Persistent Dissociation Research Articles

Persistent Dissociation and Its Neural Correlates in Predicting Outcomes After Trauma Exposure.

Dissociation, a disruption or discontinuity in psychological functioning, is often linked with worse psychiatric symptoms; however, the prognostic value of dissociation after trauma is inconsistent. Determining whether trauma-related dissociation is uniquely predictive of later outcomes would enable early identification of at-risk trauma populations. The authors conducted the largest prospective longitudinal biomarker study of persistent dissociation to date to determine its predictive capacity for adverse psychiatric outcomes following acute trauma. 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. 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. 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.

Induced-Fit Pathway Accelerated Binding of Agitoxin-2 to A K+ Channel Imaged by HS-AFM

Agitoxin-2 (AgTx2) from scorpion venom is a potent blocker of K+ channels which consists of 38 amino acids. The docking model has been elucidated by using solution structure of AgTx2 and molecular dynamics simulation with K+ channel, thus electrostatic and hydrophobic interactions that contribute to binding have been revealed. However, it remains unclear whether binding dynamics are described by a two-state model (AgTx2-bound and AgTx2-unbound) or a more complicated mechanism, such as induced fit or conformational selection. Here, we observed the binding dynamics of AgTx2 to the KcsA channel using high-speed atomic force microscopy. From images of repeated binding and dissociation of AgTx2 to the channel, single-molecule kinetic analyses revealed that the affinity of the channel for AgTx2 increased during persistent binding and decreased during persistent dissociation. We propose a four-state model, including high- and low-affinity states of the channel, with relevant rate constants. An induced-fit pathway was dominant and accelerated binding by 400 times. This is the first analytical imaging of scorpion toxin binding in real time, which is applicable to various biological dynamics including channel ligands, DNA-modifier proteins, and antigen-antibody complexes.

The Temporal Relationship Between Coping Self-Efficacy and Dissociation in Undergraduate Students

ABSTRACTDissociation is a lack of information integration resulting from a process that ranges on a continuum from normative experiences (e.g., daydreaming) to a pervasive traumatic response involving alterations and/or fragmentation in mental processes such as memory, emotion, and perception. Perceived coping self-efficacy (CSE) is a cognitive appraisal ability utilized to regulate internal and external stressors that arise from traumatic events, and is crucial for effective adaptation after extreme stress or trauma. Thus, CSE may be a critical component in decreasing dissociative experiences following a traumatic event. In the present study, 136 undergraduate students (M age = 22.36 years, SD = 6.27; 81% female, 69.1% Caucasian, 77.2% attended some college) completed self-report measures of trauma, dissociation, and coping self-efficacy. All measures were completed by the same participants at two different time points (Time 1 and Time 2) two months apart; all participants reported a history of exposure to at least one Criterion A traumatic event (according to the DSM-5) at Time 1. We hypothesized that CSE for posttraumatic coping demands at Time 2 would mediate the relationship between dissociation at Time 1 and dissociation at Time 2, and subsequently found evidence of significant mediation, 95% CI [.02, .18]. These findings suggest that initial levels of persistent dissociation negatively predict CSE, which in turn directly and negatively influence persistent dissociation at a later time point. This highlights how CSE may serve as a protective factor against persistent dissociation.

A core role for cognitive processes in the acute onset and maintenance of post-traumatic stress in children and adolescents.

BackgroundPost‐traumatic stress disorder (PTSD) is a common reaction to trauma in children and adolescents. While a significant minority of trauma‐exposed youth go on to have persistent PTSD, many youths who initially have a severe traumatic stress response undergo natural recovery. The present study investigated the role of cognitive processes in shaping the early reactions of child and adolescents to traumatic stressors, and the transition to persistent clinically significant post‐traumatic stress symptoms (PTSS).MethodsA prospective longitudinal study of youth aged 8–17 years who had attended a hospital emergency department following single trauma was undertaken, with assessments performed at 2–4 weeks (N = 226) and 2 months (N = 208) post‐trauma. Acute stress disorder and PTSD were assessed using a structured interview, while PTSS, depression severity and peritraumatic and post‐traumatic cognitive processes were assessed using self‐report questionnaires. On the basis of their PTSS scores at each assessment, participants were categorised as being on a resilient, recovery or persistent trajectory.Results PTSS decreased between the two assessments. Cognitive processes at the 2‐ to 4‐week assessment accounted for the most variance in PTSS at both the initial and follow‐up assessment. The onset of post‐traumatic stress was associated particularly with peritraumatic subjective threat, data‐driven processing and pain. Its maintenance was associated with greater peritraumatic dissociation and panic, and post‐traumatic persistent dissociation, trauma memory quality, rumination and negative appraisals. Efforts to deliberately process the trauma were more common in youth who experienced the onset of clinically significant PTSS. Regression modelling indicated that the predictive effect of baseline negative appraisals remained when also accounting for baseline PTSS and depression.ConclusionsCognitive processes play an important role in the onset and maintenance of PTSS in children and adolescents exposed to trauma. Trauma‐related appraisals play a particular role when considering whether youth make the transition from clinically significant acute PTSS to persistent PTSS.

Preliminary validation of the peri-traumatic dissociation trauma drawing assessment (PDTDA): The case of military trauma

The Peri-Traumatic Dissociative Traumatic Drawing Assessment (PDTDA) is an art-based assessment technique developed to evaluate peri-traumatic dissociation subsequent to traumatic events, based on the trauma resolution and time perception literature. To validate the PDTDA, associations between six drawing feature scales; namely, the participants’ peri-traumatic dissociation, persistent dissociation, post-traumatic stress symptoms and history of traumatic events were assessed in a sample of 49 Israeli adults who experienced military trauma. Bivariate correlation analyses indicated that peri-traumatic dissociation negatively correlated with the presence of a boundary line between the event and coping, but positively correlated with new distress symbols. A history of traumatic events negatively correlated with new resource symbols, whereas post-traumatic stress symptoms positively correlated with new distress symbols. The clinical implications are discussed in light of these preliminary findings.

Serum concentrations of brain-derived neurotrophic factor in patients diagnosed with gender dysphoria undergoing sex reassignment surgery.

Transsexualism (ICD-10) is a condition characterized by a strong and persistent dissociation with one's assigned gender. Sex reassignment surgery (SRS) and hormone therapy provide a means of allowing transsexual individuals to feel more congruent with their gender and have played a major role in treatment over the past 70 years. Brain-derived neurotrophic factor (BDNF) appears to play a key role in recovery from acute surgical trauma and environmentally mediated vulnerability to psychopathology. We hypothesize that BDNF may be a biomarker of alleviation of gender incongruence suffering. To measure preoperative and postoperative serum BDNF levels in transsexual individuals as a biomarker of alleviation of stress related to gender incongruence after SRS. Thirty-two male-to-female transsexual people who underwent both surgery and hormonal treatment were selected from our initial sample. BDNF serum levels were assessed before and after SRS with sandwich enzyme linked immunosorbent assay (ELISA). The time elapsed between the pre-SRS and post-SRS blood collections was also measured. No significant difference was found in pre-SRS or post-SRS BDNF levels or with relation to the time elapsed after SRS when BDNF levels were measured. Alleviation of the suffering related to gender incongruence after SRS cannot be assessed by BDNF alone. Surgical solutions may not provide a quick fix for psychological distress associated with transsexualism and SRS may serve as one step toward, rather than as the conclusion of, construction of a person's gender identity.

Avoidant Coping as a Mediator between Persistent Dissociation and PTSD.

Avoidant Coping as a Mediator between Persistent Dissociation and PTSD.

Investigating the dissociative subtype of posttraumatic stress disorder in a sample of traumatized detained youth.

In this study, we tested the validity of a dissociative subtype in a sample of 225 detained adolescents (142 boys, 83 girls) likely meeting full or partial criteria for posttraumatic stress disorder (PTSD). Competing theories of dissociation pose controversy regarding dissociation as a taxon versus a continuum, and results of the current study contribute to this debate by providing evidence of distinct group differences between those high and low in dissociation. Mixture modeling revealed 2 groups of youth with differing levels of depersonalization/derealization dissociative symptoms. Differences between the 2 groups of youth were investigated regarding trauma exposure and several posttraumatic reactions: posttraumatic stress symptoms (PTSS), emotion dysregulation, and emotional numbing. Compared with youth classified in the low-dissociation group, youth who exhibited high levels of dissociation demonstrated higher levels of total PTSS, posttraumatic symptom clusters of emotional numbing, intrusion, and associated features, as well as reporting more difficulties with emotion dysregulation. To test theory regarding the factors that increase the likelihood of persistent dissociation, bootstrapped regression analyses were performed to examine the possibility of an indirect effect of peritraumatic dissociation. Results consistent with statistical mediation suggested that the presence of peritraumatic dissociation at the time of trauma may contribute to the continuation of dissociative symptoms as a more generalized pattern. The results of the current study have implications for clinical treatment with traumatized youth.

The Role of Dissociation in Self-Injurious Behavior among Female Adolescents Who Were Sexually Abused

The study aimed to examine the role of dissociation (persistent versus peritraumatic) in self-injurious behavior among at-risk Israeli female adolescents. In addition, the relationship between childhood sexual abuse, depression, dissociation, and potency was investigated. A convenience sample of 93 female adolescents aged 12 years to 18 years were recruited from institutions for at-risk adolescent girls in Israel. Participants were administered an anonymous self-report questionnaire that included six measures: Demographics, Dissociative Experiences Scale, Center for Epidemiologic Studies Depression Scale, the Peritraumatic Dissociative Experiences Questionnaire, the Traumatic Events Questionnaire, and the Potency Scale. Results indicated that childhood sexual abuse increases the risk for self-injurious behavior more than threefold. Higher levels of persistent dissociation were found among girls who reported child sexual abuse compared to those who did not. Self-injurious behavior was predicted by persistent dissociation. Girls who engaged in self-injurious behavior had lower potency and higher depression levels, regardless of childhood sexual abuse history.

The relations between posttraumatic stress disorder and persistent dissociation among ex-prisoners of war: A longitudinal study.

To date, there are no empirical studies assessing the impact of war captivity on persistent dissociation (PD) and the longitudinal relations between captivity stressors, posttraumatic stress disorder (PTSD), and PD. The current study included two groups of male Israeli veterans from the 1973 Yom Kippur War: ex-prisoners of war (ex-POWs) and comparable veterans who were not taken captive. Both groups were assessed via self-report measures at three time points: T1 18 (1991), T2 30 (2003), and T3 35 (2008) years after the war. Results show that ex-POWs with PTSD reported higher levels of PD compared with ex-POWs and comparison non-POW veterans without PTSD at T3. Furthermore, PTSD symptoms at T1, T2, and T3 mediated the association between captivity and PD at T3. Loss of emotional control and detachment reactions to captivity, as well as posttraumatic intrusion symptoms, were associated with PD. Theoretical and clinical implications of these results are discussed.

EPA-1315 - Role of peritraumatic and persistent dissociation in development of posttraumatic stress disorder

Acute stress disorder (ASD) and its predictivity in development of posttraumatic stress disorder (PTSD) has been researched extensively so far. Symptoms of peritraumatic dissociation (PD) has been proven as a predictive factor for PTSD, but recent studies have shown greater need for distinction of peritraumatic versus persistent dissociation. Symptoms of PD and of persistent dissociation in subjects diagnosed with ASD will be predictive of PTSD symptoms. To investigate the development of ASD symptoms, symptoms of PD and of persistent dissociation within the first month of traumatic event (initial) and six months later (follow-up) in victims of traffic accidents. At the moment, 25 subject were included in initial phase, and 18 at follow-up. Subject were interwieved, Mini International Neuropsychiatric Interview, Acute Stress Disorder Structured Interview, Clinician Administered PTSD Scale, The Dissociative Experience Scale, and The Peritraumatic Dissociative Experiences Questionnaire were administered. 10 subjects were diagnosed with PTSD in the follow-up. Preliminary results support for a greater risk for PTSD when dissociative symptoms are present, of PD or persistent dissociation. Greater distinction of dissociative symptoms in the acute trauma phase should be taken into account when diagnosing ASD. It could be eventually helpfull with identifying individuals at risk for PTSD.

Cardboard characters, vague concerns and an old debate: Some Reflections about the Meaning of Regional Specialisation and Area Studies in Geography

German geography currently appears to be dominated by a continuing critique of essentialist concepts of regions and an equalisation of Areas Studies with a rather naive study of world regions. This is astonishing since the idea that regions do not simply exist by themselves has long been widely acknowledged. However, this does not imply that regions do not matter anymore. Any research topic is embedded in a certain regional context the knowledge of which is crucial in order to gain a more thorough understanding of the subject. In this article, we therefore want to show that the persistent dissociation of “predefined world regions” which has become a veritable credo targets at a cardboard character. We argue that the common accusation of “regional specialists” to essentialise regions, is rather contributing to an obscure othering of Area Studies than to an active understanding of the construction of spaces. Thus, against the background of our experiences as geographers in the field of African Studies, we call for a reengagement with the central idea of regional specialisation in geography to be further enriched by recent geographical discussions on different conceptualisations of space, instead leaving the on-going revitalisation of Area Studies to other disciplines.

Investigating Cognitive Pathways to Psychopathology: Predicting Depression and Posttraumatic Stress Disorder From Early Responses After Assault.

Depression and posttraumatic stress disorder (PTSD) are common after trauma, but it remains unclear what factors determine which disorder a trauma survivor will develop. A prospective longitudinal study of 222 assault survivors assessed candidate predictors derived from cognitive models of depression and PTSD at 2 weeks posttrauma (N = 222), and depression and PTSD symptom severities (N = 183, 82%) and diagnoses at 6 months (N = 205, 92%). Structural equation modeling showed that the depression and PTSD models predicted both depression and PTSD symptom severity, but that the disorder-specific models predicted the respective outcome best (43% for depression, 59% for PTSD symptom severity). Maintaining cognitive variables (hopelessness and self-devaluative thoughts in depression; cognitive responses to intrusive memories and persistent dissociation in PTSD) showed the clearest specific relationships with outcome. Model-derived variables predicted depression and PTSD diagnoses at 6 months over and above what could be predicted from initial diagnoses. Results support the role of cognitive factors in the development of depression and PTSD after trauma, and provide preliminary evidence for some specificity in maintaining cognitive mechanisms.

Peritraumatic and persistent dissociation as predictors of PTSD symptoms in a female cohort

Recent research has investigated peritraumatic and persistent dissociation as a possible predictive factor for posttraumatic stress disorder (PTSD). The current study aimed to add to this literature by examining dissociative responses in female assault survivors (N = 92 at initial assessment; n = 62 at follow-up). Dissociative symptoms experienced at 3 time points were assessed: peritraumatic dissociation (PD), persistent dissociation-initial (M = 28.2 days posttrauma) and follow-up (M = 224.9 days posttrauma), as well as initial and follow-up PTSD symptoms. We hypothesized that PD and persistent dissociative symptoms would predict chronic PTSD symptoms at the follow-up assessment with initial PTSD symptoms and assault type in the model. Hierarchical regression resulted in a significant model predicting 39% of the variance in follow-up PTSD symptom scores (p < .001). Both peritraumatic and follow-up persistent dissociative symptoms significantly and uniquely added to the variance explained in follow-up PTSD symptom score contributing 4% (p = .05) and 8% (p = .008) of the variance, respectively. Results support the predictive value of peritraumatic and persistent dissociative symptoms, and the findings suggest that persistent dissociation may contribute to the development and continuation of PTSD symptoms. We discuss the implications for assessment and possible treatment of PTSD as well as future directions.

Dissociation and memory fragmentation in post-traumatic stress disorder: An evaluation of the dissociative encoding hypothesis

Several prominent theories of post-traumatic stress disorder (PTSD) posit that peritraumatic dissociation results in insufficient encoding of the trauma memory and that persistent dissociation prevents memory elaboration, resulting in memory fragmentation and PTSD. In this review we summarise the empirical literature on peritraumatic and trait dissociation and trauma narrative fragmentation as measured by meta-memory and rater/objective coding. Across 16 studies to date, the association between dissociation and fragmentation was most prominent when examining peritraumatic dissociation and patient's own ratings of memory fragmentation. This relationship did not hold when examining trait dissociation or rater-coded or computer-generated measures of fragmentation. Thus initial evidence points more towards a strong self-reported association between constructs that is not supported on more objective fragmentation coding. Measurement overlap, construct ambiguity, and exclusion of potential confounds may underlie lack of a strong association between dissociation and objective-rated fragmentation.

Conceptualizing Mindfulness and Acceptance as Components of Psychological Resilience to Trauma

Mindfulness- and acceptance-based conceptualizations of PTSD implicate experiential avoidance and non-mindful behavior in the etiology and maintenance of the disorder. If experiential avoidance is associated with vulnerability to PTSD, then a mindful and accepting orientation toward experience may confer psychological resilience following exposure to trauma. This article examines how mindfulness- and acceptance-based theories of psychopathology relate to risk of and resilience to PTSD. Research is reviewed dealing with the impact of experiential avoidance, avoidant coping, dissociation, acceptance, and mindfulness on PTSD symptom severity and posttraumatic functioning. This review suggests that trait mindfulness and acceptance are associated with greater psychological adjustment following exposure to trauma, while experiential avoidance, persistent dissociation, and coping strategies involving emotional disengagement are associated with greater PTSD symptom severity and related psychopathology. Methodological challenges are explored and suggestions for future research and PTSD prevention programs are discussed.

Radiofrequency Catheter Ablation of Posterior Paraseptal Accessory Pathway with Atresia of the Coronary Sinus Ostium

A 42-year-old man was referred to our hospital for an electrophysiologic study because of recurrent episodes of palpitation. On coronary angiogram, an anomalous atresia of the coronary sinus (CS) ostium was discovered. The ablation catheter was inserted from the right femoral artery to the accessory pathway (AP) of posterior paraseptal area. The earliest retrograde atrial activation was recorded in the 5-6 o'clock region of the mitral annulus. Radiofrequency energy was delivered to this site, resulting in elimination of the AP. After this application, there was persistent ventriculoatrial dissociation and led to successful ablation of the AP.

Radiofrequency Catheter Ablation of Posterior Paraseptal Accessory Pathway with Atresia of the Coronary Sinus Ostium

Atresia of coronary sinus (CS) ostium is a rare abnormality and only a few case reports in association with electrophysiological studies. These patients have been reported to have a variety of several arrhythmogenic sources. A 42-year-old man was referred to our hospital for an electrophysiologic study because of recurrent episodes of palpitation. A 6-French decapolar catheter was introduced from the right jugular vein and advanced to the near the CS ostium. But, we could not be advance the catheter into the CS despite several attempts. On coronary angiogram, an anomalous atresia of the CS ostium was discovered. Regular tachycardia was easily induced by an atrial stimulus, we suggested the patient had an atrioventricular reentrant tachycardia. During the tachycardia, the earliest retrograde atrial activation was recorded in the 5–6 o’clock region of the mitral annulus. The ablation catheter was inserted from the right femoral artery to the accessory pathway (AP) of posterior paraseptal area. Radiofrequency energy was delivered to this site, resulting in elimination of the AP. After this application, there was persistent ventriculo-atrial dissociation and led to successful ablation of the AP. We report a rare case of the ablation procedure of posterior paraseptal AP with atresia of the CS ostium.

Steroid-Induced Inflammatory Neuropathy in a Patient on Tumor Necrosis Factor-α Antagonist Therapy

We describe a patient on the tumor necrosis factor-α antagonist, adalimumab, for 2 years for rheumatoid arthitis, who developed a rapidly progressive inflammatory neuropathy shortly after starting oral steroids. Adalimumab was stopped at onset of neurologic symptoms. Electrophysiology showed demyelination, which persisted at 6 month follow-up, cerebrospinal fluid analysis showed persistent albuminocytologic dissociation, and magnetic resonance studies revealed enlarged and enhancing nerve roots. Treatment with intravenous immunoglobulins resulted in slow, progressive improvement. Tumor necrosis factor-α antagonists have previously been implicated in acquired demyelinating neuropathies. In this patient, we hypothesize that adalimumab may have caused an initially asymptomatic chronic inflammatory demyelinating polyneuropathy, which became symptomatic shortly after initiation of steroid therapy. This case may raise the issue of the safety of steroids in conjunction with antitumor necrosis factor-α therapy in susceptible patients.

Risk factors predict post-traumatic stress disorder differently in men and women

BackgroundAbout twice as many women as men develop post-traumatic stress disorder (PTSD), even though men as a group are exposed to more traumatic events. Exposure to different trauma types does not sufficiently explain why women are more vulnerable.MethodsThe present work examines the effect of age, previous trauma, negative affectivity (NA), anxiety, depression, persistent dissociation, and social support on PTSD separately in men and women. Subjects were exposed to either a series of explosions in a firework factory near a residential area or to a high school stabbing incident.ResultsSome gender differences were found in the predictive power of well known risk factors for PTSD. Anxiety predicted PTSD in men, but not in women, whereas the opposite was found for depression. Dissociation was a better predictor for PTSD in women than in men in the explosion sample but not in the stabbing sample. Initially, NA predicted PTSD better in women than men in the explosion sample, but when compared only to other significant risk factors, it significantly predicted PTSD for both men and women in both studies. Previous traumatic events and age did not significantly predict PTSD in either gender.ConclusionGender differences in the predictive value of social support on PTSD appear to be very complex, and no clear conclusions can be made based on the two studies included in this article.