Dissociation may indicate a higher risk of worse mental health outcomes after trauma

Results of the largest prospective study of its kind indicate that for individuals experiencing trauma, the presence of dissociation -; a deep sense of detachment from one’s sense of self or the surrounding environment -; It may indicate a high risk of later developing severe post-traumatic stress, depression, anxiety, physical pain, and social impairment. The research, which was led by investigators at McLean Hospital, was published in American Journal of Psychiatry.

“Separation may help someone cope with the effects of trauma by providing psychological distance from the experience, but at a high cost — and separation is often associated with more severe psychiatric symptoms,” said Dr. Lauren AM Lebois, director of the Graduate Center. Dissociative Disorders and Trauma Research Program at McLean Hospital and assistant professor of psychiatry at Harvard Medical School. “Despite this, schizophrenia symptoms remain under study and undiagnosed due to a relative lack of understanding in medical and clinical practice.”

To provide insights, Leboa and colleagues examined information from the AURORA Study. The data relate to 1,464 adults treated in 22 different emergency departments across the United States who reported whether they had experienced an acute form of separation called derealization. Also, 145 patients underwent brain imaging while performing an emotional task. Three months later, the researchers collected follow-up reports on PTSD, depression, pain, anxiety symptoms, and functional impairment.

The research team found that patients who reported experiencing derealization tended to have higher levels of post-traumatic stress, anxiety, depression, pain, and functional impairment in the 3-month follow-up period. In addition, both self-reported scan results and derealization brain imaging findings predicted worse PTSD symptoms on the follow-up test-; Even after accounting for post-traumatic stress symptoms at the start of the study and history of childhood trauma.

The findings suggest the importance of screening patients for post-traumatic stress-related symptoms to identify at-risk individuals who could benefit from early interventions.

Scientists discovered that derealization was linked to altered activity in specific brain regions detected through brain imaging.

said lead researcher Kerry J. Ressler, MD, PhD, chief scientific officer at MacLean Hospital and professor of psychiatry at Harvard Medical School.

The researchers hope their findings will raise awareness of these symptoms and their potential effects.

“With any luck, this will enable more clinicians to communicate empathetically and thoughtfully communicate with patients to help them understand their symptoms and available treatments,” Lebois said. “Unfortunately, omitting the disconnection from the conversation increases the vulnerability of patients to more serious psychological problems after trauma.”

The research is an example of how patient care has been affected by analyzes of data from the AURORA-; A major national initiative based at the University of North Carolina seeks to inform the development and testing of preventive and curative interventions for individuals who have experienced traumatic events.

Samuel MacLean, MD, co-author of the AURORA study and professor of anesthesiology, emergency medicine, and psychiatry at the University of North Carolina School of Medicine said. “Studies like AURORA are necessary because post-traumatic mental health outcomes cause an enormous global burden of suffering, however, historically there have been very few large-scale longitudinal studies evaluating the neurobiological basis of these conditions.”

The AURORA study is supported by more than $30 million in funding from the National Institutes of Health, private foundations, and partnerships with leading technology companies. Forecasting tools, presentations and publications resulting from the study can be found at https://www.med.unc.edu/itr/aurora-study/.

“We are committed to helping the AURORA Initiative and its investigators like Dr. Ressler make important discoveries and close gaps in mental health research funding and patient support,” said Brandon Staglin, president of One Mind, a leading brain health nonprofit organization. AURORA Study.

This project was supported by the National Institute of Mental Health under award numbers K01 MH118467, K00 MH119603, and U01MH110925, U.S. Army Medical Research and Physical Leadership, One Mind, and the Mayday Fund. The data and/or the research tools used in preparing this manuscript were obtained from the National Institute of Mental Health (NIMH) (NDA) data archive. This manuscript reflects the views of the authors and may not reflect the views or opinions of any of the funders.


Journal reference:

Lebois, L, et al. (2022) Persistent dissociation and its neural relationships in anticipating outcomes after exposure to trauma. American Journal of Psychiatry. doi.org/10.1176/appi.ajp.21090911.