Stopyra Marion A, Simon Joe J, Rheude Christiane, Nikendei Christoph
Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
Rev Neurosci. 2022 Aug 8;34(1):103-128. doi: 10.1515/revneuro-2022-0014. Print 2023 Jan 27.
Despite a great diagnostic overlap, complex posttraumatic stress disorder (CPTSD) has been recognised by the ICD-11 as a new, discrete entity and recent empirical evidence points towards a distinction from simple posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD). The development and maintenance of these disorders is sustained by neurobiological alterations and studies using functional magnetic resonance imaging (fMRI) may further contribute to a clear differentiation of CPTSD, PTSD and BPD. However, there are no existing fMRI studies directly comparing CPTSD, PTSD and BPD. In addition to a summarization of diagnostic differences and similarities, the current review aims to provide a qualitative comparison of neuroimaging findings on affective, attentional and memory processing in CPTSD, PTSD and BPD. Our narrative review alludes to an imbalance in limbic-frontal brain networks, which may be partially trans-diagnostically linked to the degree of trauma symptoms and their expression. Thus, CPTSD, PTSD and BPD may underlie a continuum where similar brain regions are involved but the direction of activation may constitute its distinct symptom expression. The neuronal alterations across these disorders may conceivably be better understood along a symptom-based continuum underlying CPTSD, PTSD and BPD. Further research is needed to amend for the heterogeneity in experimental paradigms and sample criteria.
尽管存在很大的诊断重叠，但复杂性创伤后应激障碍（CPTSD）已被国际疾病分类第11版（ICD - 11）确认为一种新的、独立的实体，并且最近的实证证据表明它与单纯创伤后应激障碍（PTSD）和边缘型人格障碍（BPD）有所不同。这些障碍的发展和维持由神经生物学改变所支撑，而使用功能磁共振成像（fMRI）的研究可能进一步有助于明确区分CPTSD、PTSD和BPD。然而，目前尚无直接比较CPTSD、PTSD和BPD的fMRI研究。除了总结诊断差异和相似之处外，本综述旨在对CPTSD、PTSD和BPD在情感、注意力和记忆处理方面的神经影像学研究结果进行定性比较。我们的叙述性综述指出边缘 - 额叶脑网络存在失衡，这可能部分跨诊断地与创伤症状的程度及其表现相关联。因此，CPTSD、PTSD和BPD可能构成一个连续体，其中涉及相似的脑区，但激活方向可能构成其独特的症状表现。沿着基于症状的连续体来理解这些障碍中的神经元改变可能会更好，该连续体构成了CPTSD、PTSD和BPD的基础。需要进一步的研究来修正实验范式和样本标准中的异质性。
