Abstract
Post-traumatic stress disorder (PTSD) is triggered by an individual experiencing or witnessing a traumatic event, often precipitating persistent flashbacks and severe anxiety that are associated with a fearful and hypervigilant presentation. Approximately 14–30% of traumatized individuals present with the dissociative subtype of PTSD, which is often associated with repeated or childhood trauma. This presentation includes symptoms of depersonalization and derealization, where individuals may feel as if the world or self is “dream-like” and not real and/or describe “out-of-body” experiences. Here, we review putative neural alterations that may underlie how sensations are experienced among traumatized individuals with PTSD and its dissociative subtype, including those from the outside world (e.g., touch, auditory, and visual sensations) and the internal world of the body (e.g., visceral sensations, physical sensations associated with feeling states). We postulate that alterations in the neural pathways important for the processing of sensations originating in the outer and inner worlds may have cascading effects on the performance of higher-order cognitive functions, including emotion regulation, social cognition, and goal-oriented action, thereby shaping the perception of and engagement with the world. Finally, we introduce a theoretical neurobiological framework to account for altered sensory processing among traumatized individuals with and without the dissociative subtype of PTSD.
Highlights
The ability to interpret sensations from the external world and from within the internal body influences one’s perception, which informs how we navigate and communicate with our surroundings
We will discuss: (1) a brief description of sensory processing; (2) a neurobiological description of sensory processing in healthy individuals; (3) the neural aberrations among individuals with Post-traumatic stress disorder (PTSD) and its dissociative subtype that overlap with neural networks involved in sensory processing; and (4) we present an integrative model that provides a theoretical framework for sensory processing and address how it may relate to the symptom profiles observed in post-traumatic stress disorder
Overall, incorporating sensory processing into the lens through which we study post-traumatic stress disorder and other traumarelated disorders is critical for informing clinical treatment approaches that integrate mind and body
Summary
The ability to interpret sensations from the external world and from within the internal body influences one’s perception, which informs how we navigate and communicate with our surroundings. Among individuals with PTSD, it is thought that prefrontal cortex activation is decreased, causing disruption to top-down cognitive neural networks responsible for executive functioning, including multisensory integration, informed decision-making and emotion regulation (Shin et al, 2006; Etkin and Wager, 2007; Yehuda et al, 2015; Nicholson et al, 2017) This may cause bottom-up subcortical neural processes to predominate, where sensory stimuli from the external physical world and affective sensations from the internal world are paramount for driving these processes (Sarter et al, 2001; Bryant et al, 2005; Goldin et al, 2008; McRae et al, 2012; Guillery-Girard et al, 2013; Seth, 2013); how this incoming sensory information is processed among traumatized individuals has yet to be fully delineated.
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