Neural Processes of Emotional Conflict Detection and Prediction of Posttraumatic Stress Disorder Symptom Clusters in Traumatic Injury Survivors

Objective: Given the prevalence and significant burden of posttraumatic stress disorder (PTSD), identifying early predictors of symptom development following trauma is critical. PTSD is a heterogeneous disorder comprised of distinct symptom clusters-reexperiencing, avoidance, negative mood, and hyperarousal-that contribute to the broad range of possible symptom profiles. Affective and attentional regulation processes, such as emotional conflict detection, are impaired in individuals with PTSD; however, the neural mechanisms underlying these alterations and their predictive utility for the development of PTSD symptoms remain unclear. Method: Traumatic injury survivors (N = 49) without traumatic brain injury were recruited from the emergency department of an urban, Level-1 trauma center. Within 1 month of trauma exposure, participants completed a well-characterized emotional conflict task during a functional magnetic resonance imaging scan. Participants returned 6-month later for a clinical assessment of PTSD symptoms. Using a region-of-interest mask derived from whole-brain voxelwise analyses during emotional conflict detection (vs. no emotional conflict detection) we examined whether differential neural activity predicted 6-month PTSD symptom cluster severity. Results: Greater activation of the right middle frontal gyrus during emotional conflict detection prospectively predicted lower PTSD avoidance symptom severity 6 months later (above and beyond the effects of self-reported baseline PTSD and depressive symptoms, previous traumatic life events, racial discrimination, age, sex, and injury severity). Conclusions: Neural processes of emotion conflict detection measured in the early aftermath of a potentially traumatic event are useful as predictors for the development of PTSD symptoms. Clinical Impact Statement Posttraumatic stress disorder (PTSD) is an exceedingly burdensome disorder at both the societal and individual levels; however, predicting who may be at risk of developing PTSD following a traumatic event remains poorly understood. We found that, in a sample of traumatic injury survivors without traumatic brain injury, neural activation during an emotional conflict task administered within 1 month of injury predicted the development of PTSD avoidance symptoms 6 months later. Results inform on the mechanisms that may lead to the development of specific PTSD symptoms.