Psychotic-Like Symptoms and the Temporal Lobe in Trauma-Related Disorders: Diagnosis, Treatment, and Assessment of Potential Malingering

Abstract

Objective: To overview the phenomenology, etiology, assessment, and treatment of psychotic-like symptoms in traumarelated disorders focusing on the proposed role of temporal lobe dysfunction. Method: We describe the literature pertaining to (i) psychotic-like symptoms and temporal lobe dysfunction in traumarelated disorders and (ii) psychological testing profiles in trauma-related disorders. We define trauma-related disorders as borderline personality disorder, post-traumatic stress disorder, and the dissociative disorders. Our search terms were dissociative disorders, temporal lobe, trauma, post-traumatic stress disorder, borderline personality disorder, psychosis, and malingering. Results: Trauma-related psychotic-like symptoms are common and can differ in phenomenology from primary psychotic symptoms. Hallucinations consist of auditory and nonauditory content that may or may not relate to traumatic content. Child voices are highly suggestive of complex dissociative disorders. Critically, not only do these symptoms resemble those seen in temporal lobe epilepsy, but the temporal lobe is implicated in trauma-related disorders, thus providing a plausible neurobiological explanation. Despite such evidence, these symptoms are frequently considered atypical and misdiagnosed. Indeed, common structured psychological assessment tools categorize these symptoms as possible indicators of invalid testing profiles. Conclusion: Psychotic-like symptoms are common in trauma-related disorders, may be related to temporal lobe dysfunction, and are frequently misinterpreted. This may lead to ineffective treatment and inappropriate determinations of malingering in the forensic system.

The utility of the Structured Inventory of Malingered Symptomatology for distinguishing individuals with Dissociative Identity Disorder (DID) from DID simulators and healthy controls

“…Notably, research shows that symptoms similar to temporal lobe epilepsy and psychotic-like symptoms are common among individuals with trauma-related disorders (e.g. Schiavone et al, 2018 ). Many seemingly neurological symptoms are conceptualized as somatoform dissociative symptoms and are associated with PTSD symptoms and with cumulative traumatization, particularly bodily threat (Nijenhuis, Spinhoven, van Dyck, Van Der Hart, & Vanderlinden, 1998 ; Nijenhuis, Van Der Hart, Kruger, & Steele, 2004 ).…”

“…Due to the high stakes in forensic settings, testing for symptom exaggeration and feigning are a standard part of forensic assessments, although detection is particularly difficult with traumatized individuals because their presentation may appear to be exaggerated due to the complexity and severity of their symptoms (Demakis & Elhai, 2011 ). Some symptoms, including seemingly neurological ones, may be thought to be rare even though they are common among traumatized individuals (Schiavone, McKinnon, & Lanius, 2018 ).…”

The moderation of maternal parenting on the association of trauma, dissociation, and psychosis in depressive inpatients

“…Freeman and Fowler reported that childhood trauma may be associated with the development of negative schematic beliefs, leading to misinterpretation of normal stimuli and paranoia (Freeman & Fowler, 2009 ). Another comprehensive review indicated the association between psychological trauma and psychotic-like symptoms, which may be involved in the temporal lobe dysfunction(Schiavone, McKinnon, & Lanius, 2018 ). However, the causality between trauma and psychotic symptoms remains controversial (Morgan & Fisher, 2007 ; Read, van Os, Morrison, & Ross, 2005 ).…”

An examination of the relations between emotion dysregulation, dissociation, and self-injury among dissociative disorder patients

“…Dissociative psychopathology can manifest as amnesia, depersonalization, derealization, or identity alterations and can be accompanied by positive (e.g. psychotic-like symptoms; Schiavone, McKinnon, & Lanius, 2018 ) and negative (e.g. somatosensory deficits) symptoms (Şar, 2014 ).…”

“…While dissociation is understood to be an adaptive, protective psychological process of detachment from highly traumatic events, the chronic reliance on dissociation as an escape from overwhelming experiences, emotions, and memories can put an individual at risk for developing a dissociative disorder (DD; Putnam, 2016 ). DDs are associated with a range of psychiatric symptoms (Brand et al, 2009 ; Schiavone et al, 2018 ), including emotion and behaviour dysregulation, as well as chronic self-injury. In fact, up to 86% of dissociative individuals self-injure (Ross & Norton, 1989 ; Saxe, Chawla, & Van der Kolk, 2002 ), which is more frequent than is found in other psychiatric populations (Calati, Bensassi, & Courtet, 2017 ; Saxe et al, 2002 ).…”