Individual differences in a husband and wife who developed PTSD after a motor vehicle accident: a functional MRI case study.

This report describes a husband and wife with acute posttraumatic stress disorder (PTSD) who exhibited different subjective, psychophysiological, and neurobiological responses to traumatic script-driven imagery that caused them to reexperience their traumas. The couple, who had been trapped in their car during a serious motor vehicle accident, was assessed for responses to script-driven traumatic imagery with a heart rate monitor and functional magnetic resonance imaging (fMRI). The accident involved more than 100 vehicles, multiple deaths, and serious injuries. After they crashed into a car in front of them, both subjects were trapped in their car for several minutes, during which they witnessed a child burn to death and feared that they too would die. Neither sustained physical injuries. Both reported reliving their peritraumatic responses. The man experienced intense anxiety, arousal, and escape-focused cognitions; his heart rate increased 13 bpm from baseline. Blood-oxygenation-level-dependent (BOLD) signal increases were found in his anterior frontal, anterior cingulate, superior and medial temporal, thalamic, parietal, and occipital brain regions. In contrast, the woman reported being extremely “numb” and “frozen,” had no heart rate change, and had BOLD signal increases only in occipital regions. This report highlights the importance of individual differences in subjective and biological characteristics of posttraumatic remembrances, particularly those related to peritraumatic dissociation and numbing.