Associations between posttraumatic stress disorder symptom clusters and cigarette smoking.

Abstract

Understanding the relationship between Posttraumatic stress disorder (PTSD) and cigarette smoking has been difficult due to PTSD’s symptomatic heterogeneity. This study examined common and unique lifetime cross-sectional relationships between PTSD symptom clusters (Re-experiencing [intrusive thoughts and nightmares about the trauma], Avoidance [avoidance of trauma-associated memories or stimuli], Emotional Numbing [loss of interest, interpersonal detachment, restricted positive affect], and Hyperarousal [irritability, difficulty concentrating, hypervigilance, insomnia]) and three indicators of smoking behavior: (1) smoking status; (2) cigarettes per day; and (3) nicotine dependence. Participants were adult respondents in the National Epidemiologic Survey of Alcohol and Related Conditions with a trauma history (N=23,635). All four symptom clusters associated with each smoking outcome in single-predictor models (ps<.0001). In multivariate models including all of the symptom clusters as simultaneous predictors, Emotional Numbing was the only cluster to retain a significant association with lifetime smoking over and above the other clusters, demographics, and Axis-I comorbidity (OR=1.30, p<.01). While Avoidance uniquely associated with smoking status and nicotine dependence in multivariate models, these relations fellow below significance after adjusting for demographics and comorbidity. No clusters uniquely associated with cigarettes per day. Hyperarousal uniquely related with nicotine dependence over and above the other clusters, demographics, and Axis-I comorbidity (OR=1.51, p<.001). These results suggest that: (a) common variance across PTSD symptom clusters contribute to PTSD’s linkage with smoking in the American population; and (b) certain PTSD symptom clusters may uniquely associate with particular indicators of smoking behavior. These findings may clarify the underpinnings of PTSD-smoking comorbidity and inform smoking interventions for trauma-exposed individuals.

Smoking intensity and severity of specific symptom clusters in posttraumatic stress disorder

“…Using the National Epidemiological Survey of Alcohol and Related Conditions with a trauma history (n = 23,635), Greenberg et al (2011) showed emotional numbing was the only symptom cluster significantly associated with lifetime smoking (odds ratio [OR] = 1.3, p < .001). Kirby and colleagues (2008) showed that veterans with PTSD returning from Afghanistan and Iraq who smoked were more likely to report emotional numbing than those who did not smoke.…”

Nicotine Addiction and Psychiatric Disorders

“…Similarly, patients with social phobia have also demonstrated increased rates of smoking initiation (Sonntag, Wittchen, Höfler, Kessler, & Stein, 2000). Furthermore, several studies have shown that the presence of PTSD symptoms, such as hyperarousal and emotional numbing, is a predictor for nicotine dependence and these symptoms are reduced by nicotine intake (Beckham et al, 2005; Feldner et al, 2007; Greenberg et al, 2012; Thorndike, Wernicke, Pearlman, & Haaga, 2006). Therefore, it is possible that while nicotine dependence increases one’s vulnerability to anxiety disorders, smoking may serve as a mean to alleviate symptoms associated with anxiety disorders, which, in turn, increases nicotine dependence among patients with anxiety disorders.…”

“…Therefore, these results indicate that abstinence from nicotine may worsen the conditions of the PTSD patients. This is because while PTSD symptoms are reduced during nicotine intake (Beckham et al, 2005; Feldner et al, 2007; Greenberg et al, 2012; Thorndike et al, 2006), they resurface during abstinence (Dedert et al, 2011). Therefore, most PTSD patients reinitiate smoking to alleviate their symptoms (Beckham et al, 2012).…”

“…While human studies suggest that smoking may alleviate the symptoms associated with anxiety disorders (Beckham et al, 2005; Feldner et al, 2007; Greenberg et al, 2012; Thorndike et al, 2006), nicotine abstinence worsens those symptoms (Dedert et al, 2011) and results in higher rates of reinitiation of smoking (Beckham et al, 2012; Hapke et al, 2005; Lasser et al, 2000). In line with these results, the animal studies using fear conditioning suggest that initial acute nicotine results in enhancement of hippocampus-dependent fear learning and impairment of fear extinction, whereas acute nicotine during nicotine withdrawal further enhances hippocampus-dependent fear memories, which may prolong the course of the disorder.…”

Acute nicotine enhances spontaneous recovery of contextual fear and changes c-fos early gene expression in infralimbic cortex, hippocampus, and amygdala

“…Smoking rates among PTSD patients (45.3%) are significantly higher than the nonclinical population (22.5%, Ziedonis et al 2008). In addition, a significant positive correlation exists between smoking and PTSD symptoms and the severity of PTSD symptoms is predicted by daily number of cigarettes smoked (Thorndike et al 2006;Greenberg et al 2012). Beyond PTSD, smoking rates increase when healthy individuals encounter stressful/anxiogenic situations (Pomerleau and Pomerleau 1987).…”