty. Emotion-modulated reflexes, eye-blink startle (defensive) and postauricular (appetitive), were measured in 12-to-13-year-old internationally adopted youth (from foster care or from institutional settings) and compared to non-adopted US born controls. Startle Reflex: adopted youth displayed lower overall startle amplitude across all valences and startle potentiation to negative images was negatively related to severity of pre-adoption neglect. Postauricular reflex (PAR): adopted youth showed larger PAR magnitude across all valences. Puberty: adopted youth showed diminished PAR potentiation to positive images and startle potentiation during mid/late puberty versus the opposite pattern in not-adopted. Early neglect was associated with blunted fast defensive reflexes and heightened fast appetitive reflexes. After puberty, early neglected youth showed physiological hyporeactivity to threatening and appetitive stimuli versus heightened reactivity in not adopted youth. Behavioral correlates in this sample and possible neurodevelopmental mechanisms of psychophysiological differences are discussed. © 2015 Wiley Periodicals, Inc. Dev Psychobiol 9999: XX-XX, 2015. © 2015 Wiley Periodicals, Inc.
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