Persistent Dissociation and Its Neural Correlates in Predicting Outcomes After Trauma Exposure

Lebois, Lauren A. M.; Harnett, Nathaniel G.; Rooij, Sanne J.H. van; Ely, Timothy D.; Jovanović, Tanja; Bruce, Steven E.; House, Stacey L.; Ravichandran, Caitlin; Dumornay, Nathalie M.; Finegold, Katherine E.; Hill, Sarah B.; Merker, Julia; Phillips, Karran A.; Beaudoin, Francesca L.; An, Xiuli; Neylan, Thomas C.; Clifford, Gari D.; Linnstaedt, Sarah D.; Germine, Laura; Rauch, Scott L.; Haran, John P.; Storrow, Alan B.; Lewandowski, Christopher; Musey, Paul I.; Hendry, Phyllis L.; Sheikh, Sophia; Jones, Christopher W.; Punches, Brittany E.; Swor, Robert A.; McGrath, Meghan E.; Hudak, Lauren A.; Pascual, José L.; Seamon, Mark J.; Datner, Elizabeth M.; Chang, Anna Marie; Pearson, Claire; Domeier, Robert M.; Rathlev, Niels K.; O’Neil, Brian J.; Sergot, Paulina; Sánchez, León D.; Miller, Mark W.; Pietrzak, Robert H.; Joormann, Jutta; Barch, Deanna M.; Pizzagalli, Diego A.; Sheridan, John F.; Smoller, Jordan W.; Luna, Beatríz; Harte, Steven E.; Elliott, James M.; Kessler, Ronald C.; Koenen, Karestan C.; McLean, Samuel A.; Stevens, Jennifer; Ressler, Kerry J.

doi:10.1176/appi.ajp.21090911

Cited by 37 publications

(31 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Encouraging re-connection with felt bodily experiences of movement and touch within a positively valenced therapeutic alliance will contradict previous negatively valenced multisensory experiences and attachment disruptions ( van der Kolk, 2015 ), leading to upstream regulation of arousal and affect, modulation of exteroceptive sensory input, and embodied cognitive capacities. Although cognitive-behavioral therapies are considered a first line of treatment for traumatized individuals ( Malejko et al, 2017 ; Yang et al, 2018 ), lower than 50% efficacy in PTSD patients has been reported ( Marks et al, 1998 ; Bradley et al, 2005 ; Mendes et al, 2008 ; Kar, 2011 ), and they can be less beneficial during states of stress ( van der Kolk and Fisler, 1995 ; Raio et al, 2013 ) or dissociation ( Michelson et al, 1998 ; Rufer et al, 2006 ; Spitzer et al, 2007 ; Kleindienst et al, 2011 ; LeBois et al, 2022 ; but see also Halvorsen et al, 2014 ; Zoet et al, 2018 ; Vancappel et al, 2022 ). However, we do not suggest a purely “bottom-up” approach; alternatively, we highlight the importance of combining bottom-up with top-down strategies in consideration of brainstem level sensory integration, ontogenetic development, and the fostering of vertical and horizontal integration.…”

Section: What Neuroscience Can Teach Us About Connecting Somatic Sens...mentioning

confidence: 99%

The brain-body disconnect: A somatic sensory basis for trauma-related disorders

Kearney

Lanius

2022

Front. Neurosci.

View full text Add to dashboard Cite

Although the manifestation of trauma in the body is a phenomenon well-endorsed by clinicians and traumatized individuals, the neurobiological underpinnings of this manifestation remain unclear. The notion of somatic sensory processing, which encompasses vestibular and somatosensory processing and relates to the sensory systems concerned with how the physical body exists in and relates to physical space, is introduced as a major contributor to overall regulatory, social-emotional, and self-referential functioning. From a phylogenetically and ontogenetically informed perspective, trauma-related symptomology is conceptualized to be grounded in brainstem-level somatic sensory processing dysfunction and its cascading influences on physiological arousal modulation, affect regulation, and higher-order capacities. Lastly, we introduce a novel hierarchical model bridging somatic sensory processes with limbic and neocortical mechanisms regulating an individual’s emotional experience and sense of a relational, agentive self. This model provides a working framework for the neurobiologically informed assessment and treatment of trauma-related conditions from a somatic sensory processing perspective.

show abstract

Section: What Neuroscience Can Teach Us About Connecting Somatic Sens...mentioning

confidence: 99%

The brain-body disconnect: A somatic sensory basis for trauma-related disorders

Kearney

Lanius

2022

Front. Neurosci.

View full text Add to dashboard Cite

show abstract

“…We also examined mediation effects through peritraumatic distress and dissociation (in the ED) and PTSD and MDE in the 2-week and 8-week surveys. Peritraumatic distress and dissociation were found in previous research to predict APNS (Thomas et al ., 2012 ; Lebois et al ., 2022 ). Peritraumatic distress was assessed with eight items from the Peritraumatic Distress Inventory (PDI; Brunet et al ., 2001 ).…”

Section: Methodsmentioning

confidence: 99%

Childhood adversities and risk of posttraumatic stress disorder and major depression following a motor vehicle collision in adulthood

Ziobrowski

Petukhova

King

et al. 2023

Epidemiol Psychiatr Sci

View full text Add to dashboard Cite

Aims Childhood adversities (CAs) predict heightened risks of posttraumatic stress disorder (PTSD) and major depressive episode (MDE) among people exposed to adult traumatic events. Identifying which CAs put individuals at greatest risk for these adverse posttraumatic neuropsychiatric sequelae (APNS) is important for targeting prevention interventions. Methods Data came from n = 999 patients ages 18–75 presenting to 29 U.S. emergency departments after a motor vehicle collision (MVC) and followed for 3 months, the amount of time traditionally used to define chronic PTSD, in the Advancing Understanding of Recovery After Trauma (AURORA) study. Six CA types were self-reported at baseline: physical abuse, sexual abuse, emotional abuse, physical neglect, emotional neglect and bullying. Both dichotomous measures of ever experiencing each CA type and numeric measures of exposure frequency were included in the analysis. Risk ratios (RRs) of these CA measures as well as complex interactions among these measures were examined as predictors of APNS 3 months post-MVC. APNS was defined as meeting self-reported criteria for either PTSD based on the PTSD Checklist for DSM-5 and/or MDE based on the PROMIS Depression Short-Form 8b. We controlled for pre-MVC lifetime histories of PTSD and MDE. We also examined mediating effects through peritraumatic symptoms assessed in the emergency department and PTSD and MDE assessed in 2-week and 8-week follow-up surveys. Analyses were carried out with robust Poisson regression models. Results Most participants (90.9%) reported at least rarely having experienced some CA. Ever experiencing each CA other than emotional neglect was univariably associated with 3-month APNS (RRs = 1.31–1.60). Each CA frequency was also univariably associated with 3-month APNS (RRs = 1.65–2.45). In multivariable models, joint associations of CAs with 3-month APNS were additive, with frequency of emotional abuse (RR = 2.03; 95% CI = 1.43–2.87) and bullying (RR = 1.44; 95% CI = 0.99–2.10) being the strongest predictors. Control variable analyses found that these associations were largely explained by pre-MVC histories of PTSD and MDE. Conclusions Although individuals who experience frequent emotional abuse and bullying in childhood have a heightened risk of experiencing APNS after an adult MVC, these associations are largely mediated by prior histories of PTSD and MDE.

show abstract

“…It is also critical for future work to examine how the cerebellum may be uniquely implicated in the dissociative subtype of PTSD. Dissociative symptoms in PTSD are linked to alterations within the midbrain that facilitate passive, rather than active, defensive responses (99, 100); observed differences in cerebellar functional activation and connectivity related to the dissociative subtype of PTSD (65, 67, 101, 102) may be mediated by the prominent neural pathways between the cerebellum and midbrain. The current study was also focused solely on cerebellar volumetric differences in PTSD.…”

Section: Limitationsmentioning

confidence: 99%

“…The current study was also focused solely on cerebellar volumetric differences in PTSD. Multiple studies have observed disrupted cerebellar activity both at rest (44, 65, 102) and during trauma-relevant tasks (47, 67, 81, 103) in patients with PTSD. Future work would benefit from improved localization of both functional and structural changes in the cerebellum that may be present in PTSD.…”

Section: Limitationsmentioning

confidence: 99%

Smaller total and subregional cerebellar volumes in posttraumatic stress disorder: a mega-analysis by the ENIGMA-PGC PTSD workgroup

Huggins

Baird

Briggs

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

Background: The cerebellum critically contributes to higher-order cognitive and emotional functions such fear learning and memory. Prior research on cerebellar volume in PTSD is scant and has neglected neuroanatomical subdivisions of the cerebellum that differentially map on to motor, cognitive, and affective functions. Methods: We quantified cerebellar lobule volumes using structural magnetic resonance imaging in 4,215 adults (PTSD n= 1640; Control n=2575) across 40 sites from the from the ENIGMA-PGC PTSD working group. Using a new state-of-the-art deep-learning based approach for automatic cerebellar parcellation, we obtained 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 total and subregional volume in PTSD compared to healthy controls. The Benjamini-Hochberg procedure was used to control the false discovery rate (p-FDR < 0.05). Results: PTSD was associated with significant grey and white matter reductions of the cerebellum. Compared to controls, people with PTSD demonstrated smaller total cerebellum volume. In addition, people with PTSD showed reduced volume in subregions primarily within the posterior lobe (lobule VIIB, crus II), but also the vermis (VI, VIII), flocculonodular lobe (lobule X), and cerebellar white matter (all p-FDR < 0.05). Effects of PTSD on volume were consistent, and generally more robust, when examining symptom severity rather than diagnostic status. Conclusions: These findings implicate regionally specific cerebellar volumetric differences in the pathophysiology of PTSD. The cerebellum appears to play an important role in high-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.

show abstract

Persistent Dissociation and Its Neural Correlates in Predicting Outcomes After Trauma Exposure

Cited by 37 publications

References 43 publications

The brain-body disconnect: A somatic sensory basis for trauma-related disorders

The brain-body disconnect: A somatic sensory basis for trauma-related disorders

Childhood adversities and risk of posttraumatic stress disorder and major depression following a motor vehicle collision in adulthood

Smaller total and subregional cerebellar volumes in posttraumatic stress disorder: a mega-analysis by the ENIGMA-PGC PTSD workgroup

Contact Info

Product

Resources

About