Monthly Archives: February 2018

PTSD within ASD

Post-Traumatic Stress Disorder (PTSD) has aroused considerable interest since its rst appearance in DSM-III (American Psychiatric Association, 1980) and increasing prevalence rates have been detected not only in selected samples of trauma exposed subjects but also in the general population (Kessler et al., 1995; Darves-Bornoz et al., 2008; Carmassi et al., 2014a). The number of studies conducted so far on PTSD has shed light on its clinical and neurobiological characteristics leading, for the rst time in the DSM-5 (American Psychiatric Association, 2013), to encode it in a speci cally devoted chapter, independent from other anxiety disorders, named Trauma and Stress Related Disorders, where it is included besides other speci cally trauma related disorders. PTSD uniqueness amongst psychiatric disorders is not only due to its usual relationship to a clear time of onset but also, more speci cally, to the fact that it is characterized by the failure of the normal ability to cope with traumatic events. Upon these characteristics, the identi cation of possible risk or protective factors is a core issue in this eld (Zohar et al., 2011). There is agreement concerning the differential vulnerability to PTSD related to gender, with women being the most affected, to level of exposure, to the type of trauma and to age (Karam et al., 2014; Carmassi et al., 2014b), but it is still debated which could be the basic etiopathogenetic mechanism leading to the impairment of the adaptive response (Dell’Osso et al., 2011; 2013a,b).

Some new perspectives may derive from most recent research on Autism Spectrum Disorder (ASD). Increasing data, despite still scant, suggest that ASD subjects may be often exposed to traumatic experiences and, thus, they may be likely to develop PTSD (Hofvander et al., 2009; Storch et al., 2013). A growing body of data indicates that individuals with ASD, particularly those with moderate forms and with no cognitive or language impairment, often come to clinical attention when other mental disorders arise, leading to challenging diagnostic procedures (Kamio et al, 2013). Sometimes, their ASD remain unrecognized even after the onset of these mental disorders. Takara & Kondo (2014), for example, recently reported 16% ASD prevalence rate among rst-visit depressed adult patients while Kato et al. (2013) reported rates as high as 7.3% of previously unrecognized ASD among suicide attempters hospitalized for inpatient treatment. Consistently, Storch et al., (2013) showed suicidal thoughts and behaviors to be common in youths with ASD, and associated with the presence of depression and PTSD, leading to suggest that individuals with ASD may represent a low-resilience group that could be speci cally prone to develop Trauma and Stress Related Disorders. As a matter of fact, the ability to adjust has been shown to decline dramatically over time in ASD patients with respect to healthy control subjects in the aftermath of a natural disaster exposure (Valenti et al., 2012). However, it is important to notice that only a few studies explored PTSD prevalence rates among ASD patients, and those who did it reported low rates (Mayoral et al., 2010); similarly, to the best of our knowledge, no study explored ASD symptoms in PTSD subjects.