Unfocused approaches, in contrast, may fail to achieve traction in applying neuroscience insights to improve diagnosis and treatment. When multidomain phenotypes like PTSD are defined with high diversity, any focused research approach will neglect some disorder domains. In such multidomain, clinically defined conditions, a focus on any one domain typically fails to capture all aspects of the disorder. PTSD resembles other complex syndromes defined solely by coaggregating clinical symptoms that manifest along multiple domains. ![]() Nonetheless, ICD-11 still includes mandatory diagnostic symptoms strongly associated with other disorders, including avoidance and hyperarousal, key components of all anxiety disorders. By using a narrower set, ICD-11 aims to differentiate PTSD more clearly from other frequently co-occurring conditions and nonspecific symptoms. The ICD-11 criteria include only three symptom clusters and remove nonspecific symptoms that overlap with other disorders (e.g., trouble concentrating, sleep problems, depression). DSM-5 groups 20 symptoms into four clusters, which generate numerous combinations of symptoms that could qualify for the PTSD diagnosis ( 12). ![]() Multidomain Expressions of Psychopathologyįocusing on any single symptom domain in PTSD would fail to capture the wide array of maladaptive behaviors linked to traumatic stress ( 11). In this commentary, we address two considerations surrounding the adoption of a narrow focus on memory and associated intrusive traumatic reexperiencing in PTSD research: one related to the breadth of PTSD symptomatology, and the other related to the unique clinical relevance of intrusive traumatic reexperiencing. Focusing translational PTSD research on memory disruption, as captured by the symptom domain of intrusive traumatic reexperiencing, could initiate efforts to achieve such clarification ( 10). Eventually, translational research on memory intrusion and traumatic reexperiencing may further clarify the uniqueness of imagery-related phenomena in many conditions, based on both clinical presentation and associated biology ( 9). However, these forms of imagery differ clinically from posttraumatic imagery and intrusive memories in that only the latter involve distinct here-and-now qualities. ![]() For example, imagery-related forms of intrusive rumination are common in anxiety, mood, and obsessive-compulsive disorders. Importantly, vivid mental images also occur in other conditions. Specifically, highlighting memory pathology involving intrusive reexperiencing of trauma, particularly occurring in the here and now, could focus PTSD research and therapeutics on a unique core feature of the disorder and bridge biological and cognitive neuroscience research by examining narrow, clearly defined processes under experimentally controlled conditions. However, deeper, systematic, and more extensive translational focus is needed to maximize clinical impact. Preliminary genetic, imaging, and experimental therapeutics research on memory intrusion and reexperiencing already provides unique insights into PTSD ( 5– 8). In this commentary, we outline one such domain-focused approach for PTSD research.Ī focus on the unique symptom domain of intrusive and involuntary recollection and reexperiencing of the trauma in the here and now could guide mechanisms-oriented research and provide concrete strategies for enhancing treatment of posttraumatic psychopathology. By focusing on core dimensions, research can proceed despite lingering disagreement about categorical syndrome definitions. In other psychopathological arenas, a focus on core symptom dimensions provides a nidus around which basic and clinical research can coalesce. Nearly four decades after the introduction of PTSD in DSM-III, disputes persist regarding its definition ( 3, 4), as reflected in DSM-5 and in ICD-11. ![]() Clinical disagreement may impede successful basic-to-clinical translation and contribute to stalled therapeutic advances. Recent advances in neuroscience research on stress have had only minimal impact on the diagnosis and treatment ( 1, 2) of posttraumatic stress disorder (PTSD).
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