TY - JOUR
T1 - Persistent Dissociation and Its Neural Correlates in Predicting Outcomes After Trauma Exposure
AU - Lebois, Lauren A.M.
AU - Harnett, Nathaniel G.
AU - van Rooij, Sanne J.H.
AU - Ely, Timothy D.
AU - Jovanovic, Tanja
AU - Bruce, Steven E.
AU - House, Stacey L.
AU - Ravichandran, Caitlin
AU - Dumornay, Nathalie M.
AU - Finegold, Katherine E.
AU - Hill, Sarah B.
AU - Merker, Julia B.
AU - Phillips, Karlye A.
AU - Beaudoin, Francesca L.
AU - An, Xinming
AU - Neylan, Thomas C.
AU - Clifford, Gari D.
AU - Linnstaedt, Sarah D.
AU - Germine, Laura T.
AU - Rauch, Scott L.
AU - Haran, John P.
AU - Storrow, Alan B.
AU - Lewandowski, Christopher
AU - Musey, Paul I.
AU - Hendry, Phyllis L.
AU - Sheikh, Sophia
AU - Jones, Christopher W.
AU - Punches, Brittany E.
AU - Swor, Robert A.
AU - McGrath, Meghan E.
AU - Hudak, Lauren A.
AU - Pascual, Jose L.
AU - Seamon, Mark J.
AU - Datner, Elizabeth M.
AU - Chang, Anna M.
AU - Pearson, Claire
AU - Domeier, Robert M.
AU - Rathlev, Niels K.
AU - O'Neil, Brian J.
AU - Sergot, Paulina
AU - Sanchez, Leon D.
AU - Miller, Mark W.
AU - Pietrzak, Robert H.
AU - Joormann, Jutta
AU - Barch, Deanna M.
AU - Pizzagalli, Diego A.
AU - Sheridan, John F.
AU - Smoller, Jordan W.
AU - Luna, Beatriz
AU - Harte, Steven E.
AU - Elliott, James M.
AU - Kessler, Ronald C.
AU - Koenen, Karestan C.
AU - McLean, Samuel A.
AU - Stevens, Jennifer S.
AU - Ressler, Kerry J.
N1 - Funding Information:
Dr. Lebois has received grant support from NIMH, and her spouse receives payments from Vanderbilt University for technology licensed to Acadia Pharmaceuticals. Dr. Ravichandran was supported by NIMH grant P50-MH115874. Dr. Clifford has received research funding from the NSF, NIH, and LifeBell AI, and unrestricted donations from AliveCor, Amazon Research, the Center for Discovery, the Gordon and Betty Moore Foundation, MathWorks, Microsoft Research, the Gates Foundation, Google, One Mind Foundation, and Samsung Research; he has financial interest in AliveCor and receives unrestricted funding from the company; and he is the Chief Technology Officer of MindChild Medical and Chief Scientific Officer of LifeBell AI and has ownership in both companies. Dr. Germine receives an honorarium as a member of the Scientific Advisory Board for Sage Bionetworks. Dr. Rauch has received payments from the Society of Biological Psychiatry for his role as secretary, royalties from Oxford University Press and American Psychiatric Publishing, Inc., per diem for service on an oversight committee from the VA, and payment for board service from Community Psychiatry, including equity. Dr. Sheikh has received funding from the Florida Medical Malpractice Joint Underwriter’s Association Dr. Alvin E. Smith Safety of Healthcare Services Grant, the Allergan Foundation, the NIH/NIA–funded Jacksonville Aging Studies Center, SAMHSA, and the Florida Blue Foundation. Dr. Jones has served as an investigator on studies funded by AstraZeneca, Hologic, Janssen, and Vapotherm, for which his department has received research funding. Dr. Pascual has served as a consulting legal expert witness. Dr. Joormann has served as a consultant for Janssen Pharmaceuticals. Dr. Pizzagalli has served as a consultant for Albright Stonebridge Group, BlackThorn Therapeutics, Boehringer Ingelheim, Compass Pathway, Concert Pharmaceuticals, Engrail Therapeutics, Neuroscience Software, Neurocrine Biosciences, Otsuka Pharmaceuticals, and Takeda Pharmaceuticals; he has received honoraria from the Psychonomic Society (for editorial work) and from Alkermes; he has received stock options from BlackThorn Therapeutics and Compass Pathways; and he has received research funding from the Dana Foundation, the Brain and Behavior Research Foundation, Millennium Pharmaceuticals, and NIMH. Dr. Smoller is principal investigator on a collaborative study of the genetics of depression and bipolar disorder sponsored by 23andMe for which 23andMe provides analysis time as in-kind support but no payments. Dr. Harte has received research funding from Aptinyx, Arbor Medical Innovations,andNIH.Dr.ElliottreceivesfundingfromNewSouthWalesHealth, has served as a consultant for Medbridge, and has ownership in Orofacial Therapeutics LC. Dr. Kessler has served as a consultant for Datastat, Holmusk, RallyPoint Networks, and Sage Pharmaceuticals, and he has stockoptionsinMirah,PYM,andRogaSciences.Dr.McLeanhasservedasa consultant for the Walter Reed Army Institute of Research. Dr. Ressler has served on advisory boards or as a consultant for Bioxcel, Janssen, Takeda, and Verily, and he has received sponsored research support from Alkermes, Alto Neuroscience, BrainsWay, and Takeda. The other authors report no financial relationships with commercial interests.
Funding Information:
Supported by NIMH grants K01 MH118467, K00 MH119603, and U01 MH110925US, the U.S. Army Medical Research and Material Command, One Mind, and the Mayday Fund. Data and research tools used in the preparation of this study were obtained from the NIMH Data Archive, a collaborative informatics system created by NIH to provide a national resource to support and accelerate research in mental health (data set identifier: NIMH Data Archive Digital Object Identifier 10.15154/1521347). The content of this article reflects the views of the authors and may not reflect the opinions or views of the funders. The investigators thank the trauma survivors participating in the AURORA study. Their time and effort during a challenging period of their lives make our efforts to improve recovery for future trauma survivors possible. The authors also thank the research staff at McLean Hospital, Emory University, Temple University, and Wayne State University for their efforts and aid.
Publisher Copyright:
© 2022 American Psychiatric Association. All rights reserved.
PY - 2022/9
Y1 - 2022/9
N2 - 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. 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 (N51,464), a severe type of dissociation, and completed a functional MRI emotion reactivity task and resting-state scan 2 weeks posttrauma (N5145). Three-month follow-up reports were collected of posttraumatic stress, depression, pain, anxiety symptoms, and functional impairment. 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. 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.
AB - 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. 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 (N51,464), a severe type of dissociation, and completed a functional MRI emotion reactivity task and resting-state scan 2 weeks posttrauma (N5145). Three-month follow-up reports were collected of posttraumatic stress, depression, pain, anxiety symptoms, and functional impairment. 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. 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.
UR - http://www.scopus.com/inward/record.url?scp=85135286343&partnerID=8YFLogxK
U2 - 10.1176/appi.ajp.21090911
DO - 10.1176/appi.ajp.21090911
M3 - Article
C2 - 35730162
AN - SCOPUS:85135286343
VL - 179
SP - 661
EP - 672
JO - American Journal of Psychiatry
JF - American Journal of Psychiatry
SN - 0002-953X
IS - 9
ER -