Psychophysiology of the posttraumatic stress disorder: from sulfur fumes to behavioral genetics.

&NA; Neurophysiological hypotheses regarding the body‐mind relationship in stress disorders have been formulated more than 300 years ago. In 1941 Abraham Kardiner ascribed the name “physioneurosis” to the condition known today as posttraumatic stress disorder (PTSD). Psychophysiological studies of PTSD started with the demonstration of increased responsiveness to external stimuli reminiscent of the traumatic event. Later, abnormal responses to mental imagery were studied, and these studies have resulted in new tools for the assessment and diagnosis of the disorder. Recent studies focus on responses to elementary stimulation, such as the auditory startle reflex, thereby exploring basic CNS routines of habituation and stimulus‐discrimination. This article reviews the rapidly expanding literature on the psychophysiology of PTSD. Special emphasis is given to recent studies of the auditory startle and to their implications for the neurobiology of PTSD.

[1]  S. Orr,et al.  Electrodermal psychophysiology of anxiety disorder: Orienting response and spontaneous fluctuations , 1987, Biological Psychiatry.

[2]  T. Werka,et al.  Post-stress analgesia after lesions to the central nucleus of the amygdala in rats. , 1990, Acta neurobiologiae experimentalis.

[3]  P. Lang,et al.  Affective judgment and psychophysiological response: Dimensional covariation in the evaluation of pictorial stimuli. , 1989 .

[4]  S. Orr,et al.  Psychophysiologic assessment of posttraumatic stress disorder imagery in Vietnam combat veterans. , 1987, Archives of general psychiatry.

[5]  E. Ornitz,et al.  Startle modulation in children with posttraumatic stress disorder. , 1989, The American journal of psychiatry.

[6]  Michael Davis.  The Mammalian Startle Response , 1984 .

[7]  Patrick A. Boudewyns,et al.  Physiological response to combat memories and preliminary treatment outcome in Vietnam veteran PTSD patients treated with direct therapeutic exposure. , 1990 .

[8]  J. Ison,et al.  Effects of a warning stimulus on reflex elicitation and reflex inhibition. , 1980, Psychophysiology.

[9]  M. Horowitz.  Stress response syndromes. Character style and dynamic psychotherapy. , 1974, Archives of general psychiatry.

[10]  J. Davidson,et al.  Preliminary study of carbamazepine in post-traumatic stress disorder. , 1986, Psychosomatics.

[11]  W. Wilson,et al.  Observations on persistence of war neurosis. , 1960, Diseases of the nervous system.

[12]  S. Orr,et al.  Psychophysiologic assessment of traumatic imagery in Israeli civilian patients with posttraumatic stress disorder. , 1993, The American journal of psychiatry.

[13]  D. Lykken,et al.  Habituation of the skin conductance response to strong stimuli: a twin study. , 1988, Psychophysiology.

[14]  L. Wing,et al.  Habituation of the psycho-galvanic reflex in patients with anxiety states and in normal subjects , 1964, Journal of neurology, neurosurgery, and psychiatry.

[15]  J. E. Hovens,et al.  Current psychiatric complaints of Dutch Resistance veterans from World War II: A feasibility study , 1990 .

[16]  L. Kolb,et al.  The Conditioned Emotional Response: A Sub-Class of the Chronic and Delayed Post-Traumatic Stress Disorder , 1982 .

[17]  Frances K. Graham,et al.  Discordant effects of weak prestimulation on magnitude and latency of the reflex blink , 1977 .

[18]  M. Drake.  Diagnostic and Statistical Manual of Mental Disorders (3rd ed. rev.) , 1988 .

[19]  S. Paige,et al.  Psychophysiological correlates of posttraumatic stress disorder in Vietnam veterans , 1990, Biological Psychiatry.

[20]  D. Dinges,et al.  Habituation of the startle reflex in posttraumatic stress disorder. , 1989, The Journal of neuropsychiatry and clinical neurosciences.

[21]  M. Geyer,et al.  Startle habituation and sensorimotor gating in schizophrenia and related animal models. , 1987, Schizophrenia bulletin.

[22]  Peter J. Lang,et al.  A Bio‐Informational Theory of Emotional Imagery , 1979 .

[23]  R. Pary,et al.  Post-traumatic stress disorder in Vietnam veterans. , 1988, American family physician.

[24]  T. Insel,et al.  Anxiety and cerebral blood flow during behavioral challenge. Dissociation of central from peripheral and subjective measures. , 1989, Archives of general psychiatry.

[25]  G. Rosen,et al.  Nostalgia: a ‘forgotten’ psychological disorder , 1975, Psychological Medicine.

[26]  J. Kehne,et al.  Habituation and sensitization of startle reflexes elicited electrically from the brainstem. , 1982, Science.

[27]  William A. Hunt,et al.  The startle pattern , 1939 .

[28]  S. Southwick,et al.  Neurobiological aspects of PTSD: Review of clinical and preclinical studies , 1989 .

[29]  Miles E. McFall,et al.  Autonomic responses to stress in Vietnam combat veterans with posttraumatic stress disorder , 1990, Biological Psychiatry.

[30]  J. D. McGaugh,et al.  Involvement of the amygdaloid complex in neuromodulatory influences on memory storage , 1990, Neuroscience & Biobehavioral Reviews.

[31]  E. Halgren.  Mental phenomena induced by stimulation in the limbic system. , 1982, Human neurobiology.

[32]  Z. Solomon,et al.  Reactivation of combat-related posttraumatic stress disorder. , 1987, The American journal of psychiatry.

[33]  H. Hoffman,et al.  Reflex modification in the domain of startle: I. Some empirical findings and their implications for how the nervous system processes sensory input. , 1980, Psychological review.

[34]  Michael Davis,et al.  Temporal characteristics of enhancement of startle by stimulation of the amygdala , 1988, Physiology & Behavior.

[35]  R. Laufer,et al.  Dimensions of Posttraumatic Stress Disorder among Vietnam Veterans , 1985, Journal of Nervous and Mental Disease.

[36]  J. Weilburg.  Neurobehavioral Disorders: A Clinical Approach , 1989 .

[37]  J. Brende.  Electrodermal Responses in Post‐traumatic Syndromes A Pilot Study of Cerebral Hemisphere Functioning in Vietnam Veterans , 1982, The Journal of nervous and mental disease.

[38]  E. Lindemann,et al.  Symptomatology and management of acute grief , 1944 .

[39]  E. Blanchard,et al.  Psychophysiological Responses in the Diagnosis of Posttraumatic Stress Disorder in Vietnam Veterans , 1991, The Journal of nervous and mental disease.

[40]  Joseph E LeDoux.  Information flow from sensation to emotion: Plasticity in the neural computation of stimulus value. , 1990 .

[41]  E R Kandel,et al.  From metapsychology to molecular biology: explorations into the nature of anxiety. , 1983, The American journal of psychiatry.

[42]  D L Braff,et al.  Physiological evidence of exaggerated startle response in a subgroup of Vietnam veterans with combat-related PTSD. , 1990, The American journal of psychiatry.

[43]  R. Ursano,et al.  The Vietnam veteran: memory, social context, and metaphor. , 1984, Psychiatry.

[44]  J. S. Brown,et al.  Conditioned fear as revealed by magnitude of startle response to an auditory stimulus. , 1951, Journal of experimental psychology.

[45]  Joseph E LeDoux,et al.  Topographic organization of convergent projections to the thalamus from the inferior colliculus and spinal cord in the rat , 1987, The Journal of comparative neurology.

[46]  P T Fox,et al.  Neuroanatomical correlates of a lactate-induced anxiety attack. , 1989, Archives of general psychiatry.

[47]  R. Pitman,et al.  Post-traumatic stress disorder, hormones, and memory , 1989, Biological Psychiatry.

[48]  T. Keane,et al.  A behavioral formulation of posttraumatic stress disorder in Vietnam veterans. , 1984 .

[49]  Michael Davis,et al.  Pharmacological and anatomical analysis of fear conditioning using the fear-potentiated startle paradigm. , 1986, Behavioral neuroscience.

[50]  J. Krystal,et al.  Inescapable shock, neurotransmitters, and addiction to trauma: Toward a psychobiology of post traumatic stress , 1985, Biological Psychiatry.

[51]  L. Kolb.  A neuropsychological hypothesis explaining posttraumatic stress disorders. , 1987, The American journal of psychiatry.

[52]  E. Blanchard,et al.  The psychophysiology of combat-induced post-traumatic stress disorder in Vietnam veterans. , 1986, Behaviour research and therapy.

[53]  Z. Solomon,et al.  Delayed onset PTSD among Israeli veterans of the 1982 Lebanon War. , 1989, Psychiatry.

[54]  B. Anthony,et al.  Evidence for sensory-selective set in young infants. , 1983, Science.

[55]  M. Friedman.  Toward rational pharmacotherapy for posttraumatic stress disorder: an interim report. , 1988, The American journal of psychiatry.

[56]  B Altman,et al.  Psychophysiologic responses to combat imagery of Vietnam veterans with posttraumatic stress disorder versus other anxiety disorders. , 1990, Journal of abnormal psychology.

[57]  D. Kaloupek,et al.  Imaginal flooding in the treatment of a posttraumatic stress disorder. , 1982, Journal of consulting and clinical psychology.

[58]  R. Wilson,et al.  THE SYMPATHETIC NERVOUS SYSTEM AND THE “IRRITABLE HEART OF SOLDIERS.” , 1918, British medical journal.

[59]  M. Davis,et al.  Associative learning modifies startle reflexes at the lateral lemniscus. , 1985, Behavioral neuroscience.

[60]  Joseph E LeDoux,et al.  Indelibility of Subcortical Emotional Memories , 1989, Journal of Cognitive Neuroscience.

[61]  G. Kovacs,et al.  Sites of behavioral and neurochemical action of ACTH-like peptides and neurohypophyseal hormones , 1983, Neuroscience & Biobehavioral Reviews.

[62]  S. Orr,et al.  Naloxone-reversible analgesic response to combat-related stimuli in posttraumatic stress disorder. A pilot study. , 1990, Archives of general psychiatry.

[63]  G. A. Miller,et al.  Fear behavior, fear imagery, and the psychophysiology of emotion: the problem of affective response integration. , 1983, Journal of abnormal psychology.

[64]  S. Orr,et al.  Physiologic responses to loud tones in Israeli patients with posttraumatic stress disorder. , 1992, Archives of general psychiatry.

[65]  J. Fairbank,et al.  Flooding for combat-related stress disorders: Assessment of anxiety reduction across traumatic memories , 1982 .

[66]  L A Leavitt,et al.  Lead-stimulation effects of human cardiac orienting and blink reflexes. , 1975, Journal of experimental psychology. Human perception and performance.

[67]  R. Michels,et al.  Diagnostic and Statistical Manual of Mental Disorders, 3rd ed , 1981 .

[68]  M. Hallett,et al.  Audiogenic startle reflex of man and its relationship to startle syndromes. A review. , 1986, Brain : a journal of neurology.

[69]  M. Bradley,et al.  Emotion, attention, and the startle reflex. , 1990, Psychological review.

[70]  H. Selinski.  Traumatic neurosis of war. , 1946, The Journal of the Indiana State Medical Association.

[71]  R. Pitman.  Post-traumatic stress disorder, conditioning, and network theory. , 1988 .

[72]  I. Pavlov,et al.  Conditioned reflexes: An investigation of the physiological activity of the cerebral cortex. , 1929, Annals of neurosciences.

[73]  A. Baum,et al.  Stress, intrusive imagery, and chronic distress. , 1990, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[74]  T. Blumenthal,et al.  Stimulus rise time, intensity, and bandwidth effects on acoustic startle amplitude and probability. , 1986, Psychophysiology.

[75]  Michael Davis,et al.  Anxiety and the Amygdala: Pharmacological and Anatomical Analysis of the Fear-Potentiated Startle Paradigm , 1988 .

[76]  M. Bond.  Post-traumatic Neurosis , 1982 .

[77]  N. Schneiderman,et al.  Auditory cortex lesions prevent the extinction of Pavlovian differential heart rate conditioning to tonal stimuli in rabbits , 1989, Brain Research.

[78]  E. Blanchard,et al.  Cardiac response to relevant stimuli as an adjunctive tool for diagnosing post-traumatic stress disorder in Vietnam veterans * , 1986 .

[79]  E. Ornitz,et al.  Long-term habituation and sensitization of the acoustic startle response in the normal adult human. , 1989, Psychophysiology.

[80]  Michela Gallagher,et al.  Amygdala central nucleus lesions: Effect on heart rate conditioning in the rabbit , 1979, Physiology & Behavior.

[81]  Michael Davis.  Neural Systems Involved in Fear‐Potentiated Startle , 1989, Annals of the New York Academy of Sciences.