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Original Research

Reduced Anterior Cingulate and Orbitofrontal Volumes in Child Abuse-Related Complex PTSD

Kathleen Thomaes, MD; Ethy Dorrepaal, MD; Nel Draijer, PhD; Michiel B. de Ruiter, PhD; Anton J. van Balkom, PhD; Johannes H. Smit, PhD; and Dick J. Veltman, PhD

Published: July 13, 2010

Article Abstract

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 (

Volume: 71

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