Psychophysiologische Stressreagibilität bei Frauen mit posttraumatischer Belastungsstörung (PTBS) sowie der Einfluss einer ausgeprägten Borderline-Symptomatik

Psychophysiological stress reactivity in women with posttraumatic stress disorder (PTSD) and the influence of a distinct borderline symptomatology

by Juliane Albrecht
Doctoral thesis
Date of Examination:2014-01-22
Date of issue:2014-01-15
Advisor:Prof. Dr. Christoph Herrmann-Lingen
Referee:Prof. Dr. Christoph Herrmann-Lingen
Referee:Prof. Dr. Andrea Rodenbeck
Persistent Address: http://dx.doi.org/10.53846/goediss-4303

 

 

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Abstract

English

Autonomic hyperarousal is a core symptom of posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD), which is explained by prefrontal disinhibition with resulting exaggerated stress responses. However, research has paid little attention to vagal components of stress regulation and thereby possibly missed the complexity of the problem. Therefore the present study used a multidimensional analysis model to better capture the stress reactivity in women with PTSD and BPD. We performed mental stress tests in 54 women with PTSD. Stressors included mental arithmetic and a standardized audio recording of a crying baby. For a comprehensive assessment of psychophysiological activation both alpha -and beta -adrenergic response parameters and heart rate variability parameters (high (HF-HRV) and low frequency (LF-HRV)) as well as baroreceptor sensitivity (BRS) were evaluated. The parameters were continuously recorded by a validated non-invasive monitor and compared between baseline rest and each of the stressors as well as between the two stressors. In addition, a subgroup "high borderline" was examined in comparison to the rest of the patients without pronounced borderline symptomatology. During the cognitive stressor (mental arithmetic) there was indeed a sympathetic activation with a significant increase in heart rate, cardiac index, blood pressure and LF-HRV, but the expected parasympathetic withdrawal under stress was restricted (no significant decrease of HF-HRV and BRS). On this account a dysfunctional vagal modulation in PTSD patients may be suspected. During the emotional stress exposure (crying baby), however, a decrease in the predominantly beta-adrenergic parameters and a vagal dominance (increase in BRS, decrease in LF-HRV) was observed. A distinct borderline symptomatology increased the severity of symptoms (borderline-specific, depressive and dissociative). The vagal dysfunction appears enhanced in the patients of the subgroup "high Borderline" (decreased BRS). Furthermore, the “high borderline” patients showed a significantly elevated blood pressure in comparison to the remaining patients. In conclusion, it appears that not only an increased sympathetic activation is responsible for the characteristic hyperarousal in PTSD patients but deficient parasympathetic influences play a crucial role. Both distress systems, the fear and the attachment system, seem to be impaired particularly in PTSD patients with comorbid BPD. These findings require replication and extension in subsequent studies with respect to stimuli, influence of comorbidities and confounders as well as other specific subgroups.
Keywords: posttraumatic stress disorder (PTSD); psychophysiological stress reactivity; vagal dysfunction
Schlagwörter: Posttraumatische Belastungsstörung; Stressreagibilität; Vagale Hyporeagibilität
 
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