Journal of Traumatic Stress, Vol. 17, No. I , February 2004, pp.

37-40 (0 2004)

Hippocampal Volume and Memory Performance

in a Community-Based Sample of Women With
Posttraumatic Stress Disorder Secondary to Child Abuse

Cathy L. Pederson,' ,5 Scott H. Maurer,l Patricia L. Kaminski? Kelly A. Zander,'

Christina M. Peters,' Linda A. Stokes-Crowe? and Robin E. Osborn4

Childhood abuse is linked to posttraumatic stress disorder(PTSD),which follows abuse survivorsinto

adulthood. This study identified the neuropsychological and neuromorphological sequelae of PTSD
amongprepubescently abusedwomen. Right-handedwomen aged 20-40 years were placed into PTSD
and abuse, abuse only, and normal control groups (n = 17 per group). Participantswere screened for
trauma history and psychiatric symptoms, demographically matched, and given neuropsychological
tests and a magnetic resonance scan of their brain. Women with PTSD did not express significant
deficits in memory performance or hippocampal volume when compared with the abuse and normal
control groups.
KEY WORDS: hippocampus; memory; posttraumatic stress disorder; child abuse.

Posttraumatic stress disorder (PTSD) is a mental ill-
ness resulting from child abuse, combat exposure, and
other traumaticevents. CharacteristicPTSD symptoms in-
clude flashbacks, hyperarousal, and avoidance (American
Psychiatric Association, 2000). 'henty-two percent of
women surveyed reported physical or sexual abuse during
childhood or adolescence (McCauley et al., 1997), and
approximately 60% of women who were sexually abused
as children developed PTSD (Albach & Everaerd, 1992).
PTSD has been associated with memory and hip-
pocampal deficiencies. PTSD sufferers have exhibited
deficits in auditory immediate and delayed memory
(Bremneret al., 1995,1997), and explicit short-termmem-
'Biology Department, Wittenberg University, Springfield, Ohio.
'Psychology Department, University of North Texas, Denton, Texas.
3Psychology Department, Wittenberg University, Springfield, Ohio.
4Radiology Department, Mercy Medical Center, Springfield, Ohio.
5T0 whom correspondence should be addressed at Biology Department,
Wittenberg University, PO. Box 720, Springfield, Ohio 45501-0720;
e-mail: cpederson@wittenberg.edu.
ory (Stein, Hanna, Koverola, Torchia, & McClarty, 1997).
The memory deficits in PTSD have been associated with
a small hippocampus (see Bremner, 2001, for review).
Neuromorphological studies of the hippocampus, a brain
area critical for encoding memories, revealed the left hip-
pocampus to be 12% smaller in women with PTSD sec-
ondary to child abuse (Brernner et al., 1997). In contrast,
combat veterans with PTSD had volumetric reductions in
the right hippocampus (Bremner et al., 1995) or bilaterally
(Gurvits et al., 1996). One study involving children who
developed PTSD as a result of maltreatment showed no
difference in hippocampal volume when compared with
controls pre- and postpubescently(De Bellis, Hall, Boring,
Frustaci, & Moritz,2001).
It is unclear whether a smaller hippocampus was a
premorbidphenomenon(Gilbertsonet al., 2002), occurred
as aresult of chronic traumaexposure (Bonneet al., 2001),
or was a consequenceof the PTSD itself. The present study
compared trauma survivors with and without PTSD to a
normal control group in an attempt to isolate the effect
of PTSD on hippocampal volume and function. Careful

37
0894-9867/04/0200-0037/10 2004 International Society for Traumatic Stress Studies
38 Pederson, Maurer, Kaminski, Zander, Peters, Stokes-Crowe, and Osborn
matching between the three groups was conducted in an
attempt to minimize the impact of other variables.
Method
Participants
Fifty-one right-handed women aged 20-40 years
were divided into three groups, each with 17 participants.
The PTSD group consisted of women prepubescently
abused at least 5 years who developed PTSD. The abuse
group was prepubescently abused at least 5 years but did
not develop PTSD. The normal control group had no his-
tory of abuse or PTSD. Participants were carefully
matched into triads based on age, education, and expo-
sure to alcohol, nicotine, and illicit drugs. A potential
participant was disqualified if she had a serious medical
condition or suffered a head injury that rendered her un-
conscious more than 5 min. In addition, women who had
attention deficit disorder or learning disabilities were ex-
cluded. Both university and hospital Institutional Review
Boards approved this protocol.
Procedure
Each applicant participated in a telephone interview
to assess medical history and childhood abuse status.
Those who appeared eligible signed an informed con-
sent form before completing the demographic question-
naire, Childhood Trauma Questionnaire (CTQ; Bernstein
& Fink, 1998),Trauma Symptom Inventory (TSI; Briere,
1995), and Millon Clinical Multiaxial Inventory-Third
Edition (MCMI-111; Millon, Millon, & Davis, 1994). All
participants passed validity tests and scored T < 85 (level
of clinical significance) on the alcohol dependence, drug
dependence,bipolar, delusional,and thought disorder sub-
scales of the MCMI-111. Participants in the normal control
group were required to score in the None or Minimal cat-
egory on the CTQ with a minimizatioddenial score t 2 ,
T < 85 on all scales of the MCMI-111, and T c 75 on all
scales of the TSI. To be placed into the PTSD or abuse
group, the participant qualified for the Severe to Extreme
category on the CTQ for emotional, physical and/or sex-
ual abuse. Qualified participants met with a licensed clin-
ical psychologist to confirm group assignment using the
Clinician Administered PTSD Scale (CAPS; Blake et al.,
1998). Women in the PTSD and abuse groups met Cri-
terion A of the DSM-IV-TR (American Psychiatric As-
sociation, 2000, p. 467) PTSD definition. Participants in
the PTSD group also met the remaining criteria for PTSD
whereas women in the abuse group did not. Participants
also completed the Wechsler Memory Scale-3rd Edition
(WMS; Wechsler, 1997) and the Wonderlic Personnel Test
(Wonderlic, 1988).
A magnetic resonance imaging (MRI) scan of each
participants brain was conducted on a 1.5 T Siemens
Magnatom (Vision) at Mercy Medical Center (Spring-
field, OH). The TI-weighted volumetric sagittal scan gave
192 slices with a resolution of 1 x 1 x 1. To minimize
alcohols effects on the hippocampus, participants con-
sumed two or less alcoholic drinks daily for at least 3
weeks prior to the MRI (Agartz, Momenan, Rawlings,
Kerich, & Hommer, 1999). Manual tracings of the hip-
pocampus were taken in sagittal sections. Cerebrospinal
fluid (CSF) of the lateral ventricle and the parahippocam-
pal gyms were landmarks for the lateral portions of the
hippocampus. On medial sections, CSF from the tempo-
ral horn separated the hippocampus from the amygdala.
A white-matter lamina or the implicit curve of the head
was used to define the anterior portion of the hippocam-
pus (Agartz et al., 1999). Volumetric measurements were
taken three times by a researcher blind to group status.
The average area of each slice was used to calculate the
total hippocampal volume.
Data Analysis
SPSS for Windows version 10.1 (SPSS Inc., 2000)
statistical software was used. Presence of depressive
symptoms was assessed using a chi-square test. A multi-
variate analysis of variance (MANOVA) was used for the
left versus right hippocampal volume and the five factor
scores from the WMS: auditory immediate memory, au-
ditory delayed memory, visual immediate memory, visual
delayed memory, and working memory. Univariate anal-
yses of variance (ANOVA) were used for all demographic
variables, CTQ abuse scores, total hippocampal volume,
and CAPS severity scores. Follow-up t tests determined
significantdifferencesbetween groups. CAPS scores were
only available for 12 PTSD subjects, 9 abuse group sub-
jects, and 11 controls because we changed clinical psy-
chologists midway through the study. These data have
been included in an attempt to give a thorough description
of our groups. One-tailed Pearson r tests assessed cor-
relations between the CAPS severity score and memory/
hippocampal data.
Results
Phone interviews were completed with 7 19 poten-
tial participants who responded to advertisements. Two
Hippocampal Volume and Memory in Women With PTSD Secondary to Child Abuse 39

Table 1. Demoeraohic Data Demonstrating Strong Matching Between the F'TSD. Abuse. and Normal Control Grows
PTSD (n = 17) Abuse (n = 17) Control (n = 17)
~

M SD M SD M SD ANOVA
~ ~ ~

Age (years) 24.8 5.2 26.8 6.6 23.8 5.6 F(2.48) = 1.15
Wonderlic Personnel Score" 23.5 5.7 23.2 5.8 26.1 4.2 F(2.48) = 1.46
Education (years) 13.7, 2.1 14.4,,b 1.9 15.4b 1.4 F(2,48) = 3.68*
Alcoholic drinks last year 89.1 94.3 77.7 155.7 107.7 110.7 F(2,48) c 1
Pack years smoking 4.5 6.0 3.3 6.6 3.1 7.0 F(2.48) c 1
Height (in.) 64.0 3.2 65.0 2.6 65.7 2.2 F(2,48) = 1.80
Major depressive symptoms 62.8, 28.4 50.4 32.4 12.3b 15.1 F(2.48) = 16.84**
CAPS severity score 53.7, 24.9 17.3b 21.6 0.67, 2.3 F(2.30) = 24.77**
Emotional abuse 17.9 4.5 15.5 5.3 F(1.32) = 1.96
Physical abuse 12.1 4.4 10.6 4.3 F(1,32)< 1
Sexual abuse 14.8 8.2 14.4 9.1 F(1.32) c 1

Note. Means with different subscripts differ at p c .05 by the follow-up 1-tests.
"Wonderlic equivalencies: 23 = IQ 106; 26 = IQ 113.
* p c .05. * * p c .01.

hundred fifteen women met the initial criteria and took
the CTQ, TSI, and MCMI-111. Seventy-eightwomen were
accepted and 64completed the protocol. Fifty-one women
were matched into 17 triads based on age, education, num-
ber of alcoholic drinks last year, pack years smoking, and
illicit drug experimentation.Only the completed 17 triads
were included in subsequent data analyses.
Demographic data (Table 1) were used for match-
ing participants into triads. Ninety-two percent of these
women were Caucasian, and 20% lived in a family with
an annual income less than $25,000. When participants
were categorized according to the presence of depres-
sion, the PTSD and abuse groups were similar, x 2( 1, N =
34) = 2.94, p = .09, but differed from the normal
controls.
The results of the omnibus test demonstrated no sig-
nificant differencein age-adjustedscores for the five WMS
factors scores across groups, F(5,45) = 0.83, q2 = .08.
The omnibus test revealed no significant difference be-
tween groups for hippocampal volume, F(2,48) = 1.55,
q2 = .06. One-tailed Pearson r tests revealed no correla-
tion between the CAPS severity score and the memory or
hippocampal variables (Table 2).
Discussion
There were no differences in memory performance
or hippocampal volume between the PTSD, abuse, and
normal control groups. These negative findings may be ex-
plained by the fact that our participants were (1) 20 years
younger than those in other studies (i.e., Bremner et al.,
1995, 1997), (2) milder in PTSD symptomology as indi-
cated by CAPS seventy scores below the suggested PTSD
cutoff of 55-65 (Weathers, Keane, & Davidson, 2001),
(3) not elevated on any MCMI-III scale for Axis I psychi-
atric disorders, and (4) not different between groups on
potential confounds such as substance abuse. Personality
may influence the response to trauma and consequentlythe
potential to developPTSD (Schmahl,Elzinga, & Bremner,
2002). Perhaps personality also factors into PTSD severity.
A subpopulation of PTSD sufferers who were relatively

Table 2. Mean Memory Scoresand Hippocampal Volumes (mm3)for Women in the PTSD, Abuse, and Normal Control
Groups
F'TSD Abuse Control
M SD M SD M SD ANOVA CAPS correlation'

Auditory immediate 23.8 4.4 24.4 3.2 24.8 3.0 F(2,48) c 1 -.08
Visual immediate 22.0 3.4 21.6 3.9 20.9 4.8 F(2.48) c 1 .3 1
Auditory delayed 24.7 1.8 24.7 2.5 24.7 2.3 F(2,48) < 1 .I0
Visual delayed 21.8 3.2 21.7 4.2 21.8 3.3 F(2,48) c 1 .I1
Working memory 21.5 4.6 21.5 2.9 22.7 3.4 F(2,48) c 1 -.06
Total hippocampus 5946 637 5903 713 6093 616 F(2.48) c 1 -.09
Left hippocampus 2874 370 2769 413 2956 377 F(2,48)= 1.00 -.12
Right hippocampus 3071 352 3134 375 3137 345 F(2,48) c 1 -.04

apearson correlation for F'TSD and abuse p u p s .

40 Pedemn, Maurer, Kaminski, Zander, Peters, Stokes-Crowe, and Osborn
high functioningmay have had some protective aspect like
compartmentalization, the ability to keep distinct facets
of life separate (Solomon et al., 1999). Children who em-
ployed certain coping skills may modulate their responses
to trauma such that they were less vulnerable to the devel-
opment or increased severity of PTSD.
There are limitations to this study. While the rela-
tively small sample size (N = 54) led to low statistical
power, other studies have found significanceusing smaller
samples (i.e., Bremner et al., 1997, N = 34; Gurvits et al.,
1996, N = 22). Using height to control for brain size did
not compensate for the lack of brain volume measure-
ments. Conversion of hippocampal volumes into ratios
using whole brain volume would better control for pos-
sible brain volume differences. In addition, because sub-
ject selection and matching procedures isolated PTSD, the
possibility exists that this group is not representativeof the
norm.
In conclusion, simple PTSD status may not be an
indicator for deficits in memory and hippocampal vol-
ume. Research comparing PTSD patients with differing
levels of symptom severity is needed. Moreover, future re-
search should maximize homogeneity between the PTSD
and control groups to manage third variables and isolate
the role of PTSD in hippocampal volume and memory
function.
Acknowledgments
We thank all of the experienced MRI technicians at
Mercy Medical Center for scanning our participants. We
are also grateful to Greta Hochstetler and Cindy Weisbart
for administeringthe WMS, to Megan Hoffmann for help
with tracing hippocampi, and to Margaret King for edit-
ing and formatting of the text. This work was supported
by grants from Wittenberg University's Faculty Research
Fund Board.
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