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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    • "According to former results in PTSD and the diagnostic criteria of DSM-IV, we expect the following patterns in children and adolescents with PTSD compared to controls with a trauma history and no PTSD: 1) More reports of anxiety at baseline, stronger reactivity (defined as difference between trauma script and baseline), and stronger script contrast (defined as difference between trauma and an emotionally neutral script; American Psychiatric Association, 2000). 2) Higher baseline levels, stronger reactivity, and stronger script contrast in HR (Buckley & Kaloupek, 2001; Pole, 2007), SCL (Pole, 2007), non-specific fluctuation (NSF; Grasso & Simons, 2012), and facial EMG (Pole, 2007), as well as lower reactions in RSA (Sack et al., 2004). "
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    ABSTRACT: Psychophysiological alterations such as elevated baseline levels and hyperresponsivity in cardiac, electrodermal, and facial muscle activity have been observed in adults with posttraumatic stress disorder (PTSD). There are only few, inconclusive studies investigating psychophysiological responses in children and adolescents with PTSD. This cross-sectional study sought to examine if autonomic variables, facial electromyography (EMG), and self-reported anxiety at baseline, while listening to neutral and idiosyncratic trauma scripts, differ between minors with a trauma history and PTSD, and a traumatized control (TC) group without PTSD. A better understanding of psychophysiological reactions in trauma-exposed children and adolescents could improve differential assessment and treatment decisions. PTSD was assessed using the Clinician Administered PTSD Scale for Children and Adolescents in 6- to 17-year-old trauma-exposed children, resulting in a group with PTSD according to DSM-IV (n=16) and a TC group without PTSD (n=18). Facial EMG, (para-)sympathetic measures (heart rate, electrodermal activity, respiratory sinus arrhythmia), and self-reported anxiety were measured during 5-min baseline, 3-min neutral script, and 3-min idiosyncratic trauma script. Baseline, reactivity (trauma minus baseline), and script contrast (trauma minus neutral) were analyzed by multivariate analyses of variance. Children and adolescents with PTSD reported more anxiety compared to TC for baseline, reactivity, and script contrast (ps<0.021, ds>0.59), and showed elevated corrugator supercilii muscle activity for script contrast (p<0.05, d=0.79). No group differences emerged for sympathetic or parasympathetic measures. Children and adolescents with PTSD experienced elevated anxiety at baseline and elevated anxiety and facial corrugator muscle response to an idiosyncratic trauma narrative. Autonomic hyperreactivity, typical for adult PTSD samples, did not figure prominently.
    European Journal of Psychotraumatology 02/2015; 6:25471. DOI:10.3402/ejpt.v6.25471 · 2.40 Impact Factor
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