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The distinctive neural circuitry of complex posttraumatic stress disorder during threat processing

Published online by Cambridge University Press:  08 January 2020

Richard A. Bryant Open the ORCID record for Richard A. Bryant [Opens in a new window] ,
Kim L. Felmingham ,
Gin Malhi ,
Elpiniki Andrew  and
Mayuresh S. Korgaonkar
Richard A. Bryant*
Affiliation:
School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia Brain Dynamics Centre, Westmead Institute of Medical Research, University of Sydney, Westmead, Australia
Kim L. Felmingham
Affiliation:
Department of Psychological Medicine, University of Melbourne, Melbourne, Australia
Gin Malhi
Affiliation:
Department of Psychiatry, University of Sydney, Sydney, Australia
Elpiniki Andrew
Affiliation:
School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia Brain Dynamics Centre, Westmead Institute of Medical Research, University of Sydney, Westmead, Australia
Mayuresh S. Korgaonkar
Affiliation:
Brain Dynamics Centre, Westmead Institute of Medical Research, University of Sydney, Westmead, Australia Department of Psychiatry, University of Sydney, Sydney, Australia
*
Author for correspondence: Richard A. Bryant, E-mail: [email protected]
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Abstract

Background

There is controversy over the extent to which the new International Classification of Diseases (ICD-11) diagnosis of complex posttraumatic stress disorder (CPTSD) is distinct from posttraumatic stress disorder (PTSD). This study aimed to conduct the first investigation of distinctive neural processes during threat processing in CPTSD relative to PTSD.

Method

This cross-sectional functional magnetic resonance study included 99 participants who met criteria for PTSD (PTSD = 32, CPTSD = 28) and 39 trauma-exposed controls. PTSD was assessed with the Clinician-Administered PTSD Scale (CAPS). CPTSD was assessed with an adapted version of the International Trauma Questionnaire. Neural responses were measured across the brain while threat or neutral faces were presented at both supraliminal and subliminal levels.

Results

During supraliminal presentations of threat stimuli, there was greater bilateral insula and right amygdala activation in CPTSD participants relative to PTSD. Reduced supraliminal right dorsolateral prefrontal cortex activation and increased subliminal amygdala and insula activation were observed as common dysfunction for both CPTSD and PTSD groups relative to trauma controls. There were no significant differences in terms of subliminal presentations and no differences in functional connectivity. Dissociative responses were positively associated with right insula activation (r = 0.347, p < 0.01).

Conclusions

These results provide the first evidence of distinct neural profiles of CPTSD and PTSD during threat processing. The observation of increased insula and right amygdala activation in CPTSD accords with the proposal that CPTSD is distinguished from PTSD by disturbances in emotion regulation and self-concept.

Keywords

Complex posttraumatic stress disorderemotion processingfunctional magnetic resonance imagingposttraumatic stress disorder
Type
Original Article
Information
Psychological Medicine , Volume 51 , Issue 7 , May 2021 , pp. 1121 - 1128
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Copyright
Copyright © Cambridge University Press 2020

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