Reduced Anterior Cingulate and Orbitofrontal Volumes in Child Abuse–Related Complex PTSD
J Clin Psychiatry 2010;71(12):1636-1644
© Copyright 2014 Physicians Postgraduate Press, Inc.
Purchase This PDF for $40.00
If you are not a paid subscriber, you may purchase the PDF.
(You'll need the free Adobe Acrobat Reader.)
Receive immediate full-text access to JCP. You can subscribe to JCP online-only ($86) or print + online ($156 individual).
With your subscription, receive a free PDF collection of the NCDEU Festschrift articles. Hurry! This offer ends December 31, 2011.
If you are a paid subscriber to JCP and do not yet have a username and password, activate your subscription now.
As a paid subscriber who has activated your subscription, you have access to the HTML and PDF versions of this item.
Click here to login.
Did you forget your password?
Still can't log in? Contact the Circulation Department at 1-800-489-1001 x4 or send email
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.
Method: 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 (PSVC corrected = .04) and right dorsal ACC (PSVC 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.
J Clin Psychiatry
Submitted: September 26, 2008; accepted July 7, 2009.
Online ahead of print: July 13, 2010 (doi:10.4088/JCP.08m04754blu).
Corresponding author: Kathleen Thomaes, MD, GGZ Ingeest, Department of Psychiatry, VU University Medical Center, A J Ernststraat 887, 1081 HL Amsterdam, The Netherlands (email@example.com).