Dysregulation of the Right Brain: A Fundamental Mechanism of Traumatic Attachment and the Psychopathogenesis of Posttraumatic Stress Disorder

Objective: This review integrates recent advances in attachment theory, affective neuroscience, developmental stress research, and infant psychiatry in order to delineate the developmental precursors of posttraumatic stress disorder. Method: Existing attachment, stress physiology, trauma, and neuroscience literatures were collected using Index Medicus/Medline and Psychological Abstracts. This converging interdisciplinary data was used as a theoretical base for modelling the effects of early relational trauma on the developing central and autonomic nervous system activities that drive attachment functions. Results: Current trends that integrate neuropsychiatry, infant psychiatry, and clinical psychiatry are generating more powerful models of the early genesis of a predisposition to psychiatric disorders, including PTSD. Data are presented which suggest that traumatic attachments, expressed in episodes of hyperarousal and dissociation, are imprinted into the developing limbic and autonomic nervous systems of the early maturing right brain. These enduring structural changes lead to the inefficient stress coping mechanisms that lie at the core of infant, child, and adult posttraumatic stress disorders. Conclusions: Disorganised-disoriented insecure attachment, a pattern common in infants abused in the first 2 years of life, is psychologically manifest as an inability to generate a coherent strategy for coping with relational stress. Early abuse negatively impacts the developmental trajectory of the right brain, dominant for attachment, affect regulation, and stress modulation, thereby setting a template for the coping deficits of both mind and body that characterise PTSD symptomatology. These data suggest that early intervention programs can significantly alter the intergenerational transmission of posttraumatic stress disorders.

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Psychopharmacological Treatment for Posttraumatic Stress Disorders in Naval Military Subjects

Global Journal of Health Science ◽

10.5539/gjhs.v10n3p33 ◽

2018 ◽

Vol 10 (3) ◽

pp. 33

Author(s):

Anderson Diaz Perez ◽

Elvis Eliana Pinto Aragón ◽

Carmenza Leonor Mendoza Cataño ◽

Moraima del Toro Rubio ◽

Elkin Navarro-Quiroz

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Depressive Disorders ◽

Stress Disorder ◽

Traumatic Event ◽

Cross Sectional Study ◽

Stress Disorders ◽

Cross Sectional ◽

Psychiatric Syndrome ◽

Collection Form

INTRODUCTION: Posttraumatic Stress Disorder (PTSD) is a psychiatric syndrome known since 1980 with multiple names in the military field. Its etiology is multicausal, whose predominant factor is the lack of adaptation and managing with events considered traumatic. Objective. To describe the clinical characteristics such as the type of psychological and pharmacological treatment received by the naval military with diagnosis of Posttraumatic Stress Disorder at the Psychiatric Unit of Cartagena’s Naval Hospital.METHODOLOGY: A descriptive, retrospective cross-sectional study with an associative approach (Crosstabulation). The sample was 242 navy subjects with PTSD diagnosis. The information was collected with a data collection form of medical records. The information analysis was developed through the program SPSS ® 21.0. Chi2 and value of p≤0.05 calculation was applied through the crossing of variables.RESULTS: The most prevalent type of traumatic event was the one represented by combat with the presence of depressive disorders and anxiety with a value of p≤0.05.CONCLUSIONS: The PTSD severity is related to the severity of the event, in addition if the trumatic event was repetitive.

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The Innate Alarm System and Subliminal Threat Presentation in Posttraumatic Stress Disorder: Neuroimaging of the Midbrain and Cerebellum

Chronic Stress ◽

10.1177/2470547018821496 ◽

2019 ◽

Vol 3 ◽

pp. 247054701882149 ◽

Cited By ~ 7

Author(s):

Braeden A. Terpou ◽

Maria Densmore ◽

Janine Thome ◽

Paul Frewen ◽

Margaret C. McKinnon ◽

...

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Stress Disorder ◽

Brain Activation ◽

Stimulus Presentation ◽

Neutral Stimulus ◽

Alarm System ◽

Imaging Data ◽

The Right

Background The innate alarm system, a network of interconnected midbrain, other brainstem, and thalamic structures, serves to rapidly detect stimuli in the environment prior to the onset of conscious awareness. This system is sensitive to threatening stimuli and has evolved to process these stimuli subliminally for hastened responding. Despite the conscious unawareness, the presentation of subliminal threat stimuli generates increased activation of limbic structures, including the amygdala and insula, as well as emotionally evaluative structures, including the cerebellum and orbitofrontal cortex. Posttraumatic stress disorder (PTSD) is associated with an increased startle response and decreased extinction learning to conditioned threat. The role of the innate alarm system in the clinical presentation of PTSD, however, remains poorly understood. Methods Here, we compare midbrain, brainstem, and cerebellar activation in persons with PTSD (n = 26) and matched controls (n = 20) during subliminal threat presentation. Subjects were presented with masked trauma-related and neutral stimuli below conscious threshold. Contrasts of subliminal brain activation for the presentation of neutral stimuli were subtracted from trauma-related brain activation. Group differences in activation, as well as correlations between clinical scores and PTSD activation, were examined. Imaging data were preprocessed utilizing the spatially unbiased infratentorial template toolbox within SPM12. Results Analyses revealed increased midbrain activation in PTSD as compared to controls in the superior colliculus, periaqueductal gray, and midbrain reticular formation during subliminal threat as compared to neutral stimulus presentation. Controls showed increased activation in the right cerebellar lobule V during subliminal threat presentation as compared to PTSD. Finally, a negative correlation emerged between PTSD patient scores on the Multiscale Dissociation Inventory for the Depersonalization/Derealization subscale and activation in the right lobule V of the cerebellum during the presentation of subliminal threat as compared to neutral stimuli. Conclusion We interpret these findings as evidence of innate alarm system overactivation in PTSD and of the prominent role of the cerebellum in the undermodulation of emotion observed in PTSD.

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Posttraumatic stress disorder symptom severity is associated with left hippocampal volume reduction: a meta-analytic study

CNS Spectrums ◽

10.1017/s1092852916000833 ◽

2016 ◽

Vol 22 (4) ◽

pp. 363-372 ◽

Cited By ~ 24

Author(s):

Michael D. Nelson ◽

Alecia M. Tumpap

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Effect Size ◽

Symptom Severity ◽

Stress Disorder ◽

Meta Analysis ◽

Hippocampal Volume ◽

Volume Reduction ◽

Left Hippocampus ◽

The Right

ObjectiveMany studies have reported hippocampal volume reductions associated with posttraumatic stress disorder (PTSD), while others have not. Here we provide an updated meta-analysis of such reductions associated with PTSD and evaluate the association between symptom severity and hippocampal volume.MethodsA total of 37 studies met the criteria for inclusion in the meta-analysis. Mean effect sizes (Hedges’ g) and 95% confidence intervals (CI95%) were computed for each study and then averaged to obtain an overall mean effect size across studies. Meta-regression was employed to examine the relationship between PTSD symptom severity and hippocampal volume.ResultsResults showed that PTSD is associated with significant bilateral reduction of the hippocampus (left hippocampus effect size=–0.400, p<0.001, 5.24% reduction; right hippocampus effect size=–0.462, p<0.001, 5.23% reduction). Symptom severity, as measured by the Clinician-Administered PTSD Scale (CAPS), was significantly associated with decreased left, but not right, hippocampal volume.ConclusionsPTSD was associated with significant bilateral volume reduction of the hippocampus. Increased symptom severity was significantly associated with reduced left hippocampal volume. This finding is consistent with the hypothesis that PTSD is more neurotoxic to the left hippocampus than to the right. However, whether the association between PTSD and lower hippocampal volume reflects a consequence of or a predisposition to PTSD remains unclear. More prospective studies are needed in this area.

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An investigation of resting state functional connectivity of the anterior and posterior Hippocampal subregions in posttraumatic stress disorder and its relationship with symptoms

10.32920/ryerson.14661012.v1 ◽

2021 ◽

Author(s):

Bailee L. Malivoire

Keyword(s):

Posttraumatic Stress Disorder ◽

Functional Connectivity ◽

Posttraumatic Stress ◽

Resting State ◽

Stress Disorder ◽

Brain Regions ◽

Imaging Biomarkers ◽

Resting State Functional Connectivity ◽

Hippocampal Activity ◽

The Right

Posttraumatic stress disorder (PTSD) is associated with abnormal hippocampal activity; however, the functional connectivity (FC) of the hippocampus with other brain regions and its relations with symptoms warrants further attention. I investigated FC of the hippocampus at a subregional level in PTSD during a resting state compared to trauma exposed controls (TECs). Based on imaging literature in PTSD, I targeted the FCs of the hippocampal head and tail subregions with the amygdala, medial prefrontal cortex (mPFC), and the posterior cingulate (PCC). The PTSD group had significantly greater FC compared to the TEC group between the left hippocampal head and the right amygdala, and for the left hippocampal tail with bilateral PCC. Resting state FC predicted symptom severity at time of scan and 4-months post-scan. These results highlight abnormal illness-related FC with both the hippocampal head and tail and provide support for future investigations of imaging biomarkers predictive of disease progression.

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Genetics of Posttraumatic Stress Disorder

CNS Spectrums ◽

10.1017/s1092852900008889 ◽

2003 ◽

Vol 8 (9) ◽

pp. 693-698 ◽

Cited By ~ 33

Author(s):

Ronnen H. Segman ◽

Arieh Y. Shalev

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Vietnam Veterans ◽

Stress Disorder ◽

Traumatic Event ◽

Stress Disorders ◽

Exposure Limits ◽

Traumatic Stress Disorders ◽

Family Based ◽

Chronic Course

ABSTRACTPosttraumatic stress disorder (PTSD) is a prevalent anxiety disorder marked by behavioral, physiologic, and hormonal alterations. PTSD is disabling and commonly follows a chronic course. The etiology of PTSD is unknown, although exposure to a traumatic event constitutes a necessary, but not sufficient, factor. A twin study of Vietnam veterans has shown significant genetic contribution to PTSD. The fact that PTSD's underlying genotypic vulnerability is only expressed following trauma exposure limits the usefulness of family-based linkage approaches. In contrast to the other major psychiatric disorders, large studies for the search of underlying genes have not been described in PTSD to date. Complementary approaches for locating involved genes include association-based studies employing case-control or parental genotypes for transmission dysequilibrium analysis and quantitative trait loci studies in animal models. Identification of susceptibility genes will increase our understanding of traumatic stress disorders and help to elucidate their molecular basis. The current review provides an up-to-date outline of progress in the field of PTSD.

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Trauma exposure and factors associated with ICD-11 PTSD and complex PTSD in the Lithuanian general population

International Journal of Social Psychiatry ◽

10.1177/00207640211057720 ◽

2021 ◽

pp. 002076402110577

Author(s):

Monika Kvedaraite ◽

Odeta Gelezelyte ◽

Agniete Kairyte ◽

Neil P Roberts ◽

Evaldas Kazlauskas

Keyword(s):

Risk Factors ◽

Posttraumatic Stress Disorder ◽

General Population ◽

Posttraumatic Stress ◽

Stress Disorder ◽

Previous History ◽

Trauma Exposure ◽

Stress Disorders ◽

Traumatic Experience ◽

Factors Associated

Background: After the inclusion of a novel diagnosis of Complex Posttraumatic Stress Disorder (CPTSD) in the 11th edition of the International Classification of Diseases (ICD-11), there is a growing need for research focused on not only studying the underlying risk factors of this disorder but also differentiating the risk factors of Posttraumatic Stress Disorder (PTSD) and CPTSD to understand better the factors leading to CPTSD onset and symptom maintenance. Aims: This study aimed to explore the prevalence of traumatic experiences, trauma-related disorders and risk factors associated with ICD-11 PTSD and CPTSD in a population-based Lithuanian sample using the International Trauma Questionnaire (ITQ). Methods: The study sample included 885 participants (age M[ SD] = 37.96 [14.67], 63.4% female). The Life Events Checklist was used to measure trauma exposure, PTSD and CPTSD symptoms were measured by the Lithuanian ITQ version. The Disclosure of Trauma Questionnaire (DTQ) was used to measure the urge or reluctance to talk about trauma. Results: The prevalence of at least one traumatic experience in the study sample was 81.4%. The prevalence of PTSD and CPTSD among the general population in Lithuania was 5.8% and 1.8%, respectively. Accumulative lifetime trauma exposure, sexual assault and assault with a weapon were significant predictors for both PTSD and CPTSD. Participants from the CPTSD group reported greater reluctance to disclose trauma and stronger emotional reactions than no diagnosis and PTSD groups. Results also indicate that the Lithuanian ITQ version is a valid measure for screening PTSD and CPTSD in the general population. Conclusion: Previous history of trauma and interpersonal trauma were associated with posttraumatic stress disorders but did not differentiate between PTSD and CPTSD in our study. However, social trauma-related factors, such as trauma disclosure, were associated with stronger CPTSD symptoms.

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Neural Response to Trauma-Related and Trauma-Unrelated Negative Stimuli in Remitted and Persistent Pediatric Posttraumatic Stress Disorder

10.21203/rs.3.rs-92060/v1 ◽

2020 ◽

Author(s):

Peng Wang ◽

Zulai Peng ◽

Lu Liu ◽

Li An ◽

Yuxin Liu ◽

...

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Neural Activity ◽

Stress Disorder ◽

Related Condition ◽

Unrelated Condition ◽

Significant Difference ◽

Left Hippocampus ◽

Middle Occipital Gyrus ◽

The Right

Abstract Background: Most youths who suffer from posttraumatic stress disorder (PTSD) lose their diagnosis in the first 1-2 years. However, there are few studies on this brain mechanism, and the heterogeneity of the findings is partially due to the different stimuli applied and the mixed trauma history. Therefore, the use of trauma-related/unrelated stimuli to study the remittance mechanism of earthquake-induced PTSD could advance our knowledge of PTSD and inspire future treatment.Methods: Thirteen youths with PTSD, 18 remitted participants and 18 control participants underwent functional magnetic resonance imaging (fMRI) while viewing trauma-related pictures, trauma-unrelated negative pictures and scrambled pictures.Results: Under trauma-unrelated condition, the neural activity of the left hippocampus in the remitted group was in the middle between the two other groups. Under trauma-related condition, the PTSD and the remitted group exhibited higher neural activity in the right middle occipital gyrus than controls. The remitted group showed higher neural activity in the right parahippocampal gyrus and right lingual gyrus under trauma-related condition than trauma-unrelated condition, while no significant difference was found in PTSD group.Conclusion: PTSD symptom-related group difference is mainly reflected in the left hippocampus under the trauma-unrelated condition, while the hyperactivity in the right middle occipital gyrus under trauma related condition could be an endophenotype for PTSD.

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Re-evaluating disability assessment in war veterans with posttraumatic stress disorder

Vojnosanitetski pregled ◽

10.2298/vsp150124090s ◽

2016 ◽

Vol 73 (10) ◽

pp. 945-949

Author(s):

Radomir Samardzic ◽

Bratislav Zivic ◽

Dragan Krstic ◽

Danilo Jokovic ◽

Mirko Dolic ◽

...

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Stress Disorder ◽

Local Level ◽

Diagnostic Assessment ◽

Diagnostic Process ◽

War Veterans ◽

Financial Compensation ◽

The Right ◽

Assessment Of Ptsd

Background/Aim. Sametimes war veterans may resort to such strategies as preducing exaggerated symptoms and malingerating in order to obtain material compensation rights. The aim of this study was to assess the accuracy of the diagnosis of posttraumatic stress disorder (PTSD) on the basis of which war veterans were entitled to a financial compensation due to their disability. Methods. The diagnoses of 259 war veterans were re-evaluated. Veterans were previously diagnosed by a psychiatrist on local level, while regional state medical commission determined the degree of disability and the right to a financial compensation. A team of experts, consisting of psychiatrists with research experience in the field of traumatic stress and who were trained to use a structured interview for PTSD, conducted the evaluation of medical data from veterans? military records. The diagnostic process was conducted using the standardized diagnostic interview (Clinician-Administered PTSD Scale ? CAPS), after which the diagnosis was reaffirmed or reviewed. This influenced disability status and consequential financial compensation. Results. There was a remarkable difference between the first diagnostic assessment of PTSD, conducted by the psychiatrists on local level, and the second evaluation conducted by the team of experts. In more than half of 259 veterans (52.1%) diagnosed with PTSD in the first assessment the diagnosis was not confirmed. The diagnosis was confirmed in 31.7% of veterans. Those veterans who were diagnosed with lifetime PTSD (7.3%) should also be treated as accuratelly diagnosed. This means that a total of 39% of the diagnoses were accurate. The rest (8.9%) were diagnosed with other diagnoses, but not PTSD, as was the case in the initial assessment. Conclusion. The possibility for war veterans to obtain the right to disability and financial compensation due to a diagnosis of PTSD might interfere with the proper diagnostic assessment and thus the treatment outcome. During the procedures for the obtention of these rights, exaggeration or simulation of symptoms are common. The quality of the diagnostic assessment of PTSD can be improved by applying evidence based standardized procedures.

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