Trauma Timing and Its Impact on Brain Activation During Flexible Emotion Regulation in <scp>PTSD</scp>: Insights From Functional <scp>MRI</scp>

Patients with Post-Traumatic Stress Disorder (PTSD) exhibit deficits in flexible emotion regulation and display abnormal brain activation patterns. Previous research has not examined how the age at which trauma occurs influences associated behavioral and neural abnormalities. In this study, 76 adult participants (60.5% women) diagnosed with PTSD were categorized into three age-matched groups based on the age at trauma onset: childhood, adolescence, and adulthood. Forty-five healthy adults served as a control group. All participants engaged in the Shifted Attention Emotion Appraisal Task (SEAT) while undergoing functional magnetic resonance imaging (fMRI). Our findings reveal that both the childhood and adulthood trauma groups showed significantly greater activation in the left thalamus, left frontal gyrus, and Brodmann Area 48 compared to the adolescent trauma group. Additionally, the childhood trauma group exhibited higher activation in the left inferior frontal gyrus than the adolescent group and greater activation in the left pregenual anterior cingulate cortex compared to the adulthood trauma group. These results highlight the critical role of trauma timing in understanding the behavioral and neural dimensions of PTSD, offering new insights for clinical intervention and treatment strategies.