Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
Institute of Psychology, University of Heidelberg, Heidelberg, Germany.
Eur J Psychotraumatol. 2021 Nov 17;12(1):1987686. doi: 10.1080/20008198.2021.1987686. eCollection 2021.
Early life maltreatment is a risk factor for psychiatric disorders, including post-traumatic stress disorder (PTSD). Post-traumatic stress disorder is a severe and heterogeneous disorder with fluctuating states of emotional over- and undermodulation, including hypervigilance, dissociation, and emotion regulation deficits. The perception and regulation of emotions have been linked to interoception, the cortical representation and sensing of inner bodily processes. Although first therapeutic approaches targeting bodily sensations have been found effective in patients with PTSD, and deficits in interoceptive signal representation have been reported in other trauma-related disorders, such as borderline personality disorder (BPD), the role of interoception remains largely unexplored for PTSD.
The objective was to investigate the cortical representation of cardiac interoceptive signals in patients with PTSD and its associations with early life maltreatment, trait dissociation, and emotion dysregulation.
Twenty-four medication-free patients with PTSD and 31 healthy controls (HC) completed a 5-min resting electrocardiogram (ECG) with parallel electroencephalogram (EEG). Heartbeat evoked potential (HEP) amplitudes as a measure for cortical representation of cardiac interoceptive signals were compared between groups and correlated with self-report questionnaires.
We did not find significantly different mean HEP amplitudes in patients with PTSD compared to HC, although HEPs of patients with PTSD were descriptively higher. No significant associations between mean HEP amplitudes and early life maltreatment, trait dissociation or emotion dysregulation were obtained within the groups.
The current finding does not indicate deficits in interoceptive signal representation at rest in individuals with PTSD. Whether patients with PTSD show altered HEP modulations during emotion regulation tasks and might benefit from therapeutic approaches aiming at changing the perception of bodily signals, needs to be investigated in future studies.
童年期虐待是精神障碍的一个风险因素，包括创伤后应激障碍（PTSD）。创伤后应激障碍是一种严重且异质的障碍，其情绪调节存在波动状态，包括过度警觉、分离和情绪调节缺陷。情绪的感知和调节与内感受有关，即皮质对内在身体过程的代表和感知。尽管针对躯体感觉的初步治疗方法已被证明对 PTSD 患者有效，并且在其他与创伤相关的障碍（如边缘型人格障碍（BPD））中报告了内感受信号表示的缺陷，但 PTSD 患者的内感受作用仍在很大程度上尚未得到探索。
本研究旨在探讨 PTSD 患者的心脏内感受信号皮质代表及其与童年期虐待、特质性分离和情绪失调的关系。
24 名未服用药物的 PTSD 患者和 31 名健康对照者（HC）完成了 5 分钟的静息心电图（ECG）和并行脑电图（EEG）。比较了两组之间的心跳诱发电位（HEP）幅度作为心脏内感受信号皮质代表的测量值，并与自我报告问卷相关。
与 HC 相比，PTSD 患者的平均 HEP 幅度没有显著差异，尽管 PTSD 患者的 HEP 幅度描述性更高。在组内，平均 HEP 幅度与童年期虐待、特质性分离或情绪失调之间均无显著相关性。
目前的研究结果并未表明 PTSD 个体在静息时存在内感受信号表示缺陷。PTSD 患者在情绪调节任务期间是否表现出 HEP 调制改变，以及是否可能受益于旨在改变对身体信号感知的治疗方法，需要在未来的研究中进行调查。
