Transdiagnostic trauma severity in anxiety and mood disorders: Functional brain activity during emotional scene processing

Exposure to traumatic events is not unique to post-traumatic stress disorder (PTSD) and is a significant factor in the development of physical and mental disease across the diagnostic spectrum. Using fMRI, this study assesses functional activation in the amygdala and visual cortex during emotional scene processing in a sample of anxiety and mood disorder patients (N = 162). Replicating previous studies with healthy young participants, a strong covariation was found between functional activity in the amygdala and ventral visual cortex, with blood-oxygen-level dependent (BOLD) activity overall significantly enhanced in both regions when viewing emotionally arousing, compared to neutral, scenes. BOLD changes during emotional processing predicted questionnaire reports of experienced trauma and PTSD-like symptoms (e.g., intrusive thoughts, bad dreams, re-experiencing) and associated functional impairment. Patients showing the smallest BOLD changes when viewing emotional (compared to neutral) scenes in the amygdala and ventral visual cortex reported the highest trauma scores, whereas those patients with the largest amygdala emotional reactivity differences reported the lowest trauma scores. Experiencing a life-threatening event (to self or other) that prompts high fear, distress, and functional impairment was associated with reduced functional limbic-visual activity, independent of a PTSD diagnosis. The findings suggest that experienced trauma may be a transdiagnostic vulnerability factor contributing significantly to psychopathology in many patients with anxiety and mood disorders.