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Original Article
December 2009

Smaller Global and Regional Cortical Volume in Combat-Related Posttraumatic Stress Disorder

Author Affiliations

Author Affiliations: Dissemination and Training Division, National Center for PTSD, VA Palo Alto Health Care System, Palo Alto, California (Dr Woodward); Department of Psychiatry, University of Geneva, Geneva (Drs Schaer and Eliez and Ms Cediel), and Signal Processing Laboratory, Swiss Federal Institute of Technology, Lausanne (Dr Schaer); and Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System (Dr Kaloupek), and Division of Psychiatry, Boston University School of Medicine (Dr Kaloupek), Boston, Massachusetts.

Arch Gen Psychiatry. 2009;66(12):1373-1382. doi:10.1001/archgenpsychiatry.2009.160

Context  Two sets of findings predict smaller cerebral cortical gray matter volume in adult posttraumatic stress disorder (PTSD). Measures of intracranial tissue volume and cerebral tissue volume have been observed to be smaller in adolescents with maltreatment-related PTSD. Second, lower intelligence, a risk factor for PTSD, is associated with smaller cerebral tissue volumes. Nevertheless, to our knowledge, only 1 study has observed globally smaller cerebral tissue volume in adults with PTSD.

Objectives  To apply a recently developed method providing improved estimates of cortical volume and to estimate associations between adult PTSD and selected regional cortical volumes not yet investigated.

Design  Between-group comparison of global and regional cerebral cortical volumes in adult patients with combat-related PTSD and controls.

Setting  Two Department of Veterans Affairs medical centers with large inpatient and outpatient PTSD catchments.

Participants  Ninety-seven combat-exposed veterans of the Vietnam and Persian Gulf wars.

Main Outcome Measure  Global and regional cortical volumes determined using the FreeSurfer software program and the Desikan et al parcellation (modified).

Results  Cerebral cortical volume, thickness, and area were observed to be smaller in association with adult combat-related PTSD. Robust associations were observed between PTSD and smaller cortical volumes in the parahippocampal gyrus, superior temporal cortex, lateral orbital frontal cortex, and pars orbitalis of the inferior frontal gyrus.

Conclusions  Cerebral cortical volume, thickness, and area may be smaller in adult chronic severe PTSD; however, the extracted structural variables did not mediate relations between intelligence and PTSD. The 4 regions exhibiting especially smaller cortical volumes in this sample share involvement in mechanisms subserving “top-down” facilitation of the identification of objects and words. Compromise of these regions may result in difficulty in relearning pretrauma schemata for interpreting the civilian physical and social environments.