Australian researchers say PTSD should not be seen as a purely psychological disorder.

Post-traumatic stress disorder (PTSD) should be viewed as a systemic disorder with physical comorbidities, including gastrointestinal, hepatic, cardiovascular, respiratory and sleep aspects, according to research published in the Medical Journal of Australia.

A large group of researchers from several universities and hospitals  conducted a cross-sectional analysis of the health status of 298 Australian Vietnam War veterans, of whom 108 were confirmed as having had PTSD, and 106 served as trauma-exposed control participants who did not have PTSD.

Using psychiatric interviews and psychological assessments, the researchers determined the PTSD status, trauma exposure and comorbid psychological symptoms of each veteran.

Demographic data, and medical and sleep history were collected, including a comprehensive clinical examination, electrocardiography, spirometry, liver transient elastography, and selected pathology assessments and diagnostic imaging.

The study found that “the mean total number of comorbidities was higher among those with PTSD (17.7) than in trauma-exposed controls (14.1)”.

“For 24 of 171 assessed clinical outcomes, morbidity was greater in the PTSD group, including for conditions of the gastrointestinal, hepatic, cardiovascular, and respiratory systems, sleep disorders, and laboratory pathology measures.

“In regression analyses including demographic factors, PTSD remained positively associated with 17 adverse outcomes; after adjusting for the severity of depressive symptoms, it remained significantly associated with ten,” the authors wrote.

The results indicated to the investigators that treating PTSD as a purely psychological disorder risked achieving less than optimal outcomes for patients.

“PTSD should be viewed as a systemic disorder rather than a purely psychological disorder. Integrated health care strategies for improving psychological and physical health, as well as controlling risk factors, could improve the quality of life and survival of patients,” they concluded.

“These findings are of particular importance for managing injuries in people such as emergency service workers and veterans, for whom there are significant risks of physical injury as well as of PTSD caused by trauma exposure,” writes  Professor Alexander McFarlane, director of the Centre for Traumatic Stress Studies at the University of Adelaide, in a linked editorial.

“Physical health outcomes in these populations, particularly for older members with their cumulative burden of trauma exposure, are underpinned to a significant degree by the somatic pathology, pain and disability that is driven by PTSD.

“Treatment plans for PTSD, including those for preventing ‘burnout’ in emergency service personnel, have largely failed to adopt an integrated approach or to develop management strategies that recognise the common roots of the physical and psychological dimensions of the health of these individuals.”