Predicting the development of posttraumatic stress disorder from the acuteresponse to a traumatic event

Posttraumatic stress disorder (PTSD) is a psychiatric condition that is dir ectly precipitated by an event that threatens a person's life or physical i ntegrity and that invokes a response of fear, helplessness, or horror. In r ecent years it has become clear that only a proportion of those exposed to fear-producing events develop or sustain PTSD. Thus, it seems that an impor tant challenge is to elucidate aberrations in the normal fear response that might precipitate trauma-related psychiatric disorder. This paper summariz es the findings from recent studies that examined the acute and longer term biological response to traumatic stress in people appearing to the emergen cy room immediately following trauma exposure. In the aggregate, these stud ies have demonstrated increased heart rate and lower cortisol levels at the time of the traumatic event in those who have PTSD at a follow-up time com pared to those who do not. In contrast, certain features associated with PT SD, such as intrusive symptoms and exaggerated startle responses, are only manifest weeks after the trauma. The findings suggest that the development of PTSD may be facilitated by an atypical biological response in the immedi ate aftermath of a traumatic event, which in turn leads to a maladaptive ps ychological state. Biol Psychiatry 1998;44:1305-1313 (C) 1998 Society of Bi ological Psychiatry.