Aversive Imagery in Posttraumatic Stress Disorder: Trauma Recurrence, Comorbidity, and Physiological Reactivity

doi:10.1016/j.biopsych.2009.08.023

Biological Psychiatry

Volume 67, Issue 4, 15 February 2010, Pages 346-356

https://doi.org/10.1016/j.biopsych.2009.08.023 Get rights and content

Background

Posttraumatic stress disorder (PTSD) is characterized as a disorder of exaggerated defensive physiological arousal. The novel aim of the present research was to investigate within PTSD a potential dose-response relationship between past trauma recurrence and current comorbidity and intensity of physiological reactions to imagery of trauma and other aversive scenarios.

Methods

A community sample of principal PTSD (n = 49; 22 single-trauma exposed, 27 multiple-trauma exposed) and control (n = 76; 46 never-trauma exposed, 30 trauma exposed) participants imagined threatening and neutral events while acoustic startle probes were presented and the eye-blink response (orbicularis occuli) was recorded. Changes in heart rate, skin conductance level, and facial expressivity were also indexed.

Results

Overall, PTSD patients exceeded control participants in startle reflex, autonomic responding, and facial expressivity during idiographic trauma imagery and, though less pronounced, showed heightened reactivity to standard anger, panic, and physical danger imagery. Concerning subgroups, control participants with and without trauma exposure showed isomorphic patterns. Within PTSD, only the single-trauma patients evinced robust startle and autonomic responses, exceeding both control participants and multiple-trauma PTSD. Despite greater reported arousal, the multiple-trauma relative to single-trauma PTSD group showed blunted defensive reactivity associated with more chronic and severe PTSD, greater mood and anxiety disorder comorbidity, and more pervasive dimensional dysphoria (e.g., depression, trait anxiety).

Conclusions

Whereas PTSD patients generally show marked physiological arousal during aversive imagery, concordant with self-reported distress, the most symptomatic patients with histories of severe, cumulative traumatization show discordant physiological hyporeactivity, perhaps attributable to sustained high stress and an egregious, persistent negative affectivity that ultimately compromises defensive responding.

Section snippets

Participants

Participants (81% Caucasian) were assessed at the University of Florida Fear and Anxiety Disorders Clinic: 49 treatment-seeking adults with principal diagnoses of PTSD (66% female) and 76 healthy community control participants (71% female).

Diagnostic Classification

Diagnostic groups were established using the Anxiety Disorder Interview Schedule for DSM-IV (ADIS-IV) (47), a semi-structured interview for assessing current anxiety, mood, substance use, and somatoform disorders and for screening psychosis and major medical

Affective Judgments

Both groups rated personal threat images most and neutral scenes least unpleasant, F(4,116) = 145.26, p < .001. Patients rated panic and personal threat scenes more unpleasant than control participants, ps < .05. Furthermore, control participants rated personal threat, anger, and survival threat scenes equivalently, all ns; patients rated personal threat as more aversive than all other contents, all ps < .001; content × diagnosis interaction, F(4,116) = 3.77, p < .01.

Emotional arousal also

Defensive Physiology and PTSD

As in many prior studies of idiographic trauma imagery, the total cohort of PTSD patients evinced more pronounced heart rate acceleration than control participants (21) and, concordant with more extreme aversiveness ratings, greater facial expressions of displeasure (34, 58). Patients also surpassed control participants in startle reflex potentiation during idiographic threat-related imagery, consistent with enhanced limbic (particularly amygdala) and paralimbic activation shown in parallel

Conclusion

Single- and multiple-trauma exposures yield identifiably different psychophysiological profiles, obscured when PTSD is considered, irrespective of trauma recurrence. Posttraumatic stress disorder secondary to a discrete trauma is characterized by heightened defensive reactivity during aversive imagery, whereas PTSD after higher magnitude, multiple traumas is marked by higher anxious and depressive comorbidity and a blunted reflex reaction. These findings suggest that trauma accumulation and the

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In the evaluation of treatment methods for PTSD, a combination of self-report and physiological measures seems to be feasible. The physiological measures, in combination with a robust decrease in self-rated PTSD symptoms, indicate that trauma-focused GrpMI is a promising treatment for PTSD or CPTSD. More studies are needed to confirm the results, and further research comparing with other active treatments is necessary to establish the precise role of the treatment.
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Archival ReportAversive Imagery in Posttraumatic Stress Disorder: Trauma Recurrence, Comorbidity, and Physiological Reactivity

Background

Methods

Results

Conclusions

Section snippets

Participants

Diagnostic Classification

Affective Judgments

Defensive Physiology and PTSD

Conclusion

Prog Brain Res

Neuroimage

Biol Psychiatry

Psychosomatics

Biol Psychiatry

Psychiatry Res

Biol Psychiatry

J Anxiety Disord

J Behav Ther Exp Psychiatry

Biol Psychiatry

Compr Psychiatry

Biol Psychiatry

Biol Psychiatry

Biol Psychiatry

Behav Brain Res

Behav Res Ther

Previous exposure to trauma and PTSD effects of subsequent trauma: Results from the Detroit Area Survey of Trauma

Am J Psychiatry

The psychological risks of Vietnam for U.S. veterans: A revisit with new data and methods

Science

Cumulative trauma: The impact of child sexual abuse, adult sexual assault, and spouse abuse

J Trauma Stress

Outcomes of single versus multiple trauma exposure in a screening sample

J Trauma Stress

Lifetime trauma exposure in veterans with military-related posttraumatic stress disorder: Association with current symptomatology

J Clin Psychiatry

Trauma and the Vietnam War Generation: Report of Findings from the National Vietnam Veterans Readjustment Study

Accumulated childhood trauma and symptom complexity

J Trauma Stress

Dose-effect relationships of trauma to symptoms of depression and post-traumatic stress disorder among Cambodian survivors of mass violence

Br J Psychiatry

Correlates of adverse childhood experiences among adults with severe mood disorders

Psychiatr Serv

Clinical characteristics of women with a history of childhood abuse: Unhealed wounds

JAMA

Posttraumatic stress disorder and extent of trauma exposure as correlates of medical problems and perceived health among women with childhood abuse

Women Health

Fear behavior, fear imagery, and the psychophysiology of emotion: The problem of affective response integration

J Abnorm Psychol

Emotional imagery: Conceptual structure and pattern of somato-visceral response

Psychophysiology

Fear imagery and the startle-probe reflex

J Abnorm Psychol

Role of the extended amygdala in short-duration versus sustained fear: A tribute to Dr. Lennart Heimer

Brain Struct Funct

Emotional imagery activates reward circuits

Psychophysiology

Diagnostic and Statistical Manual of Mental Disorders. 4th ed. (DSM-IV)

Psychophysiologic assessment of posttraumatic stress disorder imagery in Vietnam combat veterans

Arch Gen Psychiatry

Utility of psychophysiological measurement in the diagnosis of posttraumatic stress disorder: Results from a Department of Veterans Affairs Cooperative Study

J Consult Clin Psychol

Psychophysiological assessment of posttraumatic stress disorder imagery in World War II and Korean combat veterans

J Abnorm Psychol

Psychophysiologic assessment of women with posttraumatic stress disorder resulting from childhood sexual abuse

J Consult Clin Psychol

Psychophysiologic assessment of posttraumatic stress disorder in Vietnam nurse veterans who witnessed injury or death

J Consult Clin Psychol

Psychophysiologic assessment of traumatic imagery in Israeli civilian patients with posttraumatic stress disorder

Am J Psychiatry

Psychophysiologic responses to combat imagery of Vietnam veterans with posttraumatic stress disorder versus other anxiety disorders

J Abnorm Psychol

Psychophysiological reactivity in female sexual abuse survivors

J Trauma Stress

Physiological arousal and attention in veterans with posttraumatic stress disorder

J Psychopathol Behav Assess

Reduced heart rate responding to trauma reliving in trauma survivors with PTSD: Correlates and consequences

J Trauma Stress

Archival Report
Aversive Imagery in Posttraumatic Stress Disorder: Trauma Recurrence, Comorbidity, and Physiological Reactivity