PCOS and PTSD

Individuals with PCOS are at 1.5x increased risk of developing post-traumatic stress disorder (PTSD)[1] although it is unclear whether there is a causal relationship and, if so, whether PCOS causes PTSD, PTSD causes PCOS or both.[2] In this article we explore the link between PCOS and PTSD.

PTSD is a is a psychiatric condition where an individual experiences significant distress beyond a period of a month after experiencing or witnessing a traumatic event or series of events.[3]

The underlying cause of PCOS is a result of a complex interaction of genetic, epigenetic and environmental factors.[4] Genetic factors relate to how individual or groups of genes are implicated in health and disease.[5] Epigenetic factors relate to how genes are expressed or function, in response to the environmental factors within the womb or later in life.[6] Environmental factors include lifestyle, diet, stress/trauma and exposure to endocrine-disrupting chemicals (EDCs),[7] natural or man-made chemicals that may mimic, block or interfere with the body’s hormones.[8]

There are a variety of potential mechanisms linking PCOS and PTSD:[9]

Some of the genetic variants associated with PCOS are also linked to an increased risk of PTSD;[10]
Dysregulation of the hypothalamic-pituitary-adrenal axis (HPA-axis), the hormonal system that controls our stress response, is a common factor in PCOS and PTSD;[11]
A higher prevalence of adverse childhood experiences or trauma, is a common factor in PCOS and PTSD;[12]
PCOS is associated with changes in appearance that can lead to poor self-esteem and psychological distress, increasing the underlying risk for PTSD; and
PCOS is associated with increased prevalence of mental health conditions including anxiety, depression, eating disorders and obsessive compulsive disorder, increasing the underlying risk for PTSD.

General risk factors for PTSD include:[13],[14]

Prior history of trauma;
Childhood adversity and/or trauma;
Being female;
Being a member of a marginalized group;
Having immigrant status;
Feelings of guilt or shame around the event;
Additional stress after the original event; and
Lack of social support after the event.

There are four main types of symptoms associated with PTSD:[15],[16]

Intrusive memories: recurring unwanted memories, “flashbacks” or nightmares about the traumatic event;
Avoidance: avoiding people, places or activities that remind you of the traumatic event;
Changes in mood: negative thoughts and emotions, detachment from family, friends or activities and/or feeling numb; and
Changes in reactions/emotions: elevated fear response, trouble sleeping or concentrating and/or self-destructive behavior.

PTSD also increases the risk factor for other mental and physical health conditions, including:[17]

Depression;
Substance use disorder (SUD);
Memory problems;
Acute stress disorder;
Adjustment disorder;
Disinhibited social engagement disorder; and
Reactive attachment disorder.

A healthcare professional may diagnose PTSD based on trauma that has lasted beyond a month and is not explained by another health condition. The PTSD Checklist (PCL-5) is a self-administered 20-question report tool that may be used to assess PTSD severity at the time of diagnosis and over the course of treatment.[18]

Treatment for PTSD often includes a combination of psychotherapy, medication and lifestyle modifications, which can include:[19]

Cognitive behavioural therapy (CBT): changing patterns of thoughts, feelings and behaviours;
Cognitive processing therapy (CPT): modifying unhelpful underlying beliefs;
Cognitive therapy: modifying the negative evaluations and memories of trauma;
Eye movement desensitization and reprocessing (EMDR) therapy: briefly focusing on the trauma/memory whilst experiencing bilateral eye movements to reduce the vividness of the associated memory;
Narrative exposure therapy (NET): establishing a coherent life narrative as a context for the traumatic event; and
Selective serotonin reuptake inhibitors (SSRIs) – sertraline and paroxetime: Serotonin is a hormone involved in learning, memory, happiness, temperature regulation, sleep, sexual behavior and hunger and its deficit is linked to depression, anxiety, mania and other health conditions.[20] SSRIs block the process whereby serotonin is taken back into cells in the brain after it has carried a signal between cells (reuptake), thereby making more serotonin available to carry signals.[21]

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Sources

[1] https://www.imrpress.com/journal/CEOG/50/9/10.31083/j.ceog5009193/htm

[2] https://www.imrpress.com/journal/CEOG/50/9/10.31083/j.ceog5009193/htm

[3] https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883751/

[5] https://www.cdc.gov/genomics/about/basics.htm

[6] https://www.cdc.gov/genomics/disease/epigenetics.htm

[7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9864804/

[8] https://www.niehs.nih.gov/health/topics/agents/endocrine

[9] https://www.imrpress.com/journal/CEOG/50/9/10.31083/j.ceog5009193/htm

[10] https://www.imrpress.com/journal/CEOG/50/9/10.31083/j.ceog5009193

[11] https://www.sciencedirect.com/science/article/pii/S2666354624001273

[12] https://www.sciencedirect.com/science/article/abs/pii/S0306453020300974

[13] https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd

[14] https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967

[15] https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd

[16] https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967

[17] https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd

[18] https://www.camh.ca/en/professionals/treating-conditions-and-disorders/ptsd/ptsd---screening-and-assessment

[19] https://www.apa.org/ptsd-guideline/treatments

[20] https://my.clevelandclinic.org/health/articles/22572-serotonin

[21] https://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825

PCOS and PTSD