Smaller hippocampal volume as a vulnerability factor for the persistence of post-traumatic stress disorder

Sanne J.H. van Rooij · Mitzy Kennis · Rachel Sjouwerman · Martijn P. van den Heuvel · René S. Kahn · Elbert Geuze

145 citations0/0 files storedPsychological Medicine

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Posttraumatic Stress Disorder Research Psychoanalysis and Psychopathology Research Stress Responses and Cortisol

Abstract

BACKGROUND: Smaller hippocampal volume has often been observed in patients with post-traumatic stress disorder (PTSD). However, there is no consensus whether this is a result of stress/trauma exposure, or constitutes a vulnerability factor for the development of PTSD. Second, it is unclear whether hippocampal volume normalizes with successful treatment of PTSD, or whether a smaller hippocampus is a risk factor for the persistence of PTSD. METHOD: Magnetic resonance imaging (MRI) scans and clinical interviews were collected from 47 war veterans with PTSD, 25 healthy war veterans (combat controls) and 25 healthy non-military controls. All veterans were scanned a second time with a 6- to 8-month interval, during which PTSD patients received trauma-focused therapy. Based on post-treatment PTSD symptoms, patients were divided into a PTSD group who was in remission (n = 22) and a group in whom PTSD symptoms persisted (n = 22). MRI data were analysed with Freesurfer. RESULTS: Smaller left hippocampal volume was observed in PTSD patients compared with both control groups. Hippocampal volume of the combat controls did not differ from healthy controls. Second, pre- and post-treatment analyses of the PTSD patients and combat controls revealed reduced (left) hippocampal volume only in the persistent patients at both time points. Importantly, hippocampal volume did not change with treatment. CONCLUSIONS: Our findings suggest that a smaller (left) hippocampus is not the result of stress/trauma exposure. Furthermore, hippocampal volume does not increase with successful treatment. Instead, we demonstrate for the first time that a smaller (left) hippocampus constitutes a risk factor for the persistence of PTSD.

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References

2003International Standard Classification of Education, ISCED 1997 2005A Multidimensional Meta-Analysis of Psychotherapy for PTSD 2002Smaller hippocampal volume predicts pathologic vulnerability to psychological trauma 2003The neurobiological consequences of early stress and childhood maltreatment 1990A clinician rating scale for assessing current and lifetime PTSD. The CAPS-1 2001Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies 2007Psychological treatments for chronic post-traumatic stress disorder 2013The International Standard Classification of Education 2011

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