Reexamination of diathesis stress and neurotoxic stress theories: A qualitative review of pre‐trauma neurobiology in relation to posttraumatic stress symptoms

Abstract

Objective: Associations of neurobiological differences with posttraumatic stress disorder (PTSD) have generated interest in their temporal relation. Support has been voiced for the neurotoxic stress theory (NST) in which neurobiological differences develop following exposure and PTSD development. In contrast, the diathesis stress theory (DST) posits that neurobiological differences existed prior to exposure and may be vulnerability factors for PTSD. Studies in the first wave of neurobiological PTSD research were all cross sectional, but a second wave of research followed which used prospective repeated-measures designs that measured neurobiology prior to trauma exposure experiences, allowing greater causal inference.Methods: This study reviewed the second-wave studies in hopes of developing a preliminary consensus to support either the NST or the DST based on this more powerful prospective, repeated-measures study design.Results: Twenty-five second-wave studies were located that measured neurobiology prior to traumatic experiences. Nineteen studies supported the DST. Of 10 studies that were capable of testing the NST, only 3 were supportive. Conclusion:The implications of the NST versus the DST have profound implications for understanding the fragility of the human brain and possible paths forward for future research on assessment, treatment, and social policy.

To what extent do post-traumatic mental health and other problems reflect pre-existing problems? Findings from the prospective comparative population-based VICTIMS-study

“…Our results are also in line with a recent large case-control study reporting pre-trauma psychiatric diagnoses were the strongest predictor of severe post-trauma psychiatric comorbidity defined as ⩾3 psychiatric diagnosis during 5-year post-trauma interval (Gradus et al, 2022). Moreover, the findings of DiGangi et al (2013), Danese et al (2017), Scheeringa (2021), Gradus et al (2022), and current findings question if some outcomes of the well-known meta-analysis of Brewin et al (2000) and Ozer et al (2003) on (bi-variate) risk factors for PTSD and PTSD symptom-severity are still valid. Both meta-analysis suffered from “heavy reliance on [.…”

“…Moreover, the findings of DiGangi et al (2013) , Danese et al. (2017) , Scheeringa (2021) , Gradus et al (2022) , and current findings question if some outcomes of the well-known meta-analysis of Brewin et al (2000) and Ozer et al (2003) on (bi-variate) risk factors for PTSD and PTSD symptom-severity are still valid. Both meta-analysis suffered from “heavy reliance on [.…”

“…Similarly, Danese et al (2017) found that impairments in cognitive functions (such as memory, perceptual reasoning, and verbal comprehension) predated childhood victimization. A review by Scheeringa (2021) on the association of neurobiological differences with PTSD found that 19 of the identified 25 studies testing the diathesis stress theory had positive results, for example, found that neurobiological differences existed prior to exposure. These findings suggest that PTSD symptomatology manifests mainly in individuals in which psychopathology and social-ecological factors were actually present before the index trauma.…”

Influences of prepandemic bullying victimization and COVID-19 peer discrimination on Chinese American adolescents’ mental health during the COVID-19 pandemic.

“…In our study, the new context of the COVID-19 pandemic and the subsequent change in adolescents’ social interaction and learning contexts could interact with their past bullying victimization and current peer discrimination experiences to influence their mental health adjustment. The diathesis-stress perspective proposes that victims’ psychopathological adjustment is the result of the interaction between an individual’s preexisting vulnerability in the neurobiological, cognitive, or emotional domain and certain environmental stressors (Cicchetti & Toth, 1998; Scheeringa, 2021). In our study, Chinese American adolescents’ retrospective perception of prepandemic bullying victimization experience could potentially function as a dispositional vulnerability or strength to interact with their new environmental stressors—COVID-19 peer discrimination and this interaction could lead to different paths of mental health adjustment during the COVID-19 pandemic.…”