Emotion Modulation in PTSD: Clinical and Neurobiological Evidence for a Dissociative Subtype
Open accessAbstract
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.
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When the prefrontal cortex is shutdown among individuals with classic PTSD, it can propagate an emotion under-modulation symptom profile, including hypervigilance and hyperarousal symptoms.
“Specifically, when the prefrontal cortex is shutdown among individuals with classic PTSD, it can propagate an emotion under-modulation symptom profile, which includes hypervigilance and hyperarousal symptoms.”
From How Processing of Sensory Information From the Internal and External Worlds Shape the Perception and Engagement With the World in the Aftermath of Trauma: Implications for PTSD (2021) · cites this paper as Lanius et al., 2010
The Neurobiological Studies section links reduced medial prefrontal activation and failed prefrontal inhibition to emotional undermodulation in the reexperiencing/hyperaroused PTSD subtype. It does not describe the prefrontal cortex as completely “shutdown.” The Clinical Studies section identifies hypervigilance as a PTSD symptom, but does not specifically link it to that undermodulation mechanism. (LLM, conf=0.83)
Experimental — accuracy not yet measuredIn response to trauma scripts, patients with the reexperiencing/hyperarousal response-as in PTSD-show decreased activation in anterior brain regions implicated in regulating arousal and emotion (ventromedial prefrontal cortex and rostral anterior cingulate cortex), decreased activation in the thalamus and occipital cortices, and increased activity in the amygdala and insula.
“In response to trauma scripts, patients with the reexperiencing/hyperarousal response—as in PTSD—show decreased activation in anterior brain regions implicated in regulating arousal and emotion (ventromedial prefrontal cortex and rostral anterior cingulate cortex), decreased activation in the thalamus and occipital cortices, and increased activity in the amygdala and insula.53–58”
From Fear and the Defense Cascade (2015) · cites this paper as [56]
The Neurobiological Studies section (page unavailable) reports low ventromedial prefrontal and rostral anterior cingulate activation in reexperiencing/hyperaroused PTSD, increased amygdala activation after traumatic reminders, and a positive correlation between reexperiencing severity during trauma scripts and right anterior insula activation. It does not report the claimed decreases in thalamic or occipital activation; the insula finding is a correlation, rather than an unqualified increase across patients. (LLM, conf=0.88)
Experimental — accuracy not yet measuredLanius et al. proposed a neurobiological model of PTSD-DS characterized primarily by symptoms of derealization, depersonalization, and tonic hypoarousal that contrasted with the more typical symptoms of re-experiencing and hyperarousal that feature predominately in the majority of cases of PTSD.
“Building on this seminal work, Lanius et al. (2010) proposed a neurobiological model of PTSD-DS, characterized primarily by symptoms of derealization, depersonalization, and tonic hypoarousal that contrasted with the more typical symptoms of re-experiencing and hyperarousal that feature predominately in the majority of cases of PTSD.”
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., 2010
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThis undermines the proposed neurobiological basis of the defense cascade model and the dissociative subtype as a whole.
“Ultimately, this undermines the proposed neurobiological basis (e.g. Lanius et al., 2010; Terpou et al., 2019) of the defense cascade model and the dissociative subtype as a whole.”
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., 2010
The Abstract and the Neurobiological Studies section propose a neural basis for the dissociative subtype of PTSD, involving prefrontal inhibition of limbic regions. The cited passages do not identify that account as the neurobiological basis of a defense cascade model. The assertion that this basis is undermined is the citing authors’ own conclusion, not a finding attributed to Lanius et al. (LLM, conf=0.82)
Experimental — accuracy not yet measuredIndividuals with PTSD have unique neural signatures that overlap with key brain regions involved in sensory transmission of interoceptive and exteroceptive sensations, including the brainstem, insula, and prefrontal cortex.
“In addition to these core cognitive and affective symptoms, individuals with PTSD have shown unique neural signatures that overlap with key brain regions involved in the sensory transmission of incoming interoceptive and exteroceptive sensations, including the brainstem, the insula, and the prefrontal cortex (Lanius et al., 2010; Nicholson et al., 2015, 2017; Daniels et al., 2016; Sierk et al., 2”
From How Processing of Sensory Information From the Internal and External Worlds Shape the Perception and Engagement With the World in the Aftermath of Trauma: Implications for PTSD (2021) · cites this paper as Lanius et al., 2010
The Neurobiological Studies section reports distinct activation patterns in PTSD involving the medial prefrontal cortex and anterior insula, and describes the insula’s role in interoception. It does not identify a brainstem signature or characterize these regions collectively as transmitting incoming interoceptive and exteroceptive sensations. Page numbers are unavailable in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measured
In patients with the PTSD dissociative subtype, the prefrontal cortex is thought to play an inhibitory role on subcortical structures identified in the innate alarm system, including the amygdala and the periaqueductal gray, which contributes to an emotion over-modulation symptom profile including depersonalization/derealization and emotional detachment behaviors.
“Moreover, in patients with the PTSD dissociative subtype, the prefrontal cortex is thought to play an inhibitory role on subcortical structures identified in the innate alarm system, including the amygdala and the periaqueductal gray, which contributes to an emotion over-modulation symptom profile, including depersonalization/derealization and emotional detachment behaviors (Lanius et al., 2010; N”
From How Processing of Sensory Information From the Internal and External Worlds Shape the Perception and Engagement With the World in the Aftermath of Trauma: Implications for PTSD (2021) · cites this paper as Lanius et al., 2010
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredSensory-based treatments may be an alternative mechanism that can bring online the prefrontal cortex, a key brain region for multisensory integration, emotion regulation and social cognition, which may be offline under certain conditions.
“Here, we propose that sensory-based treatments may be an alternative mechanism that can bring online the prefrontal cortex, a key brain region for multisensory integration, emotion regulation and social cognition, which may be offline under certain conditions (Lanius et al., 2010; Aupperle et al., 2013).”
From How Processing of Sensory Information From the Internal and External Worlds Shape the Perception and Engagement With the World in the Aftermath of Trauma: Implications for PTSD (2021) · cites this paper as Lanius et al., 2010
The Neurobiological Studies section (page unavailable) describes the medial prefrontal cortex as involved in emotion regulation and reports low activation in the reexperiencing/hyperaroused PTSD subgroup. It also reports increased prefrontal activation in dissociative PTSD. The paper does not establish multisensory integration or social cognition as prefrontal functions, or show that sensory-based treatments bring the cortex online; the treatment proposal is the citing authors’ own. (LLM, conf=0.86)
Experimental — accuracy not yet measuredLanius and colleagues proposed a model of heightened prefrontal recruitment with dampening of amygdala-based threat responding in dissociative PTSD.
“Lanius and colleagues have proposed a model of heightened prefrontal recruitment with associated dampening of amygdala-based threat responding [64].”
From Trauma, PTSD, and the Developing Brain (2017) · cites this paper as [64]
Greater activity in prefrontal cortex was associated with subjective feelings of dissociation across various emotionally provocative tasks.
“Similarly, greater activity in prefrontal cortex was associated with subjective feelings of dissociation (e.g., depersonalization/derealization) across various emotionally provocative tasks [147–149].”
From Treatment of dissociative identity disorder: leveraging neurobiology to optimize success (2024) · cites this paper as [147]
Individuals with the dissociative subtype of PTSD have greater activity in regions associated with top-down regulation and diminished activity in limbic regions when presented with emotionally provocative autobiographical trauma-related scripts.
“prior work indicates that individuals with the dissociative subtype of PTSD have greater activity in regions associated with “top-down” regulation (e.g., prefrontal cortex) and diminished activity in limbic regions (e.g., amygdala) when presented with emotionally provocative autobiographical trauma-related scripts [147,148].”
From Treatment of dissociative identity disorder: leveraging neurobiology to optimize success (2024) · cites this paper as [147]
Dissociation can become maladaptive and possibly interfere with treatment.
“Thereby, dissociation can become maladaptive [10] and possibly interfere with treatment [46–50].”
From Dissociation and Alterations in Brain Function and Structure: Implications for Borderline Personality Disorder (2017) · cites this paper as [10]
Dissociation can develop in the aftermath of trauma and generalize across situations.
“Dissociation can also develop in the aftermath of trauma and generalize across situations”
From Dissociation and Alterations in Brain Function and Structure: Implications for Borderline Personality Disorder (2017) · cites this paper as [10]
Lanius and colleagues proposed a neurobiological model distinguishing two types of responses to traumatic reminders: D-PTSD patients over-modulate emotions, whereas re-experiencing patients under-modulate emotions.
“Based on more recent neuroimaging findings in PTSD [10], Lanius and colleagues (2010) proposed a neurobiological model that distinguishes between two types of responses to traumatic reminders or other stressors: patients with a dissociative response type (D-PTSD) are thought to “over-modulate” their emotions, as opposed to patients who primarily suffer from re-experiencing symptoms”
From Dissociation and Alterations in Brain Function and Structure: Implications for Borderline Personality Disorder (2017) · cites this paper as [10]
In Krause-Utz et al. (2014), patients who reported a stronger increase of state dissociation (DSS) showed significantly lower amygdala reactivity to negative distractors.
“Patients who reported a stronger increase of state dissociation (DSS) showed significantly lower amygdala reactivity to negative distractors [139], in line with aforementioned findings by Hazlett and colleagues [135] and theoretical models [10].”
From Dissociation and Alterations in Brain Function and Structure: Implications for Borderline Personality Disorder (2017) · cites this paper as [10]
Dissociation may be a protective strategy to cope with overwhelming emotions in traumatic/stressful situations.
“Dissociation may be a protective strategy to cope with overwhelming emotions in traumatic/stressful situations [1, 3, 10].”
From Dissociation and Alterations in Brain Function and Structure: Implications for Borderline Personality Disorder (2017) · cites this paper as [10]
Pathological dissociation is a complex and heterogeneous phenomenon, which has been closely linked to traumatic stress.
“Pathological dissociation is a complex and heterogeneous phenomenon [2–4, 153], which has been closely linked to traumatic stress [1, 10].”
From Dissociation and Alterations in Brain Function and Structure: Implications for Borderline Personality Disorder (2017) · cites this paper as [10]
Neurobiological studies of PTSD-DS continue to underscore the observation that depersonalization and derealization represent distinct responses from re-experiencing/hyperarousal reactivity in persons with PTSD.
“Neurobiological studies of PTSD-DS continue to underscore the observation that depersonalization and derealization represent distinct responses from re-experiencing/hyperarousal reactivity in persons with PTSD (Lanius et al., 2010(Lanius et al., , 2012(Lanius et al., , 2006;;Nicholson et al., 2015).”
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., 2010
Whereas reliving responses are thought to be mediated by a failure of prefrontal inhibition or top-down control of limbic regions, depersonalization and derealization responses are thought to be mediated by increased prefrontal inhibition of limbic regions.
“Specifically, whereas reliving responses are thought to be mediated by a failure of prefrontal inhibition or top-down control of limbic regions, depersonalization and derealization responses are thought to be mediated by increased prefrontal inhibition of limbic regions.”
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., 2010
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., 2010
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., 2010
Lanius et al. (2010) postulated that among individuals with the PTSD dissociative subtype, overactivation in the prefrontal cortex exerts top-down inhibitory effects on the amygdala.
“Lanius et al. (2010) postulated that among individuals with the PTSD dissociative subtype, overactivation in the prefrontal cortex exerts top-down inhibitory effects on the amygdala, which is a key structure for emotion processing.”
From How Processing of Sensory Information From the Internal and External Worlds Shape the Perception and Engagement With the World in the Aftermath of Trauma: Implications for PTSD (2021) · cites this paper as Lanius et al. (2010)
Previous studies by our research group suggest that among individuals with the PTSD dissociative subtype, the prefrontal cortex exerts top-down inhibitory effects on emotional reactivity structures.
“Interestingly, these patterns differ from previous studies conducted by our research group that suggest among individuals with the PTSD dissociative subtype, the prefrontal cortex exerts top-down inhibitory effects on emotional reactivity structures (Lanius et al., 2010; Nicholson et al., 2017).”
From How Processing of Sensory Information From the Internal and External Worlds Shape the Perception and Engagement With the World in the Aftermath of Trauma: Implications for PTSD (2021) · cites this paper as Lanius et al., 2010
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“Alterations in memory encoding and storage ensue, leading to fragmentation and compartmentalization of memory and impairments in memory retrieval (5, 6).”
BackgroundSelf-citationGinzburg, K., Koopman, C., Butler, L. D., Palesh, O., Kraemer, H. C., Classen, C. C., & Spiegel, D. (2006) · Journal of Trauma & Dissociation · doi:10.1300/j229v07n02_02 · Cited by 101 · cited 1× · see citing works
“(42) used signal detection analyses to identify high and low dissociation PTSD subgroups in a sample of 122 women who were seeking treatment for childhood sexual abuse.”
MethodSelf-citationLimbic and prefrontal responses to facial emotion expressions in depersonalization
Lemche, E., Surguladze, S. A., Giampietro, V., Anilkumar, A. P., Brammer, M. J., Sierra, M., Chitnis, X. A., Williams, S., Gasston, D., Joraschky, P., et al. (2007) · Neuroreport · doi:10.1097/wnr.0b013e328057deb3 · Cited by 83 · cited 1× · see citing works
“A subsequent investigation of a group of depersonalization disorder patients examined event-related fMRI to neutral, mild, and intensely happy and sad facial expressions, with simultaneous measurements of skin conductance levels (38).”
BackgroundKraus, A., Esposito, F., Seifritz, E., Di Salle, F., Ruf, M., Valerius, G., Ludaescher, P., Bohus, M., & Schmahl, C. (2009) · Biological Psychiatry · doi:10.1016/j.biopsych.2008.10.028 · Cited by 83 · see citing works
Self-citationPain Response in Depersonalization: A Functional Imaging Study Using Hypnosis in Healthy Subjects
Röder, C. H., Michal, M., Overbeck, G., van de Ven, V. G., & Linden, D. E. J. (2007) · Psychotherapy and Psychosomatics · doi:10.1159/000097970 · Cited by 82 · cited 1× · see citing works
“(28) found decreased amygdala activity in response to painful stimulation during hypnosis-induced states of depersonalization.”
BackgroundA taxometric investigation of dissociation in Vietnam veterans
Waelde, L. C., Silvern, L. E., & Fairbank, J. A. (2005) · Journal of Traumatic Stress · doi:10.1002/jts.20034 · Cited by 72 · see citing works
Dissociative Symptomatology in Posttraumatic Stress Disorder and Disorders of Extreme Stress
Zucker, M., Spinazzola, J., Blaustein, M. E., & van der Kolk, B. A. (2006) · Journal of Trauma & Dissociation · doi:10.1300/j229v07n01_03 · Cited by 57 · see citing works
Traumatic Dissociation: Neurobiology and Treatment
Dorahy, M. J., & Spiegel, D. (2007) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615377503 · Cited by 52 · see citing works
Self-citationLeft hemispheric activation in depersonalization disorder: A case report
Hollander, E., Carrasco, J. L., Mullen, L. S., Trungold, S., DeCaria, C. M., & Towey, J. P. (1992) · Biological Psychiatry · doi:10.1016/0006-3223(92)90161-r · Cited by 47 · cited 1× · see citing works
“(37) reported a case study of a patient with primary depersonalization disorder, studied using brain electrical activity mapping.”
BackgroundBirmes, P. J., Carreras, D., Ducassé, J.-L., Charlet, J.-P., Warner, B. A., Lauque, D., & Schmitt, L. (2001) · The Canadian Journal of Psychiatry · doi:10.1177/070674370104600711 · Cited by 40 · cited 1× · see citing works
“perception, attentional focus, and awareness of pain among others (12, 13).”
BackgroundEmotional learning during dissociative states in borderline personality disorder
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 · cited 1× · see citing works
“Also, dissociative symptoms block emotional learning in a classical conditioning paradigm (53).”
BackgroundSelf-citationPosttraumatic stress disorder: future directions in science and practice.
Keane, T. M. (2008) · PubMed · Cited by 12 · see citing works
Flagged first, then by citations
Research works printed but not linked: 3
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Sorted by citations
Mental health in elite athletes: International Olympic Committee consensus statement (2019)
Reardon, C. L., Hainline, B., Aron, C. M., Baron, D., Baum, A. L., Bindra, A., Budgett, R., Campriani, N., Castaldelli-Maia, J. M., Currie, A., et al. (2019) · British Journal of Sports Medicine · doi:10.1136/bjsports-2019-100715 · Cited by 1,277 · see citing works
“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.”
Into the unknown: A review and synthesis of contemporary models involving uncertainty
Carleton, R. N. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.02.007 · Cited by 1,104 · see citing works
Post-traumatic stress disorder.
Yehuda, R., Hoge, C. W., McFarlane, A. C., Vermetten, E., Lanius, R. A., Nievergelt, C. M., Hobfoll, S. E., Koenen, K. C., Neylan, T. C., & Hyman, S. E. (2015) · Nature Reviews Disease Primers · doi:10.1038/nrdp.2015.57 · Cited by 870 · see citing works
Self-citationChildhood 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
“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.”
BackgroundEvaluation of the evidence for the trauma and fantasy models of dissociation.
Dalenberg, C. J., Brand, B. L., Gleaves, D. H., Dorahy, M. J., Loewenstein, R. J., Cardeña, E., Frewen, P. A., Carlson, E. B., & Spiegel, D. (2012) · Psychological Bulletin · doi:10.1037/a0027447 · Cited by 667 · see citing works
Self-citationFriedman, M. J., Resick, P. A., Bryant, R. A., & Brewin, C. R. (2011) · Depression and Anxiety · doi:10.1002/da.20767 · Cited by 629 · see citing works
“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 heightened autonomic…”
BackgroundThe Lancet Psychiatry Commission on psychological treatments research in tomorrow's science
Holmes, E. A., Ghaderi, A., Harmer, C. J., Ramchandani, P. G., Cuijpers, P., Morrison, A. P., Roiser, J. P., Bockting, C. L. H., O'Connor, R. C., Shafran, R., et al. (2018) · The Lancet Psychiatry · doi:10.1016/s2215-0366(17)30513-8 · Cited by 624 · see citing works
Herzog, J. I., & Schmahl, C. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00420 · Cited by 583 · see citing works
“This pattern of hypo-activity to threat-related cues has repeatedly been found in patients with PTSD and severe dissociative symptomatology, pointing toward a specific dissociative subtype in PTSD [for further details please see for example: (78)].”
BackgroundSelf-citationLyssenko, 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
Self-citationKozlowska, K., Walker, P., McLean, L., & Carrive, P. (2015) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000065 · Cited by 468 · see citing works
Lanius, R. A., Brand, B., Vermetten, E., Frewen, P. A., & Spiegel, D. (2012) · Depression and Anxiety · doi:10.1002/da.21889 · Cited by 459 · see citing works
“Third, a model has been described that specifies different aspects of emotion dysregulation contributing to the subtypes of PTSD.[1] In this model, reexperiencing/hyperarousal reactivity is viewed as a form of emotion dysregulation that involves emotional undermodulation, mediated by failure of prefrontal inhibition o…”
BackgroundMethodInfluentialSelf-citationBrain circuit dysfunction in post-traumatic stress disorder: from mouse to man
Fenster, R. J., Lebois, L. A. M., Ressler, K. J., & Suh, J. (2018) · Nature Reviews Neuroscience · doi:10.1038/s41583-018-0039-7 · Cited by 456 · see citing works
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-citationKaram, E. G., Friedman, M. J., Hill, E. D., Kessler, R. C., McLaughlin, K. A., Petukhova, M., Sampson, L., Shahly, V., Angermeyer, M. C., Bromet, E. J., et al. (2014) · Depression and Anxiety · doi:10.1002/da.22169 · Cited by 446 · see citing works
“[7] Finally, when considering the Dissociative Subtype of PTSD, which is associated with a greater number of TEs, it has also been shown that, in comparison with individuals with PTSD alone, those with PTSD and dissociative symptoms benefit more from different therapeutic approaches.[40] Specifically, individuals with…”
ResultMcTeague, L. M., Rosenberg, B. M., Lopez, J. W., Carreon, D. M., Huemer, J., Jiang, Y., Chick, C. F., Eickhoff, S. B., & Etkin, A. (2020) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2019.18111271 · Cited by 388 · see citing works
“Regarding activation, both hyper- and hypoactivation of the dorsomedial prefrontal cortex during tasks like mental imagery have been observed across and even within disorder categories, such as PTSD and depression (47, 48).”
BackgroundA critical evaluation of the complex PTSD literature: Implications for <i>DSM‐5</i>
Resick, P. A., Bovin, M. J., Calloway, A. L., Dick, A. M., King, M. W., Mitchell, K. S., Suvak, M. K., Wells, S. Y., Stirman, S. W., & Wolf, E. J. (2012) · Journal of Traumatic Stress · doi:10.1002/jts.21699 · Cited by 365 · see citing works
“, in press) who exhibit a distinct neurocircuitry marked by over-modulation of brain regions governing emotion (Lanius et al., 2010).”
BackgroundInfluentialAkiki, T. J., Averill, C. L., & Abdallah, C. G. (2017) · Current Psychiatry Reports · doi:10.1007/s11920-017-0840-4 · Cited by 365 · 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
“[57] Phasic treatment models with an emphasis on symptom management skills, modulation of dissociation, and development of safety as the primary tasks of treatment, appear to have better outcomes for dissociative forms of PTSD and severe DDs.[35,58]”
BackgroundResultInfluentialSelf-citationDissociation 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
“Empirical support for the subtype includes evidence for antecedent validators (that trauma and stress are linked to dissociation) (4), concurrent validators (that distinctive psychobiological mechanisms underlie dissociation) (9), predictive validators (that dissociation predicts poor treatment outcome) (10,11), and d…”
BackgroundSelf-citationZoladz, P. R., & Diamond, D. M. (2013) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2013.03.024 · Cited by 308 · see citing works
“Lanius et al. (2010), and more recently Wolf et al. (2012), xtended this concept further by characterizing a dissociative subype of PTSD which can be distinguished clinically, and with unique eurobiological features, from non-dissociative PTSD.”
Emotion Dysregulation and Negative Affect
Bradley, B., DeFife, J. A., Guarnaccia, C., Phifer, J. E., Fani, N., Ressler, K. J., & Westen, D. (2011) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.10m06409blu · Cited by 306 · see citing works
Review of somatic symptoms in post-traumatic stress disorder
Gupta, M. A. (2013) · International Review of Psychiatry · doi:10.3109/09540261.2012.736367 · Cited by 286 · see citing works
“Lanius et al. (2010) discuss that dissociation is a regulatory state that is invoked to cope with extreme arousal in PTSD, through hyperinhibition of limbic regions.”
BackgroundInfluentialEmotional Dysregulation in Children and Adolescents With Psychiatric Disorders. A Narrative Review
Paulus, F. W., Ohmann, S., Möhler, E., Plener, P. L., & Popow, C. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.628252 · Cited by 335 · see citing works
“Intrusions emerge from emotional under-regulation, whereas emotional numbing, avoidance, and dissociation are indicative of emotional over-regulation (158).”
BackgroundTowards 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
Nicholson, A. A., Rabellino, D., Densmore, M., Frewen, P. A., Paret, C., Kluetsch, R., Schmahl, C., Théberge, J., Neufeld, R. W. J., McKinnon, M. C., et al. (2017) · Human Brain Mapping · doi:10.1002/hbm.23402 · Cited by 273 · see citing works
“…of symptoms experienced by patients with posttraumatic stress disorder (PTSD) [Aghajani et al., 2016; Birn et al., 2014; Etkin and Wager, 2007; Lanius et al. 2010, 2015; Mickleborough et al., 2011; Patel et al., 2012; Pitman et al., 2012; Shin and Liberzon, 2010; Stevens et al., 2013;…”
BackgroundResultInfluentialSelf-citationClassification of trauma and stressor-related disorders in DSM-5
Friedman, M. J., Resick, P. A., Bryant, R. A., Strain, J. J., Horowitz, M. J., & Spiegel, D. (2011) · Depression and Anxiety · doi:10.1002/da.20845 · Cited by 254 · see citing works
“[93–98] Specifically, patients diagnosed with DID have been found to have smaller hippocampal volume[98] and hyperactivity of frontal cortex associated with limbic inhibition.[32] The underlying idea is that integration of sensory, motor, cognitive, and affective experience is an achievement, not a given, and that tra…”
BackgroundResultInfluentialSelf-citationSmith, B. W., Ortiz, J. A., Steffen, L. E., Tooley, E. M., Wiggins, K. T., Yeater, E. A., Montoya, J. D., & Bernard, M. L. (2011) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0025189 · Cited by 255 · see citing works
“Th is a rti cl e is in te nd ed so le ly fo r t he p er so na l u se o f t he in di vi du al u se r a nd is n ot to b e di ss em in at ed b ro ad ly . to maintain a sharper focus on the emergency at hand and decrease the likelihood of dissociation (Lanius et al., 2010; Ozer et al., 2008).”
A Latent Class Analysis of Dissociation and Posttraumatic Stress Disorder
Wolf, E. J., Miller, M. W., Reardon, A. F., Ryabchenko, K. A., Castillo, D. T., & Freund, R. (2012) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2011.1574 · Cited by 253 · see citing works
“The dissociative subtype hypothesis posits that dissociation is present primarily in a distinct subset of individuals with PTSD and is characterized by blunted or inhibited emotional and physiologic responses to internal and external traumarelated stimuli.(10) Previous studies using taxometric analysis,(9) examination…”
BackgroundResultTrauma, PTSD, and the Developing Brain
Herringa, R. J. (2017) · Current Psychiatry Reports · doi:10.1007/s11920-017-0825-3 · Cited by 248 · see citing works
Lanius, R. A., Frewen, P. A., Tursich, M., Jetly, R., & McKinnon, M. C. (2015) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v6.27313 · Cited by 246 · see citing works
Self-citationHill, M. N., Campolongo, P., Yehuda, R., & Patel, S. (2017) · Neuropsychopharmacology · doi:10.1038/npp.2017.162 · Cited by 239 · see citing works
“That being said, there are specific variants and subsets of this disease, such as those which experience a high degree of dissociation, that may represent as unique subtype of PTSD, which exhibits opposite alterations in activation of these cortico-limbic circuits (Lanius et al, 2010).”
BackgroundThe Latest Neuroimaging Findings in Borderline Personality Disorder
Krause-Utz, A., Winter, D., Niedtfeld, I., & Schmahl, C. (2014) · Current Psychiatry Reports · doi:10.1007/s11920-014-0438-z · Cited by 235 · see citing works
Self-citationDissociation debates: everything you know is wrong
Loewenstein, R. J. (2018) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2018.20.3/rloewenstein · Cited by 231 · see citing works
Self-citationTHE ANXIETY SPECTRUM AND THE REFLEX PHYSIOLOGY OF DEFENSE: FROM CIRCUMSCRIBED FEAR TO BROAD DISTRESS
McTeague, L. M., & Lang, P. J. (2012) · Depression and Anxiety · doi:10.1002/da.21891 · Cited by 230 · see citing works
“Hopefully, efforts will increase to examine possible deficiencies in neurocircuit activation and/or connectivity underlying the blunted physiological reflex activation coincident with severe negative affectivity.[68, 145]”
BackgroundMarcela Ot’alora, G., Grigsby, J., Poulter, B., Derveer, J. W. V., Giron, S. G., Jerome, L., Feduccia, A. A., Hamilton, S., Yazar‐Klosinski, B., Emerson, A., et al. (2018) · Journal of Psychopharmacology · doi:10.1177/0269881118806297 · Cited by 233 · see citing works
Schimmenti, A., & Caretti, V. (2014) · Psychoanalytic Psychology · doi:10.1037/a0038019 · Cited by 222 · see citing works
The Foundations of Resilience: What Are the Critical Resources for Bouncing Back from Stress?
Smith, B. W., Epstein, E. M., Ortiz, J. A., Christopher, P. J., & Tooley, E. M. (2012) · Plenum series on human exceptionality · doi:10.1007/978-1-4614-4939-3_13 · Cited by 225 · see citing works
Feduccia, A. A., & Mithoefer, M. C. (2018) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2018.03.003 · Cited by 217 · see citing works
Epidemiology of dissociative disorders: An overview
Sar, V. (2011) · Epidemiology Research International · doi:10.1155/2011/404538 · Cited by 212 · see citing works
“Dissociative subtypes have been proposed for psychiatric disorders such as PTSD [8] and schizophrenia [12, 13].”
BackgroundTreatment of Posttraumatic Stress Disorder: A State-of-the-art Review
Burback, L., Brémault‐Phillips, S., Nijdam, M. J., McFARLANE, A. C., & Vermetten, E. H. G. J. M. (2023) · Current Neuropharmacology · doi:10.2174/1570159x21666230428091433 · Cited by 232 · see citing works
Self-citationNeurobiological development in the context of childhood trauma.
Cross, D., Fani, N., Powers, A. D., & Bradley, B. (2017) · Clinical Psychology Science and Practice · doi:10.1111/cpsp.12198 · Cited by 227 · see citing works
“For some individuals exposed to trauma—particularly abuse—attending to their current physiological state can evoke trauma-related reminders and subsequent distress and is thus avoided (Lanius et al., 2010).”
InfluentialDissociative 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
“…et al. (2008) provides further evidence for the cortico-limbic high state-dissociation scores during the neuroimaging procedure as measured by the Clinician Administered Dissociative Symptom Scale showed enhanced activation in the ventral prefrontal cortex during conscious fear processing…”
Self-citationOut-of-body-induced hippocampal amnesia
Bergouignan, L., Nyberg, L., & Ehrsson, H. H. (2014) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1318801111 · Cited by 199 · see citing works
“, in posttraumatic stress disorder (25), borderline disorder (23), and schizophrenia (24)].”
BackgroundPlana, I., Lavoie, M.-A., Battaglia, M., & Achim, A. M. (2013) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2013.09.005 · Cited by 207 · see citing works
The Return of the Repressed: The Persistent and Problematic Claims of Long-Forgotten Trauma
Otgaar, H., Howe, M. L., Patihis, L., Merckelbach, H. L. G. J., Lynn, S. J., Lilienfeld, S. O., & Loftus, E. F. (2019) · Perspectives on Psychological Science · doi:10.1177/1745691619862306 · Cited by 211 · see citing works
“Likewise, some research has shown limbic inhibition via the frontal cortex among individuals with a subtype of PTSD that involves emotional suppression (Lanius et al., 2010).”
BackgroundWolf, E. J., Lunney, C. A., Miller, M. W., Resick, P. A., Friedman, M. J., & Schnurr, P. P. (2012) · Depression and Anxiety · doi:10.1002/da.21946 · Cited by 198 · see citing works
“Clinically, the inclusion of the subtype in the DSM would cue clinicians to assess for dissociation and could inform case conceptualization and treatment planning.”
BackgroundInfluentialFord, J. D., & Gómez, J. M. (2015) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2015.989563 · Cited by 199 · see citing works
A framework for understanding the pathophysiology of functional neurological disorder
Drane, D. L., Fani, N., Hallett, M., Khalsa, S. S., Perez, D. L., & Roberts, N. A. (2020) · CNS Spectrums · doi:10.1017/s1092852920001789 · Cited by 205 · see citing works
“This underregulation of emotional response is relevant to deficits in fear extinction, while over-regulation is linked to dissociative responses.(12) Figure 1.”
BackgroundNicholson, 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
“This region was chosen as the model postulated by Lanius et al. (2010) hypothesizes that PFC regions exhibit differential top down inhibition in PTSD+DS versus PTSD-DS.”
BackgroundMethodResultInfluentialSelf-citationCloitre, M., Petkova, E., Wang, J., & Lu Lassell, F. (2012) · Depression and Anxiety · doi:10.1002/da.21920 · Cited by 183 · see citing works
“Among the most commonly proposed is the use of a sequenced or stage-based approach where an initial or preparatory phase is introduced to focus on reducing symptom severity and dissociation before engaging in trauma memory by strengthening skills related to self-soothing and connection to the social and physical envir…”
BackgroundSteuwe, C., Lanius, R. A., & Frewen, P. (2012) · Depression and Anxiety · doi:10.1002/da.21944 · Cited by 182 · see citing works
“[17–19] Dissociation is also assumed to be associated with symptoms of emotional numbing.[20, 21] The centrality of dissociative symptoms in PTSD subjects is also a matter of significant debate (for review see [2,22]).”
BackgroundSelf-citationDissociation in posttraumatic stress disorder part I: Definitions and review of research.
Carlson, E. B., Dalenberg, C. J., & McDade‐Montez, E. (2012) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/a0027748 · Cited by 182 · see citing works
“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).”
BackgroundCarhart-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
“For example, patients with pronounced dissociative symptoms exhibit elevated mPFC and reduced MTL responses to trauma-related cues (51) presumably as”
BackgroundPTSD-related neuroimaging abnormalities in brain function, structure, and biochemistry
Harnett, N. G., Goodman, A. M., & Knight, D. C. (2020) · Experimental Neurology · doi:10.1016/j.expneurol.2020.113331 · Cited by 185 · see citing works
“Prior investigations of the dissociative subtype of PTSD have observed ventromedial PFC “hyperactivity” and amygdala “hypoactivity” (Hopper et al., 2007; Lanius et al., 2010).”
BackgroundEmpathy and Alexithymia in Borderline Personality Disorder: Clinical and Laboratory Measures
New, A. S., Rot, M. A. H., Ripoll, L. H., Pérez-Rodríguez, M. M., Lazarus, S. A., Zipursky, E., Weinstein, S. R., Koenigsberg, H. W., Hazlett, E. A., Goodman, M. S., et al. (2012) · Journal of Personality Disorders · doi:10.1521/pedi.2012.26.5.660 · Cited by 171 · see citing works
Resick, P. A., Suvak, M. K., Johnides, B. D., Mitchell, K. S., & Iverson, K. M. (2012) · Depression and Anxiety · doi:10.1002/da.21938 · Cited by 169 · see citing works
“[6] Thus, Lanius et al.[6] recently proposed that there is sufficient neurobiological evidence to warrant a dissociative subtype of PTSD based on emotion dysregulation that involves emotional overmodulation.”
BackgroundNeuropeptide Y and posttraumatic stress disorder
Sah, R., & Geracioti, T. D. (2012) · Molecular Psychiatry · doi:10.1038/mp.2012.101 · Cited by 171 · see citing works
Schmahl, C., Herpertz, S. C., Bertsch, K., Ende, G., Flor, H., Kirsch, P., Lis, S., Meyer-Lindenberg, A., Rietschel, M., Schneider, M., et al. (2014) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/2051-6673-1-12 · Cited by 168 · see citing works
Self-citationDissociative 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.20923 · Cited by 162 · see citing works
“[57] Phasic treatment models with an emphasis on symptom management skills, modulation of dissociation, and development of safety as the primary tasks of treatment, appear to have better outcomes for dissociative forms of PTSD and severe DDs.[35,58]”
BackgroundResultInfluentialSelf-citationNicholson, A. A., Friston, K. J., Zeidman, P., Harricharan, S., McKinnon, M. C., Densmore, M., Neufeld, R. W. J., Théberge, J., Corrigan, F., Jetly, R., et al. (2017) · Human Brain Mapping · doi:10.1002/hbm.23748 · Cited by 159 · see citing works
Self-citationA Randomized Controlled Study of Neurofeedback for Chronic PTSD
van der Kolk, B. A., Hodgdon, H., Gapen, M., Musicaro, R. M., Suvak, M. K., Hamlin, E., & Spinazzola, J. (2016) · PLoS ONE · doi:10.1371/journal.pone.0166752 · Cited by 174 · see citing works
Peterson, A., Thome, J., Frewen, P., & Lanius, R. A. (2014) · The Canadian Journal of Psychiatry · doi:10.1177/070674371405900602 · Cited by 156 · see citing works
Self-citationPTSD, 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 168 · see citing works
“This subtype is supported by fMRI research by Lanius et al. (2010) showing separate neural manifestations of dissociative and hyperarousal subtypes of PTSD.”
BackgroundSteudte‐Schmiedgen, S., Kirschbaum, C., Alexander, N., & Stalder, T. (2016) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2016.07.015 · Cited by 165 · see citing works
“Besides MD comorbidity, there is also increasing evidence suggesting two PTSD subtypes, i.e., re-experienced/hyperaroused and dissociative/hypoaroused, which may show distinct neural correlates (reviews: Lanius et al., 2010; Wolf et al., 2012).”
BackgroundMother–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
“…one rarer type consisting of dissociative symptoms and emotional overmodulation and another more common type consisting primarily of hyperarousal, reexperiencing symptoms, and emotional undermodulation (Lanius et al., 2010; Lanius, Brand, Vermetten, Frewen, & Spiegel, 2012; Stein et al., 2012).”
InfluentialHébert, M., Langevin, R., & Oussaïd, E. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.08.044 · Cited by 158 · see citing works
The brain-body disconnect: A somatic sensory basis for trauma-related disorders
Kearney, B. E., & Lanius, R. A. (2022) · Frontiers in Neuroscience · doi:10.3389/fnins.2022.1015749 · Cited by 154 · see citing works
Self-citationBrand, B. L., Sar, V., Stavropoulos, P., Krüger, C., Korzekwa, M., Martínez-Taboas, A., & Middleton, W. (2016) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000100 · Cited by 153 · see citing works
Self-citationLanius, R. A., Frewen, P., Vermetten, E. H. G. J. M., & Yehuda, R. (2010) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v1i0.5467 · Cited by 153 · see citing works
“…concepts of emotional under- and over-modulation provide the basis for expanding the fear circuitry model to potentially accommodate abnorm- alities in the regulation of multiple emotional states that are often observed in PTSD (Frewen & Lanius, 2006; Lanius et al., 2010; Liberzon & Martis 2006).”
BackgroundSelf-citationKnefel, M., Tran, U. S., & Lueger-Schuster, B. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.09.002 · Cited by 146 · see citing works
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-citationComplex trauma and intimate relationships: The impact of shame, guilt and dissociation
Dorahy, M. J., Corry, M., Shannon, M., Webb, K., McDermott, B., Ryan, M., & F.W. Dyer, K. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.10.010 · Cited by 145 · see citing works
“Dissociation has historically been understood as an intrapsychic process where an individual experiences alterations in identity, cognition, and/or awareness (e.g., Cardeña and Carlson, 2011; Carlson and Putnam, 1993; Lanius et al., 2010; Van der Hart and Dorahy, 2009).”
BackgroundAron, C. M., Harvey, S., Hainline, B. W., Hitchcock, M., & Reardon, C. L. (2019) · British Journal of Sports Medicine · doi:10.1136/bjsports-2019-100695 · Cited by 144 · see citing works
Acute stress disorder revisited
Cardeña, E., & Carlson, E. (2011) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-032210-104502 · Cited by 204 · see citing works
The link between dissociation and both suicide attempts and non-suicidal self-injury: Meta-analyses
Calati, R., Bensassi, I., & Courtet, P. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.01.035 · Cited by 138 · see citing works
Wang, T., Liu, J., Zhang, J., Zhan, W., Li, L., Wu, M. C., Huang, H., Zhu, H., Kemp, G. J., & Gong, Q. (2016) · Scientific Reports · doi:10.1038/srep27131 · Cited by 137 · see citing works
Kim, S. H., Schneider, S. M., Bevans, M., Kravitz, L., Mermier, C., Qualls, C., & Burge, M. R. (2013) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2012-3742 · Cited by 135 · see citing works
“Further analyses show that MBX had comparable effects on all 3 symptom subtypes, resulting in improvement of both clinically and neurobiologically opposing symptom characteristics: undermodulated emotional dysregulation (re-experiencing and hyperarousal symptoms) and overmodulated emotional dysregulation (avoidance an…”
BackgroundTekın, A., Karadağ, H., Süleymanoğlu, M., Tekin, M., Kayran, Y., Alpak, G., & Şar, V. (2016) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v7.28556 · Cited by 137 · see citing works
“…have been found between these two types of PTSD. Hyperinhibition of the limbic regions by medial prefrontal areas was shown with emotional overmodulation, while the failure of prefrontal inhibition of limbic regions was found with emotional undermodulation (Bremner, 1999; Lanius et al., 2010).”
BackgroundDevelopmental trauma, complex PTSD, and the current proposal of DSM-5
Şar, V. (2011) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v2i0.5622 · Cited by 136 · see citing works
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
“…PTSDþDS emotional overmodulation, which consists of amygdala hypoactivation associated with chronic emotional numbing, where amygdala activity is negatively correlated to dissociation among PTSD patients (Hopper et al., 2007; Lanius et al., 2010; Mickleborough et al., 2011; Nicholson et al., 2015).”
InfluentialSelf-citationInfluence of emotional distraction on working memory performance in borderline personality disorder
Krause-Utz, A., Oei, N. Y. L., Niedtfeld, I., Bohus, M., Spinhoven, P., Schmahl, C., & Elzinga, B. M. (2012) · Psychological Medicine · doi:10.1017/s0033291712000153 · Cited by 131 · see citing works
“Dissociative states might prevent habituation to negatively arousing situations and new learning (Lanius et al. 2010).”
InfluentialSelf-citationHarricharan, S., Rabellino, D., Frewen, P. A., Densmore, M., Théberge, J., McKinnon, M. C., Schore, A. N., & Lanius, R. A. (2016) · Brain and Behavior · doi:10.1002/brb3.579 · Cited by 127 · see citing works
“Taken together, these findings may help to explain why individuals with PTSD can feel emotionally detached from their traumatic memories during states of depersonalization (Krystal, Bennett, Bremner, Southwick, & Charney, 1995; Lanius et al., 2010; Spiegel, 1997).”
BackgroundSelf-citationDissociation and emotion regulation strategies: A meta-analytic review
Cavicchioli, M., Scalabrini, A., Northoff, G., Mucci, C., Ogliari, A., & Maffei, C. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.09.011 · Cited by 130 · see citing works
In Search of Neural Endophenotypes of Postpartum Psychopathology and Disrupted Maternal Caregiving
Moses‐Kolko, E. L., Horner, M. S., Phillips, M. L., Hipwell, A. E., & Swain, J. E. (2014) · Journal of Neuroendocrinology · doi:10.1111/jne.12183 · Cited by 129 · see citing works
Lanius, R. A. (2015) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v6.27905 · Cited by 127 · see citing works
Self-citationPerkonigg, A., Höfler, M., Cloitre, M., Wittchen, H.-U., Trautmann, S., & Maercker, A. (2016) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-015-0639-4 · Cited by 144 · see citing works
“The heterogeneity of PTSD has prompted various attempts to improve the construct validity by investigating subtypes and specifiers [4, 5] and examining the structure of PTSD symptoms [6, 7].”
BackgroundDissociative tendencies and individual differences in high hypnotic suggestibility
Terhune, D. B., Cardeña, E., & Lindgren, M. (2011) · Cognitive Neuropsychiatry · doi:10.1080/13546805.2010.503048 · Cited by 125 · see citing works
“There is accumulating evidence for two subtypes of posttraumatic stress disorder (Lanius et al., 2010): a nondissociative subtype that experiences hyperarousal and vivid reliving of the traumatic event during exposure to threatening stimuli, and a dissociative subtype that responds with…”
BackgroundLiu, F., Xie, B., Wang, Y., Guo, W., Fouché, J., Long, Z., Wang, W., Chen, H., Li, M., Duan, X., et al. (2014) · Brain Topography · doi:10.1007/s10548-014-0386-2 · Cited by 123 · see citing works
“Recent studies have found that dysfunctions of the limbic regions are associated with emotion dysregulation in PTSD patients (Etkin and Wager 2007; Lanius et al. 2010).”
BackgroundPerez, D. L., Dworetzky, B. A., Dickerson, B. C., Leung, L., Cohn, R., Baslet, G. C., & Silbersweig, D. (2014) · Clinical EEG and Neuroscience · doi:10.1177/1550059414555905 · Cited by 125 · see citing works
“This would be consistent with increased amygdalar activation observed in FMD patients during both affectively valenced58 and motor tasks.59 In contrast to FMD subjects, preliminary neuroimaging results in PNES potentially link trait dissociation to increased resting-state perigenual ACC activations.29,30 This is notew…”
BackgroundPathways towards the proliferation of avoidance in anxiety and implications for treatment.
Arnaudova, I., Kindt, M., Fanselow, M., & Beckers, T. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2017.04.004 · Cited by 111 · see citing works
The innate alarm system in PTSD: conscious and subconscious processing of threat.
Lanius, R. A., Rabellino, D., Boyd, J. E., Harricharan, S., Frewen, P. A., & McKinnon, M. C. (2017) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2016.11.006 · Cited by 120 · see citing works
Self-citationFarina, B., Liotti, M., & Imperatori, C. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.00933 · Cited by 111 · see citing works
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
Rabellino, D., Densmore, M., Théberge, J., McKinnon, M. C., & Lanius, R. A. (2018) · Human Brain Mapping · doi:10.1002/hbm.24081 · Cited by 119 · see citing works
“…one’s surroundings for safety (Porges, 2011), the hippocampus has been associated with contextual fear learning, memory retrieval, sensitization, and mediation processes in stress response (Lanius et al., 2010a; Liberzon & Abelson, 2016; Patel, Spreng, Shin, & Girard, 2012; Shin & Liberzon, 2010).”
BackgroundInfluentialSelf-citationFord, J. D., & Delker, B. C. (2018) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2018.1440479 · Cited by 120 · see citing works
“, stressrelated coping involving physiological arousal (Lanius et al., 2010)—were associated with hypervigilance, whereas it was dissociative symptoms—stress reactions that occur when arousal or distress exceed adaptive capacities JOURNAL OF TRAUMA & DISSOCIATION 281”
BackgroundResultLanius, R. A., Bluhm, R. L., & Frewen, P. A. (2011) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2011.01755.x · Cited by 158 · see citing works
“Teaching PTSD patients with impairments in emotional awareness to identify their affective feelings early on in treatment may make exposure-based treatments more efficient (78, 86, 162, 163) because such therapies are dependent on a patient s judgment of their internal affect and as well as a reliable report of their…”
BackgroundInfluentialSelf-citationAmygdala in action: Relaying biological and social significance to autobiographical memory
Markowitsch, H. J., & Staniloiu, A. (2010) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2010.10.007 · Cited by 117 · 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
Fact or Factitious? A Psychobiological Study of Authentic and Simulated Dissociative Identity States
Reinders, A. A. T. S., Willemsen, A. T. M., Vos, H. P. J., den Boer, J. A., & Nijenhuis, E. R. S. (2012) · PLoS ONE · doi:10.1371/journal.pone.0039279 · Cited by 120 · see citing works
“Our findings support the cortico-limbic inhibition model of trauma-related dissociative disorders [41,47].”
ResultBedard-Gilligan, M., & Zoellner, L. A. (2012) · Memory · doi:10.1080/09658211.2012.655747 · Cited by 116 · see citing works
“…of theoretical models discussing the overlap among dissociation, trauma exposure, and memory processing including work on neurobiological underpinnings of dissociation and traumatic responses (e.g., Bremner, 2000, 2003; Krystal, Bennett, Bremner, Southwick, & Charney, 1996; Lanius et al., 2010).”
Influential
- Authors
- Lanius, R. A., Vermetten, E., Loewenstein, R. J., Brand, B., Schmahl, C., Bremner, J. D., & Spiegel, D.
- Affiliations
- Western University (CA)
- ORCID
- Venue
- American Journal of Psychiatry
- Published
- 2010-06-01
- Volume
- 167
- Issue
- 6
- Pages
- 640-647
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- PMC
- PMC3226703
- OpenAlex
- W2124556602
- Cited by
- 1,123
- References
- 53
- Citations by year
- 2026: 61 · 2025: 74 · 2024: 64 · 2023: 67 · 2022: 69 · 2021: 74 · 2020: 71 · 2019: 61 · 2018: 84 · 2017: 84 · 2016: 71 · 2015: 66 · 2014: 86 · 2013: 57 · 2012: 74
- FWCI
- 8.63
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- AstraZeneca
- H. Lundbeck A/S
- National Institutes of Health (UL1TR000454)
- National Institute on Aging (P01AG018784)
- National Heart, Lung, and Blood Institute (R01HL088726)
- National Institute of Mental Health (R21MH080208, R01MH056120, R01MH047226, K24MH076955, T32MH067547, R01MH060556)
- National Cancer Institute (R01CA118567, R01CA061309, U01CA197282)
- National Center for Research Resources (S10RR016917)
- National Center for Advancing Translational Sciences
- National Center for Complementary and Integrative Health (RC1AT005733, P30AT005886)
- 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, emotional dysregulation, re-experiencing, hyperarousal, limbic regions, dissociation, trauma treatment, symptom profiles
- MeSH terms
- Affect, Amygdala, Cerebral Cortex, Chronic Disease, Dissociative Disorders, Gyrus Cinguli, Humans, Magnetic Resonance Imaging, Memory Disorders, Neural Inhibition, Stress Disorders, Post-Traumatic
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