The distinctive neural circuitry of complex posttraumatic stress disorder during threat processing
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.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
An fMRI investigation provided evidence of distinct neural profiles of complex PTSD and PTSD patients during processing of threatening stimuli, with increased insula and right amygdala activation in complex PTSD.
“A functional magnetic resonance imaging (fMRI) investigation 38 has provided evidence of distinct neural profiles of complex PTSD and PTSD patients during the processing of threatening stimuli, with increased insula and right amygdala activation in complex PTSD”
Cites
(1998) · The Journal of Clinical Psychiatry · Cited by 19,139 · see citing works
How do you feel — now? The anterior insula and human awareness
(Bud) Craig, A. D. (2009) · Nature Reviews Neuroscience · doi:10.1038/nrn2555 · Cited by 6,657 · see citing works
The development of a Clinician-Administered PTSD Scale
Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Gusman, F. D., Charney, D. S., & Keane, T. M. (1995) · Journal of Traumatic Stress · doi:10.1002/jts.2490080106 · Cited by 5,024 · see citing works
Neural systems supporting interoceptive awareness
Critchley, H. D., Wiens, S., Rotshtein, P., Öhman, A., & Dolan, R. J. (2004) · Nature Neuroscience · doi:10.1038/nn1176 · Cited by 3,406 · see citing works
Experimental and theoretical approaches to conscious processing
Dehaene, S., & Changeux, J.-P. (2011) · Neuron · doi:10.1016/j.neuron.2011.03.018 · Cited by 2,573 · see citing works
Subcortical and cortical brain activity during the feeling of self-generated emotions
Damasio, A. R., Grabowski, T. J., Bechara, A., Damasio, H., Ponto, L. L. B., Parvizi, J., & Hichwa, R. D. (2000) · Nature Neuroscience · doi:10.1038/79871 · Cited by 2,117 · see citing works
(2012) · Springer eBooks · doi:10.1007/springerreference_179754 · Cited by 2,095 · see citing works
Conscious, preconscious, and subliminal processing: a testable taxonomy
Dehaene, S., Changeux, J.-P., Naccache, L., Sackur, J., & Sergent, C. (2006) · Trends in Cognitive Sciences · doi:10.1016/j.tics.2006.03.007 · Cited by 2,067 · see citing works
Phelps, E. A., Delgado, M. R., Nearing, K. I., & LeDoux, J. E. (2004) · Neuron · doi:10.1016/j.neuron.2004.08.042 · Cited by 1,753 · see citing works
McLaren, D. G., Ries, M. L., Xu, G., & Johnson, S. C. (2012) · NeuroImage · doi:10.1016/j.neuroimage.2012.03.068 · Cited by 1,445 · see citing works
Cloitre, M., Shevlin, M., Brewin, C. R., Bisson, J. I., Roberts, N. P., Maercker, A., Karatzias, T., & Hyland, P. (2018) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12956 · Cited by 1,314 · see citing works
Fusar‐Poli, P., Placentino, A., Carletti, F., Landi, P., Allen, P., Surguladze, S., Benedetti, F., Abbamonte, M., Gasparotti, R., Barale, F., et al. (2009) · Journal of Psychiatry and Neuroscience · doi:10.1139/jpn.0953 · Cited by 1,292 · see citing works
Emotion Modulation in PTSD: Clinical and Neurobiological Evidence for a Dissociative Subtype
Lanius, R. A., Vermetten, E., Loewenstein, R. J., Brand, B., Schmahl, C., Bremner, J. D., & Spiegel, D. (2010) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2009.09081168 · Cited by 1,123 · see citing works
Shin, L. M., Wright, C. I., Cannistraro, P. A., Wedig, M. M., McMullin, K., Martis, B., Macklin, M. L., Lasko, N. B., Cavanagh, S. R., Krangel, T. S., et al. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.3.273 · Cited by 960 · see citing works
Bremner, J. D., Krystal, J. H., Putnam, F. W., Southwick, S. M., Marmar, C., Charney, D. S., & Mazure, C. M. (1998) · Journal of Traumatic Stress · doi:10.1023/a:1024465317902 · Cited by 817 · see citing works
Post-Traumatic Stress Disorder
Shalev, A. Y., Liberzon, I., & Marmar, C. R. (2017) · New England Journal of Medicine · doi:10.1056/nejmra1612499 · Cited by 799 · see citing works
A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD
Brewin, C. R., Cloitre, M., Hyland, P., Shevlin, M., Maercker, A., Bryant, R. A., Humayun, A., Jones, L. M., Kagee, A., Rousseau, C., et al. (2017) · Clinical Psychology Review · doi:10.1016/j.cpr.2017.09.001 · Cited by 678 · cited 2× · see citing works
“Individuals with CPTSD and BPD can be distinguished on the basis of their symptom profiles (Brewin et al., 2017), and so future studies could investigate differential neural patterns in individuals with BPD v.”
BackgroundSelf-citationFriedman, M. J., Resick, P. A., Bryant, R. A., & Brewin, C. R. (2011) · Depression and Anxiety · doi:10.1002/da.20767 · Cited by 629 · see citing works
Self-citationBehavioral problems after early life stress: contributions of the hippocampus and amygdala
Hanson, J. L., Nacewicz, B. M., Sutterer, M. J., Cayo, A. A., Schaefer, S. M., Rudolph, K. D., Shirtcliff, E. A., Pollak, S. D., & Davidson, R. J. (2015) · Biological Psychiatry · doi:10.1016/j.biopsych.2014.04.020 · Cited by 627 · see citing works
Distinguishing PTSD, Complex PTSD, and Borderline Personality Disorder: A latent class analysis
Cloitre, M., Garvert, D. W., Weiss, B., Carlson, E. B., & Bryant, R. A. (2014) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v5.25097 · Cited by 468 · see citing works
Self-citationHow the Neurocircuitry and Genetics of Fear Inhibition May Inform Our Understanding of PTSD
Jovanović, T., & Ressler, K. J. (2010) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2009.09071074 · Cited by 441 · see citing works
A critical evaluation of the complex PTSD literature: Implications for <i>DSM‐5</i>
Resick, P. A., Bovin, M. J., Calloway, A. L., Dick, A. M., King, M. W., Mitchell, K. S., Suvak, M. K., Wells, S. Y., Stirman, S. W., & Wolf, E. J. (2012) · Journal of Traumatic Stress · doi:10.1002/jts.21699 · Cited by 365 · see citing works
Karatzias, T., Shevlin, M. E., Fyvie, C., Hyland, P., Efthymiadou, E., Wilson, D., Roberts, N. P., Bisson, J. I., Brewin, C. R., & Cloître, M. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.09.032 · Cited by 365 · see citing works
Heightened neural reactivity to threat in child victims of family violence
McCrory, E. J., De Brito, S. A., Sebastian, C. L., Mechelli, A., Bird, G., Kelly, P. A., & Viding, E. (2011) · Current Biology · doi:10.1016/j.cub.2011.10.015 · Cited by 327 · see citing works
Neuronal correlates of cognitive reappraisal in borderline patients with affective instability
Schulze, L., Domes, G., Krüger, A., Berger, C., Fleischer, M., Prehn, K., Schmahl, C., Grossmann, A., Hauenstein, K., & Herpertz, S. C. (2011) · Biological Psychiatry · doi:10.1016/j.biopsych.2010.10.025 · Cited by 266 · cited 1× · see citing works
“, 2016), potentially reflecting the enhanced emotional reactivity commonly observed in BPD, however, these studies have used negative stimuli not involving facial expressions (Schulze et al., 2011).”
BackgroundBryant, R. A., Kemp, A. H., Felmingham, K. L., Liddell, B. J., Olivieri, G., Peduto, A. J., Gordon, E., & Williams, L. M. (2007) · Human Brain Mapping · doi:10.1002/hbm.20415 · Cited by 251 · see citing works
Self-citationWilliams, L. M., Liddell, B. J., Rathjen, J., Brown, K. J., Gray, J. A., Phillips, M. L., Young, A., & Gordon, E. (2003) · Human Brain Mapping · doi:10.1002/hbm.10154 · Cited by 251 · see citing works
Fonzo, G. A., Simmons, A. N., Thorp, S. R., Norman, S. B., Paulus, M. P., & Stein, M. B. (2010) · Biological Psychiatry · doi:10.1016/j.biopsych.2010.04.028 · Cited by 235 · see citing works
Enhanced amygdala reactivity to emotional faces in adults reporting childhood emotional maltreatment
van Harmelen, A., van Tol, M., Demenescu, L. R., van der Wee, N. J. A., Veltman, D. J., Aleman, A., van Buchem, M. A., Spinhoven, P., Penninx, B. W. J. H., & Elzinga, B. M. (2012) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nss007 · Cited by 229 · see citing works
Morey, R. A., Dunsmoor, J. E., Haswell, C. C., Brown, V. M., Vora, A., Weiner, J., Stjepanovic, D., Wagner, H. R., Workgroup, V. M.-A. M., Brancu, M., et al. (2015) · Translational Psychiatry · doi:10.1038/tp.2015.196 · Cited by 221 · see citing works
Choi, J., Jeong, B., Polcari, A., Rohan, M. L., & Teicher, M. H. (2012) · NeuroImage · doi:10.1016/j.neuroimage.2011.09.033 · Cited by 215 · see citing works
Childhood maltreatment: altered network centrality of cingulate, precuneus, temporal pole and insula
Teicher, M. H., Anderson, C. M., Ohashi, K., & Polcari, A. (2014) · Biological Psychiatry · doi:10.1016/j.biopsych.2013.09.016 · Cited by 202 · see citing works
Suh, J., & Reesman, J. L. (2017) · Springer eBooks · doi:10.1007/978-3-319-56782-2_1973-3 · Cited by 201 · see citing works
Functional Neuroanatomy of Emotion and Its Regulation in PTSD
Fitzgerald, J. M., DiGangi, J. A., & Phan, K. L. (2018) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000185 · Cited by 177 · see citing works
Schmahl, C., Herpertz, S. C., Bertsch, K., Ende, G., Flor, H., Kirsch, P., Lis, S., Meyer-Lindenberg, A., Rietschel, M., Schneider, M., et al. (2014) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/2051-6673-1-12 · Cited by 168 · see citing works
Felmingham, K., Kemp, A. H., Williams, L., Falconer, E., Olivieri, G., Peduto, A., & Bryant, R. (2008) · Psychological Medicine · doi:10.1017/s0033291708002742 · Cited by 165 · see citing works
Self-citationKorgaonkar, M. S., Grieve, S. M., Etkin, A., Koslow, S. H., & Williams, L. M. (2013) · Neuropsychopharmacology · doi:10.1038/npp.2012.252 · Cited by 135 · see citing works
Self-citationLudäscher, P., Valerius, G., Stiglmayr, C., Mauchnik, J., Lanius, R. A., Bohus, M., & Schmahl, C. (2010) · Journal of Psychiatry and Neuroscience · doi:10.1503/jpn.090022 · Cited by 131 · see citing works
Neuronal correlates of social cognition in borderline personality disorder
Mier, D. U., Lis, S., Esslinger, C., Sauer, C., Hagenhoff, M., Ulferts, J., Gallhofer, B., & Kirsch, P. (2012) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nss028 · Cited by 130 · see citing works
Lanius, R. A., Frewen, P. A., Girotti, M., Neufeld, R. W. J., Stevens, T. K., & Densmore, M. (2007) · Psychiatry Research: Neuroimaging · doi:10.1016/j.pscychresns.2006.11.006 · Cited by 126 · see citing works
Knefel, M., & Lueger‐Schuster, B. (2013) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v4i0.22608 · Cited by 107 · see citing works
Schulze, L., Schulze, A., Renneberg, B., Schmahl, C., & Niedtfeld, I. (2019) · Biological Psychiatry: Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2018.11.004 · Cited by 102 · see citing works
Rabinak, C. A., MacNamara, A., Kennedy, A. E., Angstadt, M., Stein, M. B., Liberzon, I., & Phan, K. L. (2014) · Depression and Anxiety · doi:10.1002/da.22243 · Cited by 89 · see citing works
White, S. F., Costanzo, M. E., Blair, J. R., & Roy, M. J. (2015) · NeuroImage: Clinical · doi:10.1016/j.nicl.2014.11.012 · Cited by 88 · see citing works
Schulze, L., Schmahl, C., & Niedtfeld, I. (2016) · Biological Psychiatry · doi:10.1016/j.biopsych.2015.03.027 · Cited by 48 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Reed, G. M., First, M. B., Billieux, J., Cloitre, M., Briken, P., Achab, S., Brewin, C. R., King, D. L., Kraus, S. W., & Bryant, R. A. (2022) · World Psychiatry · doi:10.1002/wps.20960 · Cited by 182 · see citing works
Self-citationCloitre, M., Brewin, C. R., Bisson, J. I., Hyland, P., Karatzias, T., Lueger-Schuster, B., Maercker, A., Roberts, N. P., & Shevlin, M. (2020) · European Journal of Psychotraumatology · doi:10.1080/20008198.2020.1739873 · Cited by 60 · see citing works
The relationship between dissociation and complex post-traumatic stress disorder: A scoping review
Fung, H. W., Chien, W. T., Lam, S. K. K., & Ross, C. A. (2023) · Trauma, Violence, & Abuse · doi:10.1177/15248380221120835 · Cited by 58 · see citing works
- Authors
- Bryant, R. A., Felmingham, K. L., Malhi, G., Andrew, E., & Korgaonkar, M. S.
- Affiliations
- The University of Sydney (AU)
- The University of Melbourne (AU)
- Corresponding author
- Bryant, Richard A.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2020-01-08
- Volume
- 51
- Issue
- 7
- Pages
- 1121-1128
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W3000333001
- Cited by
- 46
- References
- 45
- Citations by year
- 2026: 9 · 2025: 9 · 2024: 8 · 2023: 7 · 2022: 10 · 2021: 2 · 2020: 1
- FWCI
- 2.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Keywords
- complex PTSD, post-traumatic stress disorder, threat processing, insula, amygdala, dorsolateral prefrontal cortex, dissociation, emotion regulation, self-concept, neural circuits
- MeSH terms
- Adult, Amygdala, Cross-Sectional Studies, Dissociative Disorders, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Stress Disorders, Post-Traumatic, Prefrontal Cortex, International Classification of Diseases, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
