title: History of childhood maltreatment augments dorsolateral prefrontal processing of emotional valence in PTSD.
abstract: Posttraumatic stress disorder (PTSD) is characterized by conflicting findings of both increased and decreased amygdala and prefrontal reactivity to threat or trauma stimuli. Childhood maltreatment (CM), a potent risk factor for PTSD, exerts long-lasting influences on threat processing and prefrontal-amygdala function. This suggests that CM history may influence PTSD neural phenotypes related to threat processing. Here, we adapt a well-characterized emotional conflict paradigm to investigate CM effects on both emotional conflict and emotional valence processing within PTSD stratified by task relevance. Forty-two individuals with PTSD (22 reporting extensive CM history (PTSD-CM)) and 20 trauma-exposed healthy controls (TEHCs) underwent functional magnetic resonance imaging while identifying affect of emotional faces (fear and happy) overlaid with a goal-irrelevant emotional distractor word ("FEAR" or "HAPPY"). We examined effects of CM on conflict, conflict adaptation, valence-related activation (fear vs. happy) for goal-relevant (face) and goal-irrelevant stimuli (word), and valence effects in interaction with goal-relevancy (face vs. word). Though no activation differences between groups were observed for conflict contrasts nor for valence effects in the amygdala, CM status interacted with valence processing differences as a function of goal relevance in the left dorsolateral prefrontal cortex (dlPFC). Here, PTSD-CM displayed greater activation relative to PTSD to negative valence when stimuli were goal-irrelevant. CM history also moderated relationships between activation abnormalities and PTSD re-experiencing symptoms. These findings provide initial evidence that CM history augments dorsolateral prefrontal bias to implicitly processed stimulus valence in PTSD.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Palo Alto, 94305 CA, USA; Stanford Neurosciences Institute, Stanford University, 318 Campus Drive, Suite S170, Stanford 94305 CA, USA; Veterans Affairs Palo Alto Healthcare System, The Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), 3801 Miranda Avenue, Palo Alto, 94304 CA, USA.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Fonzo
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Palo Alto, 94305 CA, USA; Stanford Neurosciences Institute, Stanford University, 318 Campus Drive, Suite S170, Stanford 94305 CA, USA; Veterans Affairs Palo Alto Healthcare System, The Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), 3801 Miranda Avenue, Palo Alto, 94304 CA, USA; Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
authors.forename: Julia
authors.initials: J
authors.lastname: Huemer
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Palo Alto, 94305 CA, USA; Stanford Neurosciences Institute, Stanford University, 318 Campus Drive, Suite S170, Stanford 94305 CA, USA; Veterans Affairs Palo Alto Healthcare System, The Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), 3801 Miranda Avenue, Palo Alto, 94304 CA, USA. Electronic address: amitetkin@stanford.edu.
authors.forename: Amit
authors.initials: A
authors.lastname: Etkin
mesh_terms: D000328:Adult; D054523:Adult Survivors of Child Abuse; D004644:Emotions / Q000502:physiology*; D005149:Facial Expression; D005260:Female; D059907:Functional Neuroimaging / Q000379:methods*; D006040:Goals; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017397:Prefrontal Cortex / Q000503:physiopathology*; D013313:Stress Disorders, Post-Traumatic / Q000503:physiopathology*
keywords: Childhood maltreatment; PTSD; Valence; fMRI