Persistent Dissociation and Its Neural Correlates in Predicting Outcomes After Trauma Exposure.
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Lebois Lauren A M, Harnett Nathaniel G, van Rooij Sanne J H, Ely Timothy D, Jovanovic Tanja, Bruce Steven E, House Stacey L, Ravichandran Caitlin, Dumornay Nathalie M, Finegold Katherine E, Hill Sarah B, Merker Julia B, Phillips Karlye A, Beaudoin Francesca L, An Xinming, Neylan Thomas C, Clifford Gari D, Linnstaedt Sarah D, Germine Laura T, Rauch Scott L, Haran John P, Storrow Alan B, Lewandowski Christopher, Musey Paul I, Hendry Phyllis L, Sheikh Sophia, Jones Christopher W, Punches Brittany E, Swor Robert A, McGrath Meghan E, Hudak Lauren A, Pascual Jose L, Seamon Mark J, Datner Elizabeth M, Chang Anna M, Pearson Claire, Domeier Robert M, Rathlev Niels K, O'Neil Brian J, Sergot Paulina, Sanchez Leon D, Miller Mark W, Pietrzak Robert H, Joormann Jutta, Barch Deanna M, Pizzagalli Diego A, Sheridan John F, Smoller Jordan W, Luna Beatriz, Harte Steven E, Elliott James M, Kessler Ronald C, Koenen Karestan C, McLean Samuel A, Stevens Jennifer S, Ressler Kerry J
Аннотация
METHODS: All data were part of the Freeze 2 data release from the Advancing Understanding of Recovery After Trauma (AURORA) study. Study participants provided self-report data about persistent derealization (N=1,464), a severe type of dissociation, and completed a functional MRI emotion reactivity task and resting-state scan 2 weeks posttrauma (N=145). Three-month follow-up reports were collected of posttraumatic stress, depression, pain, anxiety symptoms, and functional impairment.
RESULTS: Derealization was associated with increased ventromedial prefrontal cortex (vmPFC) activation in the emotion reactivity task and decreased resting-state vmPFC connectivity with the cerebellum and orbitofrontal cortex. In separate analyses, brain-based and self-report measures of persistent derealization at 2 weeks predicted worse 3-month posttraumatic stress symptoms, distinct from the effects of childhood maltreatment history and current posttraumatic stress symptoms.
CONCLUSIONS: The findings suggest that persistent derealization is both an early psychological and biological marker of worse later psychiatric outcomes. The neural correlates of trauma-related dissociation may serve as potential targets for treatment engagement to prevent posttraumatic stress disorder. These results underscore dissociation assessment as crucial following trauma exposure to identify at-risk individuals, and they highlight an unmet clinical need for tailored early interventions.