Reduced Visual Imagery Vividness as a Risk Factor for PTSD: Implications for Aphantasia and Imagery-Based Treatments

Recent theoretical models such as the generative adversarial framework propose that the ability to generate high-fidelity visual images may intensify the severity of post-traumatic stress disorder (PTSD), particularly the intrusive re-experiencing of traumatic events. Meanwhile, individuals with minimal imagery (aphantasia) may be protected. To evaluate this relationship, 312 Veterans completed the Vividness of Visual Imagery Questionnaire (VVIQ) and the PTSD Checklist for DSM-5 (PCL-5). Results indicated that lower VVIQ scores (less vivid imagery) were associated with greater PTSD severity. This inverse relationship was observed across all PTSD symptom clusters, with the strongest association for the negative cognition/mood cluster. Five of the eight Veterans who reported very low VVIQ scores (consistent with aphantasia) had clinically significant PTSD and high levels of intrusive symptoms, further indicating that aphantasia was not protective. These findings have implications for PTSD treatments and suggest that reduced visual imagery is associated with impaired processing of traumatic experiences.