Posttraumatic stress disorder: a narrative review
DOI:
https://doi.org/10.15574/HW.2025.3(178).8695Keywords:
post-traumatic stress disorder, statistics, epidemiology, clinical symptoms, brain, magnetic resonance imaging, drugs, microbiota, comorbidityAbstract
Post-traumatic stress disorder (PTSD) is a syndrome and mental disorder that may develop either immediately or after a delay in adults, adolescents, and children (regardless of ethnicity, nationality, culture, or age) who have experienced or witnessed one or more traumatic events, a series of events, or a set of circumstances.
The aim of this review is to contextualize PTSD within the semantic framework of syndrome description, based on an integrated body of reliable and interrelated knowledge on the subject.
PTSD in children, adolescents, and women is examined through the following dimensions: statistics and epidemiology; clinical symptomatology; diagnostic methods; elements of research methodology; brain growth chart databases and age-normed MRI templates of the brain; target anatomy; genetics; key elements of PTSD pathogenesis; the microbiome; PTSD and comorbidity; PTSD risk prediction; stress resilience; PTSD treatment strategies; pharmacological agents for the prevention and treatment of PTSD; probiotics; evidence-based classical pharmacotherapies; non-recommended pharmacological agents and treatment approaches; and promising directions for future research.
Conclusions. The relevance of research on PTSD is driven by the high prevalence of traumatic events in human life and their consequences, including the development of PTSD. PTSD can adversely affect various aspects of an individual's life, including mental and physical health, social relationships, and overall functioning. The need for continued research in this field is associated with the search for effective methods of diagnosis, treatment, and rehabilitation of individuals suffering from PTSD, as well as with the development of preventive measures aimed at reducing the likelihood of this disorder.
The authors declare no conflict of interest.
References
Admon R, Lubin G, Stern O, Rosenberg K, Sela L et al. (2009). Human vulnerability to stress depends on amygdala's predisposition and hippocampal plasticity. Proceedings of the National Academy of Sciences of the United States of America. 106(33): 14120-14125. https://doi.org/10.1073/pnas.0903183106; PMid:19666562 PMCid:PMC2729030
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. 5th ed. American Psychiatric Publishing. https://doi.org/10.1176/appi.books.9780890425596
Auxéméry Y. (2012). Posttraumatic stress disorder (PTSD) as a consequence of the interaction between an individual genetic susceptibility, a traumatogenic event and a social context. Encephale. 38(5): 373-380. https://doi.org/10.1016/j.encep.2011.12.003; PMid:23062450
Blackie M, De Boer K, Seabrook L, Bates G, Nedeljkovic M. (2024). Digital-based interventions for complex post-traumatic stress disorder: A systematic literature review. Trauma, Violence, & Abuse. 25(4): 3115-3130. https://doi.org/10.1177/15248380241238760; PMid:38533796 PMCid:PMC11370210
Bremner JD, Southwick SM, Johnson DR, Yehuda R, Charney DS. (1993). Childhood physical abuse and combat-related posttraumatic stress disorder in Vietnam veterans. American Journal of Psychiatry. 150(2): 235-239. https://doi.org/10.1176/ajp.150.2.235; PMid:8422073
Bromis K, Calem M, Reinders AATS, Williams SCR, Kempton MJ. (2018). Meta-analysis of 89 structural MRI studies in posttraumatic stress disorder and comparison with major depressive disorder. American Journal of Psychiatry. 175(10): 989-998. https://doi.org/10.1176/appi.ajp.2018.17111199; PMid:30021460 PMCid:PMC6169727
Burback L, Brémault-Phillips S, Nijdam MJ, McFarlane A, Vermetten E. (2024). Treatment of posttraumatic stress disorder: A state-of-the-art review. Current Neuropharmacology. 22(4): 557-635. https://doi.org/10.2174/1570159X21666230428091433; PMid:37132142 PMCid:PMC10845104
Burton MS, Cooper AA, Mello PG, Feeny NC, Zoellner LA. (2021). Latent profiles of comorbid depression as predictors of PTSD treatment outcome. Behavior Therapy. 52(4): 970-981. https://doi.org/10.1016/j.beth.2020.12.005; PMid:34134835 PMCid:PMC8543494
Butkevich IP, Mikhailenko VA, Vershinina EA. (2020). Combination of stressful influences during critical periods of development increases resistance to stress of inflammatory pain in adult rats. Russian Journal of Physiology. 106(3): 267-282. https://doi.org/10.31857/S0869813920030024
Casey BJ, Cannonier T, Conley MI, Cohen AO, Barch DM, Heitzeg MM et al. (2018). The Adolescent Brain Cognitive Development (ABCD) study: Imaging acquisition across 21 sites. Developmental Cognitive Neuroscience. 32: 43-54. https://doi.org/10.1016/j.dcn.2018.03.001; PMid:29567376 PMCid:PMC5999559
Dean DC, Tisdall MD, Wisnowski JL, Feczko E, Gagoski B, Alexander AL et al. (2024). Quantifying brain development in the HEALthy Brain and Child Development (HBCD) Study: The magnetic resonance imaging and spectroscopy protocol. Developmental Cognitive Neuroscience. 70: 101452. https://doi.org/10.1016/j.dcn.2024.101452; PMid:39341120 PMCid:PMC11466640
Dong HM, Castellanos FX, Yang N, Zhang Z, Zhou Q, He Y et al. (2020). Charting brain growth in tandem with brain templates at school age. Science Bulletin. 65(22): 1924-1934. https://doi.org/10.1016/j.scib.2020.07.027; PMid:36738058
Duncan LE, Cooper BN, Shen H. (2018). Robust findings from 25 years of PTSD genetics research. Current Psychiatry Reports. 20(12): 115. https://doi.org/10.1007/s11920-018-0980-1. Erratum: Duncan LE, Cooper BN, Shen H. (2018). Erratum to: Robust findings from 25 years of PTSD genetics research. Current Psychiatry Reports. 20(12): 119. https://doi.org/10.1007/s11920-018-0984-x; PMid:30474743 PMCid:PMC6828490
Eaton S, Cornwell H, Hamilton-Giachritsis C, Fairchild G. (2022). Resilience and young people's brain structure, function and connectivity: A systematic review. Neuroscience & Biobehavioral Reviews. 132: 936-956. https://doi.org/10.1016/j.neubiorev.2021.11.001; PMid:34740756
Egan LA, Park HRP, Gatt JM. (2024). Resilience to stress and trauma: A narrative review of neuroimaging research. Current Opinion in Behavioral Sciences. 58: 101408. https://doi.org/10.1016/j.cobeha.2024.101408
Galatzer-Levy IR, Bryant RA. (2013). 636,120 ways to have posttraumatic stress disorder. Perspectives on Psychological Science. 8(6): 651-662. https://doi.org/10.1177/1745691613504115; PMid:26173229
Giotakos O. (2020). Neurobiology of emotional trauma. Psychiatriki. 31(2): 162-171. https://doi.org/10.22365/jpsych.2020.312.162; PMid:32840220
Gurvits TV, Shenton ME, Hokama H, Ohta H, Lasko NB, Gilbertson MW et al. (1996). Magnetic resonance imaging study of hippocampal volume in chronic, combat-related posttraumatic stress disorder. Biological Psychiatry. 40(11): 1091-1099. https://doi.org/10.1016/S0006-3223(96)00229-6; PMid:8931911
Harnett NG, van Rooij SJH, Ely TD, Lebois LAM, Murty VP, Jovanovic T et al. (2021). Prognostic neuroimaging biomarkers of trauma-related psychopathology: Resting-state fMRI shortly after trauma predicts future PTSD and depression symptoms in the AURORA study. Neuropsychopharmacology. 46(7): 1263-1271. https://doi.org/10.1038/s41386-020-00946-8; PMid:33479509 PMCid:PMC8134491
Howell BR, Styner MA, Gao W, Yap PT, Wang L, Baluyot K et al. (2019). The UNC/UMN Baby Connectome Project (BCP): An overview of the study design and protocol development. NeuroImage. 185: 891-905. https://doi.org/10.1016/j.neuroimage.2018.03.049; PMid:29578031 PMCid:PMC6151176
Hudays A, Gallagher R, Hazazi A, Arishi A, Bahari G. (2022). Eye movement desensitization and reprocessing versus cognitive behavior therapy for treating post-traumatic stress disorder: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health. 19(24): 16836. https://doi.org/10.3390/ijerph192416836; PMid:36554717 PMCid:PMC9778888
Jin MJ, Jeon H, Hyun MH, Lee SH. (2019). Influence of childhood trauma and brain-derived neurotrophic factor Val66Met polymorphism on posttraumatic stress symptoms and cortical thickness. Scientific Reports. 9(1): 6028. https://doi.org/10.1038/s41598-019-42563-6; PMid:30988377 PMCid:PMC6465240
Kanaan RA, Oliver G, Dharan A, Sendi S, Maier A, Mohebbi M et al. (2023). A multi-centre, double-blind, 12-week, randomized, placebo-controlled trial of adjunctive N-acetylcysteine for treatment-resistant PTSD. Psychiatry Research. 327: 115398. https://doi.org/10.1016/j.psychres.2023.115398; PMid:37540942
Ke S, Hartmann J, Ressler KJ, Liu YY, Koenen KC. (2023). The emerging role of the gut microbiome in posttraumatic stress disorder. Brain, Behavior, and Immunity. 114: 360-370. https://doi.org/10.1016/j.bbi.2023.09.005; PMid:37689277 PMCid:PMC10591863
Kunimatsu A, Yasaka K, Akai H, Kunimatsu N, Abe O. (2020). MRI findings in posttraumatic stress disorder. Journal of Magnetic Resonance Imaging. 52(2): 380-396. https://doi.org/10.1002/jmri.26929; PMid:31515885
Lapshin MS, Kondashevskaya MV, Epishev VV, Patochkina NA. (2023). Pathogenesis of post-traumatic stress disorder, therapeutic targets. Advances in Physiological Sciences. 54(1): 55-69. https://doi.org/10.31857/S0301179823010058
Lee B, Shim I, Lee H, Hahm DH. (2018). Berberine alleviates symptoms of anxiety by enhancing dopamine expression in rats with post-traumatic stress disorder. Korean Journal of Physiology & Pharmacology. 22(2): 183-192. https://doi.org/10.4196/kjpp.2018.22.2.183; PMid:29520171 PMCid:PMC5840077
Malan-Muller S, Valles-Colomer M, Foxx CL, Vieira-Silva S, van den Heuvel LL, Raes J et al. (2022). Exploring the relationship between the gut microbiome and mental health outcomes in a posttraumatic stress disorder cohort relative to trauma-exposed controls. European Neuropsychopharmacology. 56: 24-38. https://doi.org/10.1016/j.euroneuro.2021.11.009; PMid:34923209
Nievergelt CM, Maihofer AX, Klengel T, Atkinson EG, Chen CY, Choi KW et al. (2019). International meta-analysis of PTSD genome-wide association studies identifies sex- and ancestry-specific genetic risk loci. Nature Communications. 10(1): 4558. https://doi.org/10.1038/s41467-019-12576-w; PMid:31594949 PMCid:PMC6783435
Petakh P, Oksenych V, Kamyshna I, Boisak I, Lyubomirskaya K, Kamyshnyi O. (2024). Exploring the interplay between posttraumatic stress disorder, gut microbiota, and inflammatory biomarkers: A comprehensive meta-analysis. Frontiers in Immunology. 15: 1349883. https://doi.org/10.3389/fimmu.2024.1349883; PMid:38410510 PMCid:PMC10895958
Polimanti R, Wendt FR. (2021). Posttraumatic stress disorder: From gene discovery to disease biology. Psychological Medicine. 51(13): 2178-2188. https://doi.org/10.1017/S0033291721000210; PMid:33583458 PMCid:PMC8364573
Prasad A, Chaichi A, Kelley DP, Francis J, Gartia MR. (2019). Current and future functional imaging techniques for post-traumatic stress disorder. RSC Advances. 9(42): 24568-24594. https://doi.org/10.1039/C9RA03562A; PMid:35527877 PMCid:PMC9069787
Rauch SL, Whalen PJ, Shin LM, McInerney SC, Macklin ML, Lasko NB et al. (2000). Exaggerated amygdala response to masked facial stimuli in posttraumatic stress disorder: A functional MRI study. Biological Psychiatry. 47(9): 769-776. https://doi.org/10.1016/S0006-3223(00)00828-3; PMid:10812035
Richards JE, Sanchez C, Phillips-Meek M, Xie W. (2016). A database of age-appropriate average MRI templates. NeuroImage. 124; Pt B: 1254-1259. https://doi.org/10.1016/j.neuroimage.2015.04.055; PMid:25941089 PMCid:PMC4630162
Sanchez CE, Richards JE, Almli CR. (2012). Neurodevelopmental MRI brain templates for children from 2 weeks to 4 years of age. Developmental Psychobiology. 54(1): 77-91. https://doi.org/10.1002/dev.20579; PMid:21688258 PMCid:PMC3184192
Schrader C, Ross A. (2021). A review of PTSD and current treatment strategies. Missouri Medicine. 118(6): 546-551. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8672952/.
Semenova OG, Vyushina AV, Pritvorova AV, Rakitskaya VV, Ordyan NE. (2024). Morphological adrenal glands changes in rats with different individual-typological behavior features in the PTSD model after dalargin injections. Russian Journal of Physiology. 110(1): 58-78. https://doi.org/10.31857/S0869813924010048
Shayganfard M. (2023). Berberine: Is it a promising agent for mental disorders treatment? Current Molecular Pharmacology. 16(3): 307-320. https://doi.org/10.2174/1874467215666220509213122; PMid:35538795
Sheynin S, Wolf L, Ben-Zion Z, Sheynin J, Reznik S, Keynan JN et al. (2021). Deep learning model of fMRI connectivity predicts PTSD symptom trajectories in recent trauma survivors. NeuroImage. 238: 118242. https://doi.org/10.1016/j.neuroimage.2021.118242; PMid:34098066 PMCid:PMC8350148
Siehl S, Robjant K, Crombach A. (2021). Systematic review and meta-analyses of the long-term efficacy of narrative exposure therapy for adults, children and perpetrators. Psychotherapy Research. 31(6): 695-710. https://doi.org/10.1080/10503307.2020.1847345; PMid:33205713
Soares JM, Magalhães R, Moreira PS, Sousa A, Ganz E, Sampaio A et al. (2016). A hitchhiker's guide to functional magnetic resonance imaging. Frontiers in Neuroscience. 10: 515. https://doi.org/10.3389/fnins.2016.00515; PMid:27891073 PMCid:PMC5102908
Spragge F, Bakkeren E, Jahn MT, B N Araujo E, Pearson CF, Wang X et al. (2023). Microbiome diversity protects against pathogens by nutrient blocking. Science. 382(6676): eadj3502. https://doi.org/10.1126/science.adj3502; PMid:38096285 PMCid:PMC7616675
Stauffer CS, Morrison TE, Meinzer NK, Leung D, Buffington J, Sheh EG et al. (2022). Effects of oxytocin administration on fear-potentiated acoustic startle in co-occurring PTSD and alcohol use disorder: A randomized clinical trial. Psychiatry Research. 308: 114340. https://doi.org/10.1016/j.psychres.2021.114340; PMid:34983010 PMCid:PMC9074818
Torrico TJ, Mikes BA. (2024). Posttraumatic stress disorder in children. In StatPearls [Internet]. StatPearls Publishing. URL: https://www.ncbi.nlm.nih.gov/books/NBK559140/.
Van der Kolk BA. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York, NY: Viking.
Villalón-Reina JE, Zhu AH, Nir TM, Thomopoulos SI, Laltoo E, Kushan L et al. (2023, Nov). Large-scale normative modeling of brain microstructure. 2023 19th International Symposium on Medical Information Processing and Analysis (SIPAIM). https://doi.org/10.1109/SIPAIM56729.2023.10373451; PMCid:PMC11524148
Wei W, Zhang K, Chang J, Zhang S, Ma L, Wang H et al. (2024). Analyzing 20 years of resting-state fMRI research: Trends and collaborative networks revealed. Brain Research. 1822: 148634. https://doi.org/10.1016/j.brainres.2023.148634; PMid:37848120
Winder C, Lodhia A, Basso M, Cohen Kadosh K. (2025). Gut microbiome differences in individuals with PTSD compared to trauma-exposed controls: A systematic review. Frontiers in Neuroscience. 19: 1540180. https://doi.org/10.3389/fnins.2025.1540180; PMid:40066155 PMCid:PMC11891237
Xiao S, Yang Z, Su T, Gong J, Huang L, Wang Y. (2022). Functional and structural brain abnormalities in posttraumatic stress disorder: A multimodal meta-analysis of neuroimaging studies. Journal of Psychiatric Research. 155: 153-162. https://doi.org/10.1016/j.jpsychires.2022.08.010; PMid:36029627
Xian-Yu CY, Deng NJ, Zhang J, Li HY, Gao TY et al. (2022). Cognitive behavioral therapy for children and adolescents with post-traumatic stress disorder: Meta-analysis. Journal of Affective Disorders. 308: 502-511. https://doi.org/10.1016/j.jad.2022.04.111; PMid:35460743
Yirmiya K, Turjeman S, Shtossel O, Zagoory-Sharon O, Moadi L, Rubin E et al. (2024). Microbiome signature of posttraumatic stress disorder and resilience in youth. Psychological Trauma: Theory, Research, Practice, and Policy. 17(7): 1490-1504. https://doi.org/10.1037/tra0001727; PMid:39023942
Zhou Y, Yuan X, Guo M. (2025). Unlocking NAC's potential ATF4 and m6A dynamics in rescuing cognitive impairments in PTSD. Metabolic Brain Disease. 40(2): 129. https://doi.org/10.1007/s11011-024-01485-7’ PMid:39954094
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Ukrainian Journal Health of Woman
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The policy of the Journal UKRAINIAN JOURNAL «HEALTH OF WOMAN» is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license (СС BY-NC).
Authors transfer the copyright to the Journal UKRAINIAN JOURNAL «HEALTH OF WOMAN» when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.
Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.
The use of published materials for commercial purposes is strongly prohibited.
