Biomarkers of emotional trauma-induced posttraumatic stress disorder: a systematic review (2023)


Post-traumatic stress disorder (PTSD) is a psychiatric disorder that can evolve into a chronic condition that severely affects a person's quality of life by causing distress and dysfunction in everyday social and work settings. It is now well known that the onset of PTSD is triggered by a traumatic stressor. Trauma can be defined as a reaction to a profoundly shocking event that overwhelms a person's ability to cope, causing feelings of powerlessness, self-consciousness, and the ability to feel a wide range of emotions and experiences (Giller, 1999). The word "trauma" comes from ancient Greek.traumaIt also describes the deleterious effects of disruptive external factors and the body's potential to exhibit resistance/resiliency to such factors. Traumatic events occur frequently in life and can lead to trauma in response to emotional responses strictly related to the psychological meaning and psychological representation of the trauma (Harned et al., 2015). This process involves the activation of biological responses at the cortical and limbic level through autonomic, endocrine, and cognitive activation. Most commonly, the response to a traumatic event involves initial acute stress, including symptoms of depression and anxiety in the first few days after the event, followed by recovery. In some cases, mental or emotional disorders cannot be adequately articulated by the human brain and persist, so they can be considered PTSD (Foa et al., 2006). A PTSD diagnosis can only be made after a complete medical examination, including medical records, objective assessment, interviews, and clinical evaluation by a specialist. Several psychometric tools, such as the CAPS-5 clinical interview, MMPI2, and TDI, can help professionals identify clinical states and assess their severity (Denning, 2023; Grattagliano et al., 2022; Weathers et al., 2018). subjects In PTSD, key symptoms include fear and worry along with other features and conditions, including arousal, avoidance, sleep disturbance, and intrusive symptoms (eg, flashbacks and nightmares) (Al Jowf et al., 2023).

Worldwide, the prevalence of PTSD ranges from 2.1% to 9.2% (Koenen et al. 2017; Goldstein et al. 2016; Kessler et al. 2014; Kessler et al. 2005; van Ameringen et al. al, 2008), and arises from numerous and highly variable traumatic events. These include trauma from physical and sexual events, complex trauma (ie multiple traumas over a sustained period), trauma from loss or abandonment, trauma from neglect (ie lack of attendance, those related to war, terrorism, civil unrest and cultural trauma). ). In general, PTSD is more likely to occur after experiencing physical trauma, eg, rape or physical violence, serious car accident, terrorist attack. In such cases, physical injury can overlap with distressing emotional responses, which can eventually lead to chronic mental illness due to physical and psychological impairments (Weiss et al., 2022; Spadoni et al., 2018; Dedert et al., 2010 ; Pietrzak et al., 2012). Given the close relationship between psychological distress and emotional responses, PTSD may be a purely "emotional" response to trauma. The concept of 'emotional trauma' is often discussed but, although not clearly defined, a single and generally accepted definition of 'emotional trauma' is still lacking (Weis et al., 2022; Stolorow, 2015; Wright, 2004). In general, it can refer to trauma resulting from a single or repeated traumatic experience, but does not involve physical harm, for example, bullying, discrimination, humiliation, or other experience of powerlessness.

Interestingly, not all people exposed to the same traumatic event subsequently develop PTSD symptoms. Instead, the frequency and intensity of this occurrence were related to individual and social risk factors (Kroll, 2003; Sareen et al., 2013; Stein et al., 2007; Yehuda, 2002; Andrews et al., 2007; Smid et al., 2009; Utzon-Frank et al., 2014). For example, intentional trauma is more strongly associated with PTSD than unintentional traumatic events (Kessler, 1995; Kessler et al., 2014), and longer durations of trauma exposure are associated with increased risk of PTSD ( Nagamine et al. People, 2020), while women are twice as likely as men to experience PTSD (Tolin & Foa, 2006). Furthermore, while most subjects exhibited "resilience" (Ioannidis et al., 2020; Kalisch et al., 2019) and recovered from PTSD without long-term consequences, a small proportion of patients may experience comorbid mental illness. (Henderson et al., 2000; Kessler et al., 1997; Qassem et al., 2021). These may include generalized anxiety disorder and major depressive disorder, which have overlapping symptoms and are often interrelated (Qassem et al., 2021), leading to further impairment and increased risk of suicide in subjects (Flory and Yehuda, 2015). Additionally, PTSD often coexists with bipolar disorder, schizophrenia, and problematic alcohol and drug abuse.

An intensive research effort is underway to explore the pathophysiological dynamics of PTSD, but many unknowns remain. Primary messages describe PTSD with altered biological factors and mechanisms associated with brain circuitry (ie, dysfunctional threat detection, emotion regulation, and situation processing), neurochemical factors (eg, noradrenergic system, serotonin signaling, dopamine ) and the HPA hypothalamic-pituitary-adrenal system) (Al Jowf et al., 2023; Toledo and Carson, 2022). Unraveling the pathophysiological mechanisms underlying PTSD may support the identification of reliable and appropriate PTSD biomarkers that may facilitate more accurate diagnosis and help identify resilience to increased risk of persistent physical and mental health problems after less exposure to trauma. of the individual. Several potential biomarkers are associated with pathophysiological changes in subjects with PTSD, but their identification remains a key open challenge (Al Jowf et al., 2023). PTSD is a multifaceted mental health disorder with variable syndromes (Bonanno, Mancini et al., 2012), and this diagnostic heterogeneity associated with a multifactorial etiology has led to a lack of disease-specific biomarkers to date (Domingo-Fernández et al., 2019). ; Lehrner and Yehuda, 2014; Yehuda et al., 2013). Furthermore, even when reliable PTSD biomarkers can be identified, it is difficult to determine their specificity for PTSD (unlike any common comorbid psychiatric disorder). Another question is how changes in marker values ​​are affected by comorbidities or symptom severity. From this perspective, it would be useful to identify biomarkers associated with specific types of trauma.

The aim of this systematic review was to provide an overview of the biomarkers associated with PTSD, which is diagnosed with emotional trauma alone, referring here to single or repeated traumatic experiences that do not involve physical trauma. The potential impact of confounding stressors was limited by selectively focusing on studies of adult civilians who had not experienced war-related trauma.

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Find sources and strategies

Initially, the Cochrane Library was asked to identify any systematic reviews whose objectives might overlap with current research.

Subsequently, a systematic bibliographic search was carried out in three electronic databases: PubMed, Scopus and Evidence Based Mental Health. The strings used to search each database are formulated from defined key termsthe firstand considered adequate to meet the objectives of the review. In particular, the literature search was based on


Preliminary findings from the Cochrane Library included nine studies whose objectives did not match those of this systematic review, highlighting the originality of this study.

Overall, the literature search for this study included one study investigating epigenetic modifications in PTSD, four articles focusing on brain imaging, and one article on salivary cortisol levels.

Summary of characteristics and key findings of selected studies

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Biomarkers are "characteristics that are objectively measured and evaluated as indicators of normal biological processes, pathogenic processes, or pharmacological responses to therapeutic interventions" that can be used to predict risk or resistance to a particular disease, or to diagnose a disease (Atkinson et al., 2001). Molecular, enzymatic, imaging, electrophysiological, and genetic data are commonly used as biomarkers. Although many biological and neurobiological

author contribution

All authors contributed to the writing and critical review of the article. All authors agree to submit the final version.


No funds declared.

Data Availability Statement

The authors acknowledge that data supporting the findings of this study are presented in the article.

references not cited

Kenneth et al., 2015

Declaration of conflicting interests

There are no competing financial interests to report.

© 2023 Elsevier Masson SAS. all rights reserved.

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