THE DISSOCIATIVE SUBTYPE OF POSTTRAUMATIC STRESS DISORDER: RATIONALE, CLINICAL AND NEUROBIOLOGICAL EVIDENCE, AND IMPLICATIONS: Dissociative Subtype of PTSD

Lanius, Ruth A.; Brand, Bethany; Vermetten, Eric; Frewen, Paul A.; Spiegel, David

doi:10.1002/da.21889

Cited by 459Posttraumatic Stress Disorder ResearchPsychosomatic Disorders and Their TreatmentsPsychoanalysis and Psychopathology Research

THE DISSOCIATIVE SUBTYPE OF POSTTRAUMATIC STRESS DISORDER: RATIONALE, CLINICAL AND NEUROBIOLOGICAL EVIDENCE, AND IMPLICATIONS: Dissociative Subtype of PTSD

Lanius, Ruth A., Brand, Bethany, Vermetten, Eric, Frewen, Paul A., Spiegel, David·2012·Depression and Anxiety

DOI 10.1002/da.21889

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Abstract

BACKGROUND: Clinical and neurobiological evidence for a dissociative subtype of posttraumatic stress disorder (PTSD) has recently been documented. A dissociative subtype of PTSD is being considered for inclusion in the forthcoming Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) to address the symptoms of depersonalization and derealization found among a subset of patients with PTSD. This article reviews research related to the dissociative subtype including antecedent, concurrent, and predictive validators as well as the rationale for recommending the dissociative subtype. METHODS: The relevant literature pertaining to the dissociative subtype of PTSD was reviewed. RESULTS: Latent class analyses point toward a specific subtype of PTSD consisting of symptoms of depersonalization and derealization in both veteran and civilian samples of PTSD. Compared to individuals with PTSD, those with the dissociative subtype of PTSD also exhibit a different pattern of neurobiological response to symptom provocation as well as a differential response to current cognitive behavioral treatment designed for PTSD. CONCLUSIONS: We recommend that consideration be given to adding a dissociative subtype of PTSD in the revision of the DSM. This facilitates more accurate analysis of different phenotypes of PTSD, assist in treatment planning that is informed by considering the degree of patients' dissociativity, will improve treatment outcome, and will lead to much-needed research about the prevalence, symptomatology, neurobiology, and treatment of individuals with the dissociative subtype of PTSD.

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Trauma-related dissociation may be an innate defense mechanism to cope with and detach from trauma or trauma-related cues.
“Trauma-related dissociation may be an innate defense mechanism to cope with and detach from trauma or trauma-related cues (Dalenberg & Carlson, 2012; Lanius et al., 2012).”
From Trauma-related dissociation and the autonomic nervous system: a systematic literature review of psychophysiological correlates of dissociative experiencing in PTSD patients (2022) · cites this paper as Lanius et al., 2012
A dissociative sub-type of PTSD (PTSD/D) has been identified that is associated with analgesia rather than hyperalgesia.
“However, a dissociative sub-type of PTSD (PTSD/D) has been identified [101] that is associated with analgesia rather than hyperalgesia.”
From Complex PTSD and borderline personality disorder (2021) · cites this paper as [101]
While dissociation can be adaptive in certain situations, generalized and involuntary dissociative responses can have detrimental effects across multiple life domains.
“While dissociation can be adaptive in certain situations (e.g., in threatening situations that cannot be escaped or controlled), generalized and involuntary dissociative responses can have detrimental effects across multiple life domains [9].”
From Dissociation and Alterations in Brain Function and Structure: Implications for Borderline Personality Disorder (2017) · cites this paper as [9]
This pattern of brain activity is similar to that seen in patients with PTSD-DS during presentation of trauma-related scripts.
“this pattern of brain activity is similar to that seen in patients with the PTSD-DS during presentation of trauma-related scripts (Lanius et al., 2010(Lanius et al., , 2012(Lanius et al., , 2006)).”
From A review of the relation between dissociation, memory, executive functioning and social cognition in military members and civilians with neuropsychiatric conditions (2016) · cites this paper as Lanius et al., 2012
Individuals with PTSD with high levels of dissociative symptomatology show distinct patterns of neural activity.
“Evidence of distinct patterns of neural activity (Frewen and Lanius, 2006;Lanius et al., 2010Lanius et al., , 2012) )”
From A review of the relation between dissociation, memory, executive functioning and social cognition in military members and civilians with neuropsychiatric conditions (2016) · cites this paper as Lanius et al., 2012

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Ebner-Priemer, U. W., Mauchnik, J., Kleindienst, N., Schmahl, C., Peper, M., Rosenthal, M. Z., Flor, H., & Bohus, M. (2009) · Journal of Psychiatry and Neuroscience · doi:10.1139/jpn.0929 · Cited by 27 · see citing works
Effects of a Psychoeducational Group Intervention for Children Victims of Sexual Abuse
Hébert, M., & Tourigny, M. (2010) · Journal of Child & Adolescent Trauma · doi:10.1080/19361521003726930 · Cited by 11 · see citing works
The Influence of Current Stress on Dissociative Experiences: An Exploratory Study in a Non-Clinical Population
Wachter, D. D., Lange, A., Vanderlinden, J., Pouw, J., & Strübbe, E. H. (2006) · Journal of Trauma & Dissociation · doi:10.1300/j229v07n01_07 · Cited by 6 · see citing works

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Evidence for proposed ICD-11 PTSD and complex PTSD: a latent profile analysis
Cloitre, M., Garvert, D. W., Brewin, C. R., Bryant, R. A., & Maercker, A. (2013) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v4i0.20706 · Cited by 751 · see citing works
Childhood maltreatment, emotional dysregulation, and psychiatric comorbidities
Dvir, Y., Ford, J. D., Hill, M., & Frazier, J. A. (2014) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000014 · Cited by 698 · see citing works
Post-traumatic stress disorder: clinical and translational neuroscience from cells to circuits
Ressler, K. J., Berretta, S., Bolshakov, V. Y., Rosso, I. M., Meloni, E. G., Rauch, S. L., & Carlezon, W. A. (2022) · Nature Reviews Neurology · doi:10.1038/s41582-022-00635-8 · Cited by 531 · see citing works
Dissociation in psychiatric disorders: a meta-analysis of studies using the dissociative experiences scale
Lyssenko, L., Schmahl, C., Bockhacker, L., Vonderlin, R., Bohus, M., & Kleindienst, N. (2018) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2017.17010025 · Cited by 541 · see citing works
Mindfulness-based treatments for posttraumatic stress disorder: a review of the treatment literature and neurobiological evidence
Boyd, J. E., Lanius, R. A., & McKinnon, M. C. (2018) · Journal of Psychiatry and Neuroscience · doi:10.1503/jpn.170021 · Cited by 407 · see citing works
Self-citation
Finalizing PTSD in DSM-5 : Getting Here From There and Where to Go Next
Friedman, M. J. (2013) · Journal of Traumatic Stress · doi:10.1002/jts.21840 · Cited by 415 · see citing works
ABERRANT RESTING-STATE BRAIN ACTIVITY IN POSTTRAUMATIC STRESS DISORDER: A META-ANALYSIS AND SYSTEMATIC REVIEW: Theoretical Review: Brain Activity in PTSD during Rest
Koch, S. B. J., van Zuiden, M., Nawijn, L., Frijling, J. L., Veltman, D. J., & Olff, M. (2016) · Depression and Anxiety · doi:10.1002/da.22478 · Cited by 334 · see citing works
Dissociative disorders in DSM-5
Spiegel, D., Loewenstein, R. J., Lewis-Fernández, R., Sar, V., Simeon, D., Vermetten, E., Cardeña, E., & Dell, P. F. (2011) · Depression and Anxiety · doi:10.1002/da.20874 · Cited by 330 · see citing works
Self-citation
Dissociation in posttraumatic stress disorder: Evidence from the world mental health surveys
Stein, D. J., Koenen, K. C., Friedman, M. J., Hill, E., McLaughlin, K. A., Petukhova, M., Ruscio, A. M., Shahly, V., Spiegel, D., Borges, G., et al. (2013) · Biological Psychiatry · doi:10.1016/j.biopsych.2012.08.022 · Cited by 328 · see citing works
Self-citation
The underlying dimensions of DSM-5 posttraumatic stress disorder symptoms in an epidemiological sample of Chinese earthquake survivors
Liu, P., Wang, L., Cao, C., Wang, R., Zhang, J., Zhang, B., Wu, Q., Zhang, H., Zhao, Z., Fan, G., et al. (2014) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2014.03.008 · Cited by 277 · see citing works
Towards an integrative theory of psychogenic non-epileptic seizures (PNES)
Brown, R. J., & Reuber, M. (2016) · Clinical Psychology Review · doi:10.1016/j.cpr.2016.06.003 · Cited by 279 · see citing works
Brain Activity and Functional Connectivity Associated with Hypnosis
Jiang, H., White, M. P., Greicius, M. D., Waelde, L. C., & Spiegel, D. (2016) · Cerebral Cortex · doi:10.1093/cercor/bhw220 · Cited by 239 · see citing works
Self-citation
Emotional Mental Imagery as Simulation of Reality: Fear and Beyond—A Tribute to Peter Lang
Ji, J. L., Heyes, S. B., MacLeod, C., & Holmes, E. A. (2016) · Behavior Therapy · doi:10.1016/j.beth.2015.11.004 · Cited by 234 · see citing works
Complex PTSD and borderline personality disorder
Ford, J. D., & Courtois, C. A. (2021) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-021-00155-9 · Cited by 209 · see citing works
“Although dissociative symptoms are highly correlated with PTSD symptom severity among adults decades after experiencing childhood sexual abuse [123], pathological dissociation was not included in the PTSD diagnosis until the DSM-5 revision identified a dissociative subtype of PTSD (PTSD/D) [100, 101].”
Background
Dissociative Disorders in DSM-5
Spiegel, D., Lewis‐Fernández, R., Lanius, R. A., Vermetten, E. H. G. J. M., Simeon, D., & Friedman, M. J. (2013) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-050212-185531 · Cited by 211 · see citing works
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The Relationship of Psychological Trauma and Dissociative and Posttraumatic Stress Disorders to Nonsuicidal Self-Injury and Suicidality: A Review
Ford, J. D., & Gómez, J. M. (2015) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2015.989563 · Cited by 199 · see citing works
The dissociative subtype of posttraumatic stress disorder: unique resting-state functional connectivity of basolateral and centromedial amygdala complexes.
Nicholson, A. A., Densmore, M., Frewen, P. A., Théberge, J., Neufeld, R. W., McKinnon, M. C., & Lanius, R. A. (2015) · Neuropsychopharmacology · doi:10.1038/npp.2015.79 · Cited by 180 · see citing works
Self-citation
EVIDENCE FOR A DISSOCIATIVE SUBTYPE OF PTSD BY LATENT PROFILE AND CONFIRMATORY FACTOR ANALYSES IN A CIVILIAN SAMPLE
Steuwe, C., Lanius, R. A., & Frewen, P. (2012) · Depression and Anxiety · doi:10.1002/da.21944 · Cited by 182 · see citing works
Self-citation
Complex PTSD, affect dysregulation, and borderline personality disorder
Ford, J. D., & Courtois, C. A. (2014) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/2051-6673-1-9 · Cited by 182 · see citing works
The Effects of Acutely Administered 3,4-Methylenedioxymethamphetamine on Spontaneous Brain Function in Healthy Volunteers Measured with Arterial Spin Labeling and Blood Oxygen Level–Dependent Resting State Functional Connectivity
Carhart-Harris, R. L., Murphy, K., Leech, R., Erritzøe, D., Wall, M. B., Ferguson, B., Williams, L. T. J., Roseman, L., Brugger, S. P., Meer, I. D., et al. (2014) · Biological Psychiatry · doi:10.1016/j.biopsych.2013.12.015 · Cited by 178 · see citing works
Dissociation predicts poor response to dialectial behavioral therapy in female patients with borderline personality disorder
Kleindienst, N., Limberger, M. F., Ebner-Priemer, U. W., Keibel-Mauchnik, J., Dyer, A., Berger, M., Schmahl, C., & Bohus, M. (2011) · Journal of Personality Disorders · doi:10.1521/pedi.2011.25.4.432 · Cited by 171 · see citing works
PTSD, emotion dysregulation, and dissociative symptoms in a highly traumatized sample
Powers, A. D., Cross, D., Fani, N., & Bradley, B. (2014) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2014.12.011 · Cited by 166 · see citing works
Mother–infant attachment and the intergenerational transmission of posttraumatic stress disorder
Enlow, M. B., Egeland, B. R., Carlson, E. A., Blood, E., & Wright, R. J. (2013) · Development and Psychopathology · doi:10.1017/s0954579413000515 · Cited by 159 · see citing works
Posttraumatic Stress Disorder in DSM-5: New Criteria, New Measures, and Implications for Assessment
Weathers, F. W., Marx, B. P., Friedman, M. J., & Schnurr, P. P. (2014) · Psychological Injury and Law · doi:10.1007/s12207-014-9191-1 · Cited by 156 · see citing works
Lifetime traumatic stressors and adverse childhood experiences uniquely predict concurrent PTSD, complex PTSD, and dissociative subtype of PTSD symptoms whereas recent adult non-traumatic stressors do not: results from an online survey study
Frewen, P., Zhu, J., & Lanius, R. (2019) · European Journal of Psychotraumatology · doi:10.1080/20008198.2019.1606625 · Cited by 151 · see citing works
Self-citation
Distinct intrinsic network connectivity patterns of post‐traumatic stress disorder symptom clusters
Tursich, M., Ros, T., Frewen, P. A., Kluetsch, R. C., Calhoun, V. D., & Lanius, R. A. (2015) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12387 · Cited by 148 · see citing works
Self-citation
A Review of the Neurobiological Basis of Trauma-Related Dissociation and Its Relation to Cannabinoid- and Opioid-Mediated Stress Response: a Transdiagnostic, Translational Approach
Lanius, R. A., Boyd, J. E., McKinnon, M. C., Nicholson, A. A., Frewen, P., Vermetten, E., Jetly, R., & Spiegel, D. (2018) · Current Psychiatry Reports · doi:10.1007/s11920-018-0983-y · Cited by 138 · see citing works
Self-citation
Conceptualization, Assessment, and Treatment of Traumatic Stress in First Responders: A Review of Critical Issues
Lewis-Schroeder, N. F., Kieran, K., Murphy, B. L., Wolff, J. D., Robinson, M. A., & Kaufman, M. L. (2018) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000176 · Cited by 134 · see citing works
Unique insula subregion resting-state functional connectivity with amygdala complexes in posttraumatic stress disorder and its dissociative subtype.
Nicholson, A. A., Sapru, I., Densmore, M., Frewen, P. A., Neufeld, R. W. J., Théberge, J., McKinnon, M. C., & Lanius, R. A. (2016) · Psychiatry Research: Neuroimaging · doi:10.1016/j.pscychresns.2016.02.002 · Cited by 128 · see citing works
Self-citation
Trauma-related dissociation and altered states of consciousness: a call for clinical, treatment, and neuroscience research
Lanius, R. A. (2015) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v6.27905 · Cited by 127 · see citing works
Self-citation
Changes in Comorbid Conditions After Prolonged Exposure for PTSD: a Literature Review
van Minnen, A., Zoellner, L. A., Harned, M. S., & Mills, K. L. (2015) · Current Psychiatry Reports · doi:10.1007/s11920-015-0549-1 · Cited by 128 · see citing works
Dissociation and Alterations in Brain Function and Structure: Implications for Borderline Personality Disorder
Krause-Utz, A., Frost, R., Winter, D., & Elzinga, B. M. (2017) · Current Psychiatry Reports · doi:10.1007/s11920-017-0757-y · Cited by 116 · see citing works
Biomarkers of Pathological Dissociation: A Systematic Review
Roydeva, M. I., & Reinders, A. A. T. S. (2021) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2020.11.019 · Cited by 116 · see citing works
The effect of acutely administered MDMA on subjective and BOLD-fMRI responses to favourite and worst autobiographical memories
Carhart-Harris, R. L., Wall, M. B., Erritzoe, D., Kaelen, M., Ferguson, B., De Meer, I., Tanner, M., Bloomfield, M., Williams, T. M., Bolstridge, M., et al. (2014) · The International Journal of Neuropsychopharmacology · doi:10.1017/s1461145713001405 · Cited by 108 · see citing works
Betray my trust, shame on me: Shame, dissociation, fear, and betrayal trauma.
Platt, M., & Freyd, J. (2015) · Psychological Trauma · doi:10.1037/tra0000022 · Cited by 112 · see citing works
Dissociation predicts treatment response in eye-movement desensitization and reprocessing for posttraumatic stress disorder
Bae, H., Kim, D., & Park, Y. C. (2016) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2015.1037039 · Cited by 104 · see citing works
Heterogeneity of defensive responses after exposure to trauma: Blunted autonomic reactivity in response to startling sounds
D'Andrea, W., Pole, N., DePierro, J., Freed, S., & Wallace, D. B. (2013) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2013.07.008 · Cited by 111 · see citing works
Trauma and Dissociation: Implications for Borderline Personality Disorder
Vermetten, E. H. G. J. M., & Spiegel, D. (2014) · Current Psychiatry Reports · doi:10.1007/s11920-013-0434-8 · Cited by 101 · see citing works
Self-citation
Hierarchical structure of emotional disorders: From individual symptoms to the spectrum.
Waszczuk, M. A., Kotov, R., Ruggero, C. J., Gámez, W., & Watson, D. (2017) · Journal of Abnormal Psychology · doi:10.1037/abn0000264 · Cited by 97 · see citing works
A review of the relation between dissociation, memory, executive functioning and social cognition in military members and civilians with neuropsychiatric conditions
McKinnon, M. C., Boyd, J. E., Frewen, P. A., Lanius, U. F., Jetly, R., Richardson, J. D., & Lanius, R. A. (2016) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2016.07.017 · Cited by 94 · see citing works
“Notably, this pattern of brain activity is similar to that seen in patients with the PTSD-DS during presentation of trauma-related scripts (Lanius et al., 2010, 2012, 2006).”
InfluentialSelf-citation
Opposite brain emotion-regulation patterns in identity states of dissociative identity disorder: A PET study and neurobiological model
Reinders, A. A. T. S., Willemsen, A. T. M., den Boer, J. A., Vos, H. P. J., Veltman, D. J., & Loewenstein, R. J. (2014) · Psychiatry Research: Neuroimaging · doi:10.1016/j.pscychresns.2014.05.005 · Cited by 96 · see citing works
Desynchronization of autonomic response and central autonomic network connectivity in posttraumatic stress disorder
Thome, J., Densmore, M., Frewen, P., McKinnon, M. C., Théberge, J., Nicholson, A. A., Koenig, J., Thayer, J. F., & Lanius, R. A. (2016) · Human Brain Mapping · doi:10.1002/hbm.23340 · Cited by 92 · see citing works
Self-citation
Prolonged exposure therapy for the treatment of patients diagnosed with psychogenic non-epileptic seizures (PNES) and post-traumatic stress disorder (PTSD)
Myers, L., Vaidya-Mathur, U., & Lancman, M. E. (2016) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2016.10.019 · Cited by 94 · see citing works
A novel approach to PTSD modeling in rats reveals alternating patterns of limbic activity in different types of stress reaction
Ritov, G., Boltyansky, B., & Richter-Levin, G. (2016) · Molecular Psychiatry · doi:10.1038/mp.2015.169 · Cited by 92 · see citing works
A research programme to evaluate DBT-PTSD, a modular treatment approach for Complex PTSD after childhood abuse
Bohus, M., Schmahl, C. G., Fydrich, T., Steil, R., Müller‐Engelmann, M., Herzog, J., Ludäscher, P., Kleindienst, N., & Priebe, K. (2019) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-019-0099-y · Cited by 92 · see citing works
Classifying heterogeneous presentations of PTSD via the default mode, central executive, and salience networks with machine learning
Nicholson, A. A., Harricharan, S., Densmore, M., Neufeld, R. W. J., Ros, T., McKinnon, M. C., Frewen, P., Théberge, J., Jetly, R., Pedlar, D., et al. (2020) · NeuroImage Clinical · doi:10.1016/j.nicl.2020.102262 · Cited by 92 · see citing works
Self-citation
Relationships between posttraumatic stress disorder (PTSD), dissociation, quality of life, hopelessness, and suicidal ideation among earthquake survivors
Ozdemir, O., Boysan, M., Özdemir, P. G., & Yılmaz, E. (2015) · Psychiatry Research · doi:10.1016/j.psychres.2015.05.045 · Cited by 95 · see citing works
Presence of the dissociative subtype of PTSD does not moderate the outcome of intensive trauma-focused treatment for PTSD
Zoet, H. A., Wagenmans, A., van Minnen, A., & de Jongh, A. (2018) · European Journal of Psychotraumatology · doi:10.1080/20008198.2018.1468707 · Cited by 92 · see citing works
FOCAL AND ABERRANT PREFRONTAL ENGAGEMENT DURING EMOTION REGULATION IN VETERANS WITH POSTTRAUMATIC STRESS DISORDER: Research Article: Prefrontal Regulation of Affect in PTSD
Rabinak, C. A., MacNamara, A., Kennedy, A. E., Angstadt, M., Stein, M. B., Liberzon, I., & Phan, K. L. (2014) · Depression and Anxiety · doi:10.1002/da.22243 · Cited by 89 · see citing works
Alterations of consciousness in psychogenic nonepileptic seizures: Emotion, emotion regulation and dissociation
Roberts, N. A., & Reuber, M. (2013) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2013.09.035 · Cited by 90 · see citing works
Comorbid trajectories of postpartum depression and PTSD among mothers with childhood trauma history: Course, predictors, processes and child adjustment
Oh, W., Muzik, M., McGinnis, E. W., Hamilton, L., Menke, R. A., & Rosenblum, K. L. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.04.037 · Cited by 89 · see citing works
Dissociation and posttraumatic stress disorder: a latent profile analysis
Blevins, C. A., Weathers, F. W., & Witte, T. K. (2014) · Journal of Traumatic Stress · doi:10.1002/jts.21933 · Cited by 85 · see citing works
Memory Repression: Brain Mechanisms underlying Dissociative Amnesia
Kikuchi, H., Fujii, T., Abe, N., Suzuki, M., Takagi, M., Mugikura, S., Takahashi, S., & Mori, E. (2009) · Journal of Cognitive Neuroscience · doi:10.1162/jocn.2009.21212 · Cited by 85 · see citing works
The Roles of Emotion Dysregulation and Dissociation in the Association Between Sexual Abuse and Self-Injury Among Juvenile Justice–Involved Youth
Chaplo, S. D., Kerig, P. K., Bennett, D. C., & Modrowski, C. A. (2015) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2015.989647 · Cited by 81 · see citing works
The Psychedelic Future of Post-Traumatic Stress Disorder Treatment
Zaretsky, T. G., Jagodnik, K. M., Barsic, R., Antonio, J. H., Bonanno, P. A., MacLeod, C., Pierce, C., Carney, H., Morrison, M. T., Saylor, C. F., et al. (2024) · Current Neuropharmacology · doi:10.2174/1570159x22666231027111147 · Cited by 85 · see citing works
Reality versus fantasy: Reply to Lynn et al. (2014).
Dalenberg, C. J., Brand, B. L., Loewenstein, R. J., Gleaves, D. H., Dorahy, M. J., Cardeña, E., Frewen, P., Carlson, E. B., & Spiegel, D. (2014) · Psychological Bulletin · doi:10.1037/a0036685 · Cited by 81 · see citing works
Self-citation
Biomarkers in the diagnosis and study of psychogenic nonepileptic seizures: A systematic review
Sundararajan, T., Tesar, G. E., & Jimenez, X. F. (2015) · Seizure · doi:10.1016/j.seizure.2015.12.011 · Cited by 79 · see citing works
Emergency department predictors of posttraumatic stress reduction for trauma-exposed individuals with and without an early intervention
Price, M., Kearns, M., Houry, D., & Rothbaum, B. O. (2014) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0035537 · Cited by 77 · see citing works
Latent profile analysis and principal axis factoring of the DSM-5 dissociative subtype
Frewen, P. A., Brown, M. F. D., Steuwe, C., & Lanius, R. A. (2015) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v6.26406 · Cited by 78 · see citing works
Self-citation
Intrinsic connectivity networks in post-traumatic stress disorder during sub- and supraliminal processing of threat-related stimuli
Rabellino, D., Tursich, M., Frewen, P. A., Daniels, J. K., Densmore, M., Théberge, J., & Lanius, R. A. (2015) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12418 · Cited by 78 · see citing works
Self-citation
A GENOME-WIDE ASSOCIATION STUDY OF CLINICAL SYMPTOMS OF DISSOCIATION IN A TRAUMA-EXPOSED SAMPLE: Research Article: Genetics of Dissociation
Wolf, E. J., Rasmusson, A. M., Mitchell, K. S., Logue, M. W., Baldwin, C. T., & Miller, M. W. (2014) · Depression and Anxiety · doi:10.1002/da.22260 · Cited by 75 · see citing works
Is it trauma- or fantasy-based? comparing dissociative identity disorder, post-traumatic stress disorder, simulators, and controls
Vissia, E. M., Giesen, M. E., Chalavi, S., Nijenhuis, E. R. S., Draijer, N., Brand, B. L., & Reinders, A. A. T. S. (2016) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12590 · Cited by 85 · see citing works
Self-citation
Title: “Labels Matter: Is it stress or is it Trauma?”
Richter‐Levin, G., & Sandi, C. (2021) · Translational Psychiatry · doi:10.1038/s41398-021-01514-4 · Cited by 82 · see citing works
Risk factors predicting posttraumatic stress reactions in adolescents after 2011 Van earthquake
Kadak, M. T., Nasıroğlu, S., Boysan, M., & Aydın, A. (2013) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2013.04.003 · Cited by 74 · see citing works
Gray matter volume alterations related to trait dissociation in PTSD and traumatized controls
Nardo, D., Högberg, G., Lanius, R. A., Jacobsson, H., Jonsson, C., Hällström, T., & Pagani, M. (2012) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12026 · Cited by 71 · see citing works
Self-citation
Psychiatric Illnesses as Disorders of Network Dynamics
Durstewitz, D., Huys, Q. J. M., & Koppe, G. (2020) · Biological Psychiatry Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2020.01.001 · Cited by 80 · see citing works
Trauma-related dissociation and the autonomic nervous system: a systematic literature review of psychophysiological correlates of dissociative experiencing in PTSD patients
Beutler, S., Mertens, Y. L., Ladner, L., Schellong, J., Croy, I., & Daniels, J. K. (2022) · European Journal of Psychotraumatology · doi:10.1080/20008066.2022.2132599 · Cited by 64 · see citing works
“…concomitant with altered brain activity in fronto-limbic circuits were labeled ‘physiological non-responders’ and would later fall into the dissociative subtype of PTSD (American Psychiatric Association, 2013; Lanius et al., 2010; Lanius et al., 2012; Spiegel et al., 2011; Terpou et al., 2019).”
BackgroundMethod
Traumatic dissociation: Theory, research, and treatment.
Bailey, T. D., & Brand, B. L. (2017) · Clinical Psychology Science and Practice · doi:10.1111/cpsp.12195 · Cited by 70 · see citing works
Self-citation
Does dissociation moderate treatment outcomes of narrative exposure therapy for PTSD? A secondary analysis from a randomized controlled clinical trial
Halvorsen, J. Ø., Stenmark, H. I., Neuner, F., & Nordahl, H. M. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.03.010 · Cited by 70 · see citing works
Treatment-refractory posttraumatic stress disorder (TRPTSD): a review and framework for the future
Koek, R. J., Schwartz, H. N., Scully, S., Langevin, J., Spangler, S. L., Korotinsky, A., Jou, K., & Leuchter, A. F. (2016) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2016.01.015 · Cited by 70 · see citing works
Peripersonal Space and Bodily Self-Consciousness: Implications for Psychological Trauma-Related Disorders
Rabellino, D., Frewen, P. A., McKinnon, M. C., & Lanius, R. A. (2020) · Frontiers in Neuroscience · doi:10.3389/fnins.2020.586605 · Cited by 69 · see citing works
Self-citation
Electrocortical processing of social signals of threat in combat-related post-traumatic stress disorder
MacNamara, A., Post, D., Kennedy, A. E., Rabinak, C. A., & Phan, K. L. (2013) · Biological Psychology · doi:10.1016/j.biopsycho.2013.08.009 · Cited by 69 · see citing works
DSM–5’s Posttraumatic Stress Disorder with Dissociative Symptoms: Challenges and Future Directions
Dorahy, M. J., & van der Hart, O. (2014) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2014.908806 · Cited by 69 · see citing works
PTSD prevalence and symptom structure of DSM-5 criteria in adolescents and young adults surviving the 2011 shooting in Norway
Hafstad, G. S., Dyb, G. A., Jensen, T. K., Steinberg, A. M., & Pynoos, R. S. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.06.055 · Cited by 68 · see citing works
The Dissociative Subtype of Post-traumatic Stress Disorder: Research Update on Clinical and Neurobiological Features
van Huijstee, J., & Vermetten, E. H. G. J. M. (2017) · Current topics in behavioral neurosciences · doi:10.1007/7854_2017_33 · Cited by 69 · see citing works
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A network analysis of DSM-5 posttraumatic stress disorder and functional impairment in UK treatment-seeking veterans
Ross, J., Murphy, D., & Armour, C. (2018) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2018.05.007 · Cited by 66 · see citing works
TRANCEFORMATIONS: HYPNOSIS IN BRAIN AND BODY
Spiegel, D. (2013) · Depression and Anxiety · doi:10.1002/da.22046 · Cited by 67 · see citing works
Self-citation
Dissociation in Borderline Personality Disorder: Recent Experimental, Neurobiological Studies, and Implications for Future Research and Treatment
Krause-Utz, A., Frost, R., Chatzaki, E., Winter, D., Schmahl, C. G., & Elzinga, B. M. (2021) · Current Psychiatry Reports · doi:10.1007/s11920-021-01246-8 · Cited by 66 · see citing works
The Shutdown Dissociation Scale (Shut-D)
Schalinski, I., Schauer, M., & Elbert, T. R. (2015) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v6.25652 · Cited by 62 · see citing works
Trauma-Related Altered States of Consciousness: Exploring the 4-D Model
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Authors: Lanius, R. A., Brand, B., Vermetten, E., Frewen, P. A., & Spiegel, D.
Affiliations: Western University (CA)
Towson University (US)
Military Mental Health; Utrecht; The Netherlands
Stanford Medicine (US)
Corresponding author: Spiegel, David
ORCID: Lanius, Ruth A.
Brand, Bethany
Vermetten, Eric
Frewen, Paul A.
Spiegel, David
Venue: Depression and Anxiety
Publisher: Hindawi Limited
Published: 2012-03-16
Volume: 29
Issue: 8
Pages: 701-708
ISSN: 1091-4269 (ISSN-L)
DOI: 10.1002/da.21889
OpenAlex: W2101424636
Cited by: 459
References: 71
Citations by year: 2026: 18 · 2025: 33 · 2024: 27 · 2023: 25 · 2022: 30 · 2021: 35 · 2020: 30 · 2019: 31 · 2018: 43 · 2017: 33 · 2016: 33 · 2015: 45 · 2014: 44 · 2013: 19 · 2012: 9
FWCI: 5.45
Type: journal article
Language: en
Open access: closed
Licence: doi.wiley.com/10.1002/tdm_license_1.1 (tdm, 1264 d)
Locations: Depression and Anxiety (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords: post-traumatic stress disorder, depersonalization, derealization, PTSD subtypes, DSM-5, latent class analysis, neurobiology of PTSD, cognitive behavioral therapy, veterans
MeSH terms: Brain, Dissociative Disorders, Humans, Stress Disorders, Post-Traumatic, Comorbidity, Disease Progression

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THE DISSOCIATIVE SUBTYPE OF POSTTRAUMATIC STRESS DISORDER: RATIONALE, CLINICAL AND NEUROBIOLOGICAL EVIDENCE, AND IMPLICATIONS: Dissociative Subtype of PTSD

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