Office of Research & Development

 

Posttraumatic Stress Disorder (PTSD)

PTSD icon

In earlier wars, it was called "soldier's heart," "shell shock," or "combat fatigue." Today, doctors recognize the issues described by each of these terms as a distinct medical condition called posttraumatic stress disorder (PTSD).

While PTSD can affect people who have experienced a wide range of life-threatening events, in Veterans the condition is commonly associated with combat trauma. It has taken a significant toll on many war Veterans who currently use VA health care, including Iraq and Afghanistan Veterans. Something else that can lead to PTSD is military sexual assault or harassment.

PTSD also affects many people who have lived through traumatic events not related to military service, such as physical or sexual assaults, car crashes or other serious accidents, fires, or natural disasters. About 60 percent of American men, and 50 percent of women, experience at least one trauma in their lives, and a small but significant number develop serious problems such as PTSD.

One of VA Research's top priorities is to continually improve the ability to prevent, diagnose, and treat PTSD. Today, Veterans with PTSD benefit from many effective treatments, including psychotherapy and various medications that were developed and refined with major contributions from VA investigators.

Selected Major Accomplishments

  • VA established the National Center for PTSD to set the agenda for research and education on the disorder.
  • VA researchers determined the overall prevalence of PTSD in women Veterans.
  • Both prolonged-exposure therapy and cognitive processing therapy can significantly reduce symptoms in Veterans with PTSD, according to several VA research studies.
  • VA researchers and Defense colleagues showed that prazosin, a drug used to treat high blood pressure and prostate problems, is an effective treatment for PTSD nightmares and sleep disturbances.

Selected Milestones and Major Events

Overview

PTSD is an anxiety disorder that affects many Veterans. Human beings have a physical and psychological reaction to violence, whether it happens to them or they just witness it.

In the Civil War, Veterans with PTSD were said to have an illness called soldier's heart. In World War I, the illness was called shell shock; in World War II, battle fatigue; and in Vietnam, it was referred to as combat stress.

In 1980, PTSD was given its clinical name and scientific definition, and was included in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.

PTSD can lead to distressing and persistent symptoms, such as re-experiencing the trauma through flashbacks or nightmares; an emotional numbness; insomnia; relationship problems; sudden anger; and drug and alcohol abuse.

While stress is common after a trauma, for those with PTSD reactions such as reliving an event in their mind and feeling distant or angry do not go away over time and can even get worse.

VA's commitment

VA has a continuing commitment to fund efforts to understand, prevent, and treat PTSD. The wide-ranging nature of our current PTSD research includes studies of Veterans, subgroups of Veterans, families, and couples. Veterans of all eras are included in these studies.

VA researchers are advancing the understanding of PTSD and its effects, developing and testing treatments for the condition, and finding ways to prevent PTSD from occurring after trauma occurs.

Ongoing studies range from investigations of the genetic or biochemical foundations of the disorder to evaluations of new or existing treatments, including large multisite clinical trials. VA's National Center for PTSD is a VA group of research centers that focus entirely on the condition.

The Center is a world leader in research and education programs focusing on PTSD and other psychological and mental consequences of traumatic stress. It currently consists of seven VA academic centers of excellence across the United States, with headquarters in White River Junction, Vt.

In September 2012, VA and the Department of Defense (DoD) announced that the two departments were combining more than $100 million to fund two new consortia aimed at improving diagnosis and treatment of PTSD and mild traumatic brain injury.

These organizations are bringing together leading scientists and researchers throughout the nation, and are part of VA and DoD's response to an executive order to improve access to Posttraumatic Stress Disorder (PTSD) services for Veterans, Service members, and military families.

Completed studies

In the 1980s, Patricia Resick, PhD, developed cognitive processing therapy (CPT), a 12-session cognitive behavioral treatment that can be administered to individuals or to groups to help victims overcome symptoms of sexual trauma.

In 2006, a study led by Candice M. Monson, PhD, found that the symptoms of Veterans with PTSD were significantly reduced in those who received CPT. CPT is now one of the two most effective treatments used by VA clinicians for the illness. The other is prolonged exposure therapy, which several groups of VA researchers have found also effectively reduces PTSD symptoms. A VA cooperative study is now comparing the two treatments head to head, to better understand the pros and cons of each for specific types of patients.

In 2007, a team of VA researchers led by Murray A. Raskind, MD, published a study demonstrating that a generic drug called prazosin, used by millions of Americans for high blood pressure and prostate problems, could also be used to reduce nightmares in Veterans with PTSD.

The researchers found that patients taking prazosin got an average of 94 minutes of additional sleep a night, increased the time and duration of their rapid eye movement (REM) sleep cycles, had fewer trauma-related nightmares, woke up less in the middle of the night in distress, and appeared to have more normal dreams.

The drug has been undergoing further study in a major VA cooperative study, and results are pending analysis and publication.

VA's Seattle Epidemiologic Research and Information Center (ERIC) maintains a registry of approximately 7,000 twins, all of whom served in the military during the Vietnam War era. The Vietnam Era Twin Registry is one of the largest national twin registries in the United States, and has been in existence in more than 20 years.

Using data from this registry, a team of researchers from VA, Massachusetts General Hospital, and Tufts University found in 2011 that an area in the brain called the dorsal anterior cingulate is activated more greatly in response to stimuli in Veterans who developed PTSD and their twins who did not serve in combat, as opposed to the Veterans and who did not develop PTSD after serving in combat and their twins.

In 2011, researchers from VA's Palo Alto Health Care System and Stanford University found that Iraq and Afghanistan Veterans diagnosed with PTSD have more physical ailments than Veterans without Posttraumatic Stress Disorder (PTSD) conditions. In particular, women Veterans with PTSD were found to be more susceptible to physical health issues than their male counterparts.

In 2012, VA and Duke University researchers found that recent combat veterans with PTSD have less volume in the amygdala of their brains—an area that is critical in determining how people respond to fear and anxiety. They did not determine whether this physiological difference was caused by a traumatic event, or whether PTSD develops more readily in those with smaller amygdalas.

In a national study of women Veterans from various eras published in 2013, 13 percent screened positive for PTSD. Among U.S. women in general, the lifetime prevalence of PTSD is just under 10 percent.

The study was the first to establish the overall prevalence of PTSD among women U.S. Veterans. Earlier studies focused only on those who use VA care, or women who served during a specific era.

Also in 2013, VA researchers found what one called a "biomarker of resilience," which may help to explain why some people who are exposed to trauma never develop PTSD.

In the study, scans of PTSD-affected brains showed clusters of neurons (nerve cells that are the basic building blocks of the nervous system) that were locked into long-term interactions with other neurons. As a result, they weren't able to encode new information. Study participants who did not develop PTSD showed no such patterns.

Ongoing studies

In May 2011, the Office of Research and Development convened a meeting to explore what is known about the use of complementary and alternative medicine therapies in treating PTSD and to create future research agenda. The therapies discussed included meditation, massage, and yoga. In follow-up to the meeting, VA funded three studies of the effects of meditation on PTSD. One study looked at the "mantram" technique of meditation, a simple technique in which Veterans silently repeat a word or phrase that holds personal meaning for them. In a preliminary study, the technique had helped lessen PTSD symptoms in nearly a third of participants.

The other two studies are looking at the effectiveness of a kind of meditation called mindfulness-based stress reduction. Both studies are ongoing, but are no longer recruiting participants. (For more information see www.clinicaltrials.gov/show/NCT01532999 and www.clinicaltrials.gov/ct2/show/NCt01548742.) VA is also looking at the potential benefits of transcranial magnetic stimulation (an FDA-approved procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression) for Veterans with PTSD.

VA genomics researchers are working to identify genes that affect a person's response to the experience of deployment, especially combat exposures. By conducting careful assessments in Veterans affected by combat-related PTSD and, with their consent, analyzing their DNA samples, researchers hope to pinpoint genetic variants that contribute to PTSD. VA's PATRIOT study team (Cooperative Studies Program study #575) is recruiting 20,000 Iraq and Afghanistan veterans for this purpose.

The Marine Resiliency Study, based in San Diego, involves some 2,600 Marines. VA and DoD researchers are probing dozens of risk factors, from biological to behavioral, that may affect the abilities of service members to withstand emotional stress.

In 2014, Marine Resiliency Study researchers learned that traumatic brain injury during a deployment was by far the strongest predictor of post-deployment PTSD symptoms in service members and Veterans, far more significant than prior traumatic brain injuries or the intensity of combat they experienced. Researchers are continuing to analyze the data they have collected.

More on our Website

Video: Posttraumatic Stress Disorder

For Veterans with PTSD, substance abuse increases mortality risk, VA News Feature

Heart-mind mystery: unraveling the link between PTSD and heart disease, VA Research Currents, Spring 2014

Poor sleep increases risk, severity of PTSD, research shows, VA Research Currents, Winter 2013-14

Genetics plays role in lessening PTSD in some women, VA Research Currents, Winter 2013-14

Natural supplement put to test for PTSD, VA Research Currents, Fall 2013

Inexpensive generic drug shown effective for nightmares, other PTSD symptoms. VA Research Currents, Fall 2013

For Veterans with PTSD, videoconferencing proves effective for delivering therapy, VA Research Currents, May 2013

'Mantram' technique benefits Veterans with PTSD, VA Research Currents, May 2013

Study yields potential biomarker for PTSD-resistant brains, VA Research Currents, Mar.-Apr. 2013

Survey of national sample: PTSD affects more than one in eight women Veterans, VA Research Currents, Mar.-Apr. 2013

PTSD tied to changes in brain's 'amygdala', VA Research Currents, Dec. 2012-Jan. 2013

Exposure therapy for PTSD works in groups, VA Research Currents, Dec. 2012-Jan. 2013

Seattle Epidemiologic Research and Information Center, (ERIC )

Selected Scientific Articles by our Researchers

Cognitive processing therapy for veterans with military-related posttraumatic stress disorder . Monson CM, Schnurr PP, Resick PA, Friedman MJ, Young-Xu Y, Stevens SP. This trial provided some of the most encouraging results of PTSD treatment for veterans with chronic PTSD and supports increased use of cognitive-behavioral treatments in this population. J Consult Clin Psychol. 2006 Oct;74(5):898-907.

A parallel group placebo controlled study of Prazosin for trauma nightmares and sleep disturbance in combat Veterans with post-traumatic stress disorder . Raskind, MA, Peskind ER, Hoff DJ, Hart KL, Holmes HA, Warren D, Shofer J, O'Connell J, Taylor F, Gross C, Rohde K, McFall ME. Prazosin is an effective and well-tolerated treatment for trauma nightmares, sleep disturbance, and global clinical status in Veterans with chronic PTSD. Biol Psychiatry, 2007 Apr 15;61(8):928-34.

Complementary and alternative medicine in VA specialized PTSD treatment programs. Libby DJ, Pilver CE, Desai R. The widespread use of CAM treatments in VA PTSD programs presents an opportunity for researchers to assess the effect of CAM on Posttraumatic Stress Disorder (PTSD) service use and PTSD symptoms among Veterans. Psychiatr Serv. 2012 Nov;63(11):1134-6.

Medical care needs of returning Veterans with PTSD: their other burden . Frayne SM, Chiu, VY, Iqbal S, Berg EA, Laungani KJ, Cronkite RC, Pavao J, Kimerling R. Among both women and men Iraq and Afghanistan Veterans who use VHA, the burden of medical illness is greater for those with PTSD than for those with no Posttraumatic Stress Disorder (PTSD) conditions. J Gen Intern Med. Jan 2011; 26(1):33-39.

Exaggerated activation of dorsal anterior cingulate cortex during cognitive interference: a monozygotic twin study of posttraumatic stress disorder. Shin LM, Bush G, Milad MR, Lasko NB, Brohawn KC, Hughes KC, Macklin ML, Gold Al, Karpf RD, Orr SP, Rauch SL, Pitman RK. Hyper-responsivity in the dorsal anterior cingulate appears to be a familial risk factor for the development of PTSD following psychological trauma. Am J Psychiatry, 2011 Sep;168(9):979-85

Amygdala volume changes with posttraumatic stress disorder in a large case-controlled veteran group. Morey RA, Gold AL, LaBar K, Beall SK, Brown VM, Haswell CC, Nasser JD, Mid-Atlantic MIRECC Workgroup, Wagner, HR, McCarthy G. The study establishes diminished amygdala volume in a large cohort of recent military Veterans with PTSD compared to trauma-exposed non-PTSD Veterans. Arch Gen Psychiatry, Nov 2012;69(11):1169-1178.

PTSD risk and Posttraumatic Stress Disorder (PTSD) care engagement in a multi-war era community sample of women veterans. Washington DC, Davis TD, Der-Martirosian C, Yano EM. More than one in eight women veterans in a national survey of 3,611 women veterans screened positive for PTSD. J Gen Intern Med. 2013 Jul;28(7):894-900.

Neural network modulation by trauma as a marker of resilience: differences between veterans with posttraumatic stress disorder and resilient controls . James LM, Engdahl BE, Leuthold AC, Lewis SM, Van Kampen E, Georgopolous AP. Neural modulation distinguishes resilient veterans from those with PTSD and is postulated to have an important role in healthy response to trauma. JAMA Psychiatry. 2013 Apr;70(4);410-8.

Effectiveness of national implementation of prolonged exposure therapy in Veterans Affairs care. Eftekhari A, Ruzek Jl, Crowley JJ, Rosen CS, Greenbaum MA, Karlin BE. In a study of 1931 Veterans treated by 804 clinicians, clinically significant reductions in PTSD were achieved through prolonged exposure therapy among male and female Veterans of all war eras and Veterans with combat-related and non-combat-related-PTSD. JAMA Psychiatry, 2013 Sep:70(9):949-55.

Association between traumatic brain injury and risk of posttraumatic stress disorder in active-duty marines . Yurgil KA, Barkauskas DA, Vasterling JJ, Nievergelt CM, Larson GE, Schork NJ, Litz BT, Nash WP, Baker DG, Marine Resiliency Study Team. Even when accounting for predeployment symptoms, prior TBI, and combat intensity, TBI during the most recent deployment is the strongest predictor of post deployment PTSD symptoms. JAMA Psychiatry, 2014 Feb 1;71(2):149-57.

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