Aversive Imagery in Posttraumatic Stress Disorder: Trauma Recurrence, Comorbidity, and Physiological Reactivity
Aversive Imagery in Posttraumatic Stress Disorder: Trauma Recurrence, Comorbidity, and Physiological Reactivity
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DOI：
10.1016/j.biopsych.2009.08.023
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发表时间：
2010-02-15
影响因子：
10.6
通讯作者：
Bradley, Margaret M.
中科院分区：
文献类型：
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作者：
McTeague, Lisa M.;Lang, Peter J.;Bradley, Margaret M.
背景：创伤后应激障碍（PTSD）是一种过度防御性生理唤醒障碍。本研究的新目的是调查PTSD中过去创伤复发和当前并发症之间的潜在剂量反应关系以及对创伤和其他厌恶场景的生理反应强度。（n = 49; 22例单一创伤暴露，27例多发创伤暴露）和对照组（n = 76; 46个从未受过创伤30创伤暴露）的参与者想象威胁和中性事件，而声学惊吓探头，并记录眨眼反应（眼轮匝肌）。心率，皮肤电导水平和面部表情的变化也indexed.Results：总体而言，PTSD患者超过控制参与者的惊吓反射，自主神经反应，面部表情在具体的创伤图像，虽然不太明显，表现出高度的反应标准的愤怒，恐慌，和身体的危险图像。关于亚组，对照组的参与者和没有创伤暴露表现出同构模式。在PTSD中，只有单一创伤患者表现出强烈的惊吓和自主反应，超过了对照组和多重创伤PTSD。尽管报告的唤醒程度更高，但相对于单一创伤PTSD组，多重创伤组显示出与更慢性和严重的PTSD、更大的情绪和焦虑障碍共病以及更普遍的维度焦虑相关的迟钝的防御反应（例如，结论：尽管PTSD患者通常在厌恶性意象中表现出明显的生理唤醒，与自我报告的痛苦一致，但具有严重累积创伤史的最有症状的患者表现出不一致的生理低反应性，这可能归因于持续的高压力和令人震惊的持续负面情感，最终损害了防御反应。
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.