Persistent Dissociation and its Neural Correlates Uniquely Predict Worse Outcomes after Trauma Exposure

Am J Psychiatry, 2022 · DOI: 10.1176/appi.ajp.21090911 · Published: September 1, 2022

Simple Explanation

This study investigates the link between dissociation after trauma and later psychiatric outcomes, focusing on derealization. The research examines whether persistent derealization can predict posttraumatic stress, depression, pain, anxiety, and functional impairment. The study also explores the neural correlates of derealization using fMRI to identify potential biological markers for predicting adverse outcomes.

Study Duration

3 months

Participants

1,464 adults who presented in the emergency department within 72 hours after a trauma exposure

Evidence Level

Longitudinal biomarker study

Key Findings

1
Derealization was associated with increased activity in the ventromedial prefrontal cortex (vmPFC) during an emotion reactivity task.
2
Derealization was associated with decreased resting-state connectivity between the vmPFC and the cerebellum and orbitofrontal cortex.
3
Both self-report and brain-based measures of persistent derealization predicted worse posttraumatic stress symptoms at 3 months.

Research Summary

This study investigated the predictive capacity of persistent derealization, a type of dissociation, for adverse psychiatric outcomes following acute trauma. The research found that derealization, measured both through self-report and brain imaging, predicted worse posttraumatic stress symptoms three months post-trauma. These findings suggest that persistent derealization is both an early psychological and biological marker of worse later psychiatric outcomes, highlighting the need for early identification and intervention for at-risk individuals.

Practical Implications

Early Identification of At-Risk Individuals

Screening for dissociation in the weeks following trauma can help identify individuals at risk of a worse psychiatric course.

Potential Treatment Targets

The neural correlates of trauma-related dissociation, such as vmPFC activity and connectivity, may serve as potential targets for treatment engagement to prevent PTSD.

Need for Tailored Interventions

The study highlights an unmet clinical need for tailored early interventions for individuals with prominent dissociative symptoms.

Study Limitations

1
The study has not tested whether the neural correlates and self-report measures of derealization directly cause the later psychiatric outcomes.
2
It is possible that some derealization preceded the specific traumatic event that brought individuals to the emergency department in this study.
3
The study focused solely on derealization, and the findings may not be generalizable to other types of dissociation.

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