Stress hormones and PTSD

Abstract

There are now several hundred peer-reviewed journal articles that report on various aspects of hypothalamic-pituitary-adrenal (HPA) axis functioning in posttraumatic stress disorder (PTSD). Yet, published reports do not always show agreement. This review discusses approaches to the interpretation of neuroendocrine results in consideration of discrepant observations. A disturbing tendency in the literature has been to dismiss HPA axis findings as directly relevant to PTSD pathophysiology or to try to reach consensus regarding contrasting views in the literature by designating majority findings as more true than findings occurring less frequently. There have been few attempts to evaluate the meaning of disparate observations or determine whether specific methodological considerations compromise the findings or their interpretation. There has been a reluctance to assign a rank ordering to observations that are more definitive because they use a superior endocrine strategy that might result in weighting some studies more heavily than others. Finally, there have been few attempts to incorporate the observed discrepancies into a coherent model of neuroendocrine functioning in PTSD. This chapter attempts to analyze the literature from this framework. © 2009 Humana Press.