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Cited by 506Posttraumatic Stress Disorder ResearchPsychosomatic Disorders and Their TreatmentsMemory Processes and Influences

Brain activation during script-driven imagery induced dissociative responses in PTSD: a functional magnetic resonance imaging investigation

Lanius, Ruth A, Williamson, Peter C, Boksman, Kristine, Densmore, Maria, Gupta, Madhulika, Neufeld, Richard W.J, Gati, Joseph S, Menon, Ravi S·2002·Biological Psychiatry
DOI 10.1016/s0006-3223(02)01367-7
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Abstract

Background The goal of this study was to examine the neuronal circuitry underlying dissociative responses to traumatic script-driven imagery in sexual-abuse-related posttraumatic stress disorder (PTSD). Pilot studies in our laboratory have shown that PTSD patients had very different responses to traumatic script-driven imagery. Approximately 70% of patients relived their traumatic experience and showed an increase in heart rate while recalling the traumatic memory. The other 30% of patients had a dissociative response with no concomitant increase in heart rate. This article focuses on the latter group.Methods The neuronal circuitry underlying dissociative responses in PTSD was studied using the traumatic script-driven symptom provocation paradigm adapted to functional magnetic resonance imaging (fMRI) at a 4 Tesla field strength in 7 subjects with sexual-abuse-related PTSD and 10 control subjects.Results Compared with control subjects, PTSD patients in a dissociative state showed more activation in the superior and middle temporal gyri (BA 38), the inferior frontal gyrus (BA 47), the occipital lobe (BA 19), the parietal lobe (BA 7), the medial frontal gyrus (BA 10), the medial cortex (BA 9), and the anterior cingulate gyrus (BA 24 and 32).Conclusions These findings suggest that prefrontal and limbic structures underlie dissociative responses in PTSD. Differences observed clinically, psychophysiologically, and neurobiologically between patients who respond to traumatic script-driven imagery with dissociative versus nondissociative responses may suggest different neuronal mechanisms underlying these two distinct reactions.

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  • In a script-driven imagery fMRI study, about 70% of PTSD patients reported marked re-experiencing symptoms and showed a substantial increase in heart rate during the script.

    “The majority of patients (∼70%) reported marked re-experiencing symptoms and showed a substantial increase in heart rate during the script.”

    From Dissociation and Alterations in Brain Function and Structure: Implications for Borderline Personality Disorder (2017) · cites this paper as [57]

  • In the same study, a smaller patient group (~30%) did not show heart rate increase and showed stronger activity in medial frontal gyrus, anterior and medial cingulate, middle temporal gyri, precuneus, occipital areas, and IFG compared to traumatized controls without PTSD.

    “In a smaller patient group (∼30%), however, this heart rate increase was not observed—instead, these patients showed stronger activity in the medial frontal gyrus, anterior and medial cingulate, middle temporal gyri (BA38), precuneus, occipital areas, and inferior frontal gyrus (IFG), compared to a control group of traumatized persons who had not developed PTSD [57].”

    From Dissociation and Alterations in Brain Function and Structure: Implications for Borderline Personality Disorder (2017) · cites this paper as [57]

  • The VLPAG receives signals from deep somatic (muscle, joint) or visceral tissues via the dorsal horn of the spinal cord, from the parabrachial nucleus, and from the vagal sensory nucleus (the solitary track nucleus).

    “The VLPAG receives signals from deep somatic (muscle, joint) or visceral tissues via the dorsal horn of the spinal cord, from the parabrachial nucleus,25,94,95 and from the vagal sensory nucleus (the solitary track nucleus).28,96”

    From Fear and the Defense Cascade (2015) · cites this paper as [95]

  • Previous reports found an absence of heart-rate increase in response to traumatic scripts among patients with PTSD and comorbid dissociative symptoms.

    “These findings are consistent with previous reports of an absence of heart-rate increase in response to traumatic scripts among patients with PTSD and comorbid dissociative symptoms (Lanius et al., 2002), and of depressed skin conductance and heart rate when recalling a trauma among rape victims high in peri-traumatic dissociation (Griffin et al., 1997).”

    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., 2002

  • Further research by Lanius and colleagues employing trauma memory recall supports the idea of two different PTSD profiles.

    “Further research by Lanius and colleagues (Lanius et al., 2002; Lanius et al., 2005; Lanius et al., 2006) employing trauma memory recall supports the idea of two different PTSD profiles”

    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., 2002

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Authors
Lanius, R. A., Williamson, P. C., Boksman, K., Densmore, M., Gupta, M., Neufeld, R. W. J., Gati, J. S., & Menon, R. S.
Affiliations
  • Western University (CA)
  • Robarts Research Institute (CA)
Corresponding author
Lanius, Ruth A
ORCID
Venue
Biological Psychiatry
Publisher
Elsevier BV
Published
2002-08
Volume
52
Issue
4
Pages
305-311
ISSN
0006-3223 (ISSN-L)
DOI
10.1016/s0006-3223(02)01367-7
OpenAlex
W1966297906
Cited by
505
References
48
Citations by year
2026: 7 · 2025: 11 · 2024: 10 · 2023: 17 · 2022: 23 · 2021: 18 · 2020: 24 · 2019: 24 · 2018: 12 · 2017: 25 · 2016: 17 · 2015: 23 · 2014: 27 · 2013: 28 · 2012: 25
FWCI
23.40
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Biological Psychiatry (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
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Memory Processes and Influences
Keywords
post-traumatic stress disorder, dissociation, script-driven imagery, sexual abuse, brain activation, prefrontal cortex, limbic system, anterior cingulate cortex, temporal lobe, heart rate response
MeSH terms
Adult, Arousal, Brain, Brain Mapping, Child, Child Abuse, Child Abuse, Sexual, Dissociative Disorders, Female, Gyrus Cinguli, Humans, Imagination, Magnetic Resonance Imaging, Nerve Net, Mental Recall, Stress Disorders, Post-Traumatic, Temporal Lobe, Prefrontal Cortex

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