Trauma-informed research: A multifaceted exploration of PTSD

Ananda Amstadter, Ph.D., watches the world around her through a unique lens. As a researcher who has dedicated her career to understanding the human impact of traumatic events, when she sees news reports on war, natural disasters and other tragedies, her mind goes to the survivors who are left with long-term debilitating effects and how they’ll cope.  

“It’s overwhelming when you think of large events,” Amstadter said. “But it’s also empowering because there are things we can do.”  

Amstadter has been investigating post-traumatic stress disorder (PTSD) since the beginning of her academic career. She joined the School of Medicine faculty and VCU’s Virginia Institute for Psychiatric and Behavioral Genetics (VIPBG) in 2010. With dual appointments in the Department of Psychiatry and the Department of Human and Molecular Genetics, she wants to understand the causes and effects of the psychiatric disorder to inform prevention and interventional therapies.  

Recently, her expertise was put to the test on a global scale.  

In her role as president of the International Society for Traumatic Stress Studies (ISTSS) from 2021-2022, Amstadter helped coordinate outreach during the 2022 start of the Russia-Ukraine war. She chaired the organization's 38th annual presidential panel, which explored how the trauma research community could support those in the crosshairs of conflict and violence. Outreach efforts included training lay people to identify those at risk of developing PTSD, a step Amstadter said is crucial for intervention, as a common symptom of PTSD is avoiding talking about the trauma.  

“When we think of a mass trauma event and the millions of people that are affected by that trauma and we do the math, thousands are going to come out of it with a PTSD diagnosis,” Amstadter said. “It’s thinking of how we can get them the services they need on a mass level.”  

A debilitating and mysterious disorder 

PTSD is a relatively new diagnosis, only added to the Diagnostic and Statistical Manual of Mental Disorders (DSM), the American Psychiatric Association’s authority on mental health diagnoses, in 1980. However, descriptions of what experts now theorize was PTSD have been found in records dating back to as early as 1300 BCE. Following a traumatic experience, the disorder can manifest differently from person to person, but common symptoms include re-experiencing the trauma through intrusive thoughts, nightmares, or flashbacks, avoidance, negative cognitions and moods, and arousal. PTSD also co-occurs at a high rate with other psychiatric and physical health disorders, compounding its negative effects. 

Amstadter said traumatic events are more common than one might think, and that around 70% of people will experience a traumatic event, such as a natural disaster, war, assault or car accident. However, the rate of PTSD development is only around 6%, leading researchers like Amstadter to uncover the factors that put people at risk of the debilitating disorder.  

During college at the University of Washington, Amstadter volunteered as a research assistant who was assigned to watch and code psychiatric interviews for a study on borderline personality disorder. She said childhood trauma was a common theme in the interviews.  

“Borderline personality disorder is a debilitating form of psychopathology, and this was a very severe population,” Amstadter said. “Seeing a theme of trauma got me really interested in early intervention and prevention and what we can learn about the impact of trauma exposure.” 

Amstadter is also deeply invested in uncovering the genetic mysteries behind PTSD. In collaboration with researchers at Lund University in Sweden, she recently led the largest twin-sibling study of PTSD to date, which examined genetic sex differences in relation to PTSD. According to the study, which was published a study in the American Journal of Psychiatry in early June, people assigned female at birth have a higher genetic risk of developing PTSD than those assigned male at birth.  

Understanding sex differences in the biological risk of PTSD could help explain why women develop the disorder at higher rates than men, even when controlled for trauma type. It could help in advancing biological interventions, such as medications, which Amstadter said have so far shown only “modest effects.” While other treatments like psychosocial therapy have yielded far more success in both male and female patients, Amstadter said the findings could help patients who are resistant to psychosocial treatment. 

“Understanding that there’s a greater biological risk for females will hopefully lead our field to try to identify sex specific pathways,” Amstadter said. “It might be that treatment non-responders might have a different biologic signature.”  

Robert Findling, M.D., chair of the Department of Psychiatry, reflected on the impact of the study and commended Amstadter for her leadership and dedication to this patient population.  

“As an investigator, Dr. Amstadter is so talented. She asks great questions, and then sets out to answer them with stringent, innovative methodology,” Findling said. “Dr. Amstadter is a thoughtful and a vigorous advocate of psychiatric research that really advances the field. Simply put, she is the consummate academician.” 

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