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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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“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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
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“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
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“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
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“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]
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“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]
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“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]
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“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]
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“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]
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“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]
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“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]
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“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]
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In the citing paper
“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]
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“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
The cited source says what the claim attributes to it.
In the citing paper
“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
The cited source says what the claim attributes to it.
In the citing paper
“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
The cited source says what the claim attributes to it.
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“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
The cited source says what the claim attributes to it.
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“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)
The cited source says what the claim attributes to it.
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“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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Mental health in elite athletes: International Olympic Committee consensus statement (2019)
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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
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“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…”
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“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
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“[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
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“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 339
“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
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Review of somatic symptoms in post-traumatic stress disorder
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“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.”
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“Intrusions emerge from emotional under-regulation, whereas emotional numbing, avoidance, and dissociation are indicative of emotional over-regulation (158).”
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“…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;…”
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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
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“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
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“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
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
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“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
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
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 251
“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 252
Schimmenti, A., & Caretti, V. (2014) · Psychoanalytic Psychology · doi:10.1037/a0038019 · Cited by 247
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 238
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
Epidemiology of dissociative disorders: An overview
Sar, V. (2011) · Epidemiology Research International · doi:10.1155/2011/404538 · Cited by 212
“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 251
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 268
“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 229
“…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
“, 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 225
Acute stress disorder revisited
Cardeña, E., & Carlson, E. (2011) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-032210-104502 · Cited by 204
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 229
“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
“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 216
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 220
“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
“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
“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 195
“[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 200
“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 187
“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 201
“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
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
“[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 178
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
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
“[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
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
Peterson, A., Thome, J., Frewen, P., & Lanius, R. A. (2014) · The Canadian Journal of Psychiatry · doi:10.1177/070674371405900602 · Cited by 156
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
“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 177
“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 172
“…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
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
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
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 163
“…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
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
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
“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 153
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
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
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
“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
“…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 151
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
“…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
“Dissociative states might prevent habituation to negatively arousing situations and new learning (Lanius et al. 2010).”
InfluentialSelf-citationfMRI functional connectivity of the periaqueductal gray in PTSD and its dissociative subtype
Harricharan, 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
“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 146
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 134
Lanius, R. A. (2015) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v6.27905 · Cited by 127
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
“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
“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 126
“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 130
“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. S., & Beckers, T. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2017.04.004 · Cited by 134
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
Self-citationFarina, B., Liotti, M., & Imperatori, C. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.00933 · Cited by 138
Krause-Utz, A., Frost, R., Winter, D., & Elzinga, B. M. (2017) · Current Psychiatry Reports · doi:10.1007/s11920-017-0757-y · Cited by 116
Rabellino, D., Densmore, M., Théberge, J., McKinnon, M. C., & Lanius, R. A. (2018) · Human Brain Mapping · doi:10.1002/hbm.24081 · Cited by 119
“…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 131
“, 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
“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 121
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
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
“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
“…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
Metadata
- 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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