THE ESSENTIAL
- Post-traumatic stress disorder (PTSD) occurs after a distressing event and can express itself in different ways.
- According to a new study, PTSD is about more than fear reactions.
- Scientists have identified two distinct profiles: one dominated by fear, the other by deep emotional pain.
“Posttraumatic stress disorder (PTSD) is highly heterogeneous, yet most diagnostic frameworks and treatment models have historically focused on fear-related processes.explains Ziv Ben-Zion, doctor of psychology, in a communiqué. With his team, this professor and researcher of the Yale School of Medicinein the United States, has just published a study in the journal Biological Psychiatry on PTSD.
Two profiles of patients with post-traumatic stress disorder
In this work, scientists analyzed PTSD differently, not relying solely on fear. “We hypothesized that it only accounts for part of the clinical picture”, he adds. To test this theory, the researchers conducted two analyses. In the first, more than 800 people exposed to trauma completed a standardized questionnaire, the PTSD Checklist for DSM-5 (PCL-5)which lists the main symptoms of PTSD.
Through their responses, the scientists identified two distinct PTSD profiles: one dominated by fear, the other by deep emotional pain. The first was associated with symptoms of “threat reactivity,” such as flashbacks, nightmares, exaggerated startle reactions, traumatic memories, and avoidance of situations reminiscent of the trauma. The other profile, described as deep emotional pain, was characterized by psychological distress, with loss of interest, negative emotions, sleep disturbances and emotional hyperreactivity. Concerning the impact on daily life, 70% of participants considered emotional pain more debilitating than fear.
Post-traumatic stress: pretell the evolution of symptoms
In the second phase of their study, the researchers wanted to understand the impact of PTSD on the brain. Their goal was to identify signs that could predict how patients will progress. To do this, they used functional magnetic resonance imaging (fMRI) to analyze the brain connections of 162 recent trauma survivors. Certain neuronal configurations allowed them to predict the evolution of symptoms 14 months later.
However, they only managed to do this for the fear-dominated profile. For scientists, this means that at the brain level, the two profiles are based on different neuronal mechanisms. “The fact that the distinction between fear and emotional pain was replicated in independent samples increased our confidence in the model.”, the soul of Ziv Ben-Zion.
Ultimately, this discovery could allow the implementation of treatments and support more suited to each profile. According to theNational Institute of Health and Medical Research (Inserm), PTSD generally disappears within three months following the upsetting event. But around 20% of patients will develop a chronic form of the syndrome. 20% for whom this more individualized support could therefore be very useful.
