How the Neurocircuitry and Genetics of Fear Inhibition May Inform Our Understanding of PTSD

• Published in: American Journal of Psychiatry Vol. 167; no. 6; pp. 648 - 662
• Main Authors: Jovanovic, Tanja, Ressler, Kerry J
• Format: Journal Article
• Language: English
• Published: Arlington, VA American Psychiatric Association 01-06-2010
• Subjects: Adult and adolescent clinical studies; Amygdala - physiopathology; Anxiety disorders. Neuroses; Biological and medical sciences; Conditioning, Classical; Diagnostic and Statistical Manual of Mental Disorders; Fear; Fear & phobias; Humans; Inhibition, Psychological; Magnetic Resonance Imaging; Medical sciences; Nerve Net - physiopathology; Neurology; Phenotype; Post traumatic stress disorder; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology; Psychopathology. Psychiatry; Serotonin Plasma Membrane Transport Proteins - genetics; Signal Detection, Psychological; Stress Disorders, Post-Traumatic - diagnosis; Stress Disorders, Post-Traumatic - genetics; Stress Disorders, Post-Traumatic - physiopathology; Tacrolimus Binding Proteins - genetics; Affect affectivity; Fear; Anxiety disorder; Genetics; Emotion emotionality; Posttraumatic stress disorder; Inhibition; Stress
• ISSN: 0002-953X; 1535-7228
• DOI: 10.1176/appi.ajp.2009.09071074

AbstractExposure to traumatic events that produce extreme fear and horror is all too common in both military and civilian populations, but not all individuals develop posttraumatic stress disorder (PTSD) as a result of the exposure. What mediates risk and resilience in the development of PTSD and other stress-related psychopathology is of paramount importance to our further understanding of trauma-related psychopathology as well as the development of new treatment approaches. Biological factors, such as genotype and neurobiology, interact with environmental factors, such as childhood background and trauma load, to affect vulnerability and resilience in the aftermath of trauma exposure. One of the core symptoms of PTSD is the inability to control fear, which has led some investigators and clinicians to conceptualize PTSD as a disorder of fear or, more importantly, its inhibition. This review focuses on translational methods that have been used to examine fear conditioning and inhibition of fear in PTSD and summarizes genetic and neurobiological factors related to fear inhibition. The authors also discuss different pharmacological approaches that enhance fear inhibition and may improve treatment outcomes for patients with PTSD.