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Free keywords:
Emotion regulation, Neurobiology, PTSD, RDOC, Research Stress
Abstract:
Three and a half decades of research on posttraumatic stress disorder
(PTSD) has produced substantial knowledge on the pathobiology of this
frequent and debilitating disease. However, despite all research
efforts, so far no drug that has specifically targeted PTSD core
symptoms progressed to clinical use. Instead, although not overly
efficient, serotonin re-uptake inhibitors continue to be considered the
gold standard of PTSD pharmacotherapy. The psychotherapeutic treatment
and symptom-oriented drug therapy options available for PTSD treatment
today show some efficacy, although not in all PTSD patients, in
particular not in a substantial percent of those suffering from the
detrimental sequelae of repeated childhood trauma or in veterans with
combat related PTSD. PTSD has this in common with other psychiatric
disorders - in particular effective treatment for incapacitating
conditions such as resistant major depression, chronic schizophrenia,
and frequently relapsing obsessive-compulsive disorder as well as
dementia has not yet been developed through modern neuropsychiatric
research.In response to this conundrum, the National Institute of Mental
Health launched the Research Domain Criteria (RDoC) framework which aims
to leave diagnosis-oriented psychiatric research behind and to move on
to the use of research domains overarching the traditional diagnosis
systems. To the best of our knowledge, the paper at hand is the first
that has systematically assessed the utility of the RDoC system for PTSD
research. Here, we review core findings in neurobiological PTSD research
and match them to the RDoC research domains and units of analysis. Our
synthesis reveals that several core findings in PTSD such as amygdala
overactivity have been linked to all RDoC domains without further
specification of their distinct role in the pathophysiological pathways
associated with these domains. This circumstance indicates that the
elucidation of the cellular and molecular processes ultimately decisive
for regulation of psychic processes and for the expression of
psychopathological symptoms is still grossly incomplete. All in all, we
find the RDoC research domains to be useful but not sufficient for PTSD
research. Hence, we suggest adding two novel domains, namely stress and
emotional regulation and maintenance of consciousness. As both of these
domains play a role in various if not in all psychiatric diseases, we
judge them to be useful not only for PTSD research but also for
psychiatric research in general.
