The Role of Social Cognition in Post-Traumatic Stress Disorder (PTSD): A Structured Literature Review

Abstract

Post-traumatic stress disorder (PTSD) is a psychiatric disorder which can significantly impair individuals in their daily functioning. Not every person who experiences a traumatic event however develops pathology. Research supports the availability of social support, individual adaptive coping styles and effective implicit emotion regulation as resilience factors against PTSD development. Risk factors include specific features of an event, pre-existing attributes and lack of post-traumatic social support. Furthermore, social cognitive impairments are common and debilitating manifestations in PTSD patients, leading to reduced social support. The acceptance of social support is known to be of great importance for the processing of the traumatic experience. Thus, exploring the association between PTSD and different social cognitive domains seems to be worthwhile. The current literature review mainly considers cognitive empathy processes, including theory of mind (ToM), emotion recognition and social perception, but attributional styles are also discussed. Although its limitations, insights in the neural correlates of social cognitive processes may be a valuable, non-invasive manner in trying to understand dysregulated emotional processing in PTSD patients. Considering brain regions, the amygdala, hippocampus, and prefrontal cortex appear to play an important role in the pathophysiology of PTSD. No consensus yet is reached whether amygdala activity is heightened in PTSD or not, which might be attributed to comorbidity problems and heterogeneity of study designs. However, decreased hippocampal volume is repeatedly shown. FMRI studies also show reduced hippocampal activation. Lastly, studies often show less activation or even deactivation in ventral medial PFC regions, including the anterior cingulate cortex. However, other studies have undermined this. A mutual consensus whether vmPFC activity is decreased in PTSD is therefore not yet agreed on. In conclusion, social cognition plays an important role in PTSD. Systematic assessment of social cognition in clinical practice is of the essence, in order to enhance treatment decision-making and outcomes, to ultimately provide the best care for the patient.