Associated manifestations and comorbid disorders with PTSD

• Patients with posttraumatic stress disorder (PTSD) have a high rate of mental disorders comorbidity.

  Comorbid mental disorders

  According to the National Comorbidity Survey, 16% of patients with PTSD have one comorbid mental disorder, 17% have two mental disorders, and 50% have three or more. Depressive disorders, anxiety disorders, and substance abuse are 2 to 4 times more common in patients with PTSD than in the general population. Substance abuse often happens due to the patient attempting to self-manage symptoms. 

  Approximately 20% of people with PTSD reported using alcohol or other stress-reducing substances.

  Below we describe other important categories of disorders or symptoms.

  Personality disorders

  Patients with PTSD had increased rates of comorbid borderline personality disorder and antisocial disorders compared with the general population. PTSD is associated with an increased likelihood of lifetime and past-year antisocial personality disorder (odds ratios ranging from 1.8 to 3.3) in a nationally representative US sample.

  In some cases, clinicians have difficulty differentiating PTSD symptoms in patients with borderline personality disorder (BPD). A large US sample showed that 24% of patients with PTSD had a diagnosis of BPD. Compared with people who had only PTSD or only BPD, people with comorbid PTSD and BPD had more comorbidity, an increased likelihood of suicide attempts, and higher rates of childhood traumatic events.

  Somatic symptoms

  Research shows that patients with PTSD are 90 times more likely to experience physical symptoms than those without the disorder.

  Medical comorbidities

  Research data suggests that the influence of traumatic events and PTSD is associated with a number of physical illnesses. For example, large prospective epidemiological studies and retrospective data analysis have shown that bone and joint diseases, neurological, cardiovascular, respiratory, or metabolic diseases are 1.5 to 3 times more common in patients with PTSD than in individuals without PTSD.

  Research has found high rates of many medical conditions and risk factors that accompany PTSD: risk factors for cardiovascular and pulmonary disease, as well as obesity, dyslipidemia, smoking, hypertension and type II diabetes in women.

  Examples of studies include:

  • Population-based study of 3171 respondents, where PTSD was associated with an increased risk of angina (hazard ratio 2.4, 95% CI 1.3 - 4.5), heart failure (hazard ratio 3.4, 95% CI 1.9 - 6.0), bronchitis, asthma, liver and peripheral artery disease (hazard ratio range = 2.5, 3.1) after adjustment for sociodemographic factors, smoking, body mass index, blood pressure, depression and disorders associated with drinking alcohol.
  • A 2018 cohort study of 6,481 adults involved in debris cleanup following the terrorist attack on the World Trade Center in the United States found PTSD to be a risk factor for cardiovascular disease. The cumulative incidence of myocardial infarction or stroke was consistently higher in people with PTSD, regardless of depression.
  • A Swedish national registry study of more than 136,000 patients with stress-related disorders (i.e. PTSD, acute stress reaction, adjustment disorder and other stress reactions) found an increased risk of cardiovascular disease compared with siblings without PTSD and compared with a matched sample of the general population (n = 1,366,370). Cardiovascular outcomes included coronary artery disease, cerebrovascular disease, thrombosis or embolism, heart failure, arrhythmia, and fatal cardiovascular event. In the first year after diagnosis of a stress disorder, the hazard ratio for any cardiovascular disease was 1.64 (95% CI 1.45–1.84).

  Autoimmune and endocrine diseases

  The incidence rate of autoimmune diseases was higher in patients with stress-related disorders compared with matched unexposed individuals and siblings (9.1 versus 6.0 and 6.5 per 1000 person-years). Compared with the non-distressed population, patients with PTSD had an increased risk of developing several autoimmune diseases (hazard ratio 2.29, 95% CI 1.72 - 3.04).

  Aging and dementia

  A systematic review of PTSD and early aging found modest associations between PTSD and possible biological markers of accelerated aging, increased comorbidity with dementia-related conditions, and earlier mortality (mean hazard ratio 1.29).

  Alzheimer’s disease and vascular dementia

  A review of studies found preliminary evidence of higher rates of Alzheimer’s disease and vascular dementia in patients with PTSD.

  Traumatic brain injury (TBI)

  Research has shown that TBI and PTSD are common in civilians and especially in soldiers with combat-related TBI.

  For example, in a study of 2,235 American soldiers returning from combat in Iraq and Afghanistan, 11% of them had their PTSD confirmed in 2008. Among 268 soldiers with mild TBI, 62% were found to have PTSD.

  A study conducted among US soldiers found that TBI was independently associated with an increased risk of developing PTSD over a one-year follow-up period.

  Irritable bowel syndrome

  High rates of irritable bowel syndrome have been found in patients with PTSD. A 2019 systematic review of eight studies involving more than 648,000 people found an overall odds ratio of 2.80 (95% CI 2.06 - 3.54) for the association between PTSD and IBS. Most studies were conducted in the United States involving military veterans.

  The co-occurrence of PTSD and IBS is likely due to complex interactions between the brain and the gut, dysregulations in the hypothalamic-pituitary-adrenal axis, potential disturbances in immune function, the microbiome, and altered neuropeptide Y levels.

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  Sources:

  1. https://www.uptodate.com/contents/posttraumatic-stress-disorder-in-adults-epidemiology-pathophysiology-clinical-manifestations-course-assessment-and-diagnosis?topicRef=501&source=see_link#H1695800677