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Dimitrova LI, Lawrence AJ, Vissia EM, Chalavi S, Kakouris AF, Veltman DJ, Reinders AATS. Inter-identity amnesia in dissociative identity disorder resolved: A behavioural and neurobiological study. J Psychiatr Res 2024; 174:220-229. [PMID: 38653030 DOI: 10.1016/j.jpsychires.2024.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 04/08/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Dissociative identity disorder (DID) is characterised by, among others, subjectively reported inter-identity amnesia, reflecting compromised information transfer between dissociative identity states. Studies have found conflicting results regarding memory transfer between dissociative identity states. Here, we investigated inter-identity amnesia in individuals with DID using self-relevant, subject specific stimuli, and behavioural and neural measures. METHODS Data of 46 matched participants were included; 14 individuals with DID in a trauma-avoidant state, 16 trauma-avoiding DID simulators, and 16 healthy controls. Reaction times and neural activation patterns related to three types of subject specific words were acquired and statistically analysed, namely non-self-relevant trauma-related words (NSt), self-relevant trauma-related words from a trauma-avoidant identity state (St), and trauma-related words from a trauma-related identity state (XSt). RESULTS We found no differences in reaction times between XSt and St words and faster reaction times for XSt over NSt. Reaction times of the diagnosed DID group were the longest. Increased brain activation to XSt words was found in the frontal and parietal regions, while decreased brain activity was found in the anterior cingulate cortex in the diagnosed DID group. DISCUSSION The current study reproduces and amalgamates previous behavioural reports as well as brain activation patterns. Our finding of increased cognitive control over self-relevant trauma-related knowledge processing has important clinical implications and calls for the redefinition of "inter-identity amnesia" to "inter-identity avoidance".
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Affiliation(s)
- Lora I Dimitrova
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Psychiatry, Amsterdam UMC, Location VUmc, VU University Amsterdam, Amsterdam, the Netherlands
| | - Andrew J Lawrence
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Eline M Vissia
- Heelzorg, Centre for Psychotrauma, Zwolle, the Netherlands
| | - Sima Chalavi
- Research Center for Movement Control and Neuroplasticity, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Andreana F Kakouris
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Dick J Veltman
- Department of Psychiatry, Amsterdam UMC, Location VUmc, VU University Amsterdam, Amsterdam, the Netherlands
| | - Antje A T S Reinders
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
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Boysen GA. Dissociative Identity Disorder: A Review of Research From 2011 to 2021. J Nerv Ment Dis 2024; 212:174-186. [PMID: 38412243 DOI: 10.1097/nmd.0000000000001764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
ABSTRACT Dissociative identity disorder (DID) has historically been one of the most controversial topics in the study of psychopathology. Building on a previous review of empirical research on DID from 2000 to 2010, the present review examined DID research from 2011 to 2021. The research output included 56 case studies and 104 empirical studies. Within the empirical studies, approximately 1354 new cases of DID emerged, which resulted in an average samples of approximately 20. Reanalysis of previous samples was standard in the literature with only 40% of reported cases being new. Studies emerged from dozens of countries across the world, but the majority of cases were from Western counties, especially the United States. Diagnosis primarily relied upon validated measures, but 74% of all new cases came from six research groups. Overall, research on DID is steady but methodologically limited in ways that make generalization, especially about etiology, difficult.
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Affiliation(s)
- Guy A Boysen
- Department of Psychology, McKendree University, Lebanon, Illinois
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3
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Strouza AI, Lawrence AJ, Vissia EM, Kakouris A, Akan A, Nijenhuis ERS, Draijer N, Chalavi S, Reinders AATS. Identity state-dependent self-relevance and emotional intensity ratings of words in dissociative identity disorder: A controlled longitudinal study. Brain Behav 2023; 13:e3208. [PMID: 37721528 PMCID: PMC10570477 DOI: 10.1002/brb3.3208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 07/20/2023] [Accepted: 07/22/2023] [Indexed: 09/19/2023] Open
Abstract
INTRODUCTION Dissociative identity disorder (DID) is characterized by, among others, amnesic episodes and the recurrence of different dissociative identity states. While consistently observed in clinical settings, to our knowledge, no controlled research study has shown the degree to which different identity states report autobiographical knowledge over time. Hence, the current study investigates self-relevance and emotional intensity ratings of words longitudinally. METHODS Data of 46 participants were included: 13 individuals with DID, 11 DID-simulating actors, and a control group of 22 paired individuals. Individuals with DID and DID simulators participated once in the neutral identity state (NIS) and once in the trauma-related dissociative identity state (TIS). The control group paired 11 healthy controls with 11 participants with posttraumatic stress disorder (PTSD) as a NIS-TIS pair. Self-relevance ratings of different word types were collected in a baseline and a follow-up session, on average 6 weeks apart. A mixed ANOVA design was used to assess the effects of group, session, word type, and dissociative identity state. RESULTS All participants in TIS and individuals with DID in NIS rated self-relevant trauma-related words more negatively. In the NIS, the control group rated self-relevant trauma-related words as less negative, whereas the ratings of simulating actors were intermediate. There was no group-dependent longitudinal effect for intensity ratings. CONCLUSIONS This study was the first to confirm clinical observations that self-relevant and emotional processing are different between individuals with DID and controls, but consistent over time. Actors were unable to perfectly simulate DID. The finding that ratings of self-relevant trauma-related words differ between subgroups as included in the study is in line with clinical observations.
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Affiliation(s)
- Aikaterini I. Strouza
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- Department of Psychiatry, Amsterdam UMC, Location VUmcVU University AmsterdamAmsterdamThe Netherlands
| | - Andrew J. Lawrence
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | | | - Andreana Kakouris
- Department of Psychosis Studies, Institute of PsychiatryKing's College LondonLondonUK
| | - Ayse Akan
- Department of Psychosis Studies, Institute of PsychiatryKing's College LondonLondonUK
- North East London NHS Foundation TrustLondonUK
| | - Ellert R. S. Nijenhuis
- Clienia Littenheid AGPrivate Clinic for Psychiatry and PsychotherapyLittenheidSwitzerland
| | - Nel Draijer
- Department of PsychiatryVU University Medical CenterAmsterdamThe Netherlands
| | - Sima Chalavi
- Movement Control and Neuroplasticity Research Group, Department of Movement SciencesKU LeuvenLeuvenBelgium
| | - Antje A. T. S. Reinders
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
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Lanfranco RC, Martínez-Aguayo JC, Arancibia M. Assessing malingering and personality styles in dissociative identity disorder: a case study. Neurocase 2023; 29:141-150. [PMID: 38704614 DOI: 10.1080/13554794.2024.2348218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/15/2024] [Indexed: 05/06/2024]
Abstract
Dissociative Identity Disorder (DID), formerly Multiple Personality Disorder, involves two or more distinct identities controlling behaviour, stemming from trauma-related dissociation. Understanding DID's cognitive, neural, and psychometric aspects remains a challenge, especially in distinguishing genuine cases from malingering. We present a case of a DID patient with nine identities, evaluated to rule out malingering. Using the Millon Index of Personality Styles, we assessed the primary and two alternate identities, revealing marked differences. High consistency scores support validity. We suggest employing personality inventories beyond symptomatology to characterise dissociative identities' consistency and adaptation styles, aiding in malingering assessments in future studies.
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Affiliation(s)
- Renzo C Lanfranco
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, University of Edinburgh, Edinburgh, UK
- Center for Research in Cognition & Neurosciences, Université libre de Bruxelles, Brussels, Belgium
| | | | - Marcelo Arancibia
- Center of Translational Studies in Stress and Mental Health (C-ESTRES), Faculty of Sciences, Universidad de Valparaíso, Valparaíso, Chile
- Department of Psychiatry, School of Medicine, Faculty of Medicine, Universidad de Valparaíso, Valparaíso, Chile
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Siehl S, Zohair R, Guldner S, Nees F. Gray matter differences in adults and children with posttraumatic stress disorder: A systematic review and meta-analysis of 113 studies and 11 meta-analyses. J Affect Disord 2023; 333:489-516. [PMID: 37086802 DOI: 10.1016/j.jad.2023.04.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/21/2023] [Accepted: 04/14/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND In this systematic review and meta-analysis, we aimed to provide a comprehensive overview of gray matter alterations of adult- and underage patients with posttraumatic stress disorder (PTSD) in comparison to healthy trauma-exposed (TC) and non-exposed (HC) individuals. METHODS We subdivided our groups into patients with PTSD after trauma exposure in adulthood (aa) or childhood (ac) as well as children with PTSD (cc). We identified 113 studies, including 6.800 participants in our review, which we divided into studies focusing on whole-brain and region-of-interest (ROI) analysis. We performed a coordinate-based meta-analysis on 14 studies in the group of aa-PTSD. RESULTS We and found lower gray matter volume in patients with PTSD (aa) in the medial frontal gyrus (PTSD<HC/TC) and Culmen/posterior cingulate cortex (PTSD<TC). Results from ROI-based studies mainly show alterations for patients with PTSD in the prefrontal cortex, hippocampus, anterior cingulate cortex, insula, corpus callosum, and amygdala. LIMITATIONS Due to a limited number of studies reporting whole-brain results, the meta-analyses could only be performed in one subgroup and within this subgroup for a limited number of studies. CONCLUSIONS Our results are in line with psychobiological models of PTSD that associate the identified regions with brain circuits involved in context processing, threat detection and emotion regulation.
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Affiliation(s)
- Sebastian Siehl
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany.
| | - Rabia Zohair
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Stella Guldner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Frauke Nees
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
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6
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Dimitrova LI, Dean SL, Schlumpf YR, Vissia EM, Nijenhuis ERS, Chatzi V, Jäncke L, Veltman DJ, Chalavi S, Reinders AATS. A neurostructural biomarker of dissociative amnesia: a hippocampal study in dissociative identity disorder. Psychol Med 2023; 53:805-813. [PMID: 34165068 PMCID: PMC9975991 DOI: 10.1017/s0033291721002154] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/12/2021] [Accepted: 05/11/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Little is known about the neural correlates of dissociative amnesia, a transdiagnostic symptom mostly present in the dissociative disorders and core characteristic of dissociative identity disorder (DID). Given the vital role of the hippocampus in memory, a prime candidate for investigation is whether total and/or subfield hippocampal volume can serve as biological markers of dissociative amnesia. METHODS A total of 75 women, 32 with DID and 43 matched healthy controls (HC), underwent structural magnetic resonance imaging (MRI). Using Freesurfer (version 6.0), volumes were extracted for bilateral global hippocampus, cornu ammonis (CA) 1-4, the granule cell molecular layer of the dentate gyrus (GC-ML-DG), fimbria, hippocampal-amygdaloid transition area (HATA), parasubiculum, presubiculum and subiculum. Analyses of covariance showed volumetric differences between DID and HC. Partial correlations exhibited relationships between the three factors of the dissociative experience scale scores (dissociative amnesia, absorption, depersonalisation/derealisation) and traumatisation measures with hippocampal global and subfield volumes. RESULTS Hippocampal volumes were found to be smaller in DID as compared with HC in bilateral global hippocampus and bilateral CA1, right CA4, right GC-ML-DG, and left presubiculum. Dissociative amnesia was the only dissociative symptom that correlated uniquely and significantly with reduced bilateral hippocampal CA1 subfield volumes. Regarding traumatisation, only emotional neglect correlated negatively with bilateral global hippocampus, bilateral CA1, CA4 and GC-ML-DG, and right CA3. CONCLUSION We propose decreased CA1 volume as a biomarker for dissociative amnesia. We also propose that traumatisation, specifically emotional neglect, is interlinked with dissociative amnesia in having a detrimental effect on hippocampal volume.
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Affiliation(s)
- Lora I. Dimitrova
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychiatry, Amsterdam UMC, Location VUmc, VU University Amsterdam, Amsterdam, The Netherlands
| | - Sophie L. Dean
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Yolanda R. Schlumpf
- Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland
- Clienia Littenheid AG, Private Clinic for Psychiatry and Psychotherapy, Littenheid, Switzerland
| | | | - Ellert R. S. Nijenhuis
- Clienia Littenheid AG, Private Clinic for Psychiatry and Psychotherapy, Littenheid, Switzerland
| | - Vasiliki Chatzi
- Department of Biomedical Engineering, King's College London, London, UK
| | - Lutz Jäncke
- Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland
- Research Unit for Plasticity and Learning of the Healthy Aging Brain, University of Zurich, Zurich, Switzerland
| | - Dick J. Veltman
- Department of Psychiatry, Amsterdam UMC, Location VUmc, VU University Amsterdam, Amsterdam, The Netherlands
| | - Sima Chalavi
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Antje A. T. S. Reinders
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Huntjens RJC, Otgaar H, Pijnenborg GHM, Wessel I. The elusive search for a biomarker of dissociative amnesia: a reaction to Dimitrova et al. (2021). Psychol Med 2022; 52:2835-2836. [PMID: 35550208 PMCID: PMC9647544 DOI: 10.1017/s0033291722001118] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 12/30/2022]
Affiliation(s)
- R. J. C. Huntjens
- Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
| | - H. Otgaar
- Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands
- Faculty of Law and Criminology, KU Leuven, Leuven, Belgium
| | - G. H. M. Pijnenborg
- Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
| | - I. Wessel
- Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
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8
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Reinders AATS, Dimitrova LI, Schlumpf YR, Vissia EM, Dean SL, Jäncke L, Chalavi S, Veltman DJ, Nijenhuis ERS. The elusive search for a biomarker of dissociative amnesia: an overstated response to understated findings? Psychol Med 2022; 52:2837-2845. [PMID: 35855668 DOI: 10.1017/s0033291722001660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Antje A T S Reinders
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Lora I Dimitrova
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychiatry, Amsterdam UMC, Location VUmc, VU University Amsterdam, Amsterdam, The Netherlands
| | - Yolanda R Schlumpf
- Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland
- Clienia Littenheid AG, Private Clinic for Psychiatry and Psychotherapy, Sirnach, Switzerland
| | - Eline M Vissia
- Heelzorg, Centre for Psychotrauma, Zwolle, The Netherlands
| | - Sophie L Dean
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Lutz Jäncke
- Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland
- Research Unit for Plasticity and Learning of the Healthy Aging Brain, University of Zurich, Zurich, Switzerland
| | - Sima Chalavi
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Dick J Veltman
- Department of Psychiatry, Amsterdam UMC, Location VUmc, VU University Amsterdam, Amsterdam, The Netherlands
| | - Ellert R S Nijenhuis
- Clienia Littenheid AG, Private Clinic for Psychiatry and Psychotherapy, Sirnach, Switzerland
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Modesti MN, Rapisarda L, Capriotti G, Del Casale A. Functional Neuroimaging in Dissociative Disorders: A Systematic Review. J Pers Med 2022; 12:jpm12091405. [PMID: 36143190 PMCID: PMC9502311 DOI: 10.3390/jpm12091405] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 08/21/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Dissociative disorders encompass loss of integration in essential functions such as memory, consciousness, perception, motor control, and identity. Nevertheless, neuroimaging studies, albeit scarce, have suggested the existence of particular brain activation patterns in patients belonging to this diagnostic category. The aim of this review is to identify the main functional neuroimaging correlates of dissociative disorders. Methods: we searched the PubMed database to identify functional neuroimaging studies conducted on subjects with a diagnosis of a dissociative disorder, following the PRISMA guidelines. In the end, we included 13 studies in this systematic review, conducted on 51 patients with dissociative identity disorder (DID), 28 subjects affected by depersonalization disorder, 24 with dissociative amnesia, and 6 with other or not specified dissociative disorders. Results: Prefrontal cortex dysfunction seems prominent. In addition, changes in the functional neural network of the caudate are related to alterations of identity state and maintenance of an altered mental status in DID. Another role in DID seems to be played by a dysfunction of the anterior cingulate gyrus. Other regions, including parietal, temporal, and insular cortices, and subcortical areas were reported to be dysfunctional in dissociative disorders. Conclusions: Prefrontal dysfunction is frequently reported in dissociative disorders. Functional changes in other cortical and subcortical areas can be correlated with these diagnoses. Further studies are needed to clarify the neurofunctional correlations of each dissociative disorder in affected patients, in order to identify better tailored treatments.
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Affiliation(s)
- Martina Nicole Modesti
- Faculty of Medicine and Psychology, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Ludovica Rapisarda
- Faculty of Medicine and Psychology, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Gabriela Capriotti
- Unit of Nuclear Medicine, Department of Medical-Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sant’Andrea University Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Antonio Del Casale
- Unit of Psychiatry, Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sant’Andrea University Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
- Correspondence:
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10
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Vissia EM, Lawrence AJ, Chalavi S, Giesen ME, Draijer N, Nijenhuis ERS, Aleman A, Veltman DJ, Reinders AATS. Dissociative identity state-dependent working memory in dissociative identity disorder: a controlled functional magnetic resonance imaging study. BJPsych Open 2022; 8:e82. [PMID: 35403592 PMCID: PMC9059616 DOI: 10.1192/bjo.2022.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Memory function is at the core of the psychopathology of dissociative identity disorder (DID), but little is known about its psychobiological correlates. AIMS This study aims to investigate whether memory function in DID differs between dissociative identity states. METHOD Behavioural data and neural activation patterns were assessed in 92 sessions during an n-back working memory task. Participants were people with genuine diagnosed DID (n = 14), DID-simulating controls (n = 16) and a paired control group (post-traumatic stress disorder (n = 16), healthy controls (n = 16)). Both DID groups participated as authentic or simulated neutral and trauma-related identity states. Reaction times and errors of omission were analysed with repeated measures ANOVA. Working memory neural activation (main working memory and linear load) was investigated for effects of identity state, participant group and their interaction. RESULTS Identity state-dependent behavioural performance and neural activation was found. DID simulators made fewer errors of omission than those with genuine DID. Regarding the prefrontal parietal network, main working memory in the left frontal pole and ventrolateral prefrontal cortex (Brodmann area 44) was activated in all three simulated neutral states, and in trauma-related identity states of DID simulators, but not those with genuine DID or post-traumatic stress disorder; for linear load, trauma-related identity states of those with genuine DID did not engage the parietal regions. CONCLUSIONS Behavioural performance and neural activation patterns related to working memory in DID are dependent on the dissociative identities involved. The narrowed consciousness of trauma-related identity states, with a proneness to re-experiencing traumatising events, may relate to poorer working memory functioning.
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Affiliation(s)
- Eline M Vissia
- Cognitive Neuroscience Centre, University Medical Centre Groningen, University of Groningen, The Netherlands; and Centre for Psychotrauma, Heelzorg, The Netherlands
| | - Andrew J Lawrence
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Sima Chalavi
- Cognitive Neuroscience Centre, University Medical Centre Groningen, University of Groningen, The Netherlands; and Research Centre for Movement Control and Neuroplasticity, Department of Movement Sciences, Katholieke Universiteit Leuven, Belgium
| | - Mechteld E Giesen
- Cognitive Neuroscience Centre, University Medical Centre Groningen, University of Groningen, The Netherlands
| | - Nel Draijer
- Department of Psychiatry, VU University Medical Center, Amsterdam University Medical Center, The Netherlands
| | | | - André Aleman
- Cognitive Neuroscience Centre, University Medical Centre Groningen, University of Groningen, The Netherlands
| | - Dick J Veltman
- Department of Psychiatry, VU University Medical Center, Amsterdam University Medical Center, The Netherlands
| | - Antje A T S Reinders
- Cognitive Neuroscience Centre, University Medical Centre Groningen, University of Groningen, The Netherlands; and Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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11
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Reinders AATS, Dimitrova LI, Schlumpf YR, Vissia EM, Nijenhuis ERS, Jäncke L, Chalavi S, Veltman DJ. Normal amygdala morphology in dissociative identity disorder. BJPsych Open 2022; 8:e70. [PMID: 35287776 PMCID: PMC8935907 DOI: 10.1192/bjo.2022.36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Studies investigating the structure of the amygdala in relation to dissociation in psychiatric disorders are limited and have reported normal or preserved, increased or decreased global volumes. Thus, a more detailed investigation of the amygdala is warranted. Amygdala global and subregional volumes were compared between individuals with dissociative identity disorder (DID: n = 32) and healthy controls (n = 42). Analyses of covariance did not show volumetric differences between the DID and control groups. Although several unknowns make it challenging to interpret our findings, we propose that the finding of normal amygdala volume is a genuine finding because other studies using this data-set have presented robust morphological aberrations in relation to the diagnosis of DID.
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Affiliation(s)
- Antje A T S Reinders
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Lora I Dimitrova
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; and Department of Psychiatry, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, The Netherlands
| | - Yolanda R Schlumpf
- Clienia Littenheid AG, Private Clinic for Psychiatry and Psychotherapy, Littenheid, Switzerland; and Heelzorg, Centre for Psychotrauma, Zwolle, The Netherlands
| | - Eline M Vissia
- Heelzorg, Centre for Psychotrauma, Zwolle, The Netherlands
| | | | - Lutz Jäncke
- Division of Neuropsychology, Department of Psychology, University of Zurich, Switzerland; and Research Unit for Plasticity and Learning of the Healthy Aging Brain, University of Zurich, Switzerland
| | - Sima Chalavi
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Dick J Veltman
- Department of Psychiatry, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, The Netherlands
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12
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Eder-Moreau E, Zhu X, Fisch CT, Bergman M, Neria Y, Helpman L. Neurobiological Alterations in Females With PTSD: A Systematic Review. Front Psychiatry 2022; 13:862476. [PMID: 35770056 PMCID: PMC9234306 DOI: 10.3389/fpsyt.2022.862476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
Most females experience at least one traumatic event in their lives, but not all develop PTSD. Despite considerable research, our understanding of the key factors that constitute risk for PTSD among females is limited. Previous research has largely focused on sex differences, neglecting within group comparisons, thereby obviating differences between females who do and do not develop PTSD following exposure to trauma. In this systematic review, we conducted a search for the extent of existing research utilizing magnetic resonance imaging (MRI) to examine neurobiological differences among females of all ages, with and without PTSD. Only studies of females who met full diagnostic criteria for PTSD were included. Fifty-six studies were selected and reviewed. We synthesized here findings from structural MRI (sMRI), functional MRI (fMRI), diffusion tensor imaging (DTI), and resting state functional connectivity (rs-FC MRI) studies, comparing females with and without PTSD. A range of biopsychosocial constructs that may leave females vulnerable to PTSD were discussed. First, the ways timing and type of exposure to trauma may impact PTSD risk were discussed. Second, the key role that cognitive and behavioral mechanisms may play in PTSD was described, including rumination, and deficient fear extinction. Third, the role of specific symptom patterns and common comorbidities in female-specific PTSD was described, as well as sex-specific implications on treatment and parenting outcomes. We concluded by identifying areas for future research, to address the need to better understand developmental aspects of brain alterations, the differential impact of trauma types and timing, the putative role of neuroendocrine system in neurobiology of PTSD among females, and the impact of social and cultural factors on neurobiology in females with PTSD.
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Affiliation(s)
- Elizabeth Eder-Moreau
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States
| | - Xi Zhu
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States.,Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - Chana T Fisch
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States
| | - Maja Bergman
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States
| | - Yuval Neria
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States.,Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - Liat Helpman
- Department of Counseling and Human Development, Faculty of Education, University of Haifa, Haifa, Israel.,Psychiatric Research Unit, Tel Aviv Medical Center, Tel Aviv, Israel
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13
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van der Hart O. Trauma-related dissociation: An analysis of two conflicting models. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2021. [DOI: 10.1016/j.ejtd.2021.100210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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14
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Blihar D, Crisafio A, Delgado E, Buryak M, Gonzalez M, Waechter R. A Meta-Analysis of Hippocampal and Amygdala Volumes in Patients Diagnosed With Dissociative Identity Disorder. J Trauma Dissociation 2021; 22:365-377. [PMID: 33433297 DOI: 10.1080/15299732.2020.1869650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Dissociative Identity Disorder (DID), an illness characterized by multiple personality states, has long been a controversial diagnosis within the psychiatric community. Demonstrating a neuroanatomical basis for the disorder may help to resolve the controversy. Current literature on the neuroanatomy associated with DID has focused on the hippocampus and amygdala and are inconclusive. This meta-analysis pools the results from n = 3 studies to compare the mean size of these two structures between DID patients, non-DID patients, and healthy controls. Patients diagnosed with both DID & PTSD were found to have smaller hippocampi bilaterally (p< .001) compared to healthy controls; no significant difference was seen in the amygdala. When comparing DID to PTSD patients, the left hippocampus was smaller (p< .001), with a trend for a smaller right hippocampus (p = .06). A comparison of the amygdala was not possible due to a lack of data. These findings suggest that a smaller hippocampus is seen in DID patients beyond what is seen for PTSD, provides neuroanatomical evidence for the memory impairment often seen in DID patients (i.e., amnesia experienced by the host and alters), and presents a potentially novel means to understand this disorder.
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Affiliation(s)
- David Blihar
- School of Medicine, St. George's University, True Blue, Grenada, West Indies
| | - Anthony Crisafio
- School of Medicine, St. George's University, True Blue, Grenada, West Indies
| | - Elliott Delgado
- School of Medicine, St. George's University, True Blue, Grenada, West Indies
| | - Marina Buryak
- School of Medicine, St. George's University, True Blue, Grenada, West Indies
| | - Michael Gonzalez
- School of Medicine, St. George's University, True Blue, Grenada, West Indies
| | - Randall Waechter
- School of Medicine, St. George's University, True Blue, Grenada, West Indies.,Windward Islands Research and Education Foundation, New York, NY, USA
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15
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Sierk A, Manthey A, Brakemeier EL, Walter H, Daniels JK. The dissociative subtype of posttraumatic stress disorder is associated with subcortical white matter network alterations. Brain Imaging Behav 2021; 15:643-655. [PMID: 32342260 PMCID: PMC8032639 DOI: 10.1007/s11682-020-00274-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Posttraumatic stress disorder (PTSD) is characterized by intrusions, avoidance, and hyperarousal while patients of the dissociative subtype (PTSD-D) experience additional dissociative symptoms. A neurobiological model proposes hyper-inhibition of limbic structures mediated by prefrontal cortices to underlie dissociation in PTSD. Here, we tested whether functional alterations in fronto-limbic circuits are underpinned by white matter network abnormalities on a network level. 23 women with PTSD-D and 19 women with classic PTSD participated. We employed deterministic diffusion tractography and graph theoretical analyses. Mean fractional anisotropy (FA) was chosen as a network weight and group differences assessed using network-based statistics. No significant white matter network alterations comprising both frontal and limbic structures in PTSD-D relative to classic PTSD were found. A subsequent whole brain exploratory analysis revealed relative FA alterations in PTSD-D in two subcortical networks, comprising connections between the left amygdala, hippocampus, and thalamus as well as links between the left ventral diencephalon, putamen, and pallidum, respectively. Dissociative symptom severity in the PTSD-D group correlated with FA values within both networks. Our findings suggest fronto-limbic inhibition in PTSD-D may present a dynamic neural process, which is not hard-wired via white matter tracts. Our exploratory results point towards altered fiber tract communication in a limbic-thalamic circuit, which may underlie (a) an initial strong emotional reaction to trauma reminders before conscious regulatory processes are enabled and (b) deficits in early sensory processing. In addition, aberrant structural connectivity in low-level motor regions may present neural correlates for dissociation as a passive threat-response.
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Affiliation(s)
- Anika Sierk
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany, Berlin, Germany
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Antje Manthey
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany, Berlin, Germany
| | - Eva-Lotta Brakemeier
- Department of Psychology & Marburg Center for Mind, Brain and Behavior (MCMBB), Philipps-Universität Marburg, Marburg, Germany
- Department of Clinical Psychology, University of Groningen, Groningen, Netherlands
| | - Henrik Walter
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany, Berlin, Germany
| | - Judith K Daniels
- Department of Clinical Psychology, University of Groningen, Groningen, Netherlands.
- Psychologische Hochschule Berlin, Berlin, Germany.
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16
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Roydeva MI, Reinders AATS. Biomarkers of Pathological Dissociation: A Systematic Review. Neurosci Biobehav Rev 2020; 123:120-202. [PMID: 33271160 DOI: 10.1016/j.neubiorev.2020.11.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 08/20/2020] [Accepted: 11/15/2020] [Indexed: 02/06/2023]
Abstract
Pathological dissociation is a severe, debilitating and transdiagnostic psychiatric symptom. This review identifies biomarkers of pathological dissociation in a transdiagnostic manner to recommend the most promising research and treatment pathways in support of the precision medicine framework. A total of 205 unique studies that met inclusion criteria were included. Studies were divided into four biomarker categories, namely neuroimaging, psychobiological, psychophysiological and genetic biomarkers. The dorsomedial and dorsolateral prefrontal cortex, bilateral superior frontal regions, (anterior) cingulate, posterior association areas and basal ganglia are identified as neurofunctional biomarkers of pathological dissociation and decreased hippocampal, basal ganglia and thalamic volumes as neurostructural biomarkers. Increased oxytocin and prolactin and decreased tumor necrosis factor alpha (TNF-α) are identified as psychobiological markers. Psychophysiological biomarkers, including blood pressure, heart rate and skin conductance, were inconclusive. For the genetic biomarker category studies related to dissociation were limited and no clear directionality of effect was found to warrant identification of a genetic biomarker. Recommendations for future research pathways and possible clinical applicability are provided.
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Affiliation(s)
- Monika I Roydeva
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Antje A T S Reinders
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom.
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17
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Blihar D, Delgado E, Buryak M, Gonzalez M, Waechter R. A systematic review of the neuroanatomy of dissociative identity disorder. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2020. [DOI: 10.1016/j.ejtd.2020.100148] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Lotfinia S, Soorgi Z, Mertens Y, Daniels J. Structural and functional brain alterations in psychiatric patients with dissociative experiences: A systematic review of magnetic resonance imaging studies. J Psychiatr Res 2020; 128:5-15. [PMID: 32480060 DOI: 10.1016/j.jpsychires.2020.05.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/15/2020] [Accepted: 05/10/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION There is currently no general agreement on how to best conceptualize dissociative symptoms and whether they share similar neural underpinnings across dissociative disorders. Neuroimaging data could help elucidate these questions. OBJECTIVES The objective of this review is to summarize empirical evidence for neural aberrations observed in patients suffering from dissociative symptoms. METHODS A systematic literature review was conducted including patient cohorts diagnosed with primary dissociative disorders, post-traumatic stress disorder (PTSD), or borderline personality disorder. RESULTS Results from MRI studies reporting structural (gray matter and white matter) and functional (during resting-state and task-related activation) brain aberrations were extracted and integrated. In total, 33 articles were included of which 10 pertained to voxel-based morphology, 2 to diffusion tensor imaging, 10 to resting-state fMRI, and 11 to task-related fMRI. Overall findings indicated aberrations spread across diverse brain regions, especially in the temporal and frontal cortices. Patients with dissociative identity disorder and with dissociative PTSD showed more overlap in brain activation than each group showed with depersonalization/derealization disorder. CONCLUSION In conjunction, the results indicate that dissociative processing cannot be localized to a few distinctive brain regions but rather corresponds to differential neural signatures depending on the symptom constellation.
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Affiliation(s)
- Shahab Lotfinia
- Department of Clinical Psychology, Zahedan University of Medical Science, Zahedan, Iran
| | - Zohre Soorgi
- Department of Psychiatry, Zahedan University of Medical Science, Zahedan, Iran
| | - Yoki Mertens
- Department of Clinical Psychology, University of Groningen, the Netherlands
| | - Judith Daniels
- Department of Clinical Psychology, University of Groningen, the Netherlands.
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19
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Agner H, Bradshaw SD, Winfrey L, Zielinski M, Shumway ST. Family Members of Those with SUDs: Examining Associations between Family and PFC Functioning. ALCOHOLISM TREATMENT QUARTERLY 2020. [DOI: 10.1080/07347324.2020.1787117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Hannah Agner
- Addictive Disorders and Recovery Studies Program, Department of Community, Family, & Addiction Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Spencer D. Bradshaw
- Marriage and Family Therapy Program, Department of Human Development and Family Studies, Utah State University, Logan, Utah, USA
| | - Lauren Winfrey
- Addictive Disorders and Recovery Studies Program, Department of Community, Family, & Addiction Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Mazie Zielinski
- Addictive Disorders and Recovery Studies Program, Department of Community, Family, & Addiction Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Sterling T. Shumway
- Addictive Disorders and Recovery Studies Program, Department of Community, Family, & Addiction Sciences, Texas Tech University, Lubbock, Texas, USA
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20
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Harnett NG, Goodman AM, Knight DC. PTSD-related neuroimaging abnormalities in brain function, structure, and biochemistry. Exp Neurol 2020; 330:113331. [PMID: 32343956 DOI: 10.1016/j.expneurol.2020.113331] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 04/06/2020] [Accepted: 04/24/2020] [Indexed: 12/20/2022]
Abstract
Although approximately 90% of the U.S. population will experience a traumatic event within their lifetime, only a fraction of those traumatized individuals will develop posttraumatic stress disorder (PTSD). In fact, approximately 7 out of 100 people in the U.S. will be afflicted by this debilitating condition, which suggests there is substantial inter-individual variability in susceptibility to PTSD. This uncertainty regarding who is susceptible to PTSD necessitates a thorough understanding of the neurobiological processes that underlie PTSD development in order to build effective predictive models for the disorder. In turn, these predictive models may lead to the development of improved diagnostic markers, early intervention techniques, and targeted treatment approaches for PTSD. Prior research has characterized a fear learning and memory network, centered on the prefrontal cortex, hippocampus, and amygdala, that plays a key role in the pathology of PTSD. Importantly, changes in the function, structure, and biochemistry of this network appear to underlie the cognitive-affective dysfunction observed in PTSD. The current review discusses prior research that has demonstrated alterations in brain function, structure, and biochemistry associated with PTSD. Further, the potential for future research to address current gaps in our understanding of the neural processes that underlie the development of PTSD is discussed. Specifically, this review emphasizes the need for multimodal neuroimaging research and investigations into the acute effects of posttraumatic stress. The present review provides a framework to move the field towards a comprehensive neurobiological model of PTSD.
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Affiliation(s)
- Nathaniel G Harnett
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Adam M Goodman
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David C Knight
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA.
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21
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Dimitrova L, Fernando V, Vissia EM, Nijenhuis ERS, Draijer N, Reinders AATS. Sleep, trauma, fantasy and cognition in dissociative identity disorder, post-traumatic stress disorder and healthy controls: a replication and extension study. Eur J Psychotraumatol 2020; 11:1705599. [PMID: 32082509 PMCID: PMC7006753 DOI: 10.1080/20008198.2019.1705599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/14/2019] [Accepted: 11/13/2019] [Indexed: 10/26/2022] Open
Abstract
Background: Two aetiology models for dissociative identity disorder (DID) have been proposed, namely a childhood Trauma Model and an iatrogenic or Fantasy model. A recent study indicated that sleep disturbances underlie dissociative symptomatology. Objective: Our current study aims to test whether this finding can be replicated in an independent sample and to investigate if this finding still holds after correcting for childhood and adult traumatization. An experimental working memory task is included to investigate how sleep disturbance, traumatization, dissociation, and fantasy proneness impact cognitive functioning. Methods: Three groups of participants were included - individuals with DID, individuals with post-traumatic stress disorder (PTSD), and matched healthy controls. Sleep disturbances were measured and compared between the groups along with measures of childhood and adult traumatization, psychoform and somatoform [psychological and somatic] dissociative symptoms, and fantasy proneness. Cognitive capacity was assessed using a working memory task. Results: When controlled for traumatic experiences, sleep disturbances did not predict dissociative symptoms. When controlled for sleep disturbance and fantasy proneness, childhood traumatization did predict dissociative symptoms. Psychoform dissociative symptoms correlated with traumatic experiences more than with fantasy proneness. Working memory performance was similar among the participating groups. Propensity to fantasy did not discriminate individuals with DID and PTSD, and was a weak predictor of dissociative symptoms. Conclusion: Whereas DID and PTSD are associated with sleep disturbances, these features do not statistically predict dissociative symptoms in these disorders when traumatic experiences are taken into account. Fantasy proneness is not excessive in DID and PTSD. Hence, we found no evidence that sleep disturbances, propensity to fantasy and abnormal working memory capacity explain dissociative symptoms in DID and PTSD. In sum, the relationship between sleep and dissociative symptoms disappeared when potentially traumatizing events were controlled for.
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Affiliation(s)
- Lora Dimitrova
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK.,Department of Psychiatry, Amsterdam UMC, location VUMC, VU University Amsterdam, Amsterdam, the Netherlands
| | - Vinuri Fernando
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK.,Department of Psychiatry, Amsterdam UMC, location VUMC, VU University Amsterdam, Amsterdam, the Netherlands
| | - Eline M Vissia
- Heelzorg, Centre for Psychotrauma, Zwolle, The Netherlands
| | - Ellert R S Nijenhuis
- Clienia Littenheid AG, Private Clinic for Psychiatry and Psychotherapy, Littenheid, Switzerland
| | - Nel Draijer
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Antje A T S Reinders
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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22
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Reinders AATS, Marquand AF, Schlumpf YR, Chalavi S, Vissia EM, Nijenhuis ERS, Dazzan P, Jäncke L, Veltman DJ. Aiding the diagnosis of dissociative identity disorder: pattern recognition study of brain biomarkers. Br J Psychiatry 2019; 215:536-544. [PMID: 30523772 DOI: 10.1192/bjp.2018.255] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND A diagnosis of dissociative identity disorder (DID) is controversial and prone to under- and misdiagnosis. From the moment of seeking treatment for symptoms to the time of an accurate diagnosis of DID individuals received an average of four prior other diagnoses and spent 7 years, with reports of up to 12 years, in mental health services. AIM To investigate whether data-driven pattern recognition methodologies applied to structural brain images can provide biomarkers to aid DID diagnosis. METHOD Structural brain images of 75 participants were included: 32 female individuals with DID and 43 matched healthy controls. Individuals with DID were recruited from psychiatry and psychotherapy out-patient clinics. Probabilistic pattern classifiers were trained to discriminate cohorts based on measures of brain morphology. RESULTS The pattern classifiers were able to accurately discriminate between individuals with DID and healthy controls with high sensitivity (72%) and specificity (74%) on the basis of brain structure. These findings provide evidence for a biological basis for distinguishing between DID-affected and healthy individuals. CONCLUSIONS We propose a pattern of neuroimaging biomarkers that could be used to inform the identification of individuals with DID from healthy controls at the individual level. This is important and clinically relevant because the DID diagnosis is controversial and individuals with DID are often misdiagnosed. Ultimately, the application of pattern recognition methodologies could prevent unnecessary suffering of individuals with DID because of an earlier accurate diagnosis, which will facilitate faster and targeted interventions. DECLARATION OF INTEREST The authors declare no competing financial interests.
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Affiliation(s)
- Antje A T S Reinders
- Senior Research Associate with Lecturer status, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK and Department of Neuroscience, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Andre F Marquand
- Assistant Professor, Donders Institute for Brain Cognition and Behaviour, Radboud University, The Netherlands and Honorary Lecturer, Department of Clinical Neuroscience, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Yolanda R Schlumpf
- Postdoctoral Assistant, Division of Neuropsychology, Department of Psychology, University of Zurich and Clienia Littenheid AG, Private Clinic for Psychiatry and Psychotherapy, Switzerland
| | - Sima Chalavi
- Postdoctoral Researcher, Department of Neuroscience, University Medical Center Groningen, University of Groningen, The Netherlands and Research Center for Movement Control and Neuroplasticity, Department of Movement Sciences, Katholieke Universiteit Leuven, Belgium
| | - Eline M Vissia
- Mental Healthcare Psychologist, Department of Neuroscience, University Medical Center Groningen, University of Groningen and Top Referent Trauma Centrum, GGz Centraal, The Netherlands
| | - Ellert R S Nijenhuis
- Psychologist/Psychotherapist, Clienia Littenheid AG, Private Clinic for Psychiatry and Psychotherapy, Switzerland
| | - Paola Dazzan
- Professor of Neurobiology of Psychosis, Vice Dean International, Honorary Consultant Psychiatrist, Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK
| | - Lutz Jäncke
- Professor of Neuropsychology, Scientific Director, Clienia Littenheid AG, Private Clinic for Psychiatry and Psychotherapy and Research Unit for Plasticity and Learning of the Healthy Aging Brain, University of Zurich, Switzerland
| | - Dick J Veltman
- Professor of Neuroimaging in Psychiatry, Department of Psychiatry, VU University Medical Center, The Netherlands
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23
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A transdiagnostic neuroanatomical signature of psychiatric illness. Neuropsychopharmacology 2019; 44:869-875. [PMID: 30127342 PMCID: PMC6461829 DOI: 10.1038/s41386-018-0175-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/15/2018] [Accepted: 07/19/2018] [Indexed: 02/05/2023]
Abstract
Despite an increasing focus on transdiagnostic approaches to mental health, it remains unclear whether different diagnostic categories share a common neuronatomical basis. The current investigation sought to investigate whether a transdiagnostic set of structural alterations characterized schizophrenia, depression, post-traumatic stress disorder, and obsessive-compulsive disorder, and determine whether any such alterations reflected markers of psychiatric illness or pre-existing familial vulnerability. A total of 404 patients with a psychiatric diagnosis were recruited (psychosis, n = 129; unipolar depression, n = 92; post-traumatic stress disorder, n = 91; obsessive-compulsive disorder, n = 92) alongside n = 201 healthy controls and n = 20 unaffected first-degree relatives. We collected structural magnetic resonance imaging scans from each participant, and tested for transdiagnostic alterations using Voxel-based morphometry. Inferences were made at p < 0.05 after family-wise error correction for multiple comparisons. The four psychiatric groups relative to healthy controls were all characterized by significantly greater gray matter volume in the putamen (right: z-score: 5.97, p-value < 0.001; left: z-score: 4.97, p-value = 0.001); the volume of this region was positively correlated with severity of symptoms across groups (r = 0.313; p < 0.001). Putamen enlargement was also evident in unaffected relatives compared to healthy controls (right: z-score: 8.13, p-value < 0.001; left: z-score: 9.38, p-value < 0.001). Taken collectively, these findings indicate that increased putamen volume may reflect a transdiagnostic marker of familial vulnerability to psychopathology. This is consistent with emerging conceptualizations of psychiatric illness, in which each disorder is understood as a combination of diagnosis-specific features and a transdiagnostic factor reflecting general psychopathology.
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24
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Selemon LD, Young KA, Cruz DA, Williamson DE. Frontal Lobe Circuitry in Posttraumatic Stress Disorder. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2019; 3:2470547019850166. [PMID: 31435577 PMCID: PMC6703563 DOI: 10.1177/2470547019850166] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/23/2019] [Indexed: 12/31/2022]
Abstract
Symptoms of posttraumatic stress disorder include hyperarousal, avoidance of trauma-related stimuli, re-experiencing of trauma, and mood changes. This review focuses on the frontal cortical areas that form crucial links in circuitry pertinent to posttraumatic stress disorder symptomatology: (1) the conditioned fear extinction circuit, (2) the salience circuit, and (3) the mood circuit. These frontal areas include the ventromedial prefrontal cortex (conditioned fear extinction), the dorsal anterior cingulate and insular cortices (salience), and the lateral orbitofrontal and subgenual cingulate cortices (mood). Frontal lobe structural abnormalities in posttraumatic stress disorder, including volumetric reductions in the cingulate cortices, impact all three circuits. Functional analyses of frontal cortices in posttraumatic stress disorder show abnormal activation in all three according to task demand and emotional valence. Network analyses reveal altered amygdalo-frontal connectivity and failure to suppress the default mode network during cognitive engagement. Spine shape alterations also have been detected in the medial orbito-frontal cortex in posttraumatic stress disorder postmortem brains, suggesting reduced synaptic plasticity. Importantly, frontal lobe abnormalities in posttraumatic stress disorder extend beyond emotion-related circuits to include the lateral prefrontal cortices that mediate executive functions. In conclusion, widespread frontal lobe dysfunction in posttraumatic stress disorder provides a neurobiologic basis for the core symptomatology of the disorder, as well as for executive function impairment.
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Affiliation(s)
- Lynn D. Selemon
- Department of Neuroscience, Yale School
of Medicine, Yale University, New Haven, CT, USA
| | - Keith A. Young
- Baylor Scott & White Psychiatry,
Central Texas Veterans Health Care System, Temple, TX, USA
- Department of Psychiatry, Texas A&M
College of Medicine, College Station, USA
- Department of Veterans Affairs,
VISN
17 Center of Excellence for Research on Returning War
Veterans, Waco, TX,USA
| | - Dianne A. Cruz
- Department of Psychiatry and Behavioral
Sciences,
Duke
University, Durham, NC, USA
| | - Douglas E. Williamson
- Department of Psychiatry and Behavioral
Sciences,
Duke
University, Durham, NC, USA
- Durham
VA Medical Center, Durham, NC, USA
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25
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Schiavone FL, McKinnon MC, Lanius RA. Psychotic-Like Symptoms and the Temporal Lobe in Trauma-Related Disorders: Diagnosis, Treatment, and Assessment of Potential Malingering. CHRONIC STRESS 2018; 2:2470547018797046. [PMID: 32440584 PMCID: PMC7219949 DOI: 10.1177/2470547018797046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 07/30/2018] [Indexed: 11/17/2022]
Abstract
Objective To overview the phenomenology, etiology, assessment, and treatment of psychotic-like symptoms in trauma-related 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 trauma-related 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.
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Affiliation(s)
| | - Margaret C McKinnon
- Mood Disorders Program, St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, Ontario, Canada.,Homewood Research Institute, Guelph, Ontario, Canada
| | - Ruth A Lanius
- Department of Psychiatry, University of Western Ontario, London, Ontario, Canada.,Department of Neuroscience, University of Western Ontario, London, Ontario, Canada
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26
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Reinders AATS, Chalavi S, Schlumpf YR, Vissia EM, Nijenhuis ERS, Jäncke L, Veltman DJ, Ecker C. Neurodevelopmental origins of abnormal cortical morphology in dissociative identity disorder. Acta Psychiatr Scand 2018; 137:157-170. [PMID: 29282709 DOI: 10.1111/acps.12839] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To examine the two constitutes of cortical volume (CV), that is, cortical thickness (CT) and surface area (SA), in individuals with dissociative identity disorder (DID) with the view of gaining important novel insights into the underlying neurobiological mechanisms mediating DID. METHODS This study included 32 female patients with DID and 43 matched healthy controls. Between-group differences in CV, thickness, and SA, the degree of spatial overlap between differences in CT and SA, and their relative contribution to differences in regional CV were assessed using a novel spatially unbiased vertex-wise approach. Whole-brain correlation analyses were performed between measures of cortical anatomy and dissociative symptoms and traumatization. RESULTS Individuals with DID differed from controls in CV, CT, and SA, with significantly decreased CT in the insula, anterior cingulate, and parietal regions and reduced cortical SA in temporal and orbitofrontal cortices. Abnormalities in CT and SA shared only about 3% of all significantly different cerebral surface locations and involved distinct contributions to the abnormality of CV in DID. Significant negative associations between abnormal brain morphology (SA and CV) and dissociative symptoms and early childhood traumatization (0 and 3 years of age) were found. CONCLUSIONS In DID, neuroanatomical areas with decreased CT and SA are in different locations in the brain. As CT and SA have distinct genetic and developmental origins, our findings may indicate that different neurobiological mechanisms and environmental factors impact on cortical morphology in DID, such as early childhood traumatization.
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Affiliation(s)
- A A T S Reinders
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - S Chalavi
- Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Biomedical Kinesiology, Research Center for Movement Control and Neuroplasticity, KU Leuven, Leuven, Belgium
| | - Y R Schlumpf
- Division of Neuropsychology, Institute of Psychology, University of Zurich, Zurich, Switzerland.,Private Clinic for Psychiatry and Psychotherapy, Clienia Littenheid AG, Littenheid, Switzerland
| | - E M Vissia
- Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - E R S Nijenhuis
- Private Clinic for Psychiatry and Psychotherapy, Clienia Littenheid AG, Littenheid, Switzerland
| | - L Jäncke
- Division of Neuropsychology, Institute of Psychology, University of Zurich, Zurich, Switzerland.,Research Unit for Plasticity and Learning of the Healthy Aging Brain, University of Zurich, Zurich, Switzerland
| | - D J Veltman
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - C Ecker
- Department of Child & Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Goethe University, Frankfurt am Main, Germany.,Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
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27
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Corporaal SHA, Bruijn SM, Hoogkamer W, Chalavi S, Boisgontier MP, Duysens J, Swinnen SP, Gooijers J. Different neural substrates for precision stepping and fast online step adjustments in youth. Brain Struct Funct 2018; 223:2039-2053. [PMID: 29368052 PMCID: PMC5884917 DOI: 10.1007/s00429-017-1586-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/30/2017] [Indexed: 12/27/2022]
Abstract
Humans can navigate through challenging environments (e.g., cluttered or uneven terrains) by modifying their preferred gait pattern (e.g., step length, step width, or speed). Growing behavioral and neuroimaging evidence suggests that the ability to modify preferred step patterns requires the recruitment of cognitive resources. In children, it is argued that prolonged development of complex gait is related to the ongoing development of involved brain regions, but this has not been directly investigated yet. Here, we aimed to elucidate the relationship between structural brain properties and complex gait in youth aged 9–18 years. We used volumetric analyses of cortical grey matter (GM) and whole-brain voxelwise statistical analyses of white matter (WM), and utilized a treadmill-based precision stepping task to investigate complex gait. Moreover, precision stepping was performed on step targets which were either unperturbed or perturbed (i.e., unexpectedly shifting to a new location). Our main findings revealed that larger unperturbed precision step error was associated with decreased WM microstructural organization of tracts that are particularly associated with attentional and visual processing functions. These results strengthen the hypothesis that precision stepping on unperturbed step targets is driven by cortical processes. In contrast, no significant correlations were found between perturbed precision stepping and cortical structures, indicating that other (neural) mechanisms may be more important for this type of stepping.
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Affiliation(s)
- Sharissa H A Corporaal
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Tervuursevest 101, box 1501, 3001, Leuven, Belgium
| | - Sjoerd M Bruijn
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Tervuursevest 101, box 1501, 3001, Leuven, Belgium
- Department of Human Movement Sciences, MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, The Netherlands
| | - Wouter Hoogkamer
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Tervuursevest 101, box 1501, 3001, Leuven, Belgium
- Department of Integrative Physiology, University of Colorado, Boulder, USA
| | - Sima Chalavi
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Tervuursevest 101, box 1501, 3001, Leuven, Belgium
| | - Matthieu P Boisgontier
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Tervuursevest 101, box 1501, 3001, Leuven, Belgium
| | - Jacques Duysens
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Tervuursevest 101, box 1501, 3001, Leuven, Belgium
| | - Stephan P Swinnen
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Tervuursevest 101, box 1501, 3001, Leuven, Belgium
- Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven, Leuven, Belgium
| | - Jolien Gooijers
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Tervuursevest 101, box 1501, 3001, Leuven, Belgium.
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28
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Perez DL, Matin N, Williams B, Tanev K, Makris N, LaFrance WC, Dickerson BC. Cortical thickness alterations linked to somatoform and psychological dissociation in functional neurological disorders. Hum Brain Mapp 2017; 39:428-439. [PMID: 29080235 DOI: 10.1002/hbm.23853] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/21/2017] [Accepted: 10/10/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Links between dissociation and functional neurological disorder (FND)/conversion disorder are well-established, yet the pathophysiology of dissociation remains poorly understood. This MRI study investigated structural alterations associated with somatoform and psychological dissociation in FND. We hypothesized that multimodal, paralimbic cingulo-insular regions would relate to the severity of somatoform dissociation in patients with FND. METHODS FreeSurfer cortical thickness and subcortical volumetric analyses were performed in 26 patients with motor FND and 27 matched healthy controls. Patients with high dissociation as measured by the Somatoform Dissociation Questionnaire-20 (SDQ) or Dissociative Experiences Scale (DES) were compared to controls in stratified analyses. Within-group analyses were also performed with SDQ and DES scores in patients with FND. All cortical thickness analyses were whole-brain corrected at the cluster-wise level. RESULTS Patients with FND and high somatoform dissociation (SDQ > 35) showed reduced left caudal anterior cingulate cortex (ACC) cortical thickness compared to controls. In within-group analyses, SDQ scores inversely correlated with left caudal ACC cortical thickness in patients with FND. Depersonalization/derealization scores positively correlated with right lateral occipital cortical thickness. Both within-group findings remained statistically significant controlling for trait anxiety/depression, borderline personality disorder and post-traumatic stress disorder, adverse life events, and motor FND subtypes in post-hoc analyses. CONCLUSION Using complementary between-group and within-group analyses, an inverse association between somatoform dissociation and left caudal ACC cortical thickness was observed in patients with FND. A positive relationship was also appreciated between depersonalization/derealization severity and cortical thickness in visual association areas. These findings advance our neuropathobiological understanding of dissociation in FND. Hum Brain Mapp 39:428-439, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- David L Perez
- Department of Neurology, Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Psychiatry, Neuropsychiatry Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts
| | - Nassim Matin
- Department of Neurology, Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Benjamin Williams
- Department of Neurology, Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kaloyan Tanev
- Department of Psychiatry, Neuropsychiatry Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts
| | - Nikos Makris
- Center for Morphometric Analysis, Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts
| | - W Curt LaFrance
- Neuropsychiatry and Behavioral Neurology Division, Rhode Island Hospital, Departments of Psychiatry and Neurology, Brown University, Alpert Medical School, Providence, Rhode Island
| | - Bradford C Dickerson
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts.,Department of Neurology, Frontotemporal Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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29
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O'Doherty DCM, Tickell A, Ryder W, Chan C, Hermens DF, Bennett MR, Lagopoulos J. Frontal and subcortical grey matter reductions in PTSD. Psychiatry Res Neuroimaging 2017; 266:1-9. [PMID: 28549317 DOI: 10.1016/j.pscychresns.2017.05.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 05/12/2017] [Accepted: 05/19/2017] [Indexed: 12/18/2022]
Abstract
Post-traumatic stress disorder (PTSD) is characterised by a range of debilitating psychological, physical and cognitive symptoms. PTSD has been associated with grey matter atrophy in limbic and frontal cortical brain regions. However, previous studies have reported heterogeneous findings, with grey matter changes observed beyond limbic/frontal areas. Seventy-five adults were recruited from the community, 25 diagnosed with PTSD along with 25 healthy and 25 trauma exposed age and gender matched controls. Participants underwent clinical assessment and magnetic resonance imaging. The data-analyses method Voxel Based Morphometry (VBM) was used to estimate cortical grey matter volumes. When compared to both healthy and trauma exposed controls, PTSD subjects demonstrated decreased grey matter volumes within subcortical brain regions-including the hippocampus and amygdala-along with reductions in the anterior cingulate cortex, frontal medial cortex, middle frontal gyrus, superior frontal gyrus, paracingulate gyrus, and precuneus cortex. Significant negative correlations were found between total CAPS lifetime clinical scores/sub-scores and GM volume of both the PTSD and TC groups. GM volumes of the left rACC and right amygdala showed a significant negative correlation within PTSD diagnosed subjects.
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Affiliation(s)
- Daniel C M O'Doherty
- The University of Sydney, Brain and Mind Centre, 100 Mallett Street, Camperdown, NSW 2050, Australia.
| | - Ashleigh Tickell
- The University of Sydney, Brain and Mind Centre, 100 Mallett Street, Camperdown, NSW 2050, Australia
| | - Will Ryder
- The University of Sydney, Brain and Mind Centre, 100 Mallett Street, Camperdown, NSW 2050, Australia
| | - Charles Chan
- The University of Sydney, Brain and Mind Centre, 100 Mallett Street, Camperdown, NSW 2050, Australia
| | - Daniel F Hermens
- The University of Sydney, Brain and Mind Centre, 100 Mallett Street, Camperdown, NSW 2050, Australia
| | - Maxwell R Bennett
- The University of Sydney, Brain and Mind Centre, 100 Mallett Street, Camperdown, NSW 2050, Australia
| | - Jim Lagopoulos
- University of the Sunshine Coast, Sunshine Coast Mind and Neuroscience - Thompson Institute, 12 Innovation Parkway, Birtinya, QLD 4575, Australia
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30
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Howard CJ. Psychospiritual Resiliency: Enhancing Mental Health and Ecclesiastical Collaboration in Caring for Those Experiencing Dissociative Phenomena. JOURNAL OF RELIGION AND HEALTH 2017; 56:258-268. [PMID: 27395050 DOI: 10.1007/s10943-016-0279-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Trauma can oftentimes be a catalyst for changes in an individual's religious and spiritual beliefs. Beliefs about the cause of the trauma, for instance, may include attributions of possessing spirits, and are to be found in an increasingly pluralistic and multicultural society. Such preternatural explanations may be referred to as dissociative identity disorder, possession form. Unwittingly, an overreliance on neurobiological explanations and relegation of cultural idioms of distress may diminish effective collaboration with ecclesiastical authorities. Concomitantly, ecclesiastical experts are confronted with bewildering posttrauma dissociative symptomatology, and may not be prepared as diagnosticians to rule out psychobiological explanations. In both instances, client care may be compromised. Noteworthy, the current investigation integrates the author's participant observation research at the Vatican's school of Exorcism in Rome, Italy.
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31
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Abstract
Dissociation involves disruptions of usually integrated functions of consciousness, perception, memory, identity, and affect (e.g., depersonalization, derealization, numbing, amnesia, and analgesia). While the precise neurobiological underpinnings of dissociation remain elusive, neuroimaging studies in disorders, characterized by high dissociation (e.g., depersonalization/derealization disorder (DDD), dissociative identity disorder (DID), dissociative subtype of posttraumatic stress disorder (D-PTSD)), have provided valuable insight into brain alterations possibly underlying dissociation. Neuroimaging studies in borderline personality disorder (BPD), investigating links between altered brain function/structure and dissociation, are still relatively rare. In this article, we provide an overview of neurobiological models of dissociation, primarily based on research in DDD, DID, and D-PTSD. Based on this background, we review recent neuroimaging studies on associations between dissociation and altered brain function and structure in BPD. These studies are discussed in the context of earlier findings regarding methodological differences and limitations and concerning possible implications for future research and the clinical setting.
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32
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Vissia EM, Giesen ME, Chalavi S, Nijenhuis ERS, Draijer N, Brand BL, Reinders AATS. Is it Trauma- or Fantasy-based? Comparing dissociative identity disorder, post-traumatic stress disorder, simulators, and controls. Acta Psychiatr Scand 2016; 134:111-28. [PMID: 27225185 DOI: 10.1111/acps.12590] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2016] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The Trauma Model of dissociative identity disorder (DID) posits that DID is etiologically related to chronic neglect and physical and/or sexual abuse in childhood. In contrast, the Fantasy Model posits that DID can be simulated and is mediated by high suggestibility, fantasy proneness, and sociocultural influences. To date, these two models have not been jointly tested in individuals with DID in an empirical manner. METHOD This study included matched groups [patients (n = 33) and controls (n = 32)] that were compared on psychological Trauma and Fantasy measures: diagnosed genuine DID (DID-G, n = 17), DID-simulating healthy controls (DID-S, n = 16), individuals with post-traumatic stress disorder (PTSD, n = 16), and healthy controls (HC, n = 16). Additionally, personality-state-dependent measures were obtained for DID-G and DID-S; both neutral personality states (NPS) and trauma-related personality states (TPS) were tested. CONCLUSION For Trauma measures, the DID-G group had the highest scores, with TPS higher than NPS, followed by the PTSD, DID-S, and HC groups. The DID-G group was not more fantasy-prone or suggestible and did not generate more false memories. Malingering measures were inconclusive. Evidence consistently supported the Trauma Model of DID and challenges the core hypothesis of the Fantasy Model.
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Affiliation(s)
- E M Vissia
- Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M E Giesen
- Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - S Chalavi
- Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Biomedical Kinesiology, Research Center for Movement Control and Neuroplasticity, KU Leuven, Leuven, Belgium
| | - E R S Nijenhuis
- Clienia Littenheid, Psychiatrische Klinik, Littenheid, Switzerland
| | - N Draijer
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - B L Brand
- Psychology Department, Towson University, Towson, MD, USA
| | - A A T S Reinders
- Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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33
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Abstract
The etiology of dissociative identity disorder (DID) remains a topic of debate. Proponents of the fantasy model and the trauma model of DID have both called for more empirical research. To this end, the current study presents new and extended data analyses of a previously published H2O positron emission tomography imaging study. This study included 29 subjects: 11 patients with DID and 10 high- and 8 low-fantasy-prone DID-simulating mentally healthy control subjects. All subjects underwent an autobiographical memory script-driven (neutral and trauma related) imagery paradigm in 2 (simulated) dissociative personality states (neutral and trauma related). Psychobiological and psychophysiological data were obtained. Results of the new post-hoc tests on the psychophysiological responses support the trauma model. New results of the brain imaging data did not support the fantasy model. This study extends previously published results by offering important new supporting data for the trauma model of DID.
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34
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Shors TJ, Millon EM. Sexual trauma and the female brain. Front Neuroendocrinol 2016; 41:87-98. [PMID: 27085856 DOI: 10.1016/j.yfrne.2016.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/11/2016] [Accepted: 04/12/2016] [Indexed: 01/01/2023]
Abstract
Sexual aggression and violence against women (VAM) are not only social problems; they are mental health problems. Women who experience sexual trauma often express disruptions in emotional and cognitive processes, some of which lead to depression and post-traumatic stress disorder (PTSD). Animal models of neurogenesis and learning suggest that social yet aggressive interactions between a pubescent female and an adult male can disrupt processes of learning related to maternal care, which in turn reduce survival of new neurons in the female hippocampus. Mental and Physical (MAP) Training is a novel clinical intervention that was translated from neurogenesis research. The intervention, which combines meditation and aerobic exercise, is currently being used to help women learn to recover from traumatic life experiences, especially those related to sexual violence and abuse.
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Affiliation(s)
- Tracey J Shors
- Behavioral and Systems Neuroscience, Department of Psychology, Center for Collaborative Neuroscience, Rutgers University, 152 Frelinghuysen Road Room 201, Piscataway, NJ 08854, USA.
| | - Emma M Millon
- Behavioral and Systems Neuroscience, Department of Psychology, Center for Collaborative Neuroscience, Rutgers University, 152 Frelinghuysen Road Room 201, Piscataway, NJ 08854, USA
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35
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Daniels JK, Frewen P, Theberge J, Lanius RA. Structural brain aberrations associated with the dissociative subtype of post-traumatic stress disorder. Acta Psychiatr Scand 2016; 133:232-40. [PMID: 26138235 DOI: 10.1111/acps.12464] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE One factor potentially contributing to the heterogeneity of previous results on structural grey matter alterations in adult participants suffering from post-traumatic stress disorder (PTSD) is the varying levels of dissociative symptomatology. The aim of this study was therefore to test whether the recently defined dissociative subtype of PTSD characterized by symptoms of depersonalization and derealization is characterized by specific differences in volumetric brain morphology. METHOD Whole-brain MRI data were acquired for 59 patients with PTSD. Voxel-based morphometry was carried out to test for group differences between patients classified as belonging (n = 15) vs. not belonging (n = 44) to the dissociative subtype of PTSD. The correlation between dissociation (depersonalization/derealization) severity and grey matter volume was computed. RESULTS Patients with PTSD classified as belonging to the dissociative subtype exhibited greater grey matter volume in the right precentral and fusiform gyri as well as less volume in the right inferior temporal gyrus. Greater dissociation severity was associated with greater volume in the right middle frontal gyrus. CONCLUSION The results of this first whole-brain investigation of specific grey matter volume in dissociative subtype PTSD indentified structural aberrations in regions subserving the processing and regulation of emotional arousal. These might constitute characteristic biomarkers for the dissociative subtype PTSD.
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Affiliation(s)
- J K Daniels
- Clinic for Psychosomatic Medicine and Psychotherapy, Otto-von-Guericke University, Magdeburg, Germany
| | - P Frewen
- Department of Psychology, Western University, London, ON, Canada
| | - J Theberge
- Department of Diagnostic Imaging, St Joseph's Health Care London, Western University, London, ON, Canada.,Departments of Medical Imaging, Medical Biophysics and Psychiatry, Western University, London, ON, Canada
| | - R A Lanius
- Department of Psychiatry, Western University, London, ON, Canada
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