Neurocircuitry models of posttraumatic stress disorder and beyond: a meta-analysis of functional neuroimaging studies

Over the past two decades a relatively large number of studies have investigated the functional neuroanatomy of posttraumatic stress disorder (PTSD). However, findings are often inconsistent, thus challenging traditional neurocircuitry models of PTSD. As evidence mounts that cognition and behavior is an emergent property of interacting brain networks, the question arises whether PTSD can be understood by examining dysfunction in large-scale, spatially distributed neural networks. We used the activation likelihood estimation quantitative meta-analytic technique to synthesize findings across functional neuroimaging studies of PTSD that either used a non-trauma (N=20) or trauma-exposed (N=19) comparison control group. In line with neurocircuitry models, our findings support hyperactive amygdala and hypoactive medial prefrontal regions, but suggest hyperactive hippocampi. Characterization of additional regions under a triple network model showed functional alterations that largely overlapped with the salience network, central executive network, and default network. However, heterogeneity was observed within and across the neurocircuitry and triple network models, and between results based on comparisons to non-trauma and trauma-exposed control groups. Nonetheless, these results warrant further exploration of the neurocircuitry and large-scale network models in PTSD using connectivity analyses.