Abstract
Trauma-related pathological dissociation is characterized by disruptions in one’s sense of self, perceptual, and affective experience. Dissociation and its trauma-related antecedents disproportionately impact women. However, despite the gender-related prevalence and high individual and societal costs, dissociation remains widely underappreciated in clinical practice. Moreover, dissociation lacks a synthesized neurobiological model across its subtypes. Leveraging the Triple Network Model of psychopathology, we sought to parse heterogeneity in dissociative experience by examining functional connectivity of three core neurocognitive networks as related to: (1) the dimensional dissociation subtypes of depersonalization/derealization and partially-dissociated intrusions; and, (2) the diagnostic category of dissociative identity disorder (DID). Participants were 91 women with and without: a history of childhood trauma, current posttraumatic stress disorder (PTSD), and varied levels of dissociation. Participants provided clinical data about dissociation, PTSD symptoms, childhood maltreatment history, and completed a resting-state functional magnetic resonance imaging scan. We used a novel statistical approach to assess both overlapping and unique contributions of dissociation subtypes. Covarying for age, childhood maltreatment and PTSD severity, we found dissociation was linked to hyperconnectivity within central executive (CEN), default (DN), and salience networks (SN), and decreased connectivity of CEN and SN with other areas. Moreover, we isolated unique connectivity markers associated with depersonalization/derealization in CEN and DN, to partially-dissociated intrusions in CEN, and to DID in CEN. This suggests dissociation subtypes have robust functional connectivity signatures that may serve as targets for PTSD/DID treatment engagement. Our findings underscore dissociation assessment as crucial in clinical care, in particular, to reduce gender-related health disparities.
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Acknowledgements
The authors would like to thank the study participants and the hospital staff for their time, assistance, and support.
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This research was supported by the Julia Kasparian Fund for Neuroscience Research (LAML, CAP, MLK) and the National Institute of Mental Health K01 MH118467 (LAML), R21 MH112956 (MLK), and R01 MH119227 (MLK).
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LAML: Conceptualization, Methodology, Investigation, Resources, Data Curation, Writing—Original Draft, Visualization, Supervision, Project administration, Funding acquisition; PK: Conceptualization, Methodology, Software, Formal analysis, Data Curation, Writing—Original Draft; CAP: Investigation, Data Curation, Writing—Review & Editing, Project administration; AML: Investigation, Writing—Review & Editing; LO: Investigation, Writing—Review & Editing; JDW: Investigation, Writing—Review & Editing, Project administration; JTB: Conceptualization, Writing—Review & Editing; SAG: Conceptualization, Supervision, Writing—Review & Editing; NLS: Investigation, Writing—Review & Editing; KJR: Conceptualization, Writing—Review & Editing; MAR: Writing—Review & Editing; SW: Conceptualization, Investigation, Writing—Review & Editing; LDN: Conceptualization, Methodology, Software, Formal analysis, Writing—Review & Editing, Supervision; MLK: Conceptualization, Investigation, Resources, Writing—Review & Editing, Supervision, Project administration, Funding acquisition.
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LAML reports unpaid membership on the Scientific Committee for the International Society for the Study of Trauma and Dissociation (ISSTD), grant support from the National Institute of Mental Health (NIMH), K01 MH118467, and the Julia Kasparian Fund for Neuroscience Research. Dr LAML also reports spousal IP payments from Vanderbilt University for technology licensed to Acadia Pharmaceuticals unrelated to the present work. KJR has performed scientific consultation for Bioxcel, Bionomics, Acer, Takeda, and Jazz Pharma; serves on Scientific Advisory Boards for Sage and the Brain Research Foundation, and he has received sponsored research support from Takeda, Brainsway and Alto Neuroscience. He receives research funding from the NIH. MLK reports unpaid membership on the Scientific Committee for the ISSTD and grant support from the NIMH, R21 MH112956, R01 MH119227. JTB has received consulting fees from Verily Life Sciences, as well as consulting fees and equity from Mindstrong Health, Inc., unrelated the present work. Neither ISSTD nor any funding sources were involved in the analysis or preparation of the paper. All other authors have nothing to report.
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Lebois, L.A.M., Kumar, P., Palermo, C.A. et al. Deconstructing dissociation: a triple network model of trauma-related dissociation and its subtypes. Neuropsychopharmacol. 47, 2261–2270 (2022). https://doi.org/10.1038/s41386-022-01468-1
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DOI: https://doi.org/10.1038/s41386-022-01468-1
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