van Huijstee Jytte, Vermetten Eric
Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, The Netherlands.
Department Psychiatry, Leiden University Medical Center Utrecht, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands.
Curr Top Behav Neurosci. 2018;38:229-248. doi: 10.1007/7854_2017_33.
Recently, a dissociative subtype of post-traumatic stress disorder (PTSD) has been included in the DSM-5. This review focuses on the clinical and neurobiological features that distinguish the dissociative subtype of PTSD from non-dissociative PTSD. Clinically, the dissociative subtype of PTSD is associated with high PTSD severity, predominance of derealization and depersonalization symptoms, a more significant history of early life trauma, and higher levels of comorbid psychiatric disorders. Furthermore, PTSD patients with dissociative symptoms exhibit different psychophysiological and neural responses to the recall of traumatic memories. While individuals with non-dissociative PTSD exhibit an increased heart rate, decreased activation of prefrontal regions, and increased activation of the amygdala in response to traumatic reminders, individuals with the dissociative subtype of PTSD show an opposite pattern. It has been proposed that dissociation is a regulatory strategy to restrain extreme arousal in PTSD through hyperinhibition of limbic regions. In this research update, promises and pitfalls in current research studies on the dissociative subtype of PTSD are listed. Inclusion of the dissociative subtype of PTSD in the DSM-5 stimulates research on the prevalence, symptomatology, and neurobiology of the dissociative subtype of PTSD and poses a challenge to improve treatment outcome in PTSD patients with dissociative symptoms.
最近，创伤后应激障碍（PTSD）的分离性亚型已被纳入《精神疾病诊断与统计手册》第五版（DSM - 5）。本综述聚焦于区分PTSD分离性亚型与非分离性PTSD的临床和神经生物学特征。在临床上，PTSD的分离性亚型与PTSD的高严重程度、现实解体和人格解体症状占主导、更显著的早年生活创伤史以及更高水平的共病精神障碍相关。此外，有分离症状的PTSD患者在回忆创伤性记忆时表现出不同的心理生理和神经反应。当非分离性PTSD个体在面对创伤性提示时表现出心率加快、前额叶区域激活减少以及杏仁核激活增加时，PTSD分离性亚型个体则表现出相反的模式。有人提出，分离是一种通过对边缘区域的过度抑制来抑制PTSD中极端唤醒的调节策略。在本研究进展中，列出了当前关于PTSD分离性亚型研究中的前景与困境。将PTSD分离性亚型纳入DSM - 5激发了对PTSD分离性亚型的患病率、症状学和神经生物学的研究，并对改善有分离症状的PTSD患者的治疗结果构成挑战。
