Grasping Posttraumatic Stress Disorder From the Perspective of Psychoneuroimmunoendocrinology: Etiopathogenic Mechanisms and Relevance for Integrative Management

Abstract

Posttraumatic stress disorder (PTSD) is a debilitating condition caused by exposure to traumatic events that affects 5% to 10% of the population, with increased prevalence among women and individuals in war zones. Beyond psychological symptoms, PTSD induces significant physiological changes across systems. Psychoneuroimmunoendocrinology (PNIE) offers a framework to explore these complex interactions between the psyche and the nervous, immune, and endocrine systems. Studies have revealed that PTSD entails disruptions in the central and autonomic nervous, immune, and endocrine systems, including gut microbiota imbalances, which impair organ function. Integrative pathways that connect these parts include the microbiota-gut-brain axis, heart-brain axis, neuroinflammation, and hypothalamic-pituitary dysregulation, highlighting bidirectional links between mental and physical health. Viewing PTSD as an entity comprising both psychological and physiological challenges underscores the importance of integrative care strategies that combine pharmacological treatments, psychotherapy, and lifestyle interventions. These approaches are consistent with PNIE principles, which may help identify biomarkers for treatment efficacy. In this review, we discuss the pathophysiology of PTSD through a PNIE lens and its implications for improving patient care, advocating for personalized, multidisciplinary interventions in mental health.