Abstract Posttraumatic stress disorder (PTSD) can develop after trauma exposure. Some studies report that women develop PTSD at twice the rate of men, despite greater trauma exposure in men. Lipids ...and their metabolites (lipidome) regulate a myriad of key biological processes and pathways such as membrane integrity, oxidative stress, and neuroinflammation in the brain by maintaining neuronal connectivity and homeostasis. In this study, we analyzed the lipidome of 40 adults with PTSD and 40 trauma-exposed non-PTSD individuals (n = 20/sex/condition; 19–39 years old). Plasma samples were analyzed for lipidomics using Quadrupole Time-of-Flight (QToF) mass spectrometry. Additionally, ~ 90 measures were collected, on sleep, and mental and physical health indices. Poorer sleep quality was associated with greater PTSD severity in both sexes. The lipidomics analysis identified a total of 348 quantifiable known lipid metabolites and 1951 lipid metabolites that are yet unknown; known metabolites were part of 13 lipid subclasses. After adjusting for BMI and sleep quality, in women with PTSD, only one lipid subclass, phosphatidylethanolamine (PE) was altered, whereas, in men with PTSD, 9 out of 13 subclasses were altered compared to non-PTSD women and men, respectively. Severe PTSD was associated with 22% and 5% of altered lipid metabolites in men and women, respectively. Of the changed metabolites, only 0.5% measures (2 PEs and cholesterol) were common between women and men with PTSD. Several sphingomyelins, PEs, ceramides, and triglycerides were increased in men with severe PTSD. The correlations between triglycerides and ceramide metabolites with cholesterol metabolites and systolic blood pressure were dependent upon sex and PTSD status. Alterations in triglycerides and ceramides are linked with cardiac health and metabolic function in humans. Thus, disturbed sleep and higher body mass may have contributed to changes in the lipidome found in PTSD.
Abstract Background Women are twice as likely as men to develop Posttraumatic Stress Disorder (PTSD). Abnormal acquisition of conditioned fear has been suggested as a mechanism for the development of ...PTSD. While some studies of healthy humans suggest that women are either no different or express less conditioned fear responses during conditioning relative to men, differences in the acquisition of conditioned fear between men and women diagnosed with PTSD has not been examined. Methods Thirty-one participants (18 men; 13 women) with full or subsyndromal PTSD completed a fear conditioning task. Participants were shown computer-generated colored circles that were paired (CS+) or unpaired (CS−) with an aversive electrical stimulus and skin conductance levels were assessed throughout the task. Results Repeated measures ANOVA indicated a significant sex by stimulus interaction during acquisition. Women had greater differential conditioned skin conductance responses (CS + trials compared to CS− trials) than did men, suggesting greater acquisition of conditioned fear in women with PTSD. Conclusions In contrast to studies of healthy individuals, we found enhanced acquisition of conditioned fear in women with PTSD. Greater fear conditioning in women may either be a pre-existing vulnerability trait or an acquired phenomenon that emerges in a sex-dependent manner after the development of PTSD. Characterizing the underlying mechanisms of these differences is needed to clarify sex-related differences in the pathophysiology of PTSD.
Fear extinction underlies prolonged exposure, one of the most well-studied treatments for posttraumatic stress disorder (PTSD). There has been increased interest in exploring pharmacological agents ...to enhance fear extinction learning in humans and their potential as adjuncts to PE. The objective of such adjuncts is to augment the clinical impact of PE on the durability and magnitude of symptom reduction. In this study, we examined whether hydrocortisone (HC), a corticosteroid, and D-Cycloserine (DCS), an N-methyl-D-aspartate receptor partial agonist, enhance fear extinction learning and consolidation in individuals with PTSD. In a double-blind placebo-controlled 3-group experimental design, 90 individuals with full or subsyndromal PTSD underwent fear conditioning with stimuli that were paired (CS+) or unpaired (CS-) with shock. Extinction learning occurred 72 h later and extinction retention was tested one week after extinction. HC 25 mg, DCS 50 mg or placebo was administered one hour prior to extinction learning. During extinction learning, the DCS and HC groups showed a reduced differential CS+/CS- skin conductance response (SCR) compared to placebo (b = -0.19, CI = -0.01 to -37, p = 0.042 and b = -0.25, CI = -08 to -0.43, p = 0.005, respectively). A nonsignificant trend for a lower differential CS+/CS- SCR in the DCS group, compared to placebo, (b = -0.25, CI = 0.04 to -0.55, p = 0.089) was observed at retention testing, one week later. A single dose of HC and DCS facilitated fear extinction learning in participants with PTSD symptoms. While clinical implications have yet to be determined, our findings suggest that glucocorticoids and NMDA agonists hold promise for facilitating extinction learning in PTSD.
Women are diagnosed with posttraumatic stress disorder (PTSD) at twice the rate of men. This gender difference may be related to differences in PTSD experiences (e.g., more hypervigilance in women) ...or types of trauma experienced (e.g., interpersonal trauma). We examined whether attentional threat biases were associated with gender, PTSD diagnosis, and/or trauma type. Participants were 70 civilians and veterans (38 women, 32 men; 41 with PTSD, 29 without PTSD) assessed with the Clinician Administered PTSD Scale for DSM‐IV who completed a facial dot‐probe attention bias task and self‐report measures of psychiatric symptoms and trauma history. Factorial ANOVA and regression models examined associations between gender, PTSD diagnosis, index trauma type, lifetime traumatic experiences, and attentional threat biases. Results revealed that compared to women without PTSD and men both with and without PTSD, women with PTSD demonstrated attentional biases toward threatening facial expressions, d = 1.19, particularly fearful expressions, d = 0.74. Psychiatric symptoms or early/lifetime trauma did not account for these attentional biases. Biases were related to interpersonal assault index traumas, ηp2 = .13, especially sexual assault, d = 1.19. Trauma type may be an important factor in the development of attentional threat biases, which theoretically interfere with trauma recovery. Women may be more likely to demonstrate attentional threat biases due to higher likelihood of interpersonal trauma victimization rather than due to gender‐specific psychobiological pathways. Future research is necessary to clarify if sexual assault alone or in combination with gender puts individuals at higher risk of developing PTSD.
Resumen
Spanish s by Asociación Chilena de Estrés Traumático (ACET)
Diferencias de género en los sesgos de amenaza: el tipo de trauma es importante en TEPT
INFLUENCIA DE GÉNERO Y TIPO DE TRAUMA EN SESGOS DE AMENAZA
Las mujeres diagnosticadas con trastorno de estrés postraumático (TEPT) duplican la tasa de los hombres. Esta la diferencia de género puede estar relacionada con diferencias en las experiencias de TEPT (por ejemplo, más hipervigilancia en mujeres) o tipos de trauma experimentados (por ejemplo, trauma interpersonal). Examinamos si los sesgos atencionales de la amenaza se asociaron con el género, el diagnóstico de TEPT y/o el tipo de trauma. Los participantes fueron 70 civiles y veteranos (38 mujeres, 32 hombres; 41 con TEPT, 29 sin TEPT) evaluados con la Escala de TEPT Administrada por el Médico para DSM‐IV que se completó con una tarea de sesgo atencional con puntos faciales y medidas autoinformadas de síntomas psiquiátricos e historia de trauma. Por medio de una ANOVA factorial y modelos de regresión se examinaron las asociaciones entre género, diagnóstico de TEPT, tipo de trauma índice, experiencias traumáticas a lo largo de la vida y sesgos atencionales de la amenaza. Los resultados revelaron que, en comparación con las mujeres sin TEPT y los hombres con y sin TEPT, las mujeres con TEPT mostraron sesgos atencionales hacia expresiones faciales amenazantes, d = 1.19, especialmente expresiones de miedo, d = 0.74. Los síntomas psiquiátricos o experiencias tempranas de trauma en la vida no explicaron estos sesgos atencionales. Los sesgos se relacionaron con el índice de traumas por asalto interpersonal, ηp 2 = .13, especialmente agresión sexual, d = 1.19. El tipo de trauma puede ser un factor importante en el desarrollo de sesgos atencionales de la amenaza, que teóricamente interfieren con la recuperación del trauma. Las mujeres pueden ser más propensas a demostrar sesgos atencionales de las amenazas debido a una mayor probabilidad de victimización por trauma interpersonal más que debido a vías psicobiológicas específicas del género. La investigación futura es necesaria para aclarar si la agresión sexual sola o en combinación con el género pone a las personas en mayor riesgo de desarrollar TEPT.
抽象
Traditional and Simplified Chinese s by the Asian Society for Traumatic Stress Studies (AsianSTSS)
簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯
Gender differences in threat biases: Trauma type matters in PTSD
Traditional Chinese
標題: 面對威脅的偏誤的性別差異:PTSD患者的創傷類別的重要性
撮要: 女性被診斷出患創傷後壓力症(PTSD)的比率, 比男性高出兩倍。此等差異可能與PTSD經歷的差異 (如女性有較大的過度警覺) 有關, 又或是與創傷經歷的類別 (如人際創傷) 差異有關。我們檢視面對威脅的注意力偏誤是否跟性別、PTSD診斷、和/或創傷類別有關。樣本為70名平民與退役軍人 (38名女性, 32名男性;41人有PTSD, 29人無PTSD) ;他們均接受臨床治療師執行的DSM‐IV PTSD量表評估, 完成面部點探針作業, 並進行精神疾病症狀與創傷歷史的自評測量。因子變異數分析以及迴歸模型用以檢視性別、PTSD診斷、指標性創傷類別、終生的創傷經歷, 及面對威脅的注意力偏誤。結果反映, 與無PTSD的女性以及有和無PTSD的男性相比, 有PTSD的女性面對具威脅性的面部表情時, 展現注意力偏誤(d = 1.19), 特別是恐懼表情(d = 0.74)。精神疾病症狀或早期/終生的創傷並未能解釋這種注意力偏誤。偏誤跟人際襲擊的指標性創傷類別有關(ηp2 = .13), 特別是性侵犯(d = 1.19)。創傷類別在面對威脅的注意力偏誤發展中可能屬重要因素, 理論上會阻礙創傷的痊癒。女性可能會因為有較大可能經歷人際創傷, 以非因性別特殊的心理生理路徑, 而有較大機會在面對威脅時展現注意力偏誤。未來須有研究去釐清, 性侵犯是否單獨或連同性別致使個人患PTSD的風險提升。
Simplified Chinese
标题: 面对威胁的偏误的性别差异:PTSD患者的创伤类别的重要性
撮要: 女性被诊断出患创伤后压力症(PTSD)的比率, 比男性高出两倍。此等差异可能与PTSD经历的差异 (如女性有较大的过度警觉) 有关, 又或是与创伤经历的类别 (如人际创伤) 差异有关。我们检视面对威胁的注意力偏误是否跟性别、PTSD诊断、和/或创伤类别有关。样本为70名平民与退役军人 (38名女性, 32名男性;41人有PTSD, 29人无PTSD) ;他们均接受临床治疗师执行的DSM‐IV PTSD量表评估, 完成面部点探针作业, 并进行精神疾病症状与创伤历史的自评测量。因子变异数分析以及回归模型用以检视性别、PTSD诊断、指标性创伤类别、终生的创伤经历, 及面对威胁的注意力偏误。结果反映, 与无PTSD的女性以及有和无PTSD的男性相比, 有PTSD的女性面对具威胁性的面部表情时, 展现注意力偏误(d = 1.19), 特别是恐惧表情(d = 0.74)。精神疾病症状或早期/终生的创伤并未能解释这种注意力偏误。偏误跟人际袭击的指标性创伤类别有关(ηp2 = .13), 特别是性侵犯(d = 1.19)。创伤类别在面对威胁的注意力偏误发展中可能属重要因素, 理论上会阻碍创伤的痊愈。女性可能会因为有较大可能经历人际创伤, 以非因性别特殊的心理生理路径, 而有较大机会在面对威胁时展现注意力偏误。未来须有研究去厘清, 性侵犯是否单独或连同性别致使个人患PTSD的风险提升。
Abstract Police work is one of the most stressful occupations. Previous research has indicated that work stress and trauma exposure may place individuals at heightened risk for the development of ...depression symptomatology. This prospective longitudinal study was designed to examine predictors of depression symptoms in police service. Participants comprised 119 healthy police recruits from an ongoing prospective study. They completed baseline measures of depression symptoms, childhood trauma exposure, neuroticism, and self-worth during academy training. Follow-up measures of depression symptoms, PTSD symptoms, critical incident exposure, negative life events, and routine work environment stress were assessed after 12 months of police service. Hierarchical linear regression analysis was conducted to examine predictors of current levels of depression symptoms, controlling for baseline depression symptoms and current PTSD symptoms. Greater childhood trauma exposure, lower self-worth during training, and greater perceived work stress in the first year of police service predicted greater depression symptoms at 12 months. Depression symptoms at 1 year of police service were partly independent from PTSD symptoms at 12 months. Greater childhood trauma exposure and lower self-worth during training may be important variables to screen as risk factors for duty-related depression. Strategies to reduce routine work environment stress have the potential to decrease duty-related depression in law enforcement.
Skin conductance (SC) is a psychophysiological measure of sympathetic nervous system activity that is commonly used in research to assess conditioned fear responses. A portion of individuals evidence ...very low or unmeasurable SC levels (SCL) and/or response (SCR) during fear conditioning, which precludes the use of their SC data. The reason that some individuals do not produce measurable SCL and/or SCR is not clear; some early research suggested that race may be an influencing factor. In the current article, archival data from five fear conditioning samples collected from four different laboratories were examined to explore SCL and SCR magnitude in African American (AA) and non–African American (non‐AA) participants. Across studies, the aggregate group difference for exclusion due to unmeasurable SCL or no measurable SCR to an unconditioned stimulus reflected a significant medium effect size (d = 0.54). Furthermore, 24.3% (range: 0–48.3%) of AA participants met SC exclusion criteria versus 14.3% (range: 4.3–24.2%) of non‐AA participants. AA participants also displayed significantly lower SCL during habituation (d = 0.58). The low SC levels and responses in AA individuals and the consequent exclusion of their contributions to fear conditioning study results impacts the generalizability of findings across races. Given higher rates of posttraumatic stress disorder (PTSD) and chronic anxiety in AA individuals, it is important that AA individuals not be excluded from fear conditioning research, which informs the treatment of anxiety and PTSD. Examination of the basis of very low SCL and/or SCR is a potentially informative direction for future research.
This study examined the relationship between routine work environment stress and posttraumatic stress disorder (PTSD) symptoms in a sample of police officers (N = 180) who were first assessed during ...academy training and reassessed 1-year later. In a model that included gender, ethnicity, traumatic exposure prior to entering the academy, current negative life events, and critical incident exposure over the last year, routine work environment stress was most strongly associated with PTSD symptoms. We also found that routine work environment stress mediated the relationship between critical incident exposure and PTSD symptoms and between current negative life events and PTSD symptoms. Ensuring that the work environment is functioning optimally protects against the effects of duty-related critical incidents and negative life events outside police service.
Sex differences in the neurobiological mechanisms involved in fear conditioning and extinction have been suggested to contribute to differential vulnerability for the development of posttraumatic ...stress disorder (PTSD) in women compared with men. Reproductive hormones, such as estradiol, have been shown to facilitate fear conditioning and extinction learning and may explain some of these differences. However, the effect of commonly used hormonal contraceptives on the neurobiological mechanisms of fear conditioning and extinction is poorly understood. A laboratory study was conducted in trauma-exposed men and women with and without full or partial PTSD to examine effects of sex and use of hormonal birth control on fear conditioning, fear extinction learning, and extinction retention. Participants underwent fear conditioning with stimuli that were paired (CS+) or unpaired (CS−) with shock. Extinction learning occurred 72 h later, and extinction retention was tested 1 wk after extinction. Women on hormonal contraceptives (HCs) demonstrated enhanced acquisition of fear conditioning and enhanced extinction of fear as compared with women off hormonal birth control and men. While clinical implications have yet to be determined, these results suggest that hormonal contraceptives may facilitate learning during both fear acquisition and extinction. Understanding the impact of sex and hormones on fear conditioning and extinction processes may lead to new insights into the pathophysiology of PTSD and result in advancements in treatment that may vary by sex.
Alternative models of traumatic stress and broader psychopathology have been proposed to address issues of heterogeneity, comorbidity, clinical utility, and equitable representation. However, ...systematic and practical methods and guidelines to organize and apply these models remain scarce. The Middle‐Out Approach is a novel, integrative, contextually informed framework for organizing and applying existing empirical methods to evaluate current and alternative traumatic stress reactions. Rather than beginning to identify traumatic stress reactions from the top‐down (i.e., disorder‐first approach) or bottom‐up (i.e., symptom‐first approach), constructs are evaluated from the middle out (i.e., presentation‐first approach), unconstrained by higher‐order disorders or lower‐order diagnostic symptoms. This approach provides innovation over previous methods at multiple levels, including the conceptualization of traumatic stress reactions as well as the type of assessments and data sources used and how they are used in statistical analyses. Conceptualizations prioritize the identification of middle‐order phenotypes, representing person‐centered clinical presentations, which are informed by the integration of multidimensional, transdiagnostic, and multimodal (e.g., psychosocial, physiological) assessments and/or data sources. Integrated data are then analyzed concurrently using person‐centered statistical models to identify precise, discrete, and representative health outcomes within broader heterogeneous samples. Subsequent variable‐centered analyses are then used to identify culturally sensitive and contextually informed correlates of phenotypes, their clinical utility, and the differential composition within and between broader traumatic stress reactions. Examples from the moral injury literature are used to illustrate practical applications that may increase clinical utility and the accurate representation of health outcomes for diverse individuals and communities.
Abstract
Study Objectives
Published research indicates that sleep is involved in emotional information processing. Using a fear-potentiated startle (FPS) and nap sleep protocol, we examined the ...relationship of emotional learning with REM sleep (REMS) in trauma-exposed participants. We also explored the roles of posttraumatic stress disorder (PTSD) symptoms, biological sex, and an integrative measure of polysomnography-measured (PSG) sleep in the learning-sleep relationship.
Methods
After an adaptation nap, participants (N = 46) completed two more visits (counterbalanced): a stress-condition visit, which included FPS conditioning procedures prior to a nap and assessment of learning retention and fear extinction training after the nap, and a control visit, which included a nap opportunity without stressful procedures. FPS conditioning included a “fear” visual stimulus paired with an air blast to the neck and a “safety” visual stimulus never paired with an air blast. Retention and extinction involved presentation of the visual stimuli without the air blast. Primary analyses examined the relationship between FPS responses pre- and post-sleep with stress-condition REMS duration, controlling for control-nap REMS duration.
Results
Higher safety learning predicted increased REMS and increased REMS predicted more rapid extinction learning. Similar relationships were observed with an integrative PSG sleep measure. They also showed unexpected effects of PTSD symptoms on learning and showed biological sex effects on learning-sleep relationships.
Conclusions
Findings support evidence of a relationship between adaptive emotional learning and REMS. They underscore the importance of examining sex effects in sleep-learning relationships. They introduce an integrative PSG sleep measure with potential relevance to studies of sleep and subjective and biological outcomes.
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