Reduced anterior cingulate and orbitofrontal volumes in child abuse-related complex PTSD.
OBJECTIVE
Classic posttraumatic stress disorder (PTSD) is associated with smaller hippocampus, amygdala, and anterior cingulate cortex (ACC) volumes. We investigated whether child abuse-related complex PTSD--a severe form of PTSD with affect dysregulation and high comorbidity--showed similar brain volume reductions.


METHODS
We used voxel-based morphometry to measure gray matter concentrations in referred outpatients with child abuse-related complex PTSD (n = 31) compared to matched healthy nontraumatized controls (n = 28). Complex PTSD was diagnosed using the Structured Clinical Interview for DSM-IV-TR and the Structured Clinical Interview for Disorders of Extreme Stress. All respondents were scanned on a 1.5-T magnetic resonance system at the VU Medical Center, Amsterdam, The Netherlands, between September 2005 and February 2006.


RESULTS
As was hypothesized, patients with child abuse-related complex PTSD showed reductions in gray matter concentration in right hippocampus (P(SVC corrected) = .04) and right dorsal ACC (P(SVC corrected) = .02) compared to controls. In addition, a reduction in gray matter concentration in the right orbitofrontal cortex (OFC) was found. Severity of child abuse and PTSD-hyperarousal correlated negatively with ACC volume. Impulsivity correlated negatively with hippocampus volume, and anger, with hippocampus and OFC volume. Comorbidity of borderline personality disorder--compared to comorbid cluster C personality disorder--accounted for more extensive reductions in the ACC and OFC volume.


CONCLUSIONS
In complex PTSD, not only the hippocampus and the ACC but also the OFC seem to be affected, even in the absence of comorbid borderline personality disorder. These results suggest that neural correlates of complex PTSD are more severe than those of classic PTSD.
Thomaes
Kathleen
K
GGZ Ingeest, Department of Psychiatry, VU University Medical Center, A J Ernststraat 887, 1081 HL Amsterdam, The Netherlands. k.thomaes@vumc.nl
Dorrepaal
Ethy
E
Draijer
Nel
N
de Ruiter
Michiel B
MB
van Balkom
Anton J
AJ
Smit
Johannes H
JH
Veltman
Dick J
DJ
D000328:Adult; D000786:Anger; D001883:Borderline Personality Disorder / Q000473:pathology; D016022:Case-Control Studies; D002540:Cerebral Cortex / Q000473:pathology; D002648:Child; D002649:Child Abuse / Q000523:psychology*; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005625:Frontal Lobe / Q000473:pathology*; D007839:Functional Laterality; D006179:Gyrus Cinguli / Q000473:pathology*; D006624:Hippocampus / Q000473:pathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007175:Impulsive Behavior / Q000453:epidemiology / Q000473:pathology / Q000523:psychology; D008279:Magnetic Resonance Imaging; D010554:Personality Disorders / Q000453:epidemiology / Q000473:pathology* / Q000523:psychology; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology*