Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.
Int J Methods Psychiatr Res. 2021 Jun;30(2):e1864. doi: 10.1002/mpr.1864. Epub 2020 Nov 21.
Associations of neurobiological differences with posttraumatic stress disorder (PTSD) have generated interest in their temporal relation. Support has been voiced for the neurotoxic stress theory (NST) in which neurobiological differences develop following exposure and PTSD development. In contrast, the diathesis stress theory (DST) posits that neurobiological differences existed prior to exposure and may be vulnerability factors for PTSD. Studies in the first wave of neurobiological PTSD research were all cross sectional, but a second wave of research followed which used prospective repeated-measures designs that measured neurobiology prior to trauma exposure experiences, allowing greater causal inference.
This study reviewed the second-wave studies in hopes of developing a preliminary consensus to support either the NST or the DST based on this more powerful prospective, repeated-measures study design.
Twenty-five second-wave studies were located that measured neurobiology prior to traumatic experiences. Nineteen studies supported the DST. Of 10 studies that were capable of testing the NST, only 3 were supportive.
The implications of the NST versus the DST have profound implications for understanding the fragility of the human brain and possible paths forward for future research on assessment, treatment, and social policy.
神经生物学差异与创伤后应激障碍（PTSD）之间的关联引起了人们对其时间关系的兴趣。神经毒性应激理论（NST）认为，神经生物学差异是在暴露和 PTSD 发展之后出现的，这一理论得到了支持。相比之下，素质应激理论（DST）则认为，神经生物学差异在暴露之前就存在，可能是 PTSD 的脆弱性因素。在神经生物学 PTSD 研究的第一波中，所有研究都是横断面研究，但随后进行了第二波研究，采用了前瞻性重复测量设计，在创伤暴露经历之前测量神经生物学，从而可以进行更有力的因果推断。
本研究回顾了第二波研究，希望根据这种更强大的前瞻性、重复测量研究设计，初步达成支持 NST 或 DST 的共识。
共找到 25 项在创伤经历之前测量神经生物学的第二波研究。19 项研究支持 DST。在能够检验 NST 的 10 项研究中，只有 3 项是支持性的。
NST 与 DST 的含义对理解人类大脑的脆弱性以及未来评估、治疗和社会政策研究的可能方向具有深远意义。
