Emotion Modulation in PTSD: Clinical and Neurobiological Evidence for a Dissociative Subtype

By Ruth A. Lanius, Eric Vermetten, R. Loewenstein, B. Brand, Christian Schmahl, J. Bremner, D. Spiegel. American Journal of Psychiatry, 2010

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In this article, the authors present evidence regarding a dissociative subtype of PTSD, with clinical and neurobiological features that can be distinguished from nondissociative PTSD. The dissociative subtype is characterized by overmodulation of affect, while the more common undermodulated type involves the predominance of reexperiencing and hyperarousal symptoms. This article focuses on the neural manifestations of the dissociative subtype in PTSD and compares it to those underlying the reexperiencing/hyperaroused subtype. A model that includes these two types of emotion dysregulation in PTSD is described. In this model, reexperiencing/hyperarousal reactivity is viewed as a form of emotion dysregulation that involves emotional undermodulation, mediated by failure of prefrontal inhibition of limbic regions. In contrast, the dissociative subtype of PTSD is described as a form of emotion dysregulation that involves emotional overmodulation mediated by midline prefrontal inhibition of the same limbic regions. Both types of modulation are involved in a dynamic interplay and lead to alternating symptom profiles in PTSD. These findings have important implications for treatment of PTSD, including the need to assess patients with PTSD for dissociative symptoms and to incorporate the treatment of dissociative symptoms into stage-oriented trauma treatment.

Subfields: Clinical Psychology, Epidemiology, Psychiatry and Mental health

View Paper: https://www.semanticscholar.org/paper/23bf4d02546417e169c7ecc372ee08aad89e7466

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In Clinical Psychology

Citations in the corpus

Childhood Maltreatment, Emotional Dysregulation, and Psychiatric Comorbidities (2014, background): “Consistent with this view, two different forms of emotional dysregulation with distinct patterns of cortical and subcortical activation and symptom profiles in posttraumatic stress disorder (PTSD) have been identified.(16,17) Undermodulated emotion (e.”
Dissociation in Posttraumatic Stress Disorder Part I: Definitions and Review of Research (2012, background): “A small number of neuroimaging studies in samples of persons with PTSD have found dissociation in response to trauma reminders is associated with increased activity in the brain region associated with inhibition and emotion regulation (Lanius et al., 2010).”
Borderline Personality Disorder: Disorder of Trauma or Personality, a Review of the Empirical Literature (2015, background): “…at both underregulation, a core symptom found in the majority of BPD patients (Ford, 2010; van Dijke, 2008; van Dijke et al., 2010; Zanarini et al., 2002), as well as overregulation such as numbing and dissociation, reported by 1 in 5 BPD patients (Lanius et al., 2010; van Dijke et al., 2010).”
Considering PTSD for DSM‐5 (2011, background): “Neuroimaging studies suggest there may be distinctive prefrontal responses to trauma memories that distinguish individuals with dissociative from those with non-dissociative PTSD responses.[178,179] For example, individuals displaying a ‘‘hyperarousal’’ PTSD response to traumatic narratives, with he”
Mental health in elite athletes: International Olympic Committee consensus statement (2019) (2019, positive): “For example, elite athletes may compartmentalise to manage emotions, effectively concealing symptoms of trauma-related disorders.(256) Further, dissociative strategies (eg, blocking of sensory input, as intentionally utilised by endurance athletes)(257) may conceal trauma symptoms.”