Neural correlates of memories of childhood sexual abuse in women with and without posttraumatic stress disorder

Abstract

Objective: Childhood sexual abuse is very common in our society, but little is known about the long-term effects of abuse on brain function. The purpose of this study was to measure neural correlates of memories of childhood abuse in sexually abused women with and without the diagnosis of posttraumatic stress disorder (PTSD).

Method: Twenty-two women with a history of childhood sexual abuse underwent injection of [15O]H2O, followed by positron emission tomography imaging of the brain while they listened to neutral and traumatic (personalized childhood sexual abuse events) scripts. Brain blood flow during exposure to traumatic and neutral scripts was compared for sexually abused women with and without PTSD.

Results: Memories of childhood sexual abuse were associated with greater increases in blood flow in portions of anterior prefrontal cortex (superior and middle frontal gyri-areas 6 and 9), posterior cingulate (area 31), and motor cortex in sexually abused women with PTSD than in sexually abused women without PTSD. Abuse memories were associated with alterations in blood flow in medial prefrontal cortex, with decreased blood flow in subcallosal gyrus (area 25), and a failure of activation in anterior cingulate (area 32). There was also decreased blood flow in right hippocampus, fusiform/inferior temporal gyrus, supramarginal gyrus, and visual association cortex in women with PTSD relative to women without PTSD.

Conclusions: These findings implicate dysfunction of medial prefrontal cortex (subcallosal gyrus and anterior cingulate), hippocampus, and visual association cortex in pathological memories of childhood abuse in women with PTSD. Increased activation in posterior cingulate and motor cortex was seen in women with PTSD. Dysfunction in these brain areas may underlie PTSD symptoms provoked by traumatic reminders in subjects with PTSD.

FIGURE 1. PTSD Symptom Scale Scores for Women With and Without PTSD During Baseline and During Readings of Neutral Scripts and Scripts Related to Their Sexual Abuse During Childhood

^a There was a significant increase in PTSD symptoms during the traumatic scripts in women with PTSD relative to women without PTSD (group-by-time interaction: F=7.88, df=4, 80, p<0.001).

FIGURE 2. Statistical Parametric Map Overlaid on a Magnetic Resonance Image Template of Areas of Significant Interaction Between PTSD Diagnosis and Condition, Showing Areas of Relative Increase in PTSD^a

^a Areas of yellow and white represent regions in which there were significant interactions between condition (traumatic versus neutral) and group (PTSD versus non-PTSD) (z score>3.09; N=88; p<0.001). Greater increases in blood flow were seen in superior and middle frontal gyrus (areas 6 and 9), posterior cingulate, and motor cortex in women with PTSD than in women without PTSD.

FIGURE 3. Statistical Parametric Map Overlaid on a Magnetic Resonance Image Template of Areas of Significant Interaction Between PTSD Diagnosis and Condition, Showing Areas of Relative Decrease in PTSD^a

^a Areas of yellow and white represent regions in which there were significant interactions between condition (traumatic versus neutral) and group (PTSD versus non-PTSD) (z score>3.09; N=88; p<0.001). There were greater decreases in blood flow in medial prefrontal cortex (including subcallosal gyrus [area 25] and a portion of anteromedial frontal [orbitofrontal] cortex) in women with PTSD than in women without PTSD. Decreases were also seen in visual association cortex, right insula/inferior frontal gyrus, fusiform gyrus, and right hippocampus region (z score>3.09, N=88, p<0.001).