The orbitofrontal cortex is connected to primary sensory regions and the  limbic system, including the amygdala, striatum, and hypothalamus. The orbitofrontal cortex is essential for understanding the precise relationship between stimuli and motivational outcomes. It may generate more flexible assessments of stimuli and experience. The orbitofrontal cortex is also implicated in emotion regulation, specifically down-regulating and reappraising negative emotional states. This regulatory function may be part of a broader role for the orbitofrontal cortex in the self-monitoring and integration of cognitive and emotional cues in decision-making. 

Orbitofrontal Cortex

The anterior cingulate cortex and the mid-cingulate cortex may be involved in the general process of ‘self-regulation’. This region is crucial for self-control, focused problem-solving, and adaptive behavioral responses under changing conditions.  Therefore, the anterior cingulate cortex and mid-cingulate cortex may be important when the value of actions is uncertain or changing, and when multiple pieces of information must be considered to discern the optimal behavioral response. The anterior cingulate cortex and the mid-cingulate cortex have a role in decision-making and adaptively selecting actions based on anticipated outcomes; these regions are activated during reward processing, conflict monitoring, error detection, and pain. 

The anterior cingulate cortex and the 
mid-cingulate cortex

The hippocampus, a structure within the temporal lobes, is central to learning and memory. It is essential for consolidating new information into long-term memory, a process that involves transferring new learning for permanent storage. Research has shown its specific involvement in normal recognition memory and spatial memory, as demonstrated in studies where rats with hippocampal lesions showed impairment in tasks like object recognition and maze running. Furthermore, the hippocampus projects information to cortical regions, which helps to give memories meaning and connect them with other memories. It is also critical for contextualized emotional learning. The famous case of patient H.M., who could not form new memories after his hippocampus was removed, provided significant evidence for its role.

Hippocampus

Decreased gray matter concentrations:
- Right hippocampus
- Right dorsal anterior cingulate cortex (ACC)
- Right orbitofrontal cortex (OFC)

Altered activations:
- Left hippocampus
- Parahippocampal gyrus

Disturbances in these emotional processing regions:
- Left ventral ACC
- Dorsal ACC
- Dorsomedial prefrontal cortex
- Left ventrolateral prefrontal
- OFC

Calvin College

In the brains of these patients with childhood abuse c-PTSD, neuroimaging revealed decreases in gray matter concentration, altered activations in the hippocampus, and disturbances in regions essential for emotional processing. 

Childhood abuse c-PTSD neuroimaging studies: Results

Marinova, Z., & Maercker, A. (2015). Biological correlates of complex posttraumatic stress disorder-state of research and future directions. European journal of psychotraumatology, 6, 25913. https://doi.org/10.3402/ejpt.v6.25913

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