Trauma-specific Grey Matter Alterations in PTSD.

Linghui Meng,Jing Jiang,Jia Liu,Qiyong Gong,Youjin Zhao,Weina Wang,Changfeng Jin,Kaiming Li

doi:10.1038/srep33748

Abstract

Previous studies have demonstrated that patients with posttraumatic stress disorder (PTSD) caused by different types of trauma may show divergence in epidemiology, clinical manifestation and treatment outcome. However, it is still unclear whether this divergence has neuroanatomic correlates in PTSD brains. To elucidate the general and trauma-specific cortical morphometric alterations, we performed a meta-analysis of grey matter (GM) changes in PTSD (N = 246) with different traumas and trauma-exposed controls (TECs, N = 347) using anisotropic effect-size signed differential mapping and its subgroup analysis. Our results revealed general GM reduction (GMR) foci in the prefrontal-limbic-striatal system of PTSD brains when compared with those of TECs. Notably, the GMR patterns were trauma-specific. For PTSD by single-incident traumas, GMR foci were found in bilateral medial prefrontal cortex (mPFC), anterior cingulate cortex (ACC), insula, striatum, left hippocampus and amygdala; and for PTSD by prolonged traumas in the left insula, striatum, amygdala and middle temporal gyrus. Moreover, Clinician-Administered PTSD Scale scores were found to be negatively associated with the GM changes in bilateral ACC and mPFC. Our study indicates that the GMR patterns of PTSD are associated with specific traumas, suggesting a stratified diagnosis and treatment for PTSD patients.

Highlights

Posttraumatic stress disorder (PTSD) is the only major mental disorder with a known cause, i.e., an event that threatens one’s physical integrity or that of others[1]
When compared with trauma-exposed controls (TECs), posttraumatic stress disorder (PTSD) patients by fire disasters showed grey matter (GM) reductions (GMRs) in the left hippocampus[18], while GMRs were observed in the left middle temporal gyrus (MTG) of PTSD patients by combats[19]
The long-term repeated exposure to different kinds of trauma may impair memory processing in the patients, as shown by the GMR in MTG. All these results indicate that PTSD by prolonged traumas exhibits a very different GMR pattern compared with single-incident induced ones, suggesting different neural mechanism may underlie PTSD by prolonged traumas

Summary

Introduction

Posttraumatic stress disorder (PTSD) is the only major mental disorder with a known cause, i.e., an event that threatens one’s physical integrity or that of others[1]. Examples of traumatic events are natural disasters, accidents, combats, childhood abuse, sexual abuse and indirect exposure by learning that a close relative or a friend was exposed to trauma[2]. For PTSD patients by prolonged traumas, the treatment of dissociation and interpersonal problems may be the first priority, rather than focusing on the impact of specific past events and the processing of specific traumatic memories in general PTSD patients[4] These accumulated pieces of evidence indicate that there might be different areas of brain alterations or even mechanisms underlying PTSD by different kinds of trauma. We in this study performed a VBM meta-analysis on GM changes of different PTSD subtypes, i.e., single-incident vs prolonged trauma types[4,5,6]. Association between GM alterations and Clinician-Administered PTSD Scale (CAPS) scores were investigated

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