When Is an Experience “Had”? Biological State, PTSD, and Sexual Experience Under Conditions of Threat

Abstract

Post-traumatic stress disorder (PTSD) is associated with alterations in inflammatory and endocrine signaling. However, across studies, findings are highly variable, making it unclear whether biomarker changes are due to a coherent biological state that changes according to context or unrelated heterogeneity. Thus, this study aimed to evaluate whether PTSD is characterized by an integrated, between-system pattern of biological dysregulation that contributes to the experiential outcomes noted in PTSD. A meta-analysis was conducted on immune (IL-6, TNF-α) and endocrine markers (cortisol), along with a qualitative structured synthesis of other markers, such as ACTH. Results indicated that PTSD is characterized by a system-level pattern of dysregulation across interacting biological systems, including consistent inflammatory activation alongside variable endocrine regulatory control. Mechanistically, this pattern is consistent with increased excitatory signaling paired with unstable regulation, which may disrupt neural integration processes that enable experiences to be encoded as self-authored, which becomes particularly notable when applied to sexual experiences. Accordingly, the occurrence of a physical act alone may be insufficient to determine whether an experience was “had” in the sense of being encoded as self-authored and owned. This study thus highlights the importance of internal biological state in shaping conscious experiential outcomes, and in informing the terms used to define those outcomes, such as virginity and its loss.