Hostname: page-component-7b7567c8c-tnzcf Total loading time: 0 Render date: 2026-11-15T04:24:47.799Z Has data issue: false hasContentIssue false
  • English
  • Français

Association between flashbacks and structural brain abnormalities in posttraumatic stress disorder

Published online by Cambridge University Press:  16 April 2020

M.C.W. Kroes,
M.G. Whalley,
M.D. Rugg and
C.R. Brewin
M.C.W. Kroes
Affiliation:
Donders Institute for Brain, Cognition and Behaviour, Kapittelweg 29, 6525 ENNijmegen, The Netherlands
M.G. Whalley
Affiliation:
Clinical, Educational & Health Psychology, University College London, Gower Street, LondonWC1E 6BT, UK
M.D. Rugg
Affiliation:
Center for the Neurobiology of Learning and Memory, University of California, Irvine, CA92697, USA
C.R. Brewin*
Affiliation:
Clinical, Educational & Health Psychology, University College London, Gower Street, LondonWC1E 6BT, UK
*
*Corresponding author. Tel.: +44 207 679 5927. E-mail address: c.brewin@ucl.ac.uk (C.R. Brewin).
Get access

Abstract

Objective

Posttraumatic stress disorder (PTSD) is reliably associated with reduced brain volume relative to healthy controls, in areas similar to those found in depression. We investigated whether in a PTSD sample brain volumes in these areas were related to reporting specific symptoms of PTSD or to overall symptom severity.

Method

Structural MRI scans were obtained from 28 participants diagnosed with PTSD according to DSM-IV-TR. Participants reported the extent of individual PTSD symptoms using the Posttraumatic Diagnostic Scale. Voxel-based morphometry applying the Dartel algorithm implemented within SPM5 was used to identify volumetric changes, related to PTSD total, symptom cluster, and individual symptom scores.

Results

Brain volume was unrelated to overall PTSD severity, but greater reexperiencing scores predicted reduced volumes in the middle temporal and inferior occipital cortices. Increased reports of flashbacks predicted reduced volume in the insula/parietal operculum and in the inferior temporal gyrus.

Conclusion

The data illustrate the value of analyses at the symptom level within a patient population to supplement group comparisons of patients and healthy controls. Areas identified were consistent with a neurobiological account of flashbacks implicating specific abnormalities in the ventral visual stream.

Keywords

PTSDMRITraumaFlashbacksVBMNeurocircuitry

Information

Type
Original article
Information
European Psychiatry , Volume 26 , Issue 8 , November 2011, pp. 525 - 531
Copyright
Copyright © Elsevier Masson SAS 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Ashburner, JA fast diffeomorphic image registration algorithm. Neuroimage 2007; 38: 95–113.CrossRefGoogle ScholarPubMed
Beck, AT, Epstein, N, Brown, G, Steer, RAAn inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 1988; 56: 893–897.CrossRefGoogle ScholarPubMed
Beck, AT, Steer, RA, Brown, GKManual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation; 1996Google Scholar
Bergouignan, L, Chupin, M, Czechowska, Y, Kinkingnéhun, S, Lemogne, C, Le Bastard, G, et al.Can voxel-based morphometry, manual segmentation and automated segmentation equally detect hippocampal volume differences in acute depression? Neuroimage 2009; 45: 29–37.CrossRefGoogle ScholarPubMed
Bisby, JA, King, JA, Brewin, CR, Burgess, N, Curran, HVAcute effects of alcohol on intrusive memory development and viewpoint dependence in spatial memory support a dual representation model. Biol Psychiatry 2010; 68: 280–286.CrossRefGoogle ScholarPubMed
Bluhm, RL, Williamson, PC, Osuch, EA, Frewen, PA, Stevens, TK, Boksman, K, et al.Alterations in default network connectivity in posttraumatic stress disorder related to early-life trauma. J Psychiatry Neurosci 2009; 34: 187–194.Google ScholarPubMed
Brewin, CR, Dalgleish, T, Joseph, SA dual representation theory of posttraumatic stress disorder. Psychol Rev 1996; 103: 670–686.CrossRefGoogle ScholarPubMed
Brewin, CRA cognitive neuroscience account of posttraumatic stress disorder and its treatment. Behav Res Ther 2001; 39: 373–393.CrossRefGoogle ScholarPubMed
Brewin, CR, Lanius, R, Novac, A, Schnyder, U, Galea, SReformulating PTSD for DSM-V: life after criterion A. J Trauma Stress 2009; 22: 366–373.CrossRefGoogle ScholarPubMed
Brewin, CR, Gregory, JD, Lipton, M, Burgess, NIntrusive images in psychological disorders: characteristics, neural mechanisms, and treatment implications. Psychol Rev 2010; 117: 210–232.CrossRefGoogle ScholarPubMed
Burgess, N, Becker, S, King, JA, O’Keefe, JMemory for events and their spatial context: models and experiments. Philos Trans R Soc Lond B Biol Sci 2001; 356: 1493–1503.CrossRefGoogle ScholarPubMed
Byrne, P, Becker, S, Burgess, NRemembering the past and imagining the future: a neural model of spatial memory and imagery. Psychol Rev 2007; 114: 340–375.CrossRefGoogle ScholarPubMed
Chen, S, Xia, W, Li, L, Liu, J, He, Z, Zhang, Z, et al.Gray matter density reduction in the insula in fire survivors with posttraumatic stress disorder: a voxel-based morphometric study. Psychiatry Res Neuroimaging 2006; 146: 65–72.CrossRefGoogle ScholarPubMed
Corbo, V, Clément, M.-H., Armony, JL, Pruessner, JC, Brunet, ASize versus shape differences: contrasting voxel-based and volumetric analyses of the anterior cingulate cortex in individuals with acute posttraumatic stress disorder. Biol Psychiatry 2005; 58: 119–124.CrossRefGoogle ScholarPubMed
Deichmann, R, Good, CD, Josephs, O, Ashburner, J, Turner, ROptimization of 3D MP-RAGE sequences for structural brain imaging. Neuroimage 2000; 12: 112–127.CrossRefGoogle Scholar
Deichmann, R, Good, CD, Turner, RRF inhomogeneity compensation in structural brain imaging. Magn Reson Med 2002; 47: 398–402.CrossRefGoogle ScholarPubMed
Deichmann, R, Schwarzbauer, C, Turner, ROptimisation of the 3D MDEFT sequence for anatomical brain imaging: technical implications at 1.5 and 3T. Neuroimage 2004; 21: 757–767.CrossRefGoogle Scholar
Drevets, W, Price, J, Furey, MBrain structural and functional abnormalities in mood disorders: implications for neurocircuitry models of depression. Brain Struct Funct 2008; 213: 93–118.CrossRefGoogle ScholarPubMed
Drevets, W, Savitz, J, Trimble, MThe subgenual anterior cingulate cortex in mood disorders. CNS Spectr 2008; 13: 663–681.CrossRefGoogle ScholarPubMed
Elzinga, BM, Bremner, JDAre the neural substrates of memory the final common pathway in posttraumatic stress disorder (PTSD)? J Affect Disord 2002; 70: 1–17.CrossRefGoogle ScholarPubMed
First, MB, Williams, JB, Spitzer, RL, Structured Clinical Interview For DSM-IV Axis I Disorders (SCID-I), Clinician Version. American Psychiatric Publishing, Inc.; 1997.Google Scholar
Foa, E, Cashman, L, Jaycox, L, Perry, KThe validation of a self-report measure of PTSD: the Posttraumatic Diagnostic Scale. Psychol Assess 1997; 9: 445–451.CrossRefGoogle Scholar
Gilbertson, MW, Williston, SK, Paulus, LA, Lasko, NB, Gurvits, TV, Shenton, ME, et al.Configural cue performance in identical twins discordant for posttraumatic stress disorder: theoretical implications for the role of hippocampal function. Biol Psychiatry 2007; 62: 513–520.CrossRefGoogle ScholarPubMed
Gold, BT, Balota, DA, Kirchhoff, BA, Buckner, RLCommon and dissociable activation patterns associated with controlled semantic and phonological processing: evidence from fMRI adaptation. Cereb Cortex 2005; 15: 1438–1450.CrossRefGoogle ScholarPubMed
Graham, KS, Lee, A.C.H., Brett, M, Patterson, KThe neural basis of autobiographical and semantic memory: new evidence from three PET studies. Cogn Affect Behav Neurosci 2003; 3: 234–254.CrossRefGoogle ScholarPubMed
Hayasaka, S, Phan, KL, Liberzon, I, Worsley, KJ, Nichols, TENonstationary cluster-size inference with random field and permutation methods. Neuroimage 2004; 22: 676–687.CrossRefGoogle ScholarPubMed
Hopper, JW, Frewen, PA, van der Kolk, BA, Lanius, RANeural correlates of reexperiencing, avoidance, and dissociation in PTSD: symptom dimensions and emotion dysregulation in responses to script-driven trauma imagery. J Trauma Stress 2007; 20: 713–725.CrossRefGoogle ScholarPubMed
Karl, A, Schaefer, M, Malta, LS, Dörfel, D, Rohleder, N, Werner, AA meta-analysis of structural brain abnormalities in PTSD. Neurosci Biobehav Rev 2006; 30: 1004–1031.CrossRefGoogle ScholarPubMed
Kasai, K, Yamasue, H, Gilbertson, MW, Shenton, M, Rauch, SL, Pitman, RKEvidence for acquired pregenual anterior cingulate gray matter loss from a twin study of combat-related posttraumatic stress disorder. Biol Psychiatry 2008; 63: 550–556.CrossRefGoogle ScholarPubMed
Kitayama, N, Quinn, S, Bremner, JDSmaller volume of anterior cingulate cortex in abuse-related posttraumatic stress disorder. J Affect Disord 2006; 90: 171–174.CrossRefGoogle ScholarPubMed
Klein, A, Andersson, J, Ardekani, B, Ashburner, J, Avants, B, Chiang, M, et al.Evaluation of 14 nonlinear deformation algorithms applied to human brain MRI registration. Neuroimage 2009; 46: 786–802.CrossRefGoogle ScholarPubMed
Lanius, R, Bluhm, R, Lanius, U, Pain, CA review of neuroimaging studies in PTSD: heterogeneity of response to symptom provocation. J Psychiatr Res 2006; 40: 709–729.CrossRefGoogle ScholarPubMed
Ludascher, P, Valerius, G, Stiglmayr, C, Mauchnik, J, Lanius, RA, Bohus, M, et al.Pain sensitivity and neural processing during dissociative states in patients with borderline personality disorder with and without comorbid posttraumatic stress disorder: a pilot study. J Psychiatry Neurosci 2010; 35: 177–184.CrossRefGoogle ScholarPubMed
Michael, T, Ehlers, A, Halligan, SL, Clark, DMUnwanted memories of assault: what intrusion characteristics are associated with PTSD? Behav Res Ther 2005; 43: 613–628.CrossRefGoogle ScholarPubMed
Moorhead, T.W.J., Job, DE, Spencer, MD, Whalley, HC, Johnstone, EC, Lawrie, SMEmpirical comparison of maximal voxel and non-isotropic adjusted cluster extent results in a voxel-based morphometry study of comorbid learning disability with schizophrenia. Neuroimage 2005; 28: 544–552.CrossRefGoogle Scholar
North, CS, Suris, AM, Davis, M, Smith, RPToward validation of the diagnosis of posttraumatic stress disorder. Am J Psychiatry 2009; 166: 34–41.CrossRefGoogle Scholar
Osuch, EA, Benson, B, Geraci, M, Podell, D, Herscovitch, P, McCann, UD, et al.Regional cerebral blood flow correlated with flashback intensity in patients with posttraumatic stress disorder. Biol Psychiatry 2001; 50: 246–253.CrossRefGoogle ScholarPubMed
Rauch, SL, Shin, LM, Whalen, PJ, Pitman, RKNeuroimaging and the neuroanatomy of PTSD. CNS Spectr 1998; 3: 30–41.CrossRefGoogle Scholar
Rauch, SL, Shin, LM, Segal, E, Pitman, RK, Carson, MA, McMullin, K, et al.Selectively reduced regional cortical volumes in post-traumatic stress disorder. Neuroreport 2003; 14: 913–916.CrossRefGoogle ScholarPubMed
Rauch, SL, Shin, LM, Phelps, EANeurocircuitry models of posttraumatic stress disorder and extinction: human neuroimaging research – Past, present, and future. Biol Psychiatry 2006; 60: 376–382.CrossRefGoogle ScholarPubMed
Smith, MEBilateral hippocampal volume reduction in adults with post-traumatic stress disorder: a meta-analysis of structural MRI studies. Hippocampus 2005; 15: 798–807.CrossRefGoogle ScholarPubMed
Ugurbil, K, Garwood, M, Ellermann, J, Hendrich, K, Hinke, R, Hu, X, et al.Imaging at high magnetic fields: initial experiences at 4T. Magn Reson Q 1993; 9: 259–277.Google Scholar
Whalley, MG, Farmer, E, Brewin, CRPain flashbacks following the July 7th 2005 London bombings. Pain 2007; 132: 332–336.CrossRefGoogle ScholarPubMed
Woodward, SH, Kaloupek, DG, Streeter, CC, Martinez, C, Schaer, M, Eliez, SDecreased anterior cingulate volume in combat-related PTSD. Biol Psychiatry 2006; 59: 582–587.CrossRefGoogle ScholarPubMed
Worsley, KJ, Andermann, M, Koulis, T, MacDonald, D, Evans, ACDetecting changes in nonisotropic images. Hum Brain Mapp 1999; 8: 98–101.3.0.CO;2-F>CrossRefGoogle ScholarPubMed
Yamasue, H, Kasai, K, Iwanami, A, Ohtani, T, Yamada, H, Abe, O, et al.Voxel-based analysis of MRI reveals anterior cingulate gray-matter volume reduction in posttraumatic stress disorder due to terrorism. PNAS 2003; 100: 9039–9043.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.