Is it time to view PTSD as a systemic illness, not just a psychological one?
Treating PTSD purely as a psychological disorder risks overlooking physical health problems of the individuals, with potentially worse outcomes for patients, an Australian study says.
The cross-sectional study of almost 300 Vietnam War veterans compared physical comorbidities of people with PTSD compared with those who had also experienced trauma, but did not have a PTSD diagnosis.
Veterans with PTSD were significantly more likely to have physical health problems than the trauma-exposed control group.
“In particular, veterans with PTSD had higher rates of comorbidities of the gastrointestinal, cardiovascular, and respiratory systems, as well as a higher prevalence of sleep disorders,” the Queensland researchers found.
As a result, the authors said it was time to recognise that PTSD was a systemic illness and not only a psychological one.
“Integrated healthcare strategies for improving psychological and physical health, as well as controlling risk factors, could improve the quality of life and survival of patients,” they said.
Australian research suggests PTSD may occur in as many as one in five Vietnam War veterans over the course of their lives, with similar rates for those who served in Iraq, Afghanistan and peacekeeping missions.
The study was conducted at the Gallipoli Medical Research Foundation, where participants underwent evaluation by a psychiatrist, psychological and substance use assessment as well as a comprehensive medical evaluation, including investigation.
Morbidity was greater in the PTSD group for 24 of 171 assessed clinical outcomes, and patients with PTSD had a mean of 17.7 comorbidities compared with 14.1 in the control group.
Those with PTSD were also more likely to have risk factors for disease, including higher BMI, smoking and alcohol dependence.
People with PTSD frequently also present with somatic symptoms of a non-specific nature.
The fact that these lifestyle factor may have accounted for the differences between groups, including shortness of breath on exertion, fatty liver, reduced eGFR and elevated triglyceride levels, highlighted the importance of addressing the risk behaviours within PTSD therapy, the authors said.
One in five patients with PTSD had moderate or serious depressive symptoms, which the authors said added to the complexity of treatment, “augmenting the risk that PTSD will be persistent and chronic”.
After adjusting for the severity of depression – an independent risk factor for many chronic diseases – PTSD was still significantly associated with 10 comorbidities.
In an accompanying editorial, Adelaide psychiatrist Professor Alexander McFarlane said the failure to attend to the somatic pathology of PTSD had not served patients well.
“People with PTSD frequently also present with somatic symptoms of a non-specific nature that represent an integral part of the patient’s sense of ill-health,” he wrote.
The poor outcomes of evidence-based psychological interventions highlighted the need for biological therapies targeting the underlying neurophysiological and immune dysregulation accompanying PTSD, Professor McFarlane said.