Trauma-related dissociation and altered states of consciousness: a call for clinical, treatment, and neuroscience research

Voluntary recall of trauma is a key element in exposure-based psychotherapies and can trigger spontaneous dissociative responses such as flashbacks, depersonalisation, and derealisation. In order to examine the associations between cardiovascular and psychological responses to voluntary recollection of trauma, individuals with PTSD recalled a traumatic memory. Heart rate and heart rate variability were recorded continuously and the episodes when different forms of dissociation were experienced during the recall were identified. A significant increase in parasympathetic activity was found during trauma recall, with greater parasympathetic dominance being indicative of greater state depersonalisation/derealisation. Whereas overall decreases in heart rate during trauma recall were associated with increased fear and perceived threat, flashbacks were accompanied by short-term increases in heart rate. These findings demonstrate different types of cardiovascular responses associated with different psychological experiences during trauma recall. Future research directions were discussed.

Section: The Current Studymentioning

confidence: 99%

“…Accordingly, it is important to investigate ways of detecting emotional arousal (e.g. fear and perceived threat) and different states of consciousness such as depersonalisation, derealisation, and flashbacks (Lanius, 2015) during voluntary recall of trauma among individuals with PTSD.…”

mentioning

confidence: 99%

Cardiovascular and psychological responses to voluntary recall of trauma in posttraumatic stress disorder

Chou

Marca

Steptoe

et al. 2018

“…For example, Westphal et al (2011) reported that individuals with a previous diagnosis of PTSD who did not currently meet criteria for the disorder experienced reduced quality of life when compared to trauma-exposed controls. Despite these findings, limited research has sought to identify symptom level factors predictive of functional impairment among individuals with PTSD – knowledge that is central to tailoring treatment to promote both symptomatic and functional recovery (Lanius, 2015). …”

Section: Introductionmentioning

confidence: 99%

Dissociative symptoms mediate the relation between PTSD symptoms and functional impairment in a sample of military members, veterans, and first responders with PTSD

Boyd

Protopopescu

O’Connor

et al. 2018

Self Cite

Background: Posttraumatic Stress Disorder (PTSD) is associated with significant functional impairment in important areas, including interpersonal relationships and occupational or educational roles. Preliminary evidence suggests that the dissociative subtype of PTSD (PTSD+DS), characterized by marked symptoms of depersonalization and derealization, is associated with increased functional impairment and disease severity, including among military members and veterans diagnosed with PTSD. Similarly, first responders (e.g. police, fire, paramedics) have also been found to experience dissociative symptoms. Despite these findings, little work has investigated whether dissociative symptoms are related to heightened functional impairment among these populations.Objective: We examined the relation between functional impairment and symptom level variables, including dissociative symptoms of depersonalization and derealization among military members, veterans, and first responders with probable PTSD. We further investigated the hypothesis that dissociative symptoms mediate the relation between PTSD symptomatology and functional impairment.Method: Eighty-one medical charts of inpatients at a residential PTSD treatment programme were accessed via retrospective review. Sixty-two were included in the present analyses. Comparison of means on symptom measures between first responders and military members/veterans were conducted, followed by correlational and mediation analyses.Results: Compared with first responders, military members and veterans showed higher levels of derealization, functional impairment, alexithymia, anxiety, and depression. Within the total sample, dissociative symptoms emerged as the strongest correlate of functional impairment and, among the dissociative symptom clusters, derealization symptoms demonstrated the strongest relation with impairment. Mediation analyses revealed that total dissociative symptoms and derealization symptoms significantly mediated the relation between PTSD symptoms and functional impairment.Conclusions: These findings highlight the importance of assessing and treating dissociative symptoms, consistent with the dissociative subtype of PTSD, among military members, veterans, and first responders with PTSD. Successful recovery on a functional and symptomatic level may necessitate treatment of dissociative symptoms, particularly derealization.

“…Lanius (2015) further outlines how the model could guide treatment for trauma-affected patients, as TRASC of different dimensions of consciousness may require different treatments, something that future clinical studies could investigate. Studies on the impact of dissociation on treatment show inconsistent results, with some studies finding dissociation to predict poorer response (Bae, Kim, & Park, 2016; Kleindienst et al, 2016) while others fail to find such an effect (Minnen & Harned, 2012; Zoet, Wagenmans, van Minnen, & de Jongh, 2018).…”

Section: Discussionmentioning

confidence: 99%

Trauma-related altered states of consciousness in post-traumatic stress disorder patients with or without comorbid dissociative disorders

Bækkelund

Frewen

Lanius

et al. 2018

Background: The four-dimensional (‘4-D’) model has been proposed as a theoretical framework to understand and delineate trauma-related dissociative experiences, categorizing symptoms into trauma-related altered states of consciousness (TRASC) and normal waking consciousness (NWC), which occur along four dimensions: time, thought, body and emotion.Objective: The main aim of the present study was to evaluate the validity of this model in patients with post-traumatic stress disorder (PTSD), with and without comorbid dissociative disorders.Method: The predictions of the 4-D model were tested in 142 patients with PTSD, with (N = 46) and without (N = 96) comorbid dissociative disorders.Results: As predicted by the 4-D model, experiences of TRASC were less frequent and more specifically related to other measures of dissociation, dissociative disorder comorbidity and a history of childhood sexual abuse compared to experiences of NWC. The predicted lower intercorrelation of TRASC was not supported.Conclusion: The 4-D model represents a promising framework for understanding dissociation across trauma-related disorders.