Feelings of separation predict worse mental outcomes after trauma

After a trauma, feeling detached from one’s surroundings may indicate a higher risk of developing psychiatric symptoms later, according to research led by Harvard and MacLean Hospital investigators, who are part of the NIH-funded AURORA study led by Sam McClain of the United Nations University.

Results of the largest prospective study of its kind suggest that for individuals experiencing trauma, the presence of detachment—a profound sense of detachment from one’s sense of self or surroundings—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.

“Dissociation may help someone to cope in the aftermath of trauma by providing psychological distance from the experience, but at a high cost – separation is often associated with more severe psychological symptoms,” said the lead author. Lauren AM Leboa, Ph.D.boss Dissociative Disorders and Trauma Program at McLean Hospital and assistant professor of psychiatry at Harvard Medical School. “Despite this, schizophrenia symptoms remain understudied and undiagnosed due to the relative lack of understanding in medical and clinical practice.”

To provide insights, Dr. Lebois and colleagues examined information from the Advanced Understanding of RecOvery afteR traumA (AURORA) study, which she is leading nationwide. Sam McClain, MD, professor of anesthesiology, emergency medicine, and psychiatry at the University of North Carolina School of Medicine. The data relates to 1,464 adults treated in 22 different emergency departments across the US — including UNC and Harvard — who reported whether they had experienced a severe type 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 also found that patients who reported derealization tended to have higher levels of PTSD, anxiety, depression, pain, and functional impairment at the 3-month follow-up. In addition, both self-reported scan results and brain-imaging findings that were indicative of derealization predicted worse PTSD symptoms on the follow-up test—even after accounting for PTSD symptoms at the start of the study and the 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. “Therefore, persistent derealization is both an early psychological marker and a biomarker of worse later psychiatric outcomes, and its neural correlates in the brain may serve as potential future targets for therapies to prevent PTSD,” the senior author said. Keri c. Ressler, MD, PhDchief scientific officer at McLean Hospital and professor of psychiatry at Harvard Medical School.

The investigators also hope that their findings will raise awareness of these symptoms and their effects. “With any luck, this will enable more clinicians to communicate empathetically and thoughtfully communicate with patients to help them understand their symptoms and the treatment available,” said Dr. Lebois. “Unfortunately, omitting the disconnection from the conversation increases patients’ vulnerability to more serious psychological problems after trauma.”

The research is an example of how patient care is affected by analyzes of data from the AURORA study — a major national initiative headquartered at the University of North Carolina that seeks to provide information for the development and testing of preventive and curative interventions for individuals who have experienced traumatic events.

“These latest findings add to AURORA’s growing list of discoveries to help improve understanding regarding how to better prevent and treat negative mental health outcomes after trauma,” said UNC’s Sam McClain, Director of the UNC Institute for Trauma Recovery. “Studies such as AURORA are critical because post-traumatic mental health outcomes cause an enormous global burden of suffering, however, historically, large-scale longitudinal studies have been conducted to assess the supporting neurobiology 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/.

He provided more than $5 million in funding for the AURORA study, said Brandon Staglin, president of One Mind, a leading brain health nonprofit that works.

This project was supported by the National Institute of Mental Health under award numbers K01 MH118467, K00 MH119603, and U01 MH110925US, 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.

The main media contact for the findings of this research is Laura Nevis At McLean Hospital and Harvard. For AURORA inquiries at UNU School of Medicine, contact Mark Derwich.