@article{ref1,
title="Persistent dissociation and its neural correlates in predicting outcomes after trauma exposure",
journal="American journal of psychiatry",
year="2022",
author="Lebois, Lauren A. M. and Harnett, Nathaniel G. and van Rooij, Sanne J. H. and Ely, Timothy D. and Jovanovic, Tanja and Bruce, Steven E. and House, Stacey L. and Ravichandran, Caitlin and Dumornay, Nathalie M. and Finegold, Katherine E. and Hill, Sarah B. and Merker, Julia B. and Phillips, Karlye A. and Beaudoin, Francesca L. and An, Xinming and Neylan, Thomas C. and Clifford, Gari D. and Linnstaedt, Sarah D. and Germine, Laura T. and Rauch, Scott L. and Haran, John P. and Storrow, Alan B. and Lewandowski, Christopher and Musey, Paul I. Jr and Hendry, Phyllis L. and Sheikh, Sophia and Jones, Christopher W. and Punches, Brittany E. and Swor, Robert A. and McGrath, Meghan E. and Hudak, Lauren A. and Pascual, Jose L. and Seamon, Mark J. and Datner, Elizabeth M. and Chang, Anna M. and Pearson, Claire and Domeier, Robert M. and Rathlev, Niels K. and O'Neil, Brian J. and Sergot, Paulina and Sanchez, Leon D. and Miller, Mark W. and Pietrzak, Robert H. and Joormann, Jutta and Barch, Deanna M. and Pizzagalli, Diego A. and Sheridan, John F. and Smoller, Jordan W. and Luna, Beatriz and Harte, Steven E. and Elliott, James M. and Kessler, Ronald C. and Koenen, Karestan C. and McLean, Samuel A. and Stevens, Jennifer S. and Ressler, Kerry J.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="OBJECTIVE: 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. <br><br>METHODS: 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. <br><br>RESULTS: 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. <br><br>CONCLUSIONS: 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.<p /> <p>Language: en</p>",
language="en",
issn="0002-953X",
doi="10.1176/appi.ajp.21090911",
url="http://dx.doi.org/10.1176/appi.ajp.21090911"
}