The effects of trauma on brain and body: A unifying role for the midbrain periaqueductal gray

Terpou, Braeden A.; Harricharan, Sherain; McKinnon, Margaret C.; Frewen, Paul; Jetly, Rakesh; Lanius, Ruth A.

doi:10.1002/jnr.24447

Cited by 83Posttraumatic Stress Disorder ResearchStress Responses and CortisolMemory and Neural Mechanisms

The effects of trauma on brain and body: A unifying role for the midbrain periaqueductal gray

Terpou, Braeden A., Harricharan, Sherain, McKinnon, Margaret C., Frewen, Paul, Jetly, Rakesh, Lanius, Ruth A.·2019·Journal of Neuroscience Research

DOI 10.1002/jnr.24447

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Abstract

Post‐traumatic stress disorder (PTSD), a diagnosis that may follow the experience of trauma, has multiple symptomatic phenotypes. Generally, individuals with PTSD display symptoms of hyperarousal and of hyperemotionality in the presence of fearful stimuli. A subset of individuals with PTSD; however, elicit dissociative symptomatology (i.e., depersonalization, derealization) in the wake of a perceived threat. This pattern of response characterizes the dissociative subtype of the disorder, which is often associated with emotional numbing and hypoarousal. Both symptomatic phenotypes exhibit attentional threat biases, where threat stimuli are processed preferentially leading to a hypervigilant state that is thought to promote defensive behaviors during threat processing. Accordingly, PTSD and its dissociative subtype are thought to differ in their proclivity to elicit active (i.e., fight, flight) versus passive (i.e., tonic immobility, emotional shutdown) defensive responses, which are characterized by the increased and the decreased expression of the sympathetic nervous system, respectively. Moreover, active and passive defenses are accompanied by primarily endocannabinoid‐ and opioid‐mediated analgesics, respectively. Through critical review of the literature, we apply the defense cascade model to better understand the pathological presentation of defensive responses in PTSD with a focus on the functioning of lower‐level midbrain and extended brainstem systems.

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Following a threat, the type of defensive response in PTSD (hyper- vs. hypoarousal) depends on the severity of dissociative symptomatology.
“Following a threat, the type of defensive response in PTSD (hyper- vs. hypoarousal) depends on the severity of dissociative symptomatology (Terpou et al., 2019).”
From Trauma-related dissociation and the autonomic nervous system: a systematic literature review of psychophysiological correlates of dissociative experiencing in PTSD patients (2022) · cites this paper as Terpou et al., 2019
The proposed psychophysiological defense stages correspond to the severity of dissociation.
“The proposed psychophysiological defense stages correspond to the severity of dissociation.”
From Trauma-related dissociation and the autonomic nervous system: a systematic literature review of psychophysiological correlates of dissociative experiencing in PTSD patients (2022) · cites this paper as Terpou et al., 2019
This undermines the proposed neurobiological basis of the defense cascade model and the dissociative subtype as a whole.
“Ultimately, this undermines the proposed neurobiological basis (e.g. Lanius et al., 2010; Terpou et al., 2019) of the defense cascade model and the dissociative subtype as a whole.”
From Trauma-related dissociation and the autonomic nervous system: a systematic literature review of psychophysiological correlates of dissociative experiencing in PTSD patients (2022) · cites this paper as Terpou et al., 2019
Active versus passive defensive responses are characterized by increased and decreased expression of the sympathetic nervous system.
“The active versus passive responses are characterized by the increased and the decreased expression of the sympathetic nervous system.”
From A theoretical exploration of polyvagal theory in creative arts and psychomotor therapies for emotion regulation in stress and trauma (2024) · cites this paper as Terpou et al., 2019
Active and passive defenses are accompanied by primarily endocannabinoid and opioid-mediated analgesics, respectively.
“Moreover, active and passive defenses are accompanied by primarily endocannabinoid and opioid-mediated analgesics, respectively (Terpou et al., 2019).”
From A theoretical exploration of polyvagal theory in creative arts and psychomotor therapies for emotion regulation in stress and trauma (2024) · cites this paper as Terpou et al., 2019

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Central neural control of the cardiovascular system: current perspectives
Dampney, R. A. L. (2016) · AJP Advances in Physiology Education · doi:10.1152/advan.00027.2016 · Cited by 288 · see citing works
Auditory startle response in trauma survivors with posttraumatic stress disorder: a prospective study.
Shalev, A. Y., Peri, T., Brandes, D., Freedman, S., Orr, S. P., & Pitman, R. K. (2000) · American Journal of Psychiatry · doi:10.1176/appi.ajp.157.2.255 · Cited by 285 · see citing works
The Use of a Synthetic Cannabinoid in the Management of Treatment‐Resistant Nightmares in Posttraumatic Stress Disorder (PTSD)
Fraser, G. A. (2009) · CNS Neuroscience & Therapeutics · doi:10.1111/j.1755-5949.2008.00071.x · Cited by 283 · cited 1× · see citing works
“…psychoactive com‐ ponent of marijuana, tetrahydrocannabinol (THC), that acts on the endocannabinoid system, has revealed reduced nightmares and symptom severity in persons with PTSD following administration (Cameron, Watson, & Robinson, 2014; Fraser, 2009; Jetly, Heber, Fraser, & Boisvert, 2015).”
Background
Distinct Regions of the Periaqueductal Gray Are Involved in the Acquisition and Expression of Defensive Responses
De, B. M., DeCola, J. P., Maren, S., & Fanselow, M. S. (1998) · Journal of Neuroscience · doi:10.1523/jneurosci.18-09-03426.1998 · Cited by 278 · see citing works
Differential time courses and specificity of amygdala activity in posttraumatic stress disorder subjects and normal control subjects
Protopopescu, X., Pan, H., Tüscher, O., Cloître, M., Goldstein, M., Engelien, W., Epstein, J., Yang, Y., Gorman, J. M., LeDoux, J. E., et al. (2005) · Biological Psychiatry · doi:10.1016/j.biopsych.2004.12.026 · Cited by 276 · see citing works
Expression of mu, kappa, and delta opioid receptor messenger RNA in the human CNS: a 33P in situ hybridization study
Peckys, D. B., & Landwehrmeyer, G. B. (1999) · Neuroscience · doi:10.1016/s0306-4522(98)00251-6 · Cited by 273 · see citing works
Endocrinology of Stress
Romero, L. M., & Butler, L. K. (2007) · International Journal of Comparative Psychology · doi:10.46867/ijcp.2007.20.02.15 · Cited by 267 · see citing works
Selective p38α MAPK Deletion in Serotonergic Neurons Produces Stress Resilience in Models of Depression and Addiction
Bruchas, M. R., Schindler, A. G., Shankar, H., Messinger, D. I., Miyatake, M., Land, B. B., Lemos, J. C., Hagan, C. E., Neumaier, J. F., Quintana, A., et al. (2011) · Neuron · doi:10.1016/j.neuron.2011.06.011 · Cited by 266 · see citing works
Attention bias toward threat is associated with exaggerated fear expression and impaired extinction in PTSD
Fani, N., Tone, E. B., Phifer, J., Norrholm, S. D., Bradley, B., Ressler, K. J., Kamkwalala, A., & Jovanovic, T. (2012) · Psychological Medicine · doi:10.1017/s0033291711001565 · Cited by 266 · see citing works
Effects of experimental context and explicit threat cues on acoustic startle in Vietnam veterans with posttraumatic stress disorder
Grillon, C., Morgan, C. A., Davis, M., & Southwick, S. M. (1998) · Biological Psychiatry · doi:10.1016/s0006-3223(98)00034-1 · Cited by 263 · see citing works
Posttraumatic stress disorder symptoms, physiological reactivity, alcohol problems, and aggression among military veterans.
Taft, C., Kaloupek, D., Schumm, J. A., Marshall, A. D., Panuzio, J., King, D., & Keane, T. (2007) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.116.3.498 · Cited by 262 · see citing works
Updating freeze: Aligning animal and human research
Hagenaars, M. A., Oitzl, M., & Roelofs, K. (2014) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2014.07.021 · Cited by 260 · see citing works
Role of kappa-opioid receptors in stress and anxiety-related behavior
Veer, A. V., & Carlezon, W. A. (2013) · Psychopharmacology · doi:10.1007/s00213-013-3195-5 · Cited by 254 · see citing works
A Latent Class Analysis of Dissociation and Posttraumatic Stress Disorder
Wolf, E. J., Miller, M. W., Reardon, A. F., Ryabchenko, K. A., Castillo, D. T., & Freund, R. (2012) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2011.1574 · Cited by 253 · see citing works
Aversive imagery in posttraumatic stress disorder: trauma recurrence, comorbidity, and physiological reactivity
McTeague, L. M., Lang, P. J., Laplante, M.-C., Cuthbert, B. N., Shumen, J. R., & Bradley, M. M. (2010) · Biological Psychiatry · doi:10.1016/j.biopsych.2009.08.023 · Cited by 250 · see citing works
Sensitization of the Hypothalamic‐Pituitary‐Adrenal Axis in Posttraumatic Stress Disordera
Yehuda, R. (1997) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.1997.tb48269.x · Cited by 247 · see citing works
Regional alterations in the endocannabinoid system in an animal model of depression: effects of concurrent antidepressant treatment
Hill, M. N., Carrier, E. J., McLaughlin, R. J., Morrish, A. C., Meier, S. E., Hillard, C. J., & Gorzalka, B. B. (2008) · Journal of Neurochemistry · doi:10.1111/j.1471-4159.2008.05567.x · Cited by 246 · see citing works
Hyperexcitable dendrites in motoneurons and their neuromodulatory control during motor behavior
Heckman, C. J., Lee, R. H., & Brownstone, R. M. (2003) · Trends in Neurosciences · doi:10.1016/j.tins.2003.10.002 · Cited by 245 · see citing works
Differential effects of chronic unpredictable stress on hippocampal CB1 receptors in male and female rats
Reich, C. G., Taylor, M. E., & McCarthy, M. M. (2009) · Behavioural Brain Research · doi:10.1016/j.bbr.2009.05.013 · Cited by 244 · see citing works
Posttraumatic Stress in Children Exposed to Family Violence and Single-Event Trauma
McCloskey, L. A., & WALKER, M. (2000) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200001000-00023 · Cited by 242 · see citing works
Fear-potentiated startle in posttraumatic stress disorder
Morgan, C. A., Grillon, C., Southwick, S. M., Davis, M., & Charney, D. S. (1995) · Biological Psychiatry · doi:10.1016/0006-3223(94)00321-s · Cited by 242 · see citing works
CB1 cannabinoid receptors mediate anxiolytic effects: convergent genetic and pharmacological evidence with CB1-specific agents
Haller, J., Varga, B., Ledent, C., & Freund, T. F. (2004) · Behavioural Pharmacology · doi:10.1097/01.fbp.0000135704.56422.40 · Cited by 241 · see citing works
Traumatic nociceptive pain activates the hypothalamus and the periaqueductal gray: a positron emission tomography study
Hsieh, J.-C., Ståhle-Bäckdahl, M., Hägermark, Ö., Stone-Elander, S., Rosenquist, G., & Ingvar, M. (1996) · Pain · doi:10.1016/0304-3959(95)00129-8 · Cited by 240 · see citing works
Integrating Endocannabinoid Signaling and Cannabinoids into the Biology and Treatment of Posttraumatic Stress Disorder
Hill, M. N., Campolongo, P., Yehuda, R., & Patel, S. (2017) · Neuropsychopharmacology · doi:10.1038/npp.2017.162 · Cited by 239 · see citing works
Tonic immobility as an evolved predator defense: implications for sexual assault survivors
Marx, B. P., Forsyth, J. P., Gallup, G. G., Fusé, T., & Lexington, J. M. (2008) · Clinical Psychology Science and Practice · doi:10.1111/j.1468-2850.2008.00112.x · Cited by 234 · see citing works
The influence of stress hormones on emotional memory: Relevance for psychopathology
Wolf, O. T. (2007) · Acta Psychologica · doi:10.1016/j.actpsy.2007.08.002 · Cited by 233 · see citing works
Different patterns of freezing behavior organized in the periaqueductal gray of rats: Association with different types of anxiety
Brandão, M. L., Zanoveli, J. M., Ruiz-Martinez, R. C., Oliveira, L. C., & Landeira-Fernández, J. (2007) · Behavioural Brain Research · doi:10.1016/j.bbr.2007.10.018 · Cited by 232 · see citing works
Post-traumatic growth among veterans in the USA: results from the National Health and Resilience in Veterans Study
Tsai, J., El-Gabalawy, R. M., Sledge, W. H., Southwick, S. M., & Pietrzak, R. H. (2014) · Psychological Medicine · doi:10.1017/s0033291714001202 · Cited by 232 · see citing works
Altered amygdala resting-state functional connectivity in post-traumatic stress disorder
Rabinak, C. A., Angstadt, M., Welsh, R. C., Kenndy, A. E., Lyubkin, M., Martis, B., & Phan, K. L. (2011) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2011.00062 · Cited by 230 · see citing works
Exploring the roles of emotional numbing, depression, and dissociation in PTSD
Feeny, N. C., Zoellner, L. A., Fitzgibbons, L. A., & Foa, E. B. (2000) · Journal of Traumatic Stress · doi:10.1023/a:1007789409330 · Cited by 229 · see citing works
Neurofunctional correlates of posttraumatic stress disorder: a PET symptom provocation study
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Sensing the invisible: differential sensitivity of visual cortex and amygdala to traumatic context
Hendler, T., Rotshtein, P., Yeshurun, Y., Weizmann, T., Kahn, I., Bashat, D. B., Malach, R., & Bleich, A. (2003) · NeuroImage · doi:10.1016/s1053-8119(03)00141-1 · Cited by 228 · see citing works

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Treatment of Posttraumatic Stress Disorder: A State-of-the-art Review
Burback, L., Brémault‐Phillips, S., Nijdam, M. J., McFARLANE, A. C., & Vermetten, E. H. G. J. M. (2023) · Current Neuropharmacology · doi:10.2174/1570159x21666230428091433 · Cited by 232 · see citing works
Complex PTSD and borderline personality disorder
Ford, J. D., & Courtois, C. A. (2021) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-021-00155-9 · Cited by 209 · see citing works
“locus of defensive states and endogenous opioid release (the periaqueductal gray) [65, 166] in PTSD.”
Background
Neuroimaging the consciousness of self: Review, and conceptual-methodological framework
Frewen, P., Schroeter, M. L., Riva, G., Cipresso, P., Fairfield, B., Padulo, C., Kemp, A. H., Palaniyappan, L. K., Owolabi, M. O., Kusi‐Mensah, K., et al. (2020) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2020.01.023 · Cited by 177 · see citing works
Self-citation
The sense of self in the aftermath of trauma: lessons from the default mode network in posttraumatic stress disorder
Lanius, R. A., Terpou, B. A., & McKinnon, M. C. (2020) · European Journal of Psychotraumatology · doi:10.1080/20008198.2020.1807703 · Cited by 164 · see citing works
Self-citation
The brain-body disconnect: A somatic sensory basis for trauma-related disorders
Kearney, B. E., & Lanius, R. A. (2022) · Frontiers in Neuroscience · doi:10.3389/fnins.2022.1015749 · Cited by 154 · see citing works
Self-citation
A decennial review of psychotraumatology: what did we learn and where are we going?
Olff, M., Amstadter, A. B., Armour, C., Birkeland, M. S., Bui, É., Cloître, M., Ehlers, A., Ford, J. D., Greene, T., Hansen, M., et al. (2019) · European Journal of Psychotraumatology · doi:10.1080/20008198.2019.1672948 · Cited by 78 · see citing works
Self-citation
Trauma-related dissociation and the autonomic nervous system: a systematic literature review of psychophysiological correlates of dissociative experiencing in PTSD patients
Beutler, S., Mertens, Y. L., Ladner, L., Schellong, J., Croy, I., & Daniels, J. K. (2022) · European Journal of Psychotraumatology · doi:10.1080/20008066.2022.2132599 · Cited by 64 · see citing works
“into the dissociative subtype of PTSD (American Psychiatric Association, 2013; Lanius et al., 2010; Lanius et al., 2012; Spiegel et al., 2011; Terpou et al., 2019).”
BackgroundInfluential
Addressing Mental Health Concerns in Refugees and Displaced Populations: Is Enough Being Done?
Grasser, L. R. (2022) · Risk Management and Healthcare Policy · doi:10.2147/rmhp.s270233 · Cited by 68 · see citing works
Safety learning during development: Implications for development of psychopathology
Grasser, L. R., & Jovanović, T. (2021) · Behavioural Brain Research · doi:10.1016/j.bbr.2021.113297 · Cited by 54 · see citing works
Threat, safety, safeness and social safeness 30 years on: Fundamental dimensions and distinctions for mental health and well‐being
Gilbert, P. (2024) · British Journal of Clinical Psychology · doi:10.1111/bjc.12466 · Cited by 56 · see citing works
History of Childhood Trauma and Association With Borderline and Dissociative Features
Tschoeke, S., Bichescu-Burian, D. M., Steinert, T., & Flammer, E. (2020) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001270 · Cited by 34 · see citing works
The hijacked self: Disrupted functional connectivity between the periaqueductal gray and the default mode network in posttraumatic stress disorder using dynamic causal modeling
Terpou, B. A., Densmore, M., Théberge, J., Frewen, P., McKinnon, M. C., Nicholson, A. A., & Lanius, R. A. (2020) · NeuroImage Clinical · doi:10.1016/j.nicl.2020.102345 · Cited by 31 · see citing works
Self-citation
Structure of ICD-11 complex PTSD and relationship with psychoform and somatoform dissociation
Møller, L., Bach, B., Augsburger, M., Elklit, A., Søgaard, U., & Simonsen, E. H. (2021) · European Journal of Trauma & Dissociation · doi:10.1016/j.ejtd.2021.100233 · Cited by 30 · see citing works
A theoretical exploration of polyvagal theory in creative arts and psychomotor therapies for emotion regulation in stress and trauma
Haeyen, S. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1382007 · Cited by 28 · see citing works
“In turn, the patient may learn to exert cognitive control to attenuate the physiological adjustments which signal a defensive state (Terpou et al., 2019).”
BackgroundInfluential
French translation and validation of the International Trauma Questionnaire in a Canadian community sample
Cyr, G., Bélanger, C., & Godbout, N. (2022) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2022.105627 · Cited by 23 · see citing works
Biological Psychiatry in Displaced Populations: What We Know, and What We Need to Begin to Learn
Javanbakht, A., & Grasser, L. R. (2022) · Biological Psychiatry Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2022.05.001 · Cited by 24 · see citing works
Sex effects in the interaction of acute stress and pain perception
Geva, N., Golan, S., Pinchas, L., & Defrin, R. (2022) · Pain · doi:10.1097/j.pain.0000000000002743 · Cited by 22 · see citing works
Back to the Basics: Resting State Functional Connectivity of the Reticular Activation System in PTSD and its Dissociative Subtype
Thome, J., Densmore, M., Koppe, G., Terpou, B. A., Théberge, J., McKinnon, M., & Lanius, R. (2019) · Chronic Stress · doi:10.1177/2470547019873663 · Cited by 18 · see citing works
Self-citation
Acute Posttrauma Resting-State Functional Connectivity of Periaqueductal Gray Prospectively Predicts Posttraumatic Stress Disorder Symptoms
Webb, E. K., Huggins, A. A., Belleau, E. L., Taubitz, L. E., Hanson, J. L., deRoon‐Cassini, T. A., & Larson, C. L. (2020) · Biological Psychiatry Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2020.03.004 · Cited by 18 · see citing works
Memory-directed acupuncture as a neuromodulatory treatment for PTSD: Theory, clinical model and case studies
Assouline, A., Mendelsohn, A., & Reshef, A. (2022) · Translational Psychiatry · doi:10.1038/s41398-022-01876-3 · Cited by 19 · see citing works
Psychological Interventions for Survivors of Intimate Partner Violence in Humanitarian Settings: An Overview of the Evidence and Implementation Considerations
Lakin, D. P., García-Moreno, C., & Roesch, E. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19052916 · Cited by 18 · see citing works
“Trauma-Sensitive Yoga (TSY) • Research-supported link between psychological trauma, neurological problems, and physical sensations [56,57].”
Background
Decreased brain network global efficiency after attachment memories retrieval in individuals with unresolved/disorganized attachment-related state of mind
Massullo, C., Imperatori, C., Fallani, F. D. V., Ardito, R. B., Adenzato, M., Palmiero, L., Carbone, G. A., & Farina, B. (2022) · Scientific Reports · doi:10.1038/s41598-022-08685-0 · Cited by 16 · see citing works
Prefrontal control of superior colliculus modulates innate escape behavior following adversity
Ritter, A., Habusha, S., Givon, L., Edut, S., & Klavir, O. (2024) · Nature Communications · doi:10.1038/s41467-024-46460-z · Cited by 16 · see citing works
Invisible wounds: Suturing the gap between the neurobiology, conventional and emerging therapies for posttraumatic stress disorder
Gonda, X., Döme, P., Erdelyi-Hamza, B., Krause, S., Elek, L. P., Sharma, S., & Tarazi, F. I. (2022) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2022.05.010 · Cited by 14 · see citing works
Inflammation and Trauma-Related Psychopathology in Syrian and Iraqi Refugees
Grasser, L. R., Burghardt, P. R., Daugherty, A. M., Amirsadri, A., & Javanbakht, A. (2020) · Behavioral Sciences · doi:10.3390/bs10040075 · Cited by 14 · see citing works
Causal connection between dissociation and ongoing interpersonal violence: A systematic review
Tschoeke, S., Steinert, T., & Bichescu-Burian, D. M. (2019) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2019.09.030 · Cited by 13 · see citing works
What happened matters: Trauma type and cumulative trauma exposure in refugee youth psychopathology.
Hinchey, L. M.-E., Chammaa, M., Grasser, L. R., Saad, B., Gorski, K., & Javanbakht, A. (2023) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0001618 · Cited by 12 · see citing works
Dissociative Symptoms and Interoceptive Integration
Woelk, S. P., & Garfinkel, S. N. (2024) · Current topics in behavioral neurosciences · doi:10.1007/7854_2024_480 · Cited by 11 · see citing works
Trauma focused psychotherapy in patients with suicidal ideation: A scoping review
Burback, L., Dhaliwal, R., Reeson, M., Erick, T., Hartle, K. D., Chow, E., Vouronikos, G., Antunes, N., Marshall, T., Kennedy, M., et al. (2023) · Current Research in Behavioral Sciences · doi:10.1016/j.crbeha.2023.100102 · Cited by 11 · see citing works
Contrasting Associations Between Heart Rate Variability and Brainstem-Limbic Connectivity in Posttraumatic Stress Disorder and Its Dissociative Subtype: A Pilot Study
Thome, J., Densmore, M., Terpou, B. A., Théberge, J., McKinnon, M. C., & Lanius, R. A. (2022) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2022.862192 · Cited by 9 · see citing works
Self-citation
Low working memory underpins the association between aberrant functional properties of pain modulation circuitry and chronic back pain severity
Veinot, J., Cane, D. B., & Hashmi, J. A. (2025) · Journal of Pain · doi:10.1016/j.jpain.2025.104795 · Cited by 7 · see citing works
Psychophysiological assessment of trauma-focused Group Music and Imagery therapy for women with PTSD or CPTSD using script-driven imagery. A randomised controlled study.
Rudstam, G., Elofsson, U. O. E., Söndergaard, H. P., & Beck, B. D. (2023) · European Journal of Trauma & Dissociation · doi:10.1016/j.ejtd.2023.100353 · Cited by 7 · see citing works
Differences in intestinal bacteria in traumatic injury survivors with and without probable posttraumatic stress disorder
Geier, T. J., Atkinson, S. N., Pan, A. Y., Mantz-Wichman, M., Jazinski-Chambers, K., Hillard, C. J., & deRoon‐Cassini, T. A. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.06.075 · Cited by 6 · see citing works
The impact of child abuse on the neurobiology of self-processing in depressed adolescents
Engstrom, M., Liu, G., Santana‐Gonzalez, C., Teoh, J. Y., Harms, M. B., Koy, K., & Quevedo, K. M. (2021) · Neurobiology of Stress · doi:10.1016/j.ynstr.2021.100310 · Cited by 6 · see citing works
Heart and brain traumatic stress biomarker analysis with and without machine learning: A scoping review
Rountree-Harrison, D., Berkovsky, S., & Kangas, M. (2023) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2023.01.009 · Cited by 6 · see citing works
A pharmacological challenge paradigm to assess neural signatures of script-elicited acute dissociation in women with post-traumatic stress disorder
Mertens, Y. L., Manthey, A., Sierk, A., de Jong, P. J., Walter, H., & Daniels, J. K. (2023) · BJPsych Open · doi:10.1192/bjo.2023.34 · Cited by 6 · see citing works
A Matter for Life and Death: Managing Psychological Trauma in Care Homes
Estabrooks, C. A., Titley, H. K., Thorne, T. E., Banerjee, S., Feldman, H., Silvius, J. L., & Lanius, R. A. (2022) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2022.02.007 · Cited by 6 · see citing works
Self-citation
Sexarbeit und psychische Gesundheit
Büttner, M., Tschöke, S., & Gleixner, J. (2021) · Trauma und Gewalt · doi:10.21706/tg-15-4-296 · Cited by 5 · see citing works
Hypervigilance or shutdown? Electrophysiological processing of trauma-unrelated aversive stimuli after traumatic life events
Zukerman, G., Pinhas, M., & Icht, M. (2023) · Experimental Brain Research · doi:10.1007/s00221-023-06578-w · Cited by 5 · see citing works
Resolution of Dissociated Ego States Relieves Flashback-Related Symptoms in Combat-Related PTSD: A Brief Mindfulness Based Intervention
Smith, G. P., & Hartelius, G. (2020) · Military Psychology · doi:10.1080/08995605.2019.1654292 · Cited by 6 · see citing works
Psychophysiological reactions during the trauma-film paradigm and their predictive value for intrusions
Beutler, S., & Croy, I. (2023) · European Journal of Psychotraumatology · doi:10.1080/20008066.2023.2281753 · Cited by 4 · see citing works
Trauma-informed management of patients with prior sexual trauma in pelvic health physiotherapy clinical practice
Stirling, J., Wallace, Z., James, A., Shackel, R., & Elliott, J. M. (2025) · Australian and New Zealand Continence Journal · doi:10.1071/cj24042 · Cited by 4 · see citing works
Pain and the autonomic nervous system. The role of non-invasive neuromodulation with NESA microcurrents
Azevedo, N., & Medina-Ramírez, R. (2025) · Frontiers in Pain Research · doi:10.3389/fpain.2025.1410808 · Cited by 4 · see citing works
Neuroscience-based relational art therapy and deep brain reorienting in the treatment of dissociative identity disorder
Gerge, A., Rudstam, G., & Söndergaard, H. P. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1454483 · Cited by 5 · see citing works
The treatment of trauma-induced sexual pain among women: Clinical considerations for the use of adjunctive EMDR
Fonseka, T. M., & Smith, C. (2021) · The Canadian Journal of Human Sexuality · doi:10.3138/cjhs.2020-0035 · Cited by 5 · see citing works
Why We Need Trauma-Informed Campuses Now More Than Ever
Weber, K. M., Douglas, N., Popp, T. K., & Nelson, R. K. (2024) · About Campus Enriching the Student Learning Experience · doi:10.1177/10864822231223445 · Cited by 3 · see citing works
Dissociative episodes and concurrent heart rate in patients with PTSD – An ecological momentary assessment
Beutler, S., Franz, M., Daniels, J. K., Schellong, J., Weidner, K., & Croy, I. (2025) · Psychiatry Research · doi:10.1016/j.psychres.2024.116345 · Cited by 3 · see citing works
CATT haplotype of the FKBP5 gene and dissociative phenomenology
Moser, S., Knoblauch, H., Müller‐Myhsok, B., Katrinli, Ş., Mekawi, Y., Gillespie, C. F., Fani, N., Bradley, B., Michopoulos, V., Stevens, J. S., et al. (2025) · Scientific Reports · doi:10.1038/s41598-025-13865-9 · Cited by 3 · see citing works
Examining the Effects of Mental Health and Parent–Youth Relationship on the Associations Between Childhood Violence Exposure and Adolescent Dating Violence Perpetration
Russell, K. N., & Voith, L. A. (2025) · Children · doi:10.3390/children12050628 · Cited by 2 · see citing works
Peritraumatic physical symptoms and the clinical trajectory of PTSD after a terrorist attack: a network model approach
Berthail, B., Trousselard, M., Lecouvey, G., Fraisse, F., Peschanski, D., Eustache, F., Gagnepain, P., & Dayan, J. (2023) · European Journal of Psychotraumatology · doi:10.1080/20008066.2023.2225154 · Cited by 3 · see citing works
An Evolution- and Compassion-Informed Biopsychosocial Approach to the Challenge of Building an Integrated Science for Psychotherapy
Gilbert, P. (2024) · Oxford University Press eBooks · doi:10.1093/oso/9780198888727.003.0002 · Cited by 3 · see citing works
[Abdominal fibromatosis (desmoid tumor)].
Ricci, A., D'agostino, G., & Garavoglia, M. (2001) · PubMed · Cited by 3 · see citing works
Evaluating the Behavioural Responses of Healthy Newborn Calves to a Thoracic Squeeze
Holdsworth, S. E., Kells, N. J., Vallée, É., Ward, N., Mellor, D. J., & Beausoleil, N. J. (2022) · Animals · doi:10.3390/ani12070840 · Cited by 3 · see citing works
Enhanced expectation of external sensations of the chest regulates the emotional perception of fearful faces
Jung, W.-M., Lee, I.-S., Lee, Y.-S., Ryu, Y., Park, H.-J., & Chae, Y. (2021) · Brain Sciences · doi:10.3390/brainsci11070946 · Cited by 2 · see citing works
A Network Analysis of Embodied Trauma: Self-Destructive Behaviors Among Survivors of Childhood and Adolescent/Adult Sexual Assault
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Authors: Terpou, B. A., Harricharan, S., McKinnon, M. C., Frewen, P., Jetly, R., & Lanius, R. A.
Affiliations: Western University (CA)
Homewood Research Institute (CA)
Canadian Armed Forces (CA)
Corresponding author: Lanius, Ruth A.
ORCID: Terpou, Braeden A.
Harricharan, Sherain
McKinnon, Margaret C.
Frewen, Paul
Jetly, Rakesh
Lanius, Ruth A.
Venue: Journal of Neuroscience Research
Publisher: Wiley
Published: 2019-06-28
Volume: 97
Issue: 9
Pages: 1110-1140
ISSN: 0360-4012 (ISSN-L)
1097-4547
DOI: 10.1002/jnr.24447
OpenAlex: W2955374099
Cited by: 82
References: 430
Citations by year: 2026: 9 · 2025: 12 · 2024: 10 · 2023: 14 · 2022: 15 · 2021: 9 · 2020: 8 · 2019: 3
FWCI: 1.39
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Journal of Neuroscience Research (publishedVersion)
PubMed (publishedVersion)
Funders: Canadian Institutes of Health Research (137150, 97914)
Topics: Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
Life Sciences › Neuroscience › Cognitive Neuroscience › Memory and Neural Mechanisms
Keywords: post-traumatic stress disorder, dissociative subtype of PTSD, periaqueductal gray, midbrain, brainstem, defensive behavior, threat bias, hyperarousal, sympathetic nervous system, endocannabinoid system, opioid analgesia, trauma
MeSH terms: Brain, Dissociative Disorders, Emotions, Fear, Humans, Magnetic Resonance Imaging, Male, Periaqueductal Gray, Stress Disorders, Post-Traumatic

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The effects of trauma on brain and body: A unifying role for the midbrain periaqueductal gray

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