An academic study reveals: a breakthrough in the diagnosis of post-traumatic stress disorder

One track is based on fear and terror, and the second track is based on deep emotional pain that includes feelings such as guilt, sadness and shame. “We found that fear is only part of the picture among people dealing with post-trauma,” says Dr. Ben-Zion, “for many, what keeps the trauma alive is actually the emotional pain: deep sadness, guilt, shame and the loss of joy.”

In recent decades, post-traumatic stress disorder has mainly been described as a fear-centered disorder. Many diagnostic tools, theoretical models and treatment processes were based on this concept, and focused on mechanisms of threat and danger: flashbacks, vigilance, avoidance and heightened physiological response. But this focus left aside the emotional pain, although it is no less significant for many of the victims.

The research findings point to two distinct emotional profiles in post-trauma: fear on the one hand and deep emotional pain on the other. In the first stage, 68% of the participants reported that emotional pain is the factor that affects their daily functioning more than fear. In the second stage, it was found that it is possible to predict the development of symptoms based on fear through early brain connectivity patterns – mainly in brain networks involved in self-processing, mental control, recognition of salient stimuli and bodily sensations. In contrast, no similar predictive pattern was found for the development of symptoms based on emotional pain, a finding that suggests that this emotional pathway relies on different brain mechanisms.

Dr. Ben Zion emphasizes: “Post-trauma does not operate in one emotional pathway. For some of the victims, fear continues to drive the distress and for others the emotional pain does not burst outward but grows from within and sometimes interferes with functioning even more. To truly understand trauma victims, we need to identify what hurts them more, what drives them from the inside. This distinction is essential in order to develop a treatment suitable for each person’s unique emotional needs.”

The study included two complementary phases: in the first phase, 838 trauma victims participated, who filled out questionnaires about post-trauma symptoms and reported levels of fear and emotional pain, and their analysis revealed that there are two main emotional patterns that distinguish between fear and emotional pain. In the second stage, 162 trauma victims who arrived at emergency rooms in Israel shortly after a traumatic event participated.

They underwent clinical evaluations and brain scans (fMRI) after one month, six months and 14 months. The researchers used a predictive method based on machine learning to test whether early brain connectivity patterns can predict the emotional trajectory that will develop over time – fear or emotional pain, as defined in the first stage.