The results of the largest prospective study of its kind indicate that for people who experience trauma, the presence of dissociation – a deep sense of detachment from the perception of self or environment – may indicate a high risk of later develop severe post-traumatic stress, depression, anxiety, physical pain, and social impairment. The research, which was conducted by researchers at McLean Hospital, is published in the American Journal of Psychiatry.
“Dissociation can help someone cope in the aftermath of trauma by providing some psychological distance from the experience, but at a high cost – dissociation is often linked to more severe psychiatric symptoms,” said the main author. Lauren AM Lebois, PhDdirector of the Dissociative Disorders and Trauma Research Program at McLean Hospital and Assistant Professor of Psychiatry at Harvard Medical School. “Despite this, dissociative symptoms remain understudied and underdiagnosed due to a relative lack of understanding in medical and clinical practice.”
To provide insight, Lebois and colleagues reviewed information from the AURORA (Advancing Understanding of RecOvery after TraumA) study. The data included 1,464 adults treated at 22 different emergency departments across the United States who reported whether they had experienced a severe type of dissociation called derealization. Additionally, 145 of the patients underwent brain imaging during an emotional task. Three months later, the researchers collected follow-up reports on post-traumatic stress, depression, pain, anxiety symptoms and functional disorders.
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 at 3-month follow-up. . Additionally, self-reported survey scores and brain imaging findings that indicated derealization predicted worsening of PTSD symptoms at follow-up examination, even after accounting for PTSD symptoms. trauma at the start of the study and history of childhood trauma.
The findings underscore the importance of screening for symptoms related to dissociation after trauma to identify those at risk who may benefit from early interventions.
Scientists found that derealization was linked to altered activity in certain brain regions detected by brain imaging.
“Therefore, persistent derealization is both an early psychological marker and a biological marker of worse psychiatric outcomes later, and its neural correlates in the brain may serve as potential future targets for treatments aimed at preventing PTSD,” said said the main author. Kerry J. Ressler, MD, Ph.D.scientific director of McLean Hospital and professor of psychiatry at Harvard Medical School.
Investigators hope their findings will increase awareness of these symptoms and their potential sequelae.
“Hopefully, this will allow more clinicians to empathically connect and communicate thoughtfully with patients to help them understand their symptoms and available treatments,” Lebois said. “Unfortunately, omitting dissociation from the conversation increases patients’ vulnerability to more serious psychiatric problems following trauma.”
The research is an example of how patient care could be impacted by analyzes of data from the AURORA study, a major national initiative based at the University of North Carolina that seeks to inform the development and testing of preventive and therapeutic interventions for people who have experienced traumatic events.
“These latest findings add to the growing list of AURORA findings to help better understand how to better prevent and treat adverse mental health effects after trauma,” said Samuel McLean, MD, lead researcher organizing the AURORA Study and Professor of Anesthesiology, Emergency Medicine, and Psychiatry at the University of North Carolina School of Medicine. “Studies such as AURORA are essential because adverse effects on post-traumatic mental health lead to an enormous global burden of suffering, and yet historically there have been very few large-scale longitudinal studies assessing neurobiology under 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 are available at https://www.med.unc.edu/itr/aurora-study/.
“We are committed to helping the AURORA Initiative and its researchers like Dr. Ressler make important discoveries and close the gaps that exist in mental health research funding and patient support,” said Brandon Staglin, President of One Mind, a leading non-profit brain health organization. provided over $5 million in funding for the AURORA study.
This project was supported by the National Institute of Mental Health under award numbers K01 MH118467, K00 MH119603, and U01MH110925, the US Army Medical Research and Material Command, One Mind, and The Mayday Fund. Data and/or research tools used in the preparation of this manuscript were obtained from the National Institute of Mental Health (NIMH) Data Archive (NDA). This manuscript reflects the opinions of the authors and may not reflect the opinions or views of any of the funders.
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