Lack of cortisol response in patients with posttraumatic stress disorder (PTSD) undergoing a diagnostic interview

<p>Abstract</p> <p>Background</p> <p>According to DSM-IV, the diagnosis of posttraumatic stress disorder (PTSD) requires the experience of a traumatic event during which the person's response involved intense fear, helplessness, or horror. In order to diagnose PTSD...

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Main Authors: de Quervain Dominique JF, Neuner Frank, Ruf Martina, Eckart Cindy, Kolassa Iris-Tatjana, Elbert Thomas
Format: Article
Language:English
Published: BMC 2007-10-01
Series:BMC Psychiatry
Online Access:http://www.biomedcentral.com/1471-244X/7/54
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spelling doaj-3476100b21324795b3c48520da2cee212020-11-24T21:10:34ZengBMCBMC Psychiatry1471-244X2007-10-01715410.1186/1471-244X-7-54Lack of cortisol response in patients with posttraumatic stress disorder (PTSD) undergoing a diagnostic interviewde Quervain Dominique JFNeuner FrankRuf MartinaEckart CindyKolassa Iris-TatjanaElbert Thomas<p>Abstract</p> <p>Background</p> <p>According to DSM-IV, the diagnosis of posttraumatic stress disorder (PTSD) requires the experience of a traumatic event during which the person's response involved intense fear, helplessness, or horror. In order to diagnose PTSD, clinicians must interview the person in depth about his/her previous experiences and determine whether the individual has been traumatized by a specific event or events. However, asking questions about traumatic experiences can be stressful for the traumatized individual and it has been cautioned that subsequent "re-traumatization" could occur. This study investigated the cortisol response in traumatized refugees with PTSD during a detailed and standardized interview about their personal war and torture experiences.</p> <p>Methods</p> <p>Participants were male refugees with severe PTSD who solicited an expert opinion in the Psychological Research Clinic for Refugees of the University of Konstanz. 17 patients were administered the <it>Vivo </it>Checklist of War, Detention, and Torture Events, a standardized interview about traumatic experiences, and 16 subjects were interviewed about absorption behavior. Self-reported measures of affect and arousal, as well as saliva cortisol were collected at four points. Before and after the experimental intervention, subjects performed a Delayed Matching-to-Sample (DMS) task for distraction. They also rated the severity of selected PTSD symptoms, as well as the level of intrusiveness of traumatic memories at that time.</p> <p>Results</p> <p>Cortisol excretion diminished in the course of the interview and showed the same pattern for both groups. No specific response was detectable after the supposed stressor. Correspondingly, ratings of subjective well-being, memories of the most traumatic event(s) and PTSD symptoms did not show any significant difference between groups. Those in the presumed stress condition did not perform worse than persons in the control condition after the stressor. However, both groups performed poorly in the DMS task, which is consistent with memory and concentration problems demonstrated in patients with PTSD.</p> <p>Conclusion</p> <p>A comprehensive diagnostic interview including questions about traumatic events does not trigger an HPA-axis based alarm response or changes in psychological measures, even for persons with severe PTSD, such as survivors of torture. Thus, addressing traumatic experiences within a safe and empathic environment appears to impose no unacceptable additional load to the patient.</p> http://www.biomedcentral.com/1471-244X/7/54
collection DOAJ
language English
format Article
sources DOAJ
author de Quervain Dominique JF
Neuner Frank
Ruf Martina
Eckart Cindy
Kolassa Iris-Tatjana
Elbert Thomas
spellingShingle de Quervain Dominique JF
Neuner Frank
Ruf Martina
Eckart Cindy
Kolassa Iris-Tatjana
Elbert Thomas
Lack of cortisol response in patients with posttraumatic stress disorder (PTSD) undergoing a diagnostic interview
BMC Psychiatry
author_facet de Quervain Dominique JF
Neuner Frank
Ruf Martina
Eckart Cindy
Kolassa Iris-Tatjana
Elbert Thomas
author_sort de Quervain Dominique JF
title Lack of cortisol response in patients with posttraumatic stress disorder (PTSD) undergoing a diagnostic interview
title_short Lack of cortisol response in patients with posttraumatic stress disorder (PTSD) undergoing a diagnostic interview
title_full Lack of cortisol response in patients with posttraumatic stress disorder (PTSD) undergoing a diagnostic interview
title_fullStr Lack of cortisol response in patients with posttraumatic stress disorder (PTSD) undergoing a diagnostic interview
title_full_unstemmed Lack of cortisol response in patients with posttraumatic stress disorder (PTSD) undergoing a diagnostic interview
title_sort lack of cortisol response in patients with posttraumatic stress disorder (ptsd) undergoing a diagnostic interview
publisher BMC
series BMC Psychiatry
issn 1471-244X
publishDate 2007-10-01
description <p>Abstract</p> <p>Background</p> <p>According to DSM-IV, the diagnosis of posttraumatic stress disorder (PTSD) requires the experience of a traumatic event during which the person's response involved intense fear, helplessness, or horror. In order to diagnose PTSD, clinicians must interview the person in depth about his/her previous experiences and determine whether the individual has been traumatized by a specific event or events. However, asking questions about traumatic experiences can be stressful for the traumatized individual and it has been cautioned that subsequent "re-traumatization" could occur. This study investigated the cortisol response in traumatized refugees with PTSD during a detailed and standardized interview about their personal war and torture experiences.</p> <p>Methods</p> <p>Participants were male refugees with severe PTSD who solicited an expert opinion in the Psychological Research Clinic for Refugees of the University of Konstanz. 17 patients were administered the <it>Vivo </it>Checklist of War, Detention, and Torture Events, a standardized interview about traumatic experiences, and 16 subjects were interviewed about absorption behavior. Self-reported measures of affect and arousal, as well as saliva cortisol were collected at four points. Before and after the experimental intervention, subjects performed a Delayed Matching-to-Sample (DMS) task for distraction. They also rated the severity of selected PTSD symptoms, as well as the level of intrusiveness of traumatic memories at that time.</p> <p>Results</p> <p>Cortisol excretion diminished in the course of the interview and showed the same pattern for both groups. No specific response was detectable after the supposed stressor. Correspondingly, ratings of subjective well-being, memories of the most traumatic event(s) and PTSD symptoms did not show any significant difference between groups. Those in the presumed stress condition did not perform worse than persons in the control condition after the stressor. However, both groups performed poorly in the DMS task, which is consistent with memory and concentration problems demonstrated in patients with PTSD.</p> <p>Conclusion</p> <p>A comprehensive diagnostic interview including questions about traumatic events does not trigger an HPA-axis based alarm response or changes in psychological measures, even for persons with severe PTSD, such as survivors of torture. Thus, addressing traumatic experiences within a safe and empathic environment appears to impose no unacceptable additional load to the patient.</p>
url http://www.biomedcentral.com/1471-244X/7/54
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