Recent Developments in the Neurobiology of Dissociation

Krystal, John H.; Bennett, Alexandre; Bremner, J. Douglas; Southwick, Steven M.; Charney, Dennis S.

doi:10.1007/978-1-4899-0310-5_8

Cited by 11 publications

(4 citation statements)

References 139 publications

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“…This remains speculation, however; further research is clearly needed to explicate the role of affect regulation capacity in the relationship between trauma and dissociation. In fact, affect regulation itself is likely to reflect a variety of underlying phenomena, including the availability of emotional regulation skills (e.g., Wagner and Linehan, 1998) and neurobiological variables such as hypothalamic-pituitary-adrenal axis stability and level of adrenergic activation and/or sensitivity (Krystal et al, 1996;Yehuda, 1992). In light of this complexity, the finding of affect regulation difficulties among those with significant dissociative symptoms may require more in-depth exploration.…”

Section: Discussionmentioning

confidence: 97%

“…For example, there may be a range of variables that determines the extent to which an adverse event results in a dissociative response (Tillman et al, 1994). There also are other possible etiologies of dissociation: a smaller literature indicates that dissociative symptoms may arise from early insecure attachment relationships (e.g., Ogawa et al, 1997), emotional neglect (Simeon et al, 2003), neurobiological disturbance (e.g., Bechara et al, 1995), panic attacks (Krystal et al, 1991), and substance abuse (Krystal et al, 1996). These variables also may interact: early trauma and emotional neglect, for example, are often associated with attachment difficulties (Shapiro and Levendosky, 1999), all three of which are thought to lead to later neurobiological hypersensitivity to stress (van der Kolk, 2003) and affect regulation deficits (Pynoos et al, 1999).…”

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confidence: 97%

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Dissociative Symptoms and Trauma Exposure

Briere

2006

Journal of Nervous &Amp; Mental Disease

152

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Although dissociation is often described as a posttraumatic response, the actual statistical association between trauma exposure and dissociative symptoms is surprisingly small. This suggests that that some dissociative phenomena may be unrelated to trauma, or may be related in more complex ways. Analysis of the normative data for the Multiscale Dissociation Inventory revealed significant dissociative symptoms in only 8% of trauma-exposed individuals from the general population. However, 90% of those with at least one clinically significant dissociation scale on the Multiscale Dissociation Inventory reported a trauma history, and significant dissociation was found in only 2% of nontraumatized individuals. A history of interpersonal violence, number of different types of trauma exposure, posttraumatic stress, and affect dysregulation were univariate predictors of dissociative symptomatology in trauma-exposed participants, but only posttraumatic stress and affect dysregulation were multivariate predictors. Trauma is probably an important, but insufficient, condition for the development of dissociative symptomatology. Additional risk factors, such as high posttraumatic stress and/or reduced affect regulation capacities, may determine whether trauma exposure results in clinically significant dissociation.

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Section: Discussionmentioning

confidence: 97%

mentioning

confidence: 97%

Dissociative Symptoms and Trauma Exposure

Briere

2006

Journal of Nervous &Amp; Mental Disease

152

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“…Until now, CPTSD has been operationalised for research and clinical practice as a "disorder of extreme stress, not otherwise specified" (DESNOS) [2][3][4]. In the literature, DESNOS has been characterised by pathological abnormalities in interpersonal relationships, somatisation, affective regulation, dissociation and altered self-schemata [1,[4][5][6]. The beta version of the International Classification of Disease, 11th version (ICD-11), available online since 2015, contains two diagnoses of stress and trauma-related illnesses: posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (CPTSD).…”

Section: Introductionmentioning

confidence: 99%

“…These phenomena can lead to social neglect and more intense feelings of shame, guilt and lower self-esteem. Dissociative symptoms may be the result of neurobiological protective systems, which protect the organism from overwhelming burdens [3,6,29].…”

Section: Introductionmentioning

confidence: 99%

Proposed ICD-11 complex posttraumatic stress disorder, characteristics and symptoms of adults in an inpatient psychiatric setting: A descriptive study

Stadtmann¹,

Maercker²,

Binder³

et al. 2018

J Clin Invest Stud

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Background: Applying the framework of ICD-11, complex posttraumatic stress disorder will be diagnosed using the core criteria of a posttraumatic stress disorder and the presence of three additional symptoms that identify 'disturbances in self-organization': affective dysregulation, negative self-concept and disturbances in relationships. An understanding of characteristics and the symptom burden of patients with a complex posttraumatic stress disorder, hospitalised in psychiatric hospitals, is vital to develop interventions and therefore improve services. Methods:The recruitment of adults in a psychiatric inpatient setting took place in the form of a consecutive sample. The data base for this prospective descriptive study comprised data collected during regular inpatient treatment available from the internal clinic database: The sociodemographic information was collected using a clinical questionnaire and symptom values were assessed with the Brief Symptom Inventory, the Beck Depression Inventory and the Impact of Events Scale -Revised. Patients were additionally assessed using the International Trauma Questionnaire.Results: 133 agreed to participate, 47.4% (n = 63) of the patients did not fulfil the inclusion criteria of diagnosis. The final sample comprised 50 female and 20 male participants. On average, the patients were 37.84 years old (SD = ± 11.2) and 50.0% (n = 35), single people. 72.9% (n = 51) had completed secondary school or had higher education and 84.3% (n = 59) of the participants were unemployed. 92.9% indicated having a form of childhood traumatic experience and all participants had more than two trauma events. Overall, there were gender differences in the perceived symptom burden and manifestation in the symptom domains. Conclusion:The findings indicate that there may be several adverse factors related to complex posttraumatic stress disorder. The impairment was much more likely to be severe and have an impact on the functional level. The present research adds new results to the growing literature.

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