Human brain evolution and the "Neuroevolutionary Time-depth Principle:" Implications for the Reclassification of fear-circuitry-related traits in DSM-V and for studying resilience to warzone-related posttraumatic stress disorder.

The DSM-III, DSM-IV, DSM-IV-TR and ICD-10 have judiciously minimized discussion of etiologies to distance clinical psychiatry from Freudian psychoanalysis. With this goal mostly achieved, discussion of etiological factors should be reintroduced into the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). A research agenda for the DSM-V advocated the "development of a pathophysiologically based classification system". The author critically reviews the neuroevolutionary literature on stress-induced and fear circuitry disorders and related amygdala-driven, species-atypical fear behaviors of clinical severity in adult humans. Over 30 empirically testable/falsifiable predictions are presented. It is noted that in DSM-IV-TR and ICD-10, the classification of stress and fear circuitry disorders is neither mode-of-acquisition-based nor brain-evolution-based. For example, snake phobia (innate) and dog phobia (overconsolidational) are clustered together. Similarly, research on blood-injection-injury-type-specific phobia clusters two fears different in their innateness: 1) an arguably ontogenetic memory-trace-overconsolidation-based fear (hospital phobia) and 2) a hardwired (innate) fear of the sight of one's blood or a sharp object penetrating one's skin. Genetic architecture-charting of fear-circuitry-related traits has been challenging. Various, non-phenotype-based architectures can serve as targets for research. In this article, the author will propose one such alternative genetic architecture. This article was inspired by the following: A) Nesse's "Smoke-Detector Principle", B) the increasing suspicion that the "smooth" rather than "lumpy" distribution of complex psychiatric phenotypes (including fear-circuitry disorders) may in some cases be accounted for by oligogenic (and not necessarily polygenic) transmission, and C) insights from the initial sequence of the chimpanzee genome and comparison with the human genome by the Chimpanzee Sequencing and Analysis Consortium published in late 2005. Neuroevolutionary insights relevant to fear circuitry symptoms that primarily emerge overconsolidationally (especially Combat related Posttraumatic Stress Disorder) are presented. Also introduced is a human-evolution-based principle for clustering innate fear traits. The "Neuroevolutionary Time-depth Principle" of innate fears proposed in this article may be useful in the development of a neuroevolution-based taxonomic re-clustering of stress-triggered and fear-circuitry disorders in DSM-V. Four broad clusters of evolved fear circuits are proposed based on their time-depths: 1) Mesozoic (mammalian-wide) circuits hardwired by wild-type alleles driven to fixation by Mesozoic selective sweeps; 2) Cenozoic (simian-wide) circuits relevant to many specific phobias; 3) mid Paleolithic and upper Paleolithic (Homo sapiens-specific) circuits (arguably resulting mostly from mate-choice-driven stabilizing selection); 4) Neolithic circuits (arguably mostly related to stabilizing selection driven by gene-culture co-evolution). More importantly, the author presents evolutionary perspectives on warzone-related PTSD, Combat-Stress Reaction, Combat-related Stress, Operational-Stress, and other deployment-stress-induced symptoms. The Neuroevolutionary Time-depth Principle presented in this article may help explain the dissimilar stress-resilience levels following different types of acute threat to survival of oneself or one's progency (aka DSM-III and DSM-V PTSD Criterion-A events). PTSD rates following exposure to lethal inter-group violence (combat, warzone exposure or intentionally caused disasters such as terrorism) are usually 5-10 times higher than rates following large-scale natural disasters such as forest fires, floods, hurricanes, volcanic eruptions, and earthquakes. The author predicts that both intentionally-caused large-scale bioevent-disasters, as well as natural bioevents such as SARS and avian flu pandemics will be an exception and are likely to be followed by PTSD rates approaching those that follow warzone exposure. During bioevents, Amygdala-driven and locus-coeruleus-driven epidemic pseudosomatic symptoms may be an order of magnitude more common than infection-caused cytokine-driven symptoms. Implications for the red cross and FEMA are discussed. It is also argued that hospital phobia as well as dog phobia, bird phobia and bat phobia require re-taxonomization in DSM-V in a new "overconsolidational disorders" category anchored around PTSD. The overconsolidational spectrum category may be conceptualized as straddling the fear circuitry spectrum disorders and the affective spectrum disorders categories, and may be a category for which Pitman's secondary prevention propranolol regimen may be specifically indicated as a "morning after pill" intervention. Predictions are presented regarding obsessive-compulsive disorder (OCD) (e.g., female-pattern hoarding vs. male-pattern hoarding) and "culture-bound" acute anxiety symptoms (taijin-kyofusho, koro, shuk yang, shook yong, suo yang, rok-joo, jinjinia-bemar, karoshi, gwarosa, Voodoo death). Also discussed are insights relevant to pseudoneurological symptoms and to the forthcoming Dissociative-Conversive disorders category in DSM-V, including what the author terms fright-triggered acute pseudo-localized symptoms (i.e., pseudoparalysis, pseudocerebellar imbalance, psychogenic blindness, pseudoseizures, and epidemic sociogenic illness). Speculations based on studies of the human abnormal-spindle-like, microcephaly-associated (ASPM) gene, the microcephaly primary autosomal recessive (MCPH) gene, and the forkhead box p2 (FOXP2) gene are made and incorporated into what is termed "The pre-FOXP2 Hypothesis of Blood-Injection-Injury Phobia." Finally, the author argues for a non-reductionistic fusion of "distal (evolutionary) neurobiology" with clinical "proximal neurobiology," utilizing neurological heuristics. It is noted that the value of re-clustering fear traits based on behavioral ethology, human-phylogenomics-derived endophenotypes and on ontogenomics (gene-environment interactions) can be confirmed or disconfirmed using epidemiological or twin studies and psychiatric genomics

Freeze, Flight, Fight, Fright, Faint: Adaptationist Perspectives on the Acute Stress Response Spectrum

This article reviews the existing evolutionary perspectives on the acute stress response habitual faintness and blood-injection-injury type-specific phobia (BIITS phobia). In this article, an alternative evolutionary perspective, based on recent advances in evolutionary psychology, is proposed. Specifically, that fear-induced faintness (eg, fainting following the sight of a syringe, blood, or following a trivial skin injury) is a distinct Homo sapiens-specific extreme-stress survival response to an inescapable threat. The article suggests that faintness evolved in response to middle paleolithic intra-group and inter-group violence (of con-specifics) rather than as a pan-mammalian defense response, as is presently assumed. Based on recent literature, freeze, flight, fight, fright, faint provides a more complete description of the human acute stress response sequence than current descriptions. Faintness, one of three primary physiological reactions involved in BIITS phobia, is extremely rare in other phobias. Since heritability estimates are higher for faintness than for fears or phobias, the author suggests that trait-faintness may be a useful complement to trait-anxiety as an endophenotype in research on the human fear circuitry. Some implications for the forthcoming Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition as well as for clinical, health services, and transcriptomic research are briefly discusse

Evidence Based Complementary Intervention for Insomnia

Increasing scientific evidence point to a non-pharmacological complementary treatment for insomnia: white noise. Its presentation has been shown to induce sleep in human neonates and adults, probably by reducing the signal-to-noise ratio of ambient sound. White noise may be a simple, safe, cost-effective alternative to hypnotic medication in many psychiatric disorders, especially acute stress disorder and PTSD

Utility of Fear Severity and Individual Resilience Scoring as a Surge Capacity, Triage Management Tool during Large-Scale, Bio-event Disasters

Threats of bioterrorism and emerging infectious disease pandemics may result in fear related consequences. Fear based signs and symptoms, if left undetected and untreated, may be extremely debilitating and lead to chronic problems with risk of permanent damage to the brain’s locus coeruleus stress response circuits. The triage management of susceptible, exposed, and infectious victims seeking care must be sensitive and specific enough to identify individuals with excessive levels of fear in order to address the nuances of fear-based symptoms at the initial point of contact. These acute conditions, which include hyper-vigilant fear, are best managed by timely and effective information, rapid evaluation, and possibly medication that uniquely addresses the locus-coeruleus driven noradrenalin overactivation. This article recommends that a fear and resilience (FR) checklist be included as an essential triage tool to identify those most at risk. This checklist has the utility of rapid usage and capacity to respond to limitations brought about by surge capacity requirements. Whereas the utility of such a checklist is evident, predictive validity studies will be required in the future. It is important to note that a unique feature of the FR Checklist is that in addition to identifying individuals who are emotionally, medically, and socially hypo-resilient, it simultaneously identifies individuals who are hyper-resilient who can be asked to volunteer and thus rapidly expand the surge capacity

Bruxism and autonomic activity

not applicabl

Anxiety and Posttraumatic Stress Disorder in the Context of Human Brain Evolution:A Role for Theory in DSM-V?

The “hypervigilance, escape, struggle, tonic immobility”\ud evolutionarily hardwired acute peritraumatic response\ud sequence is important for clinicians to understand. Our\ud commentary supplements the useful article on human\ud tonic immobility (TI) by Marx, Forsyth, Gallup, Fusé and Lexington (2008). A hallmark sign of TI is peritraumatic\ud tachycardia, which others have documented as a\ud major risk factor for subsequent posttraumatic stress\ud disorder (PTSD). TI is evolutionarily highly conserved\ud (uniform across species) and underscores the need for\ud DSM-V planners to consider the inclusion of evolution\ud theory in the reconceptualization of anxiety and PTSD.\ud We discuss the relevance of evolution theory to the\ud DSM-V reconceptualization of acute dissociativeconversion\ud symptoms and of epidemic sociogenic disorder(epidemic “hysteria”). Both are especially in need of attention in light of the increasing threat of terrorism\ud against civilians. We provide other pertinent examples.\ud Finally, evolution theory is not ideology driven (and\ud makes testable predictions regarding etiology in “both\ud directions”). For instance, it predicted the unexpected\ud finding that some disorders conceptualized in DSM-IV-TR as innate phobias are conditioned responses and thus better conceptualized as mild forms of PTSD. Evolution\ud theory may offer a conceptual framework in\ud DSM-V both for treatment and for research on psychopathology.\u

Evidence based complementary intervention for insomnia.

Increasing scientific evidence point to a non-pharmacological complementary treatment for insomnia: white noise. Its presentation has been shown to induce sleep in human neonates and adults, probably by reducing the signal-to-noise ratio of ambient sound. White noise may be a simple, safe, cost-effective alternative to hypnotic medication in many psychiatric disorders, especially acute stress disorder and PTSD

A surgical treatment for anxiety-triggered palmar hyperhidrosis is not unlike treating tearfulness in major depression by severing the nerves to the lacrimal glands

not applicabl

Evolution of the human fear-circuitry and acute sociogenic pseudoneurological symptoms: The Neolithic balanced-polymorphism hypothesis

In light of the increasing threat of large-scale massacres such as terrorism against non-combatants (civilians), more attention is warranted not only to posttraumatic stress disorder (PTSD) but also to acute sociogenic pseudoneurological ("conversion") symptoms, especially epidemic sociogenic symptoms. We posit that conversion disorders are etiologically related to specific evolutionary pressures (inescapable threats to life) in the late stage of the human environment of evolutionary adaptedness (EEA). Bracha et al. have recently argued that from the neuroevolutionary perspective, medically unexplained efferent vasovagal syncope and medically unexplained craniofacial musculoskeletal pain in young otherwise healthy individuals, may be taxonomized as stress and fear-circuitry disorders. In the present article, we extend neuroevolutionary perspectives to acute pseudoneurological sociogenic ("conversive") symptoms: psychogenic non-epileptic attacks ("pseudoseizures"), epidemic sociogenic disorders (DSM-IV-TR Epidemic "Hysteria"), conversive motor deficits (pseudo-paralysis and pseudo-cerebellar symptoms), and psychogenic blindness. We hypothesize that these perplexing pseudoneurological stress-triggered symptoms, which constitute psychopathology in extant humans, are traceable to allele-variant polymorphisms which spread during the Neolithic EEA. During Neolithic warfare, conversive symptoms may have increased the survival odds for some non-combatants by visually (i.e., "non-verbally") signaling to predatory conspecifics that one does not present a danger. This is consistent with the age and sex pattern of conversive disorders. Testable and falsifiable predictions are presented; e.g., at the genome-transcriptome interface, one of the major oligogenic loci involved in conversive spectrum disorders may carry a developmentally sensitive allele in a stable polymorphism (balanced polymorphism) in which the gene expression mechanism is gradually suppressed by pleiotropic androgens especially dehydroxyepiandrosterone sulfate (DHEA-S). Taxonomic implications for the much-needed rapprochement between the forthcoming Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-V) and the International Classification of Diseases (ICD) are discussed

Stressful Experiences in Children and Adolescents: Initial Report from the PSEI-NCPV Honolulu Study

As part of a federal study of the biology of stress and resilience, a comprehensive, structured stress-history interview (PSEI-NCPV) was administered to 307 participants recruited in Honolulu. A moderate correlation between childhood stress and current depression was found. A relatively high rate of "severe bullying/hazing," and a high mean stress-intensity reating for "blood-drawing induced anxiety" call for further research