Women Veterans & PTSD News

A focus on female vets

Minnesota Medicine - Carmen Peota - 2015-08-01James L
When Lisa M. James, PhD, arrived at the
Brain Sciences Center

Brain Sciences Center (BSC)

A research group in collaboration with the Minnesota American Legion, Minneapolis VA Medical Center, and the University of Minnesota.
at the Minneapolis Veterans Affairs Medical Center in 2010, the young scientist was very much aware that researchers there had just shown that
Magnetoencephalography

Magnetoencephalography (MEG)

A noninvasive technique that detects magnetic fields above the surface of the head produced by postsynaptic potentials in the brain.
could be used to diagnose post-traumatic stress disorder (
Posttraumatic Stress Disorder

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
). In a 2010 article published in the Journal of Neural Engineering, they reported being able to distinguish, with better than 90 percent accuracy, between brain scans of people who did and did not have
PTSD

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
.

James was interested in building on that work, most of which had been done using male veterans as subjects. But she had a fresh question: What about female veterans?

James knew women had higher rates of
PTSD

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
than men (the rate is estimated at 20 percent for women compared with 8 percent overall) and experienced different types of trauma. "Whereas combat exposure might be more common in male veterans, things like sexual trauma are more common in female veterans," she explains. And there was some evidence that women might have a different neural signature of
PTSD

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
than men. Most important, women were participating in the military in unprecedented numbers and hadn't been studied much. It seemed to her that an intentional focus on female veterans was warranted.

James designed a research project, applied for and got a VA grant, and last August began a three-year study that will eventually include 200 female veterans in this region. She has two main goals: defining the neural signature of
PTSD

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
for women and finding a genetic basis for why some women might be more resilient than others. Specifically, she's looking at a gene called
Apolipoprotein E

Apolipoprotein E (ApoE)

a plasma lipoprotein discovered in 1973 (Shore and Shore 1973). It binds low-density lipoprotein receptors, thereby facilitating cellular lipoprotein exchange and metabolism. The human apoE polypeptide consists of 299 amino acids and comprises three polymorphisms resulting from single amino acid substitutions. Three isoforms (E4, E3, and E2) are the result of cysteine^aEUR"arginine interchanges at two sites, namely residues 112 and 158; however, other genetic variants have been described. These three isoforms, each differentially affecting protein function, result in six phenotypes: three homozygotes (E4/4, E3/3, E2/2) and three heterozygotes (E4/3, E4/2, E3/2). With respect to the number of cysteine residues per mole, E2/2 contains 4, E3/2 contains 3, E4/2 and E3/3 each contain 2, E4/3 contains 1, and E4/4 contains 0. The number of cysteine residues per mole (CysR/mole) provides a numerical, biochemical scale in lieu of the genotype-based categories.
, which she's found to be associated with
PTSD

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
symptom severity.

James and her team are asking female vets about their military experience, trauma history and mental health status; drawing blood for genetic tests; and having the women spend about five minutes lying on a table while recording their brain activity using
MEG

Magnetoencephalography (MEG)

A noninvasive technique that detects magnetic fields above the surface of the head produced by postsynaptic potentials in the brain.
. She hopes the work will have clinical applications. "Our goal is that we'd have this neural signature for
PTSD

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
in women that we can then use to potentially diagnose women vets and track treatment outcomes," she explains.

Although James says it's too early to talk about findings, this research has already attracted the attention of the American Association of Medical Colleges, which is highlighting projects aimed at rectifying a health or health care inequity related to mental health (see "Snapshot"). "We're recognizing that there are women vets," she says, "and they merit study as well as men."

Posttraumatic Stress Disorder

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
in Women Veterans

AMMCtoday - 2015-05-04James L
Researchers use brain imaging to identify biological indicators of
PTSD

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
in women and genetic tests to understand why some women will develop
PTSD

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
while others won't.

The trail of trauma

UMNnews - Health+Medicine - Deane M. Morrison - 2013-08-27
When a disaster strikes, groups of people spontaneously form and start talking all at once.And your brain does the same thing in response to personal trauma. Groups of neurons in the cerebral cortex start firing at the same time, "talking" to each other, and get locked into a correlated pattern of activity. Previous work by University of Minnesota researchers identified a particular pattern so strongly associated with post-traumatic stress disorder (
PTSD

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
) that they can clearly tell who has
PTSD

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
. Now, a new study shows that in people with
PTSD

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
, these patterns persist, just as do the intrusive, incapacitating memories or re-experiencing of the events, emotional numbing, and hyperarousal that define the disorder.

But, they found, in people who have not developed
PTSD

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
despite exposure to trauma, the patterns lack staying power. In them, "these patterns loosen and dissipate over weeks, months, or days," says lead researcher Lisa James, an assistant professor in the U's Department of Psychiatry and a researcher in the
BSC

Brain Sciences Center (BSC)

A research group in collaboration with the Minnesota American Legion, Minneapolis VA Medical Center, and the University of Minnesota.
at the Minneapolis
VA Medical Center

VA Medical Center (VAMC)

, where the study took place. "This wipes the slate clean."

"Our work means that in resilient people the brain can actively adapt to traumatic experiences in a way that those with
PTSD

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
cannot. The better we understand the brain mechanisms associated with
PTSD

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
, the sooner we can apply that knowledge to evaluating treatment efficacy."

Co-author Apostolos Georgopoulos likens the situation in a trauma-exposed brain to an infection.

How
MEG

Magnetoencephalography (MEG)

A noninvasive technique that detects magnetic fields above the surface of the head produced by postsynaptic potentials in the brain.
works


The advantage of
MEG

Magnetoencephalography (MEG)

A noninvasive technique that detects magnetic fields above the surface of the head produced by postsynaptic potentials in the brain.
is its ability to detect brain activity on a scale of milliseconds. The researchers placed an apparatus resembling a helmet over the heads of the subjects, who were asked to fixate on a stationary dot with their eyes for 60 seconds. The helmet contained 248 sensors, each of which detected the magnetic fields generated in a population comprising tens of thousands of cortical cells. Together, the sensors scanned the magnetic activity over the whole cortex.

'It's like having a disease, where you make antibodies," says Georgopoulos, a Regents Professor of neuroscience and director of the
BSC

Brain Sciences Center (BSC)

A research group in collaboration with the Minnesota American Legion, Minneapolis VA Medical Center, and the University of Minnesota.
. "If you can't make antibodies, you don't adapt to the virus. Similarly, if you don't de-correlate your brain networks, you're still sick."

Short-term tracking of the
PTSD

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
-linked patterns in people exposed to trauma could potentially identify those who are resilient vs. those who need treatment. Pattern tracking could also be used to monitor progress during
PTSD

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
treatments or to validate a simpler test for resilience, such as genetic or personality traits, the researchers say.

The work is published online in the journal JAMA Psychiatry.

How to eavesdrop on brain chatter

The researchers studied 86 veterans with
PTSD

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
and 113 veterans who were resilient to trauma. A questionnaire revealed the extent of their exposure to trauma; those with trauma exposure but no
PTSD

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
were, by definition, resilient controls.

The team used a noninvasive technique called
MEG

Magnetoencephalography (MEG)

A noninvasive technique that detects magnetic fields above the surface of the head produced by postsynaptic potentials in the brain.
(
MEG

Magnetoencephalography (MEG)

A noninvasive technique that detects magnetic fields above the surface of the head produced by postsynaptic potentials in the brain.
; see sidebar)) to study the magnetic fields generated in neurons of the right temporal lobe cortex as they received messages during neuronal "talk." Neurons receiving messages experience movements of ions across their outer membranes; these movements generate the magnetic fields.

The
MEG

Magnetoencephalography (MEG)

A noninvasive technique that detects magnetic fields above the surface of the head produced by postsynaptic potentials in the brain.
measured the strength of correlated patterns of activity in cell populations-i.e., simultaneous generation of magnetic fields-characteristic of
PTSD

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
. They discovered:

Among controls, weaker
PTSD

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
-related patterns tended to occur in those with highertrauma scores. In other words, "In controls, big trauma leads to a big adaptation," says Georgopoulos.

Also in controls, the right temporal cortex had a crucial node in which brain activity was decorrelated, a signal of adaptation. This area of the brain is a focus of future study.

Resilience isn't an all-or-nothing trait, but a continuum.

The trauma landscape

Most people are resilient to some events, so the question becomes: Why isn't everybody?

"About 60 to 90 percent of people will experience a potentially traumatic event in their lifetime, like a car accident or the sudden death of a loved one, but they are resilient. They don't develop symptoms of a psychiatric disorder," says James.

"Only seven percent of people in the general population and about 20 percent of veterans develop
PTSD

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
. Most come back [from service] without
PTSD

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
-what enables them to do that?"

To answer that question, the researchers are turning their attention to a search for genetic markers of resilience. If certain genes or, perhaps, personality traits, are found to be associated with resilience, that could allow researchers to predict one's degree of resilience before trauma hits.

"
PTSD

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
sufferers have options that include medications, talk therapy, and interventions to treat nightmares," James says. "We're interested in what happens in the brain as individuals with
PTSD

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
respond to treatment."