McLean Hospital, Belmont, MA, USA.
Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
Neuropsychopharmacology. 2022 Dec;47(13):2261-2270. doi: 10.1038/s41386-022-01468-1. Epub 2022 Oct 6.
Trauma-related pathological dissociation is characterized by disruptions in one's sense of self, perceptual, and affective experience. Dissociation and its trauma-related antecedents disproportionately impact women. However, despite the gender-related prevalence and high individual and societal costs, dissociation remains widely underappreciated in clinical practice. Moreover, dissociation lacks a synthesized neurobiological model across its subtypes. Leveraging the Triple Network Model of psychopathology, we sought to parse heterogeneity in dissociative experience by examining functional connectivity of three core neurocognitive networks as related to: (1) the dimensional dissociation subtypes of depersonalization/derealization and partially-dissociated intrusions; and, (2) the diagnostic category of dissociative identity disorder (DID). Participants were 91 women with and without: a history of childhood trauma, current posttraumatic stress disorder (PTSD), and varied levels of dissociation. Participants provided clinical data about dissociation, PTSD symptoms, childhood maltreatment history, and completed a resting-state functional magnetic resonance imaging scan. We used a novel statistical approach to assess both overlapping and unique contributions of dissociation subtypes. Covarying for age, childhood maltreatment and PTSD severity, we found dissociation was linked to hyperconnectivity within central executive (CEN), default (DN), and salience networks (SN), and decreased connectivity of CEN and SN with other areas. Moreover, we isolated unique connectivity markers associated with depersonalization/derealization in CEN and DN, to partially-dissociated intrusions in CEN, and to DID in CEN. This suggests dissociation subtypes have robust functional connectivity signatures that may serve as targets for PTSD/DID treatment engagement. Our findings underscore dissociation assessment as crucial in clinical care, in particular, to reduce gender-related health disparities.
创伤相关病理性分离的特征是自我意识、知觉和情感体验的中断。分离及其与创伤相关的前因在女性中不成比例地产生影响。然而，尽管存在与性别相关的普遍性和高个体及社会成本，但在临床实践中，分离仍然广泛被低估。此外，分离在其亚型之间缺乏综合的神经生物学模型。利用精神病理学的三重网络模型，我们试图通过检查三个核心神经认知网络的功能连接来解析分离体验的异质性，这些网络与：(1)人格解体/现实解体和部分分离侵入的维度分离亚型有关；以及(2)分离身份障碍 (DID) 的诊断类别有关。参与者为 91 名女性，她们有或没有：儿童期创伤史、当前创伤后应激障碍 (PTSD) 和不同程度的分离。参与者提供了有关分离、PTSD 症状、儿童期虐待史的临床数据，并完成了静息态功能磁共振成像扫描。我们使用一种新的统计方法来评估分离亚型的重叠和独特贡献。在协方差年龄、儿童期虐待和 PTSD 严重程度后，我们发现分离与中央执行 (CEN)、默认 (DN) 和突显网络 (SN) 内的超连接有关，以及 CEN 和 SN 与其他区域的连接减少。此外，我们还分离出与 CEN 中的人格解体/现实解体、CEN 中的部分分离侵入以及 CEN 中的 DID 相关的独特连接标记。这表明分离亚型具有稳健的功能连接特征，可作为 PTSD/DID 治疗参与的靶点。我们的研究结果强调了在临床护理中进行分离评估的重要性，特别是为了减少与性别相关的健康差异。
