Although the cerebellum contributes to higher-order cognitive and emotional functions relevant to posttraumatic stress disorder (PTSD), prior research on cerebellar volume in PTSD is scant, particularly when considering subregions that differentially map on to motor, cognitive, and affective functions. In a sample of 4215 adults (PTSD n = 1642; Control n = 2573) across 40 sites from the ENIGMA-PGC PTSD working group, we employed a new state-of-the-art deep-learning based approach for automatic cerebellar parcellation to obtain volumetric estimates for the total cerebellum and 28 subregions. Linear mixed effects models controlling for age, gender, intracranial volume, and site were used to compare cerebellum volumes in PTSD compared to healthy controls (88% trauma-exposed). PTSD was associated with significant grey and white matter reductions of the cerebellum. Compared to controls, people with PTSD demonstrated smaller total cerebellum volume, as well as reduced volume in subregions primarily within the posterior lobe (lobule VIIB, crus II), vermis (VI, VIII), flocculonodular lobe (lobule X), and corpus medullare (all p-FDR < 0.05). Effects of PTSD on volume were consistent, and generally more robust, when examining symptom severity rather than diagnostic status. These findings implicate regionally specific cerebellar volumetric differences in the pathophysiology of PTSD. The cerebellum appears to play an important role in higher-order cognitive and emotional processes, far beyond its historical association with vestibulomotor function. Further examination of the cerebellum in trauma-related psychopathology will help to clarify how cerebellar structure and function may disrupt cognitive and affective processes at the center of translational models for PTSD.

1st Department of Neurology St Anne's University Hospital and Faculty of Medicine Masaryk University Brno Czech Republic

Amsterdam UMC University of Amsterdam Psychiatry Amsterdam Neuroscience Amsterdam The Netherlands

Amsterdam UMC Vrije Universiteit Psychiatry Amsterdam Neuroscience Amsterdam The Netherlands

ARQ National Psychotrauma Centre Diemen The Netherlands

Brain Health Research Centre Department of Anatomy University of Otago Dunedin New Zealand

Brain Imaging and Analysis Center Duke University Durham NC USA

CEITEC Central European Institute of Technology Multimodal and Functional Neuroimaging Research Group Masaryk University Brno Czech Republic

Center for Behavior Genetics of Aging University of California San Diego La Jolla CA USA

Center for Brain and Behavior Research University of South Dakota Vermillion SD USA

Center for Depression Anxiety and Stress Research McLean Hospital Harvard University Belmont MA USA

Center for Global Health Equity New York University Shanghai Shanghai China

Center for Healthy Minds University of Wisconsin Madison Madison WI USA

Center for Vital Longevity School of Behavioral and Brain Sciences University of Texas at Dallas Dallas TX USA

CIC1415 CHRU de Tours Inserm Tours France

Civil Aerospace Medical Institute US Federal Aviation Administration Oklahoma City OK USA

Comprehensive Injury Center Medical College of Wisconsin Milwaukee WI USA

Department of Clinical Psychology University of Groningen Groningen The Netherlands

Department of Experimental Clinical and Health Psychology Ghent University Ghent Belgium

Department of Medical Imaging Jinling Hospital Medical School of Nanjing University Nanjing Jiangsu China

Department of Neurology University of Utah School of Medicine Salt Lake City UT USA

Department of Neuroscience Central Clinical School Monash University Melbourne Vic Australia

Department of Neuroscience University of Rochester Medical Center Rochester NY USA

Department of Neurosciences University of Toledo Toledo OH USA

Department of Pediatrics University of Minnesota Minneapolis MN USA

Department of Physical Medicine and Rehabilitation Virginia Commonwealth University Richmond VA USA

Department of Psychiatry and Behavioral Health Institute for Behavioral Medicine Research The Ohio State University Columbus OH USA

Department of Psychiatry and Behavioral Neuroscience Wayne State University School of Medicine Detroit MI USA

Department of Psychiatry and Behavioral Science Texas A and M University Health Science Center Bryan TX USA

Department of Psychiatry and Behavioral Sciences Duke School of Medicine Durham NC USA

Department of Psychiatry and Behavioral Sciences Emory University School of Medicine Atlanta GA USA

Department of Psychiatry and Behavioral Sciences Stanford University Stanford CA USA

Department of Psychiatry and Behavioral Sciences University of Minnesota Minneapolis MN USA

Department of Psychiatry and Behavioral Sciences Vanderbilt University Medical Center Nashville TN USA

Department of Psychiatry Baylor College of Medicine Houston TX USA

Department of Psychiatry Columbia University Medical Center New York NY USA

Department of Psychiatry Erasmus University Medical Center Rotterdam the Netherlands

Department of Psychiatry Harvard Medical School Boston MA USA

Department of Psychiatry Stellenbosch University Cape Town South Africa

Department of Psychiatry Texas A and M University Bryan Texas USA

Department of Psychiatry University of California San Diego La Jolla CA USA

Department of Psychiatry University of Michigan Ann Arbor MI USA

Department of Psychiatry University of Texas at Austin Austin TX USA

Department of Psychiatry University of Toledo Toledo OH USA

Department of Psychiatry University of Wisconsin Madison Madison WI USA

Department of Psychiatry Yale University School of Medicine New Haven CT USA

Department of Psychological Sciences Center for Trauma Recovery University of Missouri St Louis St Louis MO USA

Department of Psychology and Neuroscience Baylor University Waco TX USA

Department of Psychology Marquette University Milwaukee WI USA

Department of Psychology The Education University of Hong Kong Ting Kok Hong Kong

Department of Psychology University of Chinese Academy of Sciences Beijing China

Department of Psychology University of Minnesota Minneapolis MN USA

Department of Psychology University of South Dakota Vermillion SD USA

Department of Psychology University of Wisconsin Madison Madison WI USA

Department of Psychology University of Wisconsin Milwaukee Milwaukee WI USA

Department of Psychology Vanderbilt University Nashville TN USA

Department of Psychosomatic Medicine and Psychotherapy Central Institute of Mental Health Medical Faculty Mannheim Heidelberg University Heidelberg Germany

Department of Radiology Washington University School of Medicine St Louis MO USA

Department of Veteran Affairs Mid Atlantic Mental Illness Research Education and Clinical Center Durham NC USA

Departments of Comparative Medicine Neuroscience and Psychology Wu Tsai Institute Yale University New Haven CT USA

Departments of Psychiatry and of Psychology Wu Tsai Institute Yale University New Haven CT USA

Departments of Radiology Psychiatry and Biomedical Engineering University of Iowa Iowa City IA USA

Dept of Psychological and Brain Sciences Boston University Boston MA USA

Disaster Mental Health Institute Vermillion SD USA

Division of Basic Biomedical Sciences Sanford School of Medicine University of South Dakota Vermillion SD USA

Division of Clinical Neuroscience National Center for PTSD West Haven CT USA

Division of Depression and Anxiety Disorders McLean Hospital Belmont MA USA

Division of Epidemiology and Social Sciences Institute of Health and Equity Medical College of Wisconsin Milwaukee Milwaukee WI USA

Division of Trauma and Acute Care Surgery Department of Surgery Medical College of Wisconsin Milwaukee WI USA

Division of Women's Mental Health McLean Hospital Belmont MA USA

Donders Institute for Brain Cognition and Behavior Centre for Cognitive Neuroimaging Radboud University Nijmegen Nijmegen The Netherlands

George E Wahlen Veterans Affairs Medical Center Salt Lake City UT USA

H Ben Taub Department of Physical Medicine and Rehabilitation Baylor College of Medicine Houston TX USA

Imaging Genetics Center Stevens Neuroimaging and Informatics Institute Keck School of Medicine of USC Marina del Rey CA USA

Institute for Technology in Psychiatry McLean Hospital Belmont MA USA

Institute of Medical Psychology and Systems Neuroscience University of Münster Münster Germany

Laboratory for Traumatic Stress Studies Chinese Academy of Sciences Key Laboratory of Mental Health Institute of Psychology Chinese Academy of Sciences Beijing China

Masonic Institute for the Developing Brain Minneapolis MN USA

Minneapolis VA Health Care System Minneapolis MN USA

Monash Biomedical Imaging Monash University Melbourne Vic Australia

Munroe Meyer Institute University of Nebraska Medical Center Omaha NE USA

Neuroscience Research Australia Randwick NSW Australia

New York State Psychiatric Institute New York NY USA

Northwestern Neighborhood and Network Initiative Northwestern University Institute for Policy Research Evanston IL USA

SA MRC Unit on Risk and Resilience in Mental Disorders Department of Psychiatry and Neuroscience Institute University of Cape Town Cape Town South Africa

School of Medicine and Public Health University of Wisconsin Madison Madison WI USA

School of Psychology University of New South Wales Sydney Sydney NSW Australia

Sioux Falls VA Health Care System Sioux Falls SD USA

South African Medical Research Council Unit on the Genomics of Brain Disorders Department of Psychiatry Stellenbosch University Stellenbosch South Africa

Tel Aviv University Tel Aviv Yafo Israel

UMR1253 Université de Tours Inserm Tours France

University Medical Centre Charité Berlin Germany

University of Haifa Haifa Israel

VA Palo Alto Health Care System Palo Alto CA USA

Veterans Affairs Richmond Health Care Richmond VA USA

Veterans Integrated Service Network 17 Center of Excellence for Research on Returning War Veterans Waco TX USA

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