Post‐traumatic stress disorder is a systemic illness, not a mental disorder: is Cartesian dualism dead?

McFarlane, Alexander C.

doi:10.5694/mja17.00048

Cited by 26 publications

(35 citation statements)

References 13 publications

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“…Patients with pain and PTSD are challenging to treat due to symptom overlap, comorbidity, and interactive effects (Sharp & Harvey, ). Our findings demonstrate that the perception of cognitive impairment in patients with PTSD and pain is driven by perceived somatic burden, which some researchers contend has often been neglected in research, treatment, and diagnostic considerations (McFarlane, ). As trauma‐exposed patients with PTSD may incur somatic pathologies (e.g., metabolic syndrome, autoimmune diseases), somatic symptoms should be considered an integral component of trauma treatment (Carvajal, ; McLeay et al, ).…”

Section: Discussionmentioning

confidence: 62%

“…As trauma‐exposed patients with PTSD may incur somatic pathologies (e.g., metabolic syndrome, autoimmune diseases), somatic symptoms should be considered an integral component of trauma treatment (Carvajal, ; McLeay et al, ). Because PTSD is a “systemic disorder” (McFarlane, ) affecting critical biological functions, somatic symptoms are a direct result rather than secondary byproduct of trauma exposure. It is important to treat somatic symptoms, including pain, not as pathological conversion but legitimate sequelae of PTSD.…”

Section: Discussionmentioning

confidence: 99%

“…Emerging evidence links PTSD symptoms to high “disease burden” due to the association with lasting changes in autonomic functioning, neurocircuitry, major organ systems, sleep, and early mortality (McLeay et al, ; O'Donovan et al, ; Yehuda et al, ). Disruptions in these systems may cause patients to experience general and unfamiliar somatic complaints (Gupta, ; McFarlane, ; Yehuda et al, ). Compared to other psychiatric conditions, individuals with PTSD were at least twice as likely to report, and be at risk for developing, concurrent somatic symptoms (Andreski, Chilcoat, & Breslau, ).…”

Section: Posttraumatic Stress Disordermentioning

confidence: 99%

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Somatic burden and perceived cognitive problems in trauma‐exposed adults with posttraumatic stress symptoms or pain

et al. 2019

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Objective Posttraumatic stress disorder (PTSD) is associated with somatic and cognitive changes, which may be magnified when accompanied by persistent pain. The mechanisms of somatic sensation processing may extend to cognitive symptoms, revealing a potential generalization of impairment across cognitive and somatic domains in PTSD. We hypothesized that somatic burden would mediate relationships between PTSD, pain, and perceived cognitive impairment. Methods Two samples—360 trauma‐exposed college students and 268 mechanical Turk users—completed self‐report measures. Results Both samples revealed similar findings. There was a significant indirect effect of PTSD and pain on perceived cognitive problems through somatic burden. There remained a direct effect of PTSD symptoms. These findings indicate that in trauma‐exposed samples with pain, somatic burden rather than pain severity accounts for perceived cognitive problems. Conclusion High somatic burden may reflect an underlying appraisal about somatic cues, which extend in part to interpretation of cognitive cues.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Posttraumatic Stress Disordermentioning

confidence: 99%

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Somatic burden and perceived cognitive problems in trauma‐exposed adults with posttraumatic stress symptoms or pain

et al. 2019

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“…[52][53][54] Of note, it has been previously suggested that PTSD may be "a systemic disorder rather than one confined to the mind". 55 Further work is needed to determine whether PTSD has genetic overlap with immune disorders broadly and the causal direction between disorders. At minimum, the emerging genetic evidence presented here suggests that association between PTSD and health conditions may, in some cases, have some genetic origin.…”

Section: Discussionmentioning

confidence: 99%

Largest genome-wide association study for PTSD identifies genetic risk loci in European and African ancestries and implicates novel biological pathways

Nievergelt

Klengel

et al. 2018

Preprint

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Post-traumatic stress disorder (PTSD) is a common and debilitating disorder. The risk of PTSD following trauma is heritable, but robust common variants have yet to be identified by genome-wide association studies (GWAS). We have collected a multi-ethnic cohort including over 30,000 PTSD cases and 170,000 controls. We first demonstrate significant genetic correlations across 60 PTSD cohorts to evaluate the comparability of these phenotypically heterogeneous studies. In this largest GWAS meta-analysis of PTSD to date we identify a total of 6 genome-wide significant loci, 4 in European and 2 in African-ancestry analyses. Follow-up analyses incorporated local ancestry and sex-specific effects, and functional studies. Along with other novel genes, a non-coding RNA (ncRNA) and a Parkinson's Disease gene, PARK2, were associated with PTSD. Consistent with previous reports, SNP-based heritability estimates for PTSD range between 10-20%. Despite a significant shared liability between PTSD and major depressive disorder, we show evidence that some of our loci may be specific to PTSD. These results demonstrate the role of genetic variation contributing to the biology of differential risk for PTSD and the necessity of expanding GWAS beyond European ancestry.Comparability of PGC2 studies PGC2 compiled the largest collection of global PTSD GWAS to date, with subjects recruited from both clinically deeply characterized, small patient groups and large cohorts with self-reported PTSD symptoms. We did not restrict the type of trauma subjects were exposed to, and trauma included both civilian and/or military events, often with pre-existing exposure to childhood trauma. To evaluate the comparability of these phenotypically heterogeneous studies we first estimated genetic correlations with LDSC, 15 a method that leverages GWAS summary results, the only data type available to PGC-PTSD for several of the larger military and non-US cohorts. We found significant genetic correlations (r g ) between studies using a cross-validation approach including all PGC2 EUA subjects (10 runs with studies randomly placed into 2 groups; mean r g = 0.56, mean SE = 0.23, mean p = 0.029, Supplementary Table 8).Next, additional analyses on the UK Biobank cohort (UKBB) were performed. This cohort comprises a very large proportion of the data, with almost as many EUA cases as the rest of the EUA PGC2 combined (referred to as PGC1.5). PTSD screening in UKBB was based on self-reported symptoms from a mental health survey. 16 We found a considerable genetic correlation between the UKBB and PGC1.5 EUA subjects (r g = 0.73, SE = 0.21, p = 0.0005; Supplementary Table 9). Further, sensitivity analyses in the UKBB using 3 alternative inclusion criteria for PTSD cases and controls showed stable correlations with PGC1.5 (P1 -P3; r g = 0.72 -0.79; Supplementary Table 10). Subsequent analyses were based on the UKBB phenotype including the largest number of subjects (P1; N = 126,188). Sex-stratified genetic correlations support the findings of a significant genetic signal...

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“…identifizieren, dessen Bedeutung im Zusammenhang mit Traumafolgestörungen bis heute vernachlässigt wird[53]. Schließlich konnte mit der vorliegenden Untersuchung -unseres Wissens erstmalig -gezeigt werden, dass Achtsamkeitsdefizite die Behandlung der komplexen PTBS merklich beeinträchtigen können.…”

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Stationäre Therapie der komplexen PTBS in Folge körperlicher oder sexualisierter Gewalt in der Kindheit: Wirksamkeit und Prädiktoren des Behandlungsverlaufs

Kratzer

Heinz

Schennach

et al. 2018

Psychother Psych Med

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Post‐traumatic stress disorder is a systemic illness, not a mental disorder: is Cartesian dualism dead?

Cited by 26 publications

References 13 publications

Somatic burden and perceived cognitive problems in trauma‐exposed adults with posttraumatic stress symptoms or pain

Somatic burden and perceived cognitive problems in trauma‐exposed adults with posttraumatic stress symptoms or pain

Largest genome-wide association study for PTSD identifies genetic risk loci in European and African ancestries and implicates novel biological pathways

Stationäre Therapie der komplexen PTBS in Folge körperlicher oder sexualisierter Gewalt in der Kindheit: Wirksamkeit und Prädiktoren des Behandlungsverlaufs

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