Dissociative subtype of posttraumatic stress disorder or PTSD with comorbid dissociative disorders: Comparative evaluation of clinical profiles.

Swart, Sanne; Wildschut, Marleen; Draijer, Nel; Langeland, Willie; Smit, Jan

doi:10.1037/tra0000474

Cited by 34 publications

(17 citation statements)

References 40 publications

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“…One example is an externalizing type characterized by low constraint and high negative emotionality, compared to an internalizing cluster with high negative emotionality and low positive emotionality [84][85][86] . Another example is a dissociative subtype for patients with PTSD and de-personalization and/or de-realization symptoms, which was introduced by the fifth edition of the DSM [87][88][89] . It is worth noting that there is no definitive ad-hoc threshold for selection of clinical measurements, and different measures strongly efffects the clusters created and the derived classification of potnetial biomarkers.…”

Section: Methodological Considerationsmentioning

confidence: 99%

Potential Neurocognitive Biomarkers for Post Traumatic Stress Disorder (PTSD) Severity in Recent Trauma Survivors

Ben‐Zion

Zeevi

et al. 2019

Preprint

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Contemporary symptom-based diagnosis of Post-traumatic Stress Disorder (PTSD) largely overlooks related neurobehavioral findings and rely entirely on subjective interpersonal reporting. Previous studies associating objective biomarkers with PTSD have mostly used the disorder's symptom-based diagnosis as main outcome measure, overlooking the actual clustering and richness of phenotypical features associated with PTSD. Here, we aimed to computationally derive potential neurocognitive biomarkers that could efficiently differentiate PTSD subtypes, based on an observational cohort study of recent trauma survivors. A three-staged semi-unsupervised method ("3C") was used to categorize trauma survivors based on current PTSD diagnostics, derive clusters of PTSD based on features related to symptom load, and to classify participants' cluster membership using objective features. A total of 256 features were extracted from psychometrics, cognitive, structural and functional neuroimaging data, obtained from 101 adult civilians (age=34.80±11.95, 51 females) evaluated within a month of trauma exposure. Multi-domain features that best differentiated cluster membership were indicated by using importance analysis, classification trees, and ANOVA. Results revealed that entorhinal and rostral anterior cingulate cortices volumes (structural 3 domain), in-task amygdala's functional connectivity with the insula and thalamus (functional domain), executive function and cognitive flexibility (cognitive domain) best differentiated between two clusters related to PTSD severity. Cross-validation established the results' robustness and consistency within this sample. Multi-domain biomarkers revealed by the 3C analytics offer objective classifiers of post-traumatic morbidityshortly following trauma. They also map onto previously documented neurobehavioral PTSD features, supporting the future use of standardized and objective measurements to more precisely identify psychopathology subgroups shortly after trauma.

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Section: Methodological Considerationsmentioning

confidence: 99%

Potential Neurocognitive Biomarkers for Post Traumatic Stress Disorder (PTSD) Severity in Recent Trauma Survivors

Ben‐Zion

Zeevi

et al. 2019

Preprint

View full text Add to dashboard Cite

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“…Furthermore, a recent study indicated that broad and specific measures have a large overlap and high correlation. 46 Future studies could focus on other instruments with a different timing of dissociation, for example within-session (state) dissociation. 33 Thirdly, we exclusively focused on the effect of only one moderator, that is dissociation, on treatment effects.…”

Section: Limitationsmentioning

confidence: 99%

Impact of dissociation on the effectiveness of psychotherapy for post-traumatic stress disorder: meta-analysis

et al. 2020

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Background Many patients with post-traumatic stress disorder (PTSD) experience dissociative symptoms. The question of whether these dissociative symptoms negatively influence the effectiveness of psychotherapy for PTSD is unresolved. Aims To determine the influence of dissociative symptoms on psychotherapy outcome in PTSD. Method We conducted a systematic search in Cochrane, Embase, PILOTS, PsycINFO, PubMed and Web of Science for relevant clinical trials. A random-effects meta-analysis examined the impact of dissociation on psychotherapy outcome in PTSD (pre-registered at Prospero CRD42018086575). Results Twenty-one trials (of which nine were randomised controlled trials) with 1714 patients were included. Pre-treatment dissociation was not related to treatment effectiveness in patients with PTSD (Pearson's correlation coefficient 0.04, 95% CI −0.04 to 0.13). Between-study heterogeneity was high but was not explained by moderators such as trauma focus of the psychotherapy or risk of bias score. There was no indication for publication bias. Conclusions We found no evidence that dissociation moderates the effectiveness of psychotherapy for PTSD. The quality of some of the included studies was relatively low, emphasising the need for high-quality clinical trials in patients with PTSD. The results suggest that pre-treatment dissociation does not determine psychotherapy outcome in PTSD.

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“…Indeed, in an effort to account for the heterogeneity in PTSD expression, several studies attempted to characterize different clinical subtypes of the disorder. For example, an externalizing subtype characterized by low constraint and high negative emotionality, compared to an internalizing cluster with high negative emotionality and low positive emotionality [82][83][84] ; or a dissociative subtype for patients with PTSD and depersonalization and/or de-realization symptoms, introduced by the fifth edition of the DSM [85][86][87] . Furthermore, the cognitive and neural biomarkers presented here are not yet biologically validated markers (see suggested strategy for the development of biomarker tests for PTSD 88 ), and therefore could only be regarded as "potential biomarkers".…”

Section: Clinical Considerationsmentioning

confidence: 99%

Multi-domain potential biomarkers for post-traumatic stress disorder (PTSD) severity in recent trauma survivors

et al. 2020

View full text Add to dashboard Cite

Contemporary symptom-based diagnosis of post-traumatic stress disorder (PTSD) largely overlooks related neurobehavioral mechanisms and relies entirely on subjective interpersonal reporting. Previous studies associating biomarkers with PTSD have mostly used symptom-based diagnosis as the main outcome measure, disregarding the wide variability and richness of PTSD phenotypical features. Here, we aimed to computationally derive potential biomarkers that could efficiently differentiate PTSD subtypes among recent trauma survivors. A three-staged semiunsupervised method ("3C") was used to firstly categorize individuals by current PTSD symptom severity, then derive clusters based on clinical features related to PTSD (e.g. anxiety and depression), and finally to classify participants' cluster membership using objective multi-domain features. A total of 256 features were extracted from psychometrics, cognitive functioning, and both structural and functional MRI data, obtained from 101 adult civilians (age = 34.80 ± 11.95; 51 females) evaluated within 1 month of trauma exposure. The features that best differentiated cluster membership were assessed by importance analysis, classification tree, and ANOVA. Results revealed that entorhinal and rostral anterior cingulate cortices volumes (structural MRI domain), in-task amygdala's functional connectivity with the insula and thalamus (functional MRI domain), executive function and cognitive flexibility (cognitive testing domain) best differentiated between two clusters associated with PTSD severity. Cross-validation established the results' robustness and consistency within this sample. The neural and cognitive potential biomarkers revealed by the 3C analytics offer objective classifiers of post-traumatic morbidity shortly following trauma. They also map onto previously documented neurobehavioral mechanisms associated with PTSD and demonstrate the usefulness of standardized and objective measurements as differentiating clinical sub-classes shortly after trauma.

show abstract

Dissociative subtype of posttraumatic stress disorder or PTSD with comorbid dissociative disorders: Comparative evaluation of clinical profiles.

Cited by 34 publications

References 40 publications

Potential Neurocognitive Biomarkers for Post Traumatic Stress Disorder (PTSD) Severity in Recent Trauma Survivors

Potential Neurocognitive Biomarkers for Post Traumatic Stress Disorder (PTSD) Severity in Recent Trauma Survivors

Impact of dissociation on the effectiveness of psychotherapy for post-traumatic stress disorder: meta-analysis

Multi-domain potential biomarkers for post-traumatic stress disorder (PTSD) severity in recent trauma survivors

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