Posttraumatic Stress Disorder and Physical Illness: Results from Clinical and Epidemiologic Studies

Abstract

Research indicates that exposure to traumatic stressors and psychological trauma is widespread. The association of such exposures with posttraumatic stress disorder (PTSD) and other mental health conditions is well known. However, epidemiologic research increasingly suggests that exposure to these events is related to increased health care utilization, adverse health outcomes, the onset of specific diseases, and premature death. To date, studies have linked traumatic stress exposures and PTSD to such conditions as cardiovascular disease, diabetes, gastrointestinal disease, fibromyalgia, chronic fatigue syndrome, musculoskeletal disorders, and other diseases. Evidence linking cardiovascular disease and exposure to psychological trauma is particularly strong and has been found consistently across different populations and stressor events. In addition, clinical studies have suggested the biological pathways through which stressor-induced diseases may be pathologically expressed. In particular, recent studies have implicated the hypothalamic-pituitary-adrenal (HPA) and the sympathetic-adrenal-medullary (SAM) stress axes as key in this pathogenic process, although genetic and behavioral/psychological risk factors cannot be ruled out. Recent findings, indicating that victims of PTSD have higher circulating T-cell lymphocytes and lower cortisol levels, are intriguing and suggest that chronic sufferers of PTSD may be at risk for autoimmune diseases. To test this hypothesis, we assessed the association between chronic PTSD in a national sample of 2,490 Vietnam veterans and the prevalence of common autoimmune diseases, including rheumatoid arthritis, psoriasis, insulin-dependent diabetes, and thyroid disease. Our analyses suggest that chronic PTSD, particularly comorbid PTSD or complex PTSD, is associated with all of these conditions. In addition, veterans with comorbid PTSD were more likely to have clinically higher T-cell counts, hyperreactive immune responses on standardized delayed cutaneous hypersensitivity tests, clinically higher immunoglobulin-M levels, and clinically lower dehydroepiandrosterone levels. The latter clinical evidence confirms the presence of biological markers consistent with a broad range of inflammatory disorders, including both cardiovascular and autoimmune diseases.

Health status and health care utilization following collective trauma: A 3-year national study of the 9/11 terrorist attacks in the United States

“…Early physiologic stress responses (e.g., increased heart rate) have been linked to the development of psychological ailments (e.g., Posttraumatic Stress Disorder, PTSD; Ozer, Best, Lipsey, & Weiss, 2003), which have been associated with a variety of medical ailments (Schnurr & Green, 2004) and increased utilization of health care services (Boscarino, 2004;Fagan, Galea, Ahern, Bonner, & Vlahov, 2003). However, stress-related physiologic arousal may also produce unexplained physical symptoms that lead people to seek care from health professionals (Barsky, Orav, & Bates, 2005).…”

“…For example, persistent exposure to cortisol and other stress hormones can negatively affect bone density, increase blood pressure, promote atherosclerotic changes in arteries, and increase the risk of myocardial infarction (Brown, Varghese, & McEwen, 2004). Musculoskeletal ailments have also been associated with another form of allostatic loaddHPA axis hyporesponsivenessdwherein low cortisol responses to stress allow increased secretion of inflammatory cytokines that promote autoimmune and other inflammatory diseases, many of which affect the musculoskeletal system (Boscarino, 2004;McEwen, 1998). Although a growing body of animal and human studies provides evidence consistent with the allostatic load theory (Lupien, McEwen, Gunnar, & Heim, 2009), alternative models have also been proposed (e.g., Romero, Dickens, & Cyr, 2009), in part due to the difficulty in measuring allostatic load directly (see Smith, Maloney, Falkenberg, Dimulescu, & Rajeevan, 2009).…”

“…Holman et al, 2008;Shedd et al, 2004). Based on prior theory and research that has linked extreme stress to physical health ailments and utilization (e.g., Boscarino, 2004;Schnurr & Green, 2004), we hypothesized that: (a) overall rates of physical ailments would increase from before to after the 9/11 attacks, (b) higher levels of 9/11-related exposure would predict increases in physical health problems, and (c) changes in physical ailments following 9/11 would be associated with health care utilization in the years following the attacks. Finally, we examined whether specific categories of physical ailments would be associated with higher utilization.…”

Leukocyte glucocorticoid receptor expression and immunoregulation in veterans with and without post-traumatic stress disorder

“…[1][2][3][4] Several studies have implicated the hypothalamic-pituitary-adrenal axis (HPA axis) as key substrate in the pathogenic processes underlying these disorders. [5][6][7] Chronic stress and PTSD are generally thought to cause long-term alterations in the HPA axis regulation.…”

Does posttraumatic stress predict frequency of general practitioner visits in parents of terrorism survivors? A longitudinal study

“…PTSD may trouble individuals for years (Steinert, Hofmann, Leichsenring, & Kruse, 2015). Furthermore, traumatization may elicit a range of long-term somatic health complaints, including respiratory, gastrointestinal and cardiovascular disease (Boscarino, 2004; Pacella, Hruska, & Delahanty, 2013; Schnurr, Green, & Kaltman, 2007). Thus, GPs may continue to play an important role in monitoring and providing for traumatized parents, well beyond the early aftermath of a disaster.…”