Citation

Fitzgerald JM, Digangi JA, Phan KL. Harv. Rev. Psychiatry 2018; 26(3): 116-128.

Affiliation

From the Departments of Psychiatry (all), Psychology (Drs. Fitzgerald and Phan), and Anatomy and Cell Biology (Dr. Phan), and Graduate Program in Neuroscience (Dr. Phan), University of Illinois at Chicago; Jesse Brown VA Medical Center, Chicago, IL (Drs. DiGangi and Phan).

Copyright

(Copyright © 2018, President and Fellows of Harvard College, Publisher Lippincott Williams and Wilkins)

DOI

10.1097/HRP.0000000000000185

PMID

29734226

Abstract

Posttraumatic stress disorder (PTSD) is a devastating disorder, linked to profound mental, physical, occupational, and functional impairment. In addition, it is a highly complex disorder, characterized by symptom heterogeneity across multiple domains. Nevertheless, emotion dysregulation arising from the exaggerated response to threat or from the inability to regulate negative emotional states plays a defining role in the pathophysiology of PTSD. In order to improve our understanding of how emotion dysregulation manifests in this illness, functional neuroimaging research over the past 20 years provides great insight into underlying neuroanatomy of each component of emotion dysregulation in the context of PTSD. While prior reviews exist on the topic of neuroimaging findings in PTSD, the present review synthesizes that work through the lens of emotion and its regulation. Studies that employed tasks of emotional responding and symptom provocation, implicit regulation (e.g., emotional Stroop and interference), explicit regulation (e.g., cognitive reappraisal), and fear conditioning/extinction were reviewed.

FINDINGS demonstrate that emotion dysregulation in PTSD arises from complications within a large neurocircuitry involving the amygdala, insula, hippocampus, anterior cingulate cortex, and prefrontal cortex. Although an exaggerated response in the amygdala and insula to negative emotional triggers is pervasive, PTSD is also marked by deficient appraisal, resolution, and management of negative emotional states subserved by the anterior cingulate cortex and prefrontal cortex during regulation. These findings further support the importance of studying emotion-regulation deficits in tandem with exaggerated symptom provocation in order to better understand the constellation of symptoms present in those with PTSD.

Language: en