People with aphantasia report fewer PTSD intrusions but similar distress after trauma

Abstract People with aphantasia, who lack mental imagery, report fewer intrusive memories after trauma. Imagery is central to cognitive models of post-traumatic stress disorder (PTSD), but whether it makes trauma harmful is unknown; previous studies neither measured exposure nor tested questionnaire equivalence without imagery. We surveyed 340 adults with congenital aphantasia, 261 with imagery from the same community and 471 controls. Questionnaires functioned broadly equivalently. At equal exposure, people with aphantasia reported fewer intrusions and less avoidance, more trauma amnesia and less depersonalisation, but similar depression, anxiety, mood and arousal. Trauma was associated with their distress no less strongly than in people with imagery. Importantly, at equal exposure and distress, they had about half the odds of controls of reaching the PTSD screening cut-off. Imagery appears tied to how trauma is re-experienced, not how much distress follows it; low PTSD checklist score without imagery does not mean trauma had little effect.