Research analysis

Reduced anterior cingulate and orbitofrontal volumes in child abuse-related complex PTSD.

Thomaes K, Dorrepaal E, Draijer N, de Ruiter MB, van Balkom AJ, Smit JH, Veltman DJ. Journal of clinical psychiatry
2010; 71(12):1636-1644

https://europepmc.org/abstract/med/20673548

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: Measuring gray matter concentrations in referred outpatients with child abuse-related complex PTSD (n = 31) compared to matched healthy nontraumatized controls (n = 28).

RESULTS: As was hypothesized, patients with child abuse-related complex PTSD showed reductions in gray matter concentration in right hippocampus (P(SVC corrected) = .04) and right dorsal ACC (P(SVC corrected) = .02) compared to controls. In addition, a reduction in gray matter concentration in the right orbitofrontal cortex (OFC) was found. 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.

What does this research study show us?

Important conclusions:

  • Individuals with child-abuse related complex PTSD show reductions in grey matter concentration in brain in these areas:
    • Right hippocampus,
    • Right dorsal ACC and
    • Right orbitofrontal cortex (OFC)
  • Impulsivity correlates negatively with hippocampus volume
  • Anger correlates negatively with hippocampus and OFC volume
  • Comorbidity of borderline personality disorder meant more extensive correlations with ACC and OFC volume
  • Complex PTSD affects the hippocampus, ACC and OFC
  • This neural impact of Complex PTSD is more severe than classic PTSD
  • These effects are seen even without comorbid borderline personality disorder diagnosis

So, the effects are worse if individuals were also diagnosed with comorbid borderline personality disorder. But the effects were otherwise present (and still more so than classic PTSD) in individuals without this diagnosis.

If those both with and without this BPD diagnosis have the same neurological symptoms, then the common correlate is trauma, not the BPD diagnosis.

This is evidence that the borderline personality disorder diagnosis is a meaningless social construct which further serves to re-traumatise survivors of complex childhood trauma.

To explain the fact that those with a BPD diagnosis have markedly more volume differences than those without, we could consider the fact that these individuals’ trauma experiences (perhaps they were more severe; perhaps they were women more likely to be diagnosed with BPD than PTSD; or simply lived in an area with better access to services) led them to try and access help from the mental health system, which gave them their diagnosis of BPD.

Given what we know about the stigma attached to this diagnosis and the lack of a trauma-informed approach within the mental health system, it’s a likely theory that the individuals diagnosed with BPD have higher correlates because they have been diagnosed with BPD. This diagnosis has caused them more trauma to add to their complex trauma.

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