Existing biological models of post-traumatic-stress disorder (PTSD) posit that the amygdala plays a critical role in the development and expression of this disorder. However, increasing data indicate that the amygdalae are not functionally identical, raising the possibility that the two amygdalae may make differential contributions to the expression of PTSD. We present a unique patient who developed PTSD following a traffic accident that occurred two years after she had undergone removal of her left amygdala in order to treat pharmacologically intractable epilepsy. We propose that the right amygdala is preferentially involved in several processes related to the expression of PTSD symptoms, such that the disorder can occur even in the absence of the left amygdala.
KeywordsEmotion; Affect; Epilepsy; Anxiety disorders; Lateralization; Hemispheric asymmetries Neurobiological models of post-traumatic stress disorder (PTSD) consistently highlight the role of the amygdala in the development and expression of this psychopathology (Rauch, Shin & Phelps, 2006;Rauch, Shin, & Wright, 2003). Such models focus on the critical role of the amygdala in fear conditioning (seeDavis, Walker & Lee, 1997;LeDoux, 2000, Maren, 2001, for reviews), and its involvement in modulating arousal and vigilance functions (Davis & Whalen, 2001). This structure also plays a key role modulating memory for emotional context (Rudy, Huff & Matus-Amat, 2004;Malin & McGaugh, 2006). Thus, the amygdala is in a position to directly mediate many of the symptoms of PTSD, such as the sustained elevations in arousal and startle sensitivity, and the ability of contextual cues related to the trauma (e.g., places, activities, and people) to trigger emotional distress.To date, existing amygdalocentric theories of PTSD do not differentiate between the roles of the left and right amygdalae. This is not surprising given that much of the early work of fear conditioning in animals used bilateral preparations, and patients with medial temporal lobe lesions in either hemisphere have shown reductions in acquisition of conditioned fear responses (Labar et al., 1995). However, recent research suggests that the amygdalae are, in fact, structurally (Szabo et al., 2001) and functionally asymmetrical (see Baas, Aleman, & Kahn, 2004; Zald, 2003). For instance, Baker and Kim (2004) observed that in rats, posttraining lesions to the right amygdala lead to a considerably larger impairment in (Buchanan, Tranel, & Adolphs, 2006). Damage to the right amygdala also has been observed to produce a more global deficit in electrodermal responses than damage to the left amygdala (Gläscher & Adolphs, 2003;Weike et al., 2005), perhaps reflecting an asymmetry in global autonomic control.Neuroimaging data have also pointed to functional asymmetries in amygdalar function. Several studies suggest that the right amygdala responds more to experientially learned or conditioned fearful stimuli, whereas, the left amygdala appears more active during the perception of innately fear-related item...