title: Effect of direct eye contact in PTSD related to interpersonal trauma: an fMRI study of activation of an innate alarm system.
abstract: In healthy individuals, direct eye contact initially leads to activation of a fast subcortical pathway, which then modulates a cortical route eliciting social cognitive processes. The aim of this study was to gain insight into the neurobiological effects of direct eye-to-eye contact using a virtual reality paradigm in individuals with posttraumatic stress disorder (PTSD) related to prolonged childhood abuse. We examined 16 healthy comparison subjects and 16 patients with a primary diagnosis of PTSD using a virtual reality functional magnetic resonance imaging paradigm involving direct vs averted gaze (happy, sad, neutral) as developed by Schrammel et al. in 2009. Irrespective of the displayed emotion, controls exhibited an increased blood oxygenation level-dependent response during direct vs averted gaze within the dorsomedial prefrontal cortex, left temporoparietal junction and right temporal pole. Under the same conditions, individuals with PTSD showed increased activation within the superior colliculus (SC)/periaqueductal gray (PAG) and locus coeruleus. Our findings suggest that healthy controls react to the exposure of direct gaze with an activation of a cortical route that enhances evaluative 'top-down' processes underlying social interactions. In individuals with PTSD, however, direct gaze leads to sustained activation of a subcortical route of eye-contact processing, an innate alarm system involving the SC and the underlying circuits of the PAG.
authors.affiliation: LHSC-UH, 339 Windermere Road, PO Box 5339, London, Ontario, Canada N6A 5A5. ruth.lanius@lhsc.on.ca.
authors.forename: Carolin
authors.initials: C
authors.lastname: Steuwe
authors.forename: Judith K
authors.initials: JK
authors.lastname: Daniels
authors.forename: Paul A
authors.initials: PA
authors.lastname: Frewen
authors.forename: Maria
authors.initials: M
authors.lastname: Densmore
authors.forename: Sebastian
authors.initials: S
authors.lastname: Pannasch
authors.forename: Thomas
authors.initials: T
authors.lastname: Beblo
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Reiss
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Lanius
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001921:Brain / Q000098:blood supply / Q000503:physiopathology*; D004644:Emotions / Q000502:physiology; D005123:Eye; D005149:Facial Expression; D005260:Female; D006801:Humans; D007323:Instinct; D007398:Interpersonal Relations; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D013313:Stress Disorders, Post-Traumatic / Q000473:pathology / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult