Matthew J Friedman

• Geisel School of Medicine at Dartmouth

Importance Posttraumatic stress disorder (PTSD) symptom reduction is linked with lower risk of incident type 2 diabetes (T2D), but little is known about the association between PTSD and comorbid T2D outcomes. Whether PTSD is a modifiable risk factor for adverse T2D outcomes is unknown. Objective To determine whether patients with PTSD who improved...

Posttraumatic stress disorder (PTSD) Criterion A, also known as the “stressor criterion,” has been a major source of debate ever since PTSD was added to the third edition of the Diagnostic and Statistical Manual for Mental Disorders ( DSM ) in 1980. Since then, the traumatic stress field has held an ongoing debate about how to best define Criterion...

Subthreshold posttraumatic stress disorder (PTSD) has long been recognized as an important construct that identifies a subgroup of individuals who report significant PTSD symptoms and associated disability but do not endorse enough symptoms to meet the criteria for a full PTSD diagnosis. Different investigators have defined subthreshold PTSD in var...

Objective: Substance use is a common co-occurrence among psychiatrically hospitalized adults, yet it is especially difficult to identify in those with serious mental illness. Existing screening instruments are not feasible for individuals with serious mental illness, as they rely heavily on subjective self-report. This study aimed to develop and va...

Post-traumatic stress disorder (PTSD) is a common and disabling psychiatric disorder. Here we present findings from the first proteome-wide study of the postmortem PTSD brain. We performed tandem mass spectrometry on large cohort of donors (N = 66) in two prefrontal cortical areas and found differentially expressed proteins and co-expression module...

Post-traumatic stress disorder is a mental disorder that may occur in the aftermath of severe psychological trauma. We examined 1,065,750 DNA methylation (DNAm) sites from 171 donors including neurotypicals, PTSD, and major depressive disorder cases across six areas implicated in the fear circuitry of the brain. We found significant differential me...

Importance Environmental disasters, such as the Flint, Michigan, water crisis, are potentially traumatic events (PTEs) that may precipitate long-term psychiatric disorders. The water crisis was associated with acute elevations in mental health problems in the Flint community, but long-term psychiatric sequelae have not yet been evaluated using stan...

Objective: Posttraumatic stress disorder (PTSD) is a debilitating neuropsychiatric disease that is highly comorbid with major depressive disorder (MDD) and bipolar disorder. The overlap in symptoms is hypothesized to stem from partially shared genetics and underlying neurobiological mechanisms. To delineate conservation between transcriptional pat...

Background: The risk of suicide among Veterans is of major concern, particularly among those who experienced a combat deployment and/or have a history of PTSD. Design and methods: This was a retrospective cohort study of post-discharge suicide among Vietnam-era Veterans who are members of the Vietnam Era Twin (VET) Registry. The VET Registry is...

Objective: Our objective was to characterize benzodiazepine prescribing changes among veterans with posttraumatic stress disorder (PTSD) and inform efforts to deimplement low-value prescribing practices. Methods: This retrospective observational study used national Veterans Health Administration (VHA) administrative databases to examine annual per...

Importance: Posttraumatic stress disorder (PTSD) is a prevalent and serious mental health problem. Although there are effective psychotherapies for PTSD, there is little information about their comparative effectiveness. Objective: To compare the effectiveness of prolonged exposure (PE) vs cognitive processing therapy (CPT) for treating PTSD in...

Given the devastation caused by disasters and mass violence, it is critical that intervention policy be based on the most updated research findings. However, to date, no evidence-based consensus has been reached supporting a clear set of recommendations for intervention during the immediate and the mid-term post mass trauma phases. Because it is un...

Objective: Violence by patients against inpatient psychiatric unit staff is common, causing considerable suffering. Despite the Joint Commission's 2018 requirement for behavioral health organizations to use standardized instruments, no identified gold standard measures of violence and aggression exist. Therefore, accurate data are lacking on the f...

Background: Improvement in posttraumatic stress disorder (PTSD) is associated with better health behavior such as better medication adherence and greater use of nutrition and weight loss programs. However, it is not known if reducing PTSD severity is associated with smoking cessation, a poor health behavior common in patients with PTSD. Methods:...

Introduction The ongoing coronavirus disease 2019 (COVID-19) pandemic is a globally significant crisis with a rapid spread worldwide, high rates of illness and mortality, a high degree of uncertainty, and a disruption of daily life across the sociodemographic spectrum. The clinically relevant psychological consequences of this catastrophe will be l...

To the Editor The recent meta-analysis from Cénat et al¹ revealed that the estimated pooled prevalence of COVID-19–associated posttraumatic stress disorder (PTSD) was almost 22%. However, prior to the study by Janiri and colleagues,² no study to our knowledge had confirmed PTSD diagnoses among patients using a structured clinician-administered diag...

Post-traumatic stress disorder (PTSD) is a debilitating neuropsychiatric disease with a projected lifetime risk of 8.7%. PTSD is highly comorbid with depressive disorders including major depressive disorder (MDD) and bipolar disorder (BD). It is hypothesized that the overlap in symptoms stems from partially shared underlying neurobiological mechani...

Despite extensive study of the neurobiological correlates of post-traumatic stress disorder (PTSD), little is known about its molecular determinants. Here, differential gene expression and network analyses of four prefrontal cortex subregions from postmortem tissue of people with PTSD demonstrate extensive remodeling of the transcriptomic landscape...

i. Rationale, Aims and Objectives: Despite guideline recommendations against their use, clinicians prescribe benzodiazepines for various symptoms to patients with posttraumatic stress disorder (PTSD). Clinicians’ reasons in making these decisions are not fully understood. This qualitative study sought to characterize factors identified by prescribi...

Background Clinical trials reveal posttraumatic stress disorder (PTSD) improvement leads to decreased substance use among patients with comorbid substance use disorder (SUD). Using administrative medical record data, we determined whether clinically meaningful PTSD Checklist (PCL) (≥20 points) score decreases were positively associated with SUD tre...

Despite well-known peripheral immune activation in posttraumatic stress disorder (PTSD), there are no studies of brain immunologic regulation in individuals with PTSD. [11C]PBR28 Positron Emission Tomography brain imaging of the 18-kDa translocator protein (TSPO), a microglial biomarker, was conducted in 23 individuals with PTSD and 26 healthy indi...

Background Posttraumatic stress disorder (PTSD) is associated with increased risk for cardiovascular disease (CVD). Whether clinically meaningful PTSD improvement is associated with lowering CVD risk is unknown. Methods Eligible patients (n = 1079), were 30–70 years old, diagnosed with PTSD and used Veterans Health Affairs PTSD specialty clinics....

Objective: Posttraumatic stress disorder (PTSD) is associated with increased risk for cardiometabolic disease. Clinically meaningful PTSD improvement is associated with a lower risk for diabetes, but it is not known if similar associations exist for incident hypertension, hyperlipidemia, and clinically relevant weight loss (i.e., ≥5% loss). Metho...

This chapter addresses the new section in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) called ‘Trauma and stressor-related disorders’. All diagnoses within this category have two things in common: (1) a discrete traumatic/adverse event or experience that preceded the onset or aggravation of symptoms; and (2...

Posttraumatic stress disorder (PTSD) affects approximately 8% of the general population, with higher rates in extreme stress groups, including combat veterans or victims of sexual assault. Despite extensive study of the neurobiological correlates of PTSD, little is known about its molecular substrates. Here differential gene expression and network...

Objective: Posttraumatic stress disorder (PTSD) is associated with poor health behaviors, including low utilization of Veteran Health Affairs (VHA) weight loss programs. It is not known if clinically meaningful PTSD improvement is associated with increased use of weight loss programs. Methods: Medical record data was obtained from VHA patients w...

Importance Posttraumatic stress disorder (PTSD) is associated with increased risk of type 2 diabetes (T2D). Improvement in PTSD has been associated with improved self-reported physical health and hypertension; however, there is no literature, to our knowledge, on whether PTSD improvement is associated with T2D risk. Objective To examine whether cl...

Background: Patients with vs. without posttraumatic stress disorder (PTSD) are more likely to have poor antidepressant medication (ADM) adherence but it is unclear if improved PTSD is associated with ADM adherence. We determined if clinically meaningful PTSD symptom reduction was associated with ADM adherence. Methods: Electronic health record d...

The American Psychological Association (APA) developed a clinical practice guideline (CPG) to provide recommendations on psychological and pharmacological treatments for posttraumatic stress disorder (PTSD) in adults. This paper is a summary of the CPG, including the development process. Members of the guideline development panel (GDP) used a compr...

Background Posttraumatic stress disorder (PTSD) is associated with risk of cardiovascular disease (CVD). Biopsychosocial factors associated with PTSD likely account for some or all of this association. We determined whether 1, or a combination of comorbid conditions explained the association between PTSD and incident CVD. Methods and Results Eligi...

Imagine this. You are watching a movie. It is a grainy black-and-white film, clearly not a Hollywood production. The first thing you see in the center of the screen is a raised desk supporting an old-fashioned Underwood typewriter. Behind the typewriter sits a woman intermittently pecking at the keys. Each time she taps a key, there is a distinct s...

Importance Posttraumatic stress disorder (PTSD) is associated with an increased risk of type 2 diabetes mellitus (T2DM). Existing literature has adjusted for obesity in combination with other confounders, which does not allow estimating the contribution of obesity alone on the association of PTSD with incident T2DM. Objective The current study was...

The National PTSD Brain Bank (NPBB) is a brain tissue biorepository established to support research on the causes, progression, and treatment of PTSD. It is a six-part consortium led by VA’s National Center for PTSD with participating sites at VA medical centers in Boston, MA; Durham, NC; Miami, FL; West Haven, CT; and White River Junction, VT alon...

Background: Aggression and violence on acute psychiatric inpatient units is extensive and leads to negative sequelae for staff and patients. With increasingly acute inpatient milieus due to shorter lengths of stay, inpatient staff is limited in training and time to be able to provide treatments. Mobile technology provides a new platform for offeri...

Posttraumatic stress disorder (PTSD) has been conceptualized as an inability to cope with overwhelming stress that is followed by a distinctive pattern of symptoms. This concept has made it possible to develop therapeutic approaches for PTSD that include medication and psychotherapy options. In this article we summarize research studies on pharmaco...

Posttraumatic stress disorder (PTSD) is a prevalent, disabling, and often chronic condition that may develop following exposure to a traumatic event. Despite the immense social and economic ramifications of PTSD, there has been relatively little recent development of new pharmacotherapies. The majority of pharmacological randomized clinical trials...

In Reply In his letter, Guina acknowledges many positive aspects of the DSM-5, while reiterating concerns about the potential impact of these revisions. We completely agree that functional impairment and dysfunction are critically important, that posttraumatic stress disorder (PTSD) is best understood as a dimensional as well as a categorical const...

This Special Communication argues for changing the definition of posttraumatic stress disorder in DSM-5.Are changes to the definition of posttraumatic stress disorder in DSM-5 a step forward?—Yes. We take strong exception to many of the assertions, conclusions, and recommendations in the article by Hoge et al1 in this issue of JAMA Psychiatry. Alth...

We estimated the temporal course of posttraumatic stress disorder (PTSD) in Vietnam-era veterans using a national sample of male twins with a 20-year follow-up. The complete sample included those twins with a PTSD diagnostic assessment in 1992 and who completed a DSM-IV PTSD diagnostic assessment and a self-report PTSD checklist in 2012 (n = 4,138)...

Post-traumatic stress disorder (PTSD) was changed significantly in DSM-5 in that it no longer is classified as an anxiety disorder. This came about because of strong empirical evidence that PTSD should not be conceptualized exclusively as a fear-based anxiety disorder. The other clinical phenotypes clearly present in PTSD are anhedonic/dysphoric, e...

Based on the 103rd annual meeting of the American Psychopathological Association, Long-Term Outcomes in Psychopathology Research: Rethinking the Scientific Agenda explores the long-term course of illness and functioning of individuals treated for mental health and substance use disorders and the outcomes research derived from these cases. Sections...

Posttraumatic stress disorder (PTSD) is a high-priority treatment area for the Veterans Health Administration (VHA), and dissemination patterns of innovative, efficacious therapies can inform areas for potential improvement of diffusion efforts and quality prescribing. In this study, we replicated a prior examination of the period prevalence of pra...

One of the major changes in DSM-5 was removal of the Global Assessment of Functioning (GAF). To determine whether the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a suitable replacement for the GAF, this study compared how well the WHODAS 2.0 and the GAF measured functional impairment and other phenomena related to p...

In Reply Suicide is an urgent problem for all US military services, their components, and their commands as well as the United States. Because this is such a high priority, the US Army and the National Institute of Mental Health jointly funded the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) to identify “modifiable risk...

Clinical Practice Guidelines issued by the US Department of Veterans Affairs (VA) and the Department of Defense recommend prazosin for sleep/nightmares for veterans with posttraumatic stress disorder (PTSD). As existing literature suggests this novel treatment option to be underutilized, we examined a cohort of veterans with PTSD initiating prazosi...

Objective: The prevalence of post-traumatic stress disorder (PTSD) among aging Vietnam-era veterans is not well characterized. Methods: In a cross-sectional study, 5,598 male Vietnam-era veterans and members of the Vietnam Era Twin Registry were assessed for PTSD using the Composite International Diagnostic Interview. Current symptoms were measu...

There have been significant advancements in the pharmacologic management of posttraumatic stress disorder (PTSD) in the past two decades. Multisite randomized clinical trials (RCTs) have noted the efficacy of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNR Is) for PTSD treatment. Unfortunately,...

OBJECTIVES To present data on prevalence, trends, and basic sociodemographic and Army experience correlates of suicides and accident deaths among active duty Regular Army soldiers between January 1, 2004, and December 31, 2009, and thereby establish a foundation for future Army STARRS investigations. DESIGN, SETTING, AND PARTICIPANTS Analysis of tr...

This chapter begins by defining “trauma” since traumatic exposure is the necessary precursor to PTSD. It then reviews how PTSD has been regarded since ancient times. Information is presented regarding the prevalence of PTSD, both within the USA and worldwide. The important clinical and public health question regarding prevention of PTSD is addresse...

This chapter begins by describing the human stress response in order to provide the context for understanding the psychobiology of PTSD. It then discusses PTSD-related abnormalities in the brain function and structure as well as alterations in the adrenergic, serotonergic, and hypothalamic–pituitary–adrenocortical (HPA) systems. The current state-o...

Before choosing any of the specific PTSD treatments (detailed in Chaps. 4 and 5), there are a number of general questions to consider. These include timing and priority issues related to treatment (e.g., psychiatric emergency, co-occurring substance use, and situational factors). Other therapeutic considerations include combining different approach...

This chapter deals entirely with acute posttraumatic responses. It begins by describing acute stress reactions, normal reactions to traumatic events both in civilian and military contexts. Issues such as resilience and prevention are addressed with respect to such acute responses, with specific attention to Psychological First Aid for civilians and...

This chapter reviews what specific psychosocial treatments are available for adults with PTSD, as well as those for children and adolescents. Each treatment approach is described along with data from clinical trials with regard to its effectiveness. Psychoeducation and peer counseling approaches are described. Individual psychotherapeutic approache...

This chapter begins by discussing the main characteristics of PTSD and goes on to present the DSM-5 diagnostic criteria for the disorder. Each symptom is discussed in detail with illustrative examples. Practical advice is offered regarding strategies for conducting the initial clinical interview, identifying risk factors, and using standardized ass...

Posttraumatic and Acute Stress Disorder, Fifth Edition is a concise, up-to-date presentation of the latest scientific information and clinical challenges regarding posttraumatic stress disorder (PTSD) as well as acute reactions to stressful events. Written for non-PTSD specialists including practitioners in general psychiatry, primary care practiti...

The 11th edition of the International Classification of Diseases (ICD–11) is under development, and current proposals include major changes to trauma-related psychiatric diagnoses, including a heavily restricted definition of posttraumatic stress disorder (PTSD) and the addition of complex PTSD (CPTSD). We aimed to test the postulates of CPTSD in s...

Growing evidence has linked posttraumatic stress disorder (PTSD) to insulin resistance and type-2 diabetes, but most previous studies were cross-sectional. We examined the association between PTSD and incidence of diabetes in a prospective study of middle-aged male twins from the Vietnam Era Twin Registry. Lifetime PTSD was diagnosed at baseline wi...

Aims. Self-report questionnaires are frequently used in clinical and epidemiologic studies to assess post-traumatic stress disorder (PTSD). A number of studies have evaluated these scales relative to clinician administered structured interviews; however, there has been no formal evaluation of their performance relative to non-clinician administered...

Background: The development of the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) and ICD-11 has led to reconsideration of diagnostic criteria for posttraumatic stress disorder (PTSD). The World Mental Health (WMH) Surveys allow investigation of the implications of the changing criteria compared to DSM-IV and ICD-10. Me...

The diagnostic criteria for posttraumatic stress disorder (PTSD) were substantially revised for Diagnostic and Statistical Manual of Mental Disorders—5th edition (DSM-5). This in turn necessitated revision of DSM-correspondent assessment measures of PTSD. We describe the various changes to the PTSD diagnostic criteria and the corresponding changes...

Background: Although only a few people exposed to a traumatic event (TE) develop posttraumatic stress disorder (PTSD), symptoms that do not meet full PTSD criteria are common and often clinically significant. Individuals with these symptoms sometimes have been characterized as having subthreshold PTSD, but no consensus exists on the optimal defini...

Modeled after the Framingham Heart Study, the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) is designed to identify salient risk and protective factors regarding suicide, adverse mental health outcomes, and functional impairment. This groundbreaking initiative is investigating a wide range of domains, from large administr...

Clinical research suggests that posttraumatic stress disorder (PTSD) patients exposed to multiple traumatic events (TEs) rather than a single TE have increased morbidity and dysfunction. Although epidemiological surveys in the United States and Europe also document high rates of multiple TE exposure, no population-based cross-national data have exa...

Background Although only a minority of people exposed to a traumatic event (TE) develops PTSD, symptoms not meeting full PTSD criteria are common and often clinically significant. Individuals with these symptoms have sometimes been characterized as having sub-threshold PTSD, but no consensus exists on the optimal definition of this term. Data from...

Posttraumatic stress disorder (PTSD) treatment is often complicated in veterans by co-occurring conditions including pain, insomnia, brain injury, and other mental disorders. Pharmacologic approaches to these conditions can produce an accumulation of sedating medications with potential for safety concerns. The objective of this study was to charact...

To assess the relationship of posttraumatic stress disorder (PTSD) with health functioning and disability in Vietnam-era Veterans. A cross-sectional study of functioning and disability in male Vietnam-era Veteran twins. PTSD was measured by the Composite International Diagnostic Interview; health functioning and disability were assessed using the V...

Benzodiazepines, other anxiolytics, or sedative hypnotics are prescribed for 30%-50% of posttraumatic stress disorder (PTSD) patients. Prior data and theory suggest that these medications may inhibit response to exposure therapy, one of the most effective PTSD treatments. The present post hoc study reanalyzed results from a psychotherapy trial to a...

Prevalence of posttraumatic stress disorder (PTSD) defined according to the American Psychiatric Association's Diagnostic and Statistical Manual fifth edition (DSM-5; 2013) and fourth edition (DSM-IV; 1994) was compared in a national sample of U.S. adults (N = 2,953) recruited from an online panel. Exposure to traumatic events, PTSD symptoms, and f...

The process that resulted in the diagnostic criteria for posttraumatic stress disorder (PTSD) in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association; ) was empirically based and rigorous. There was a high threshold for any changes in any DSM-IV diagnostic criterion. The process is described in...

The greater emphasis on scientific evidence and the high threshold for changing any criterion in the Diagnostic and Statistical Manual for Mental Disorders (4th ed., DSM-IV) probably account for many key differences between the DSM-5 and the International Classification of Diseases and Related Health Problems (11th ver.; ICD-11) with regard to diag...