Key result
PTSD is linked to small, variable alterations in HRV compared to controls.
Why the study?
Although heart rate variability has long been believed to reflect autonomic nervous system function and alterations in PTSD, recent evidence does not support this association.
Current evidence does not support the use of heart rate variability as a standalone clinical or screening tool for assessing posttraumatic stress disorder due to methodological limitations and inconsistent results.
HRV should not guide PTSD assessment or monitoring; challenges autonomic proxy assumptions but leaves clinical utility open.
Posttraumatic stress disorder (PTSD) has been associated with alterations in heart rate variability (HRV) following exposure to potentially psychologically traumatic events . HRV has long been widely believed to reflect the autonomic nervous system (ANS) and associated modulatory cardiac impacts; however, recent evidence does not support the association. The current narrative review evaluates the current literature on HRV in relation to PTSD and other posttraumatic stress injuries (PTSI), focusing solely on empirically observed changes in HRV metrics, independent of unverified physiological interpretations. The current review highlights substantial methodological heterogeneity, inconsistent measurement approaches, and the lack of longitudinal data needed to establish causality. Results suggest that, while HRV is altered in individuals with PTSD compared to controls, the differences are small, variable, and context dependent. Substantial limitations in measurement reliability and interpretive validity preclude recommending HRV as a standalone clinical or screening tool for assessing PTSI currently. Furthermore, the HRV results should be discussed as a direct measure of a physiological signal, not as a theoretical ANS construct.
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Neary et al. (2026) conducted a review in Posttraumatic stress disorder (PTSD). Heart rate variability (HRV) vs. Controls was evaluated on Alterations in HRV metrics. Heart rate variability is altered in individuals with PTSD compared to controls, but the differences are small, variable, and context dependent.
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