Send to

Choose Destination
Psychosom Med. 2016 Sep;78(7):805-9. doi: 10.1097/PSY.0000000000000326.

Examining the Crux of Autonomic Dysfunction in Posttraumatic Stress Disorder: Whether Chronic or Situational Distress Underlies Elevated Heart Rate and Attenuated Heart Rate Variability.

Author information

From the Durham Veterans Affairs Medical Center (Dennis, Dedert, Van Voorhees, Calhoun, Dennis, Beckham), Durham, North Carolina; Department of Psychiatry and Behavioral Sciences (Dennis, Dedert, Van Voorhees, Watkins, Calhoun, Sherwood, Beckham), Duke University Medical Center, Durham, North Carolina; Department of Medical Education (Hayano), Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan; Veterans Affairs Mid-Atlantic Region Mental Illness Research (Calhoun, Beckham), Education, and Clinical Center, Durham, North Carolina; and Durham Veterans Affairs Center for Health Services Research in Primary Care (Calhoun), Durham, North Carolina.



Posttraumatic stress disorder (PTSD) has been linked to elevated heart rate (HR) and reduced heart rate variability (HRV) in cross-sectional research. Using ecological momentary assessment and minute-to-minute HRV/HR monitoring, we examined whether cross-sectional associations between PTSD symptom severity and HRV/HR were due to overall elevations in distress levels or to attenuated autonomic regulation during episodes of acute distress.


Two hundred nineteen young adults (18-39 years old), 99 with PTSD, underwent 1 day of Holter monitoring and concurrently reported distress levels via ecological momentary assessment. Using multilevel modeling, we examined the associations between momentary distress and the 5-minute means for low-frequency (LF) and high-frequency (HF) HRV and HR immediately following distress ratings, and whether PTSD symptom severity moderated these associations.


Compared with the controls, participants with PTSD recorded higher ambulatory distress (mean [standard deviation] = 1.7 [0.5] versus 1.2 [0.3], p < .001) and HR (87.2 [11.8] versus 82.9 [12.6] beats/min, p = .011), and lower ambulatory LF HRV (36.9 [14.7] versus 43.7 [16.9 ms, p = .002) and HF HRV (22.6 [12.3] versus 26.4 [14.6] milliseconds, p = .043). Overall distress level was not predictive of HR or HRV (p values > .27). However, baseline PTSD symptom severity was associated with elevated HR (t(1257) = 2.76, p = .006) and attenuated LF (t(1257) = -3.86, p < .001) and HF (t(1257) = -2.62, p = .009) in response to acute momentary distress.


Results suggest that PTSD is associated with heightened arousal after situational distress and could explain prior findings associating PTSD with HR/HRV. Implications for treatment and cardiovascular risk are discussed.

[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Wolters Kluwer Icon for PubMed Central
Loading ...
Support Center