Dissociative Subtype Of Posttraumatic Stress Disorder Research Articles

Group Dissociation-Focused Cognitive Behavioral Therapy (DF-CBT) in Patients Suffering from a Dissociative Subtype of PTSD: An Exploratory Study

ABSTRACT Dissociation is a widespread difficulty among patients suffering from Posttraumatic Stress Disorder (PTSD). However, there is no gold standard treatment for dissociative symptoms. Recent studies propose a cognitive and behavioral conceptualization for dissociation. The aim of this study was to explore the efficacy of a group program of Dissociation-Focused Cognitive Behavior Therapy (DF-CBT) on dissociative symptoms. We recruited 27 patients suffering from a dissociative subtype of PTSD in a university hospital trauma center. Participants completed questionnaires evaluating dissociation, PTSD, mindfulness abilities, beliefs about emotions, beliefs about dissociation, emotion regulation difficulties, anxiety and depression. Following an initial evaluation, participants undertook 7 sessions of DF-CBT, and were reevaluated after the last session using the same questionnaires. We found a significant reduction of dissociative, PTSD, anxiety, and depression symptoms following DF-CBT. The effect size was noticeable for all variables (.61<d < 1.1). We found an association between the reduction of dissociation and the decrease of negative beliefs about emotions and dissociation, mindfulness difficulties and emotion regulation difficulties. This study provided the first empirical evidence of the efficacy of DF-CBT. The active mechanisms involved in the program seem congruent with proposed models of dissociation. A controlled randomized trial is required for further demonstration.

Response of patients with complex forms of PTSD to highly intensive trauma treatment: A clinical cohort study.

Although highly intensive trauma treatment programs show promising results in the treatment of patients with posttraumatic stress disorder (PTSD), it remains uncertain if patients with complex forms of PTSD can benefit equally from these intensive programs. To investigate whether patients with the dissociative subtype of PTSD (PTSD + DS) and patients with probable complex PTSD (CPTSD) draw equal benefits from a highly intensive trauma treatment program as patients with PTSD. In this clinical cohort study, patients were included who attended a 5-day intensive program consisting of eye movement desensitisation reprocessing, exposure in vivo and trauma-sensitive yoga components. PTSD with DS was assessed with the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (CAPS-5), and a provisional diagnosis of CPTSD was assessed with the International Trauma Questionnaire. Primary outcome measure was self-reported PTSD-symptom severity measured by PTSD Checklist for DSM-5 at the start of the program (T1) and a week after the program (T2). Both groups, PTSD + DS (d = 0.85) and probable CPTSD (d = 0.85) benefitted significantly in terms of PTSD-symptom severity reduction and the size of the decrease was not significantly different from that of patients with PTSD. Patients with both forms of PTSD complexity can benefit even from a very brief intensive treatment program, which extends previous studies. The diagnoses of PTSD + DS and CPTSD seem helpful to assess the initial severity of the symptoms, but do not imply contra-indications to benefit from intensive treatment. Highly intensive treatment programs are promising interventions to effectively treat complex forms of PTSD and should be studied further in randomized clinical trials. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Prevalence and concordance of International Classification of Diseases-11th Revision and Diagnostic and Statistical Manual-Fifth Edition posttraumatic stress diagnostics among Northern Irish military veterans.

There are two primary competing diagnostic criteria for posttraumatic stress disorder (PTSD); the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual (DSM). These systems differ in terms of the number and nature of PTSD symptoms, the implied latent structure of the disorder, and associated posttraumatic diagnostic classifications. To investigate the prevalence and concordance of ICD-11th Revision (ICD-11) and DSM-Fifth Edition (DSM-5) PTSD, complex-PTSD (C-PTSD), and dissociative subtype of PTSD (D-PTSD) criteria in a sample of Northern Irish military veterans. Data were collected from a community sample of military veterans living in Northern Ireland (NI). Prevalence rates of ICD-11 PTSD and C-PTSD and DSM-5 PTSD and D-PTSD were estimated using validated self-report measures for each system. Concordance of caseness determined by diagnostic criteria was compared using Cohen's kappa. The DSM-5 algorithm criteria produced significantly higher prevalence estimates of PTSD (39.26%) relative to the ICD-11 algorithm criteria (32.09%). Both C-PTSD and D-PTSD were identified for subgroups within the sample (24.66% and 27.96%, respectively). There was moderate agreement between the diagnostic systems regarding PTSD caseness, and between C-PTSD and D-PTSD caseness. These findings have implications regarding the measurement of PTSD and associated diagnostic groupings for the wider literature, suggesting that the choice of diagnostic screening framework may influence classification. Both C-PTSD and D-PTSD may be relevant diagnostic considerations for the NI military veteran group. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The symptom criteria for the dissociative subtype of posttraumatic stress disorder.

The dissociative subtype of posttraumatic stress disorder (PTSD) was incorporated into the diagnostic criteria for PTSD in Diagnostic and Statisical Manual of Mental Disorders, Fifth Edition (DSM-5). The subtype requires the presence of persistent or recurrent depersonalization or derealization; however, several authors have suggested that a broader array of dissociative symptoms could be included in the criteria. The objective of the present study was to gather data on a wide range of dissociative symptoms in a sample of highly traumatized individuals. The authors administered a set of measures to 62 inpatients in a private psychiatric inpatient program specializing in PTSD and dissociative disorders. Almost every participant met International Classification of Diseases, 11th Edition criteria for complex PTSD, DSM-5 criteria for the dissociative subtype of PTSD, and DSM-5 criteria for dissociative identity disorder or other specified dissociative disorder; these four diagnoses seem to identify largely the same patients and may not be separate disorders. A broad range of dissociative symptoms was endorsed on the Dissociative Experiences Scale and the Dissociative Disorders Interview Schedule. The results support a recommendation that a broad array of symptoms be included in the criteria for the dissociative subtype of PTSD in future editions of the Diagnostic and Statistical Manual of Mental Disorders. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The role of dissociation-related beliefs about memory in trauma-focused treatment

ABSTRACT Objective: Dysfunctional cognitions play a central role in the development of post-traumatic stress disorder (PTSD). However the role of specific dissociation-related beliefs about memory has not been previously investigated. This study aimed to investigate the role of dissociation-related beliefs about memory in trauma-focused treatment. It was hypothesized that patients with the dissociative subtype of PTSD would show higher levels of dissociation-related beliefs, dissociation-related beliefs about memory would decrease after trauma-focused treatment, and higher pre-treatment dissociation-related beliefs would be associated with fewer changes in PTSD symptoms. Method: Post-traumatic symptoms, dissociative symptoms, and dissociation-related beliefs about memory were assessed in a sample of patients diagnosed with PTSD (n = 111) or the dissociative subtype of PTSD (n = 61). They underwent intensive trauma-focused treatment consisting of four or eight consecutive treatment days. On each treatment day, patients received 90 min of individual prolonged exposure (PE) in the morning and 90 min of individual eye movement desensitization and reprocessing (EMDR) therapy in the afternoon. The relationship between dissociation-related beliefs about memory and the effects of trauma-focused treatment was investigated. Results: Dissociation-related beliefs about memory were significantly associated with PTSD and its dissociative symptoms. In addition, consistent with our hypothesis, patients with the dissociative subtype of PTSD scored significantly higher on dissociation-related beliefs about memory pre-treatment than those without the dissociative subtype. Additionally, the severity of these beliefs decreased significantly after trauma-related treatment. Contrary to our hypothesis, elevated dissociation-related beliefs did not negatively influence treatment outcome. Conclusion: The results of the current study suggest that dissociation-related beliefs do not influence the outcome of trauma-focused treatment, and that trauma-focused treatment does not need to be altered specifically for patients experiencing more dissociation-related beliefs about memory because these beliefs decrease in association with treatment.

Impact of dissociation on exposure therapy for PTSD outcomes and Adherence among U.S. Military service members

Emotional engagement is necessary for successful exposure therapy for posttraumatic stress disorder (PTSD), but dissociation is considered a barrier to emotional engagement. Virtual reality exposure therapy (VRE) uses multi-sensory virtual environments to increase emotional engagement during exposure therapy, and average treatment outcomes are comparable to traditional exposure therapy. However, individual factors (e.g., depression) can predict differential responses to VRE. Studies have yet to investigate whether VRE would be more effective in treating patients with dissociation compared to traditional PE. This secondary analysis of a randomized clinical trial explores whether dissociation predicts treatment outcomes to exposure therapy among active-duty soldiers (N = 108) diagnosed with PTSD. We also examine whether individuals reporting dissociative symptoms demonstrated differential treatment responses to VRE and PE. Results indicated a significant two-way interaction between dissociation and time in treatment, such that dissociation blunted the negative relationship between time and PTSD symptoms. Dissociation was not associated with treatment session attendance or drop out. Results also revealed no significant effect of treatment group (PE or VRE) on the relationship between dissociation and PTSD symptoms. Findings contribute to a body of literature supporting the potential clinical and research utility of a dissociative subtype of PTSD.

Psychometric properties of the dissociative subtype of posttraumatic stress disorder scale: replication and extension in two German-speaking samples

ABSTRACT Background: The fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) introduced the dissociative subtype of posttraumatic stress disorder (D-PTSD). To assess this subtype, the Dissociative Subtype of PTSD Scale (DSPS), a 15-item self-report measure to identify lifetime and current dissociative symptoms of D-PTSD, was developed. However, so far, the scale has only been validated in war veterans. Moreover, criterion validity and diagnostic utility have not been examined yet. Objective: We aimed to validate the DSPS in two samples of civilian trauma-exposed German-speaking participants. Methods: In Study 1, a pre-registered online study, participants with and without PTSD symptoms (N = 558) answered questionnaires about traumatic experiences, dissociation, PTSD, depression, generalized anxiety disorder, somatic symptom disorder, alcohol use disorder, absorption, and dissociative responding to trauma-related questionnaires. In Study 2, which used secondary data of a pre-registered clinical study, participants with a PTSD diagnosis (N = 71) answered questionnaires about traumatic experiences, dissociation, PTSD, depression, generalized anxiety disorder, somatic symptom disorder, and dissociative responding to standardized trauma exposure. Moreover, PTSD, D-PTSD, and other diagnoses were assessed with structured clinical interviews. Results: Analyses confirmed a three-factor structure as well as high internal consistency, and high convergent, discriminant, and criterion validity of the DSPS. Moreover, the scale was able to identify a latent D-PTSD group and individuals with D-PTSD diagnosis. Conclusions: The DSPS constitutes a reliable and valid tool to assess D-PTSD symptoms in clinical practice and research and thereby may contribute to a better understanding of these debilitating symptoms.

Neurobiological and genetic correlates of the dissociative subtype of posttraumatic stress disorder.

Approximately 10%-30% of individuals with posttraumatic stress disorder (PTSD) exhibit a dissociative subtype of the condition defined by symptoms of depersonalization and derealization. This study examined the psychometric evidence for the dissociative subtype of PTSD in a sample of young, primarily male post-9/11-era Veterans (n = 374 at baseline and n = 163 at follow-up) and evaluated its biological correlates with respect to resting state functional connectivity (default mode network [DMN]; n = 275), brain morphology (hippocampal subfield volume and cortical thickness; n = 280), neurocognitive functioning (n = 337), and genetic variation (n = 193). Multivariate analyses of PTSD and dissociation items suggested a class structure was superior to dimensional and hybrid ones, with 7.5% of the sample comprising the dissociative class; this group showed stability over 1.5 years. Covarying for age, sex, and PTSD severity, linear regression models revealed that derealization/depersonalization severity was associated with: decreased DMN connectivity between bilateral posterior cingulate cortex and right isthmus (p = .015; adjusted-p [padj] = .097); increased bilateral whole hippocampal, hippocampal head, and molecular layer head volume (p = .010-.034; padj = .032-.053); worse self-monitoring (p = .018; padj = .079); and a candidate genetic variant (rs263232) in the adenylyl cyclase 8 gene (p = .026), previously associated with dissociation. Results converged on biological structures and systems implicated in sensory integration, the neural representation of spatial awareness, and stress-related spatial learning and memory, suggesting possible mechanisms underlying the dissociative subtype of PTSD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Turkish Adaptation of Dissociative Subtype of Post Traumatic Stress Disorder Scale

ABSTRACT After the changes in DSM-5, dissociative subtype was added to post-traumatic stress disorder. That caused a necessity for a scale to measure the mentioned change. A scale named Dissociative Subtype of Post-Traumatic Stress Disorder (DSPS) was developed to measure this subtype and help the diagnosis. The purpose of this study is to adapt the Dissociative Subtype of Post-Traumatic Stress Disorder to Turkish and examine its reliability and validity. The Dissociative Subtype of PTSD (DSPS) was translated into Turkish. DSPS, Turkish forms of The Posttraumatic Diagnostic Scale and Dissociative Experiences Scale were sent to participants via Google Forms and data from 279 people aged 18–45 were analyzed. Reliability tests and factor analysis were conducted. Factor analysis showed that scale has good model fit scores and items were loaded to the factors the same as the original study. Scales internal consistency was examined, and a good score was obtained (α=.84). Fit index values of confirmatory factor analysis were found as χ2/df = 2.51, GFI=.90, RMSEA=.07, RMR=.02. As a result of the high reliability scores and sufficient model fit scores, this scale is considered as a dependable measure to evaluate the dissociative subtype of PTSD.

Four reasons why we should screen for dissociation in competitive sports

Four reasons why we should screen for dissociation in competitive sports

Women with PTSD and Substance Use Disorders in a Research Treatment Study: A Comparison of those with and without the Dissociative Subtype of PTSD

ABSTRACT Significant differences in clinical features have been reported in women with substance use disorders (SUDs) between those with the dissociative subtype of posttraumatic stress disorder (D-PTSD) compared to those without, namely more severe trauma histories, PTSD symptoms, and general psychopathology. This presentation reports on a group of 88 women with PTSD and SUD taking part in a research treatment study. All women were assessed using the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) and were categorized into those with (n = 23, 26%) and without (n = 65, 74%) D-PTSD. Assessments for SUDs were via the Multi-International Neuropsychiatric Inventory, Seventh Version (MINI-7). Compared to those without D-PTSD, those with D-PTSD had significantly higher CAPS-5 scores (50.5 ± 9.9 v. 39.6 ± 8.8), greater number of PTSD symptoms (16.4 ± 2.6 v. 14.2 ± 2.4), more alcohol use disorder (AUD) (65.2% v. 30.8%), and more non-cocaine stimulant use disorder (34.8% v. 12.3%). No significant differences were found for other SUDs. These women with SUDs and D-PTSD have higher degrees of PTSD severity as well as unique clinical presentations. Future research is needed to explore the significance of these findings for clinical assessment and treatment.

A latent profile analysis of the dissociative subtype of PTSD in a sample of UK Armed Forces veterans residing in Northern Ireland

Background: Posttraumatic stress disorder (PTSD) and dissociation have long been associated with each other. In recent years, studies have examined support for the dissociative subtype of PTSD in several different populations. To date, no study has examined whether this subtype exists in UK Armed Forces military veterans residing in Northern Ireland. Northern Ireland has a history of prolonged civil conflict, differentiating the veterans who live in the region from veterans who live in the remainder of the United Kingdom; and increasing the likelihood that they will experience mental health difficulties. Methods: Data was collected through a cross-sectional, self-report survey from military veterans living in Northern Ireland. The effective sample for the current study was 834 veterans (90.38% males, mean age 55.81 years). A latent profile analysis of PTSD and dissociative indicators was conducted to examine the existence of the dissociative PTSD subtype. Results: Four quantitatively different latent profiles were identified; Non-symptomatic, Low PTSD, Moderate PTSD and High PTSD. There was no evidence of a dissociative PTSD subtype. Several military-type variables differentially predicted membership in the latent profiles, including combat exposure, length of service, physical injuries during service and having been medically discharged. Conclusions: The results do not support the Subtype model of the relationship between PTSD and dissociation. However, they have important implications for clinicians working with veterans in the region, as it appears that dissociation is an integral part of the PTSD presentation in Northern Irish veterans.

The dissociative subtype of PTSD in trauma-exposed individuals: a latent class analysis and examination of clinical covariates

ABSTRACT Background A dissociative subtype of posttraumatic stress disorder (D-PTSD) was introduced into the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) but latent profiles and clinical correlates of D-PTSD remain controversial. Objective The aims of our study were to identify subgroups of individuals with distinct patterns of PTSD symptoms, including dissociative symptoms, by means of latent class analyses (LCA), to compare these results with the categorization of D-PTSD vs. PTSD without dissociative features according to the CAPS-5 interview, and to explore whether D-PTSD is associated with higher PTSD severity, difficulties in emotion regulation, and depressive symptoms. Method A German sample of treatment-seeking individuals was investigated (N = 352). We conducted an LCA on the basis of symptoms of PTSD and dissociation as assessed by the CAPS-5. Moreover, severity of PTSD (PCL-5), difficulties in emotion regulation (DERS), and depressive symptoms (BDI-II) were compared between patients with D-PTSD according to the CAPS-5 interview and patients without dissociative symptoms. Results LCA results suggested a 5-class model with one subgroup showing the highest probability to fulfill criteria for the dissociative subtype and high scores on both BDI and DERS. Significantly higher scores on the DERS, BDI and PCL-5 were found in the D-PTSD group diagnosed with the CAPS-5 (n = 75; 35.7%). Sexual trauma was also reported more often by this subgroup. When comparing the dissociative subtype to the LCA results, only a partial overlap could be found. Conclusions Our findings suggest that patients with D-PTSD have significantly more problems with emotion regulation, more depressive symptoms, and more severe PTSD-symptoms. Given the results of our LCA, we conclude that the dissociative subtype seems to be more complex than D-PTSD as diagnosed by means of the CAPS-5.

Examining Neuroendocrine and Inflammatory Biomarker Profiles to Characterize PTSD Subtypes and Symptom Profiles

Posttraumatic Stress Disorder (PTSD) is characterized by various symptom profiles and high comorbidities with other conditions, including Major Depressive Disorder (MDD). A dissociative subtype of PTSD (PTSD-DST) has been specified by additional symptoms of depersonalization and derealisation. However, the underlying neurobiology of PTSD-DST is poorly understood. This study examined neuroendocrine and inflammatory biomarkers in relation to symptom profiles of PTSD.

How Processing of Sensory Information From the Internal and External Worlds Shape the Perception and Engagement With the World in the Aftermath of Trauma: Implications for PTSD.

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.

Efficacy and safety results from the first pivotal phase 3 randomized controlled trial of mdma-assisted psychotherapy for treatment of severe chronic PTSD

IntroductionPosttraumatic stress disorder is a prevalent mental health condition with substantial impact on daily functioning that lacks sufficient treatment options. Previous research has led to the designation of 3,4-methylenedioxymethamphetamine (MDMA) as a Breakthrough Therapy for treatment of post-traumatic stress disorder (PTSD) when administered as an adjunct to psychotherapy.ObjectivesHere we report the findings of the first randomized, double-blind, Phase 3 trial assessing the efficacy and safety of 3 sessions with a flexible dose of MDMA or placebo administered under direct observation to participants with severe PTSD (n = 100) as an adjunct to inner-directed psychotherapy.MethodsChange in PTSD symptoms (CAPS-5) and functional impairment (SDS) were assessed by a central, blinded Independent Rater Pool at baseline and following each treatment session. Adverse events (AEs), concomitant medications, suicidal ideation and behavior were tracked throughout the study. Vital signs were measured during experimental sessions. The primary endpoint was 18 weeks post-randomization.ResultsChange in CAPS-5 and SDS, placebo-subtracted Cohen’s d effect size, and a responder analysis will be presented. There were three serious AEs of suicidal ideation or behavior reported. MDMA was well tolerated, with some treatment emergent AEs occurring at greater frequency for the MDMA group during and after experimental sessions.ConclusionsIf MDMA-assisted psychotherapy significantly attenuates PTSD symptomatology and associated functional impairment, these results will form the basis for marketing authorization applications worldwide, including among participants with dissociative subtype of PTSD, depression, history of alcohol and substance use disorders, and adverse childhood experiences.DisclosureNo significant relationships.

Childhood maltreatment type and severity predict depersonalization and derealization in treatment-seeking women with posttraumatic stress disorder

The dissociative subtype of posttraumatic stress disorder (D-PTSD) is estimated to occur in approximately 14% of those with posttraumatic stress disorder (PTSD), and is characterized by clinically significant dissociative symptoms in addition to typical PTSD symptoms. Prior research has found childhood maltreatment contributes to dissociation and D-PTSD susceptibility, but more nuanced questions about the nature of childhood maltreatment remain unexplored. We investigated how childhood maltreatment type and severity are associated with the dissociative symptoms of D-PTSD among women with PTSD (N = 106) receiving psychiatric care at a program specializing in trauma-related disorders. Participants completed self-report surveys of psychiatric symptoms and prior trauma exposure including the PTSD Checklist for DSM-5, the Dissociative Subtype of PTSD Scale, and the Childhood Trauma Questionnaire. We used multivariate linear regression to model the association of childhood maltreatment types and dissociation. In our final model childhood emotional abuse and physical abuse significantly predicted the dissociative symptoms of D-PTSD. This suggests childhood maltreatment type and severity, in particular of emotional and physical abuse, are associated with the dissociative symptoms of D-PTSD. This work points toward potential etiological contributions to D-PTSD.

The Dissociative Subtype of Posttraumatic Stress Disorder: Forensic Considerations and Recent Controversies

This article provides an overview of the evidence concerning the dissociative subtype of posttraumatic stress disorder (PTSD) and its relevance in forensic contexts. We discuss best practices for the assessment of the subtype in forensic settings, including consideration of malingering, and the impact of the subtype on witness presentation and potential award determinations. We review recent debate concerning the definition of the subtype and how multivariate analyses can be used to inform the understanding of the relationship between PTSD and dissociation. Altering the definition of the subtype (or of the core PTSD criteria), such as by including additional types of dissociative symptoms, would likely hold major implications for diagnostic prevalence and comorbidity and could substantially affect forensic cases involving the dissociative subtype of PTSD. We suggest that for DSM-6, it would be best to use structural evidence to decide how best to revise the subtype and accurately capture its relationship with the core PTSD symptoms. It is important for forensic experts to be well-versed in the state of the science concerning this condition so as to reliably and validly assess clients and inform triers of fact of the strengths and weaknesses of this body of work.

A network analysis of posttraumatic stress disorder and dissociation in trauma-exposed adolescents

Posttraumatic stress disorder (PTSD) and dissociation have long been recognized to co-occur, leading the DSM-5 to introduce a dissociative subtype of PTSD into its nomenclature. Most research to date on the dissociative subtype has focused on adults. The current study aimed to extend this research to an adolescent sample and to examine symptom-level associations between PTSD and dissociation using network analysis. The analysis was conducted with 448 trauma-exposed detained US adolescents (24.55% female; mean age 15.98 ± 1.25 years). A network consisting of 20 DSM-5 PTSD symptoms was constructed, followed by a network consisting of 20 PTSD symptoms and five dissociative items. Expected influence bridge centrality was estimated to examine items with the most/strongest cross-construct connections (i.e. between PTSD and dissociation). The PTSD symptoms concentration problems, amnesia and recurrent memories and the dissociative items depersonalization, derealisation and can’t remember things that happened had the highest bridge centrality values. These symptom-level associations extend our understanding of the PTSD-dissociation relationship by pointing to specific symptoms of PTSD and dissociation that may drive the co-morbidity between the two constructs. These findings may inform future intervention efforts.

Uncovering the heterogeneity of posttraumatic stress disorder: Towards a personalized medicine approach for military members and Veterans

Introduction: Recently, there has been substantial interest in exploring the heterogeneity of posttraumatic stress disorder (PTSD) on a neurobiological level, as individuals with PTSD, including military members and Veterans, vary in their presentation of symptoms. Methods: Critically, a dissociative subtype of PTSD (PTSD+DS) has been defined, where a large body of evidence suggests that the unique presentation of symptoms among PTSD+DS patients is associated with aberrant neurobiological underpinnings. Results: PTSD+DS is often characterized by emotion overmodulation, with increased top-down activation from emotion regulation areas, which is associated with emotional detachment, depersonalization, and derealization. This is in stark contrast to the symptoms commonly observed in individuals with PTSD, who exhibit emotion undermodulation, which involves decreased top-down regulation of hyperactive emotion generation areas and is associated with vivid re-experiencing of trauma memories and hyperarousal. Discussion: This article examines a clinical case example that clearly illustrates this heterogeneous presentation of PTSD symptomatology and psychopathology. It discusses the implications this evidence base holds for a neurobiologically-informed, personalized medicine approach to treatment for military members and Veterans.