PTSD

Initially, I always thought that post-traumatic stress disorder (PTSD) was only associated with military veterans because of the media and movies I watched. I soon learned that I was wrong. However, I realize that I don’t actually know a lot about PTSD. This week’s list of readings was great in helping me understand what PTSD is, how it can affect you biologically, mentally, and physically, and ways to reduce it’s symptoms.

Post-traumatic stress disorder (PTSD) is a psychological condition triggered by a traumatic event (Hall, Hoerster, & Yancy, 2014). About 6.8% of people in the United States develop PTSD some time in their life, even though 75% of people experience at least one traumatic event in their life (Yehuda & LeDoux, 2007).  PTSD is described to be 3 clusters of symptoms: (1) re-experiencing symptoms (e.g. nightmares of traumatic events), (2) avoidance symptoms (e.g. distancing oneself from the reminders of the event), and (3) hyperarousal symptoms (e.g. overt physiological manifestations – insomnia) (Yehuda & LeDoux, 2007). These symptoms must be severe enough for at least one month to be considered PTSD. While there has been limited neuroscience research on understanding PTSD, Yehuda and LeDoux (2007) describe how PTSD is a condition in which the process of recovery from trauma is impeded by a mechanism (phenotype) and because of the failure to reinstate physiological homeostasis.

Typically, research focuses on White male military veterans, even though Black and Hispanic veterans experience higher rates of chronic PTSD (Hall, Hoerster, & Yancy, 2014). In an extensive literature review of PTSD, physical activity, and eating behavior, researchers discovered that individuals dealing with PTSD are less likely to exercise and more likely to have a poor diet because of their fear of bodily arousal symptoms – like increased heart rates and a shortness of breath (Hall, Hoerster, & Yancy, 2014). However, these behaviors do vary based on demographics. While a decline in exercise over time is associated to PTSD, I found it surprising that veterans had the highest odds of no regular exercise (Hall, Hoerster, & Yancy, 2014). I would assume that veterans would have the lowest odds – as they lived a numerous amount of years in routine of exercise. Women on the other hand showed more PTSD symptoms if they engaged in binge eating. Surprisingly, this extensive literature review revealed that there is barely any research on PTSD, physical activity, and eating behavior in the past 30 years – as the authors site 15 studies that could be appropriately analyzed into these three categories. Unfortunately, the literature currently availability lacks consistency in measurements (e.g. self-reports, clinical interviews, cohort studies). While it’s great to have diverse research methods, the issue here is that it becomes difficult to understand what measures are reliable and valid when they are used in experiments that are distinctly different from one another. And with the lack of replicable and follow-up studies it becomes extremely difficult to believe the arguments much of the research has to offer. For example, Hall, Hoerster, and Yancy (2014) describe how 2 studies showed that adults with PTSD were less likely to engage in regular physical activity, but another two showed no differences.

Due to the lack of research in the current literature, recent research has examined the effects of PTSD on weight gain. Kubzansky et al. (2004) showed that experiencing PTSD symptoms was not only associated with an increased risk of becoming overweight, but also altered people’s BMI trajectories over time. Specifically, this research study found that women with trauma and ongoing symptoms of PTSD had significantly higher odds of being overweight or obese compared to women who did not experience PTSD symptoms (Kubzansky et al., 2014). However, some limitations of this study were how they assessed PTSD as being associated with the “worst event” of someone’s life which could be a misclassification of PTSD as previously noted 75% experience at least one traumatic event. While this research does not offer insight on potential mechanisms that may associate PTSD with increased risk of weight gain, it does push us to explore whether PTSD can also be a risk to cardiometabolic diseases as obesity is a proven mechanism for cardiometabolic diseases (Kubzansky et al., 2014). Building off of this idea, Schnurr (2015) emphasized that more childhood trauma was associated with an elevated likelihood of serious chronic diseases (e.g. CVD).

In Schnurr (2015) we learn about potential mediators between PTSD and chronic diseases and physical health. For example, depression mediates the relationship between PTSD and pain and physical inactivity. Most importantly, a higher allostatic load may be the key mechanism between PTSD and physical health because PTSD is associated with metabolic syndrome (a combination of multiple risk factors – like obesity and hypertension), and multiple risk factors combined is a key feature of allostatic load (Schnurr, 2015). In general, Schnurr (2015) emphasized that when looking at mechanisms associated with PTSD and physical health you must look at everything – biological, psychological, behavioral, and attentional changes.

3 thoughts on “PTSD

  1. Hey Jay, you bring up a great point regarding the different clinical measures used in the studies reviewed by Hall, Hoerster, & Yancy (2014). In your post you state that using diverse research methods is a good thing, I would like to know your reasoning behind this. In PTSD research I feel there are many measures for the disorder alone. Some researchers decided to make different measures of PTSD because they thought the one before was too long and could be shortened or some questions had to be changed because the DSM-5 added or excluded previous criteria for PTSD that the DSM-IV had. Unfortunately, this makes the reader wonder which clinical measure is ultimately correct and what studies are now valid since such changes to these clinical measures have been made. Ultimately, all these different measures are hurting the field.

  2. This was a great overview of the literature, and tying many of the main concepts together. You did mention a couple of times that there is a lack of research examining the impact of PTSD on physical activity and eating behavior. You also discussed how there are varying methods of investigation (surveys, reports, observation, etc.). Therefore, I’m wondering whether you feel more compelled by the research that does demonstrate a connection between PTSD, physical activity, and eating behavior. Also, I am wondering if you think there is any connection between method of the study and results found. Do you think there is a particular method that is more appropriate for this particular population?

  3. Great synthesis of the literature, Jay! You brought up the point that individuals with PTSD are less likely to exercise due to fear of bodily arousal symptoms – like increased heart rates and a shortness of breath. I find this very interesting and have often wondered whether this might be due to changes in interoceptive awareness in individuals with PTSD. Interoceptive awareness refers to the perception of internal bodily sensations. Perhaps individuals with PTSD have an difficult time recognizing or interpreting such sensations and thus may have a difficulty dissociating the cause of increased physiological arousal during exercise, as similar symptoms are experienced during recollection of the trauma.

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