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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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In the citing paper
“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
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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)
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In the citing paper
“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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Citations
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Posttraumatic stress disorder: a theoretical model of the hyperarousal subtype
Weston, C. S. E. (2014) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2014.00037 · Cited by 114
Brand, B. L., Lanius, R. A., Vermetten, E. H. G. J. M., Loewenstein, R. J., & Spiegel, D. (2012) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2011.620687 · Cited by 119
Self-citationMothers’ unresolved trauma blunts amygdala response to infant distress
Kim, S., Fonagy, P., Allen, J. G., & Strathearn, L. (2014) · Social Neuroscience · doi:10.1080/17470919.2014.896287 · Cited by 119
“…responses (e.g., hyperarousal, re-experiencing) commonly observed in single, acute, adult-onset trauma, blunted emotional responses (e.g., emotional numbing, dissociation) have been reported in cases of prolonged, recurrent, early-onset trauma (Frewen & Lanius, 2006b; Lanius et al., 2010).”
Koreki, A., Garfkinel, S. N., Mula, M., Agrawal, N., Cope, S., Eilon, T., Gould Van Praag, C., Critchley, H. D., Edwards, M., & Yogarajah, M. (2020) · Epilepsia · doi:10.1111/epi.16532 · Cited by 109
Neural contributors to trauma resilience: a review of longitudinal neuroimaging studies
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Harricharan, S., McKinnon, M. C., & Lanius, R. A. (2021) · Frontiers in Neuroscience · doi:10.3389/fnins.2021.625490 · Cited by 110
Self-citationUnintended Consequences of Changing the Definition of Posttraumatic Stress Disorder inDSM-5
Hoge, C. W., Yehuda, R., Castro, C. A., McFARLANE, A. C., Vermetten, E. H. G. J. M., Jetly, R., Koenen, K. C., Greenberg, N. L., Shalev, A. Y., Rauch, S. A. M., et al. (2016) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2016.0647 · Cited by 111
Self-citationWest, J., Liang, B., & Spinazzola, J. (2016) · International Journal of Stress Management · doi:10.1037/str0000040 · Cited by 108
“…suggests that the variety of symptoms related to chronic childhood trauma can present significant challenges in treatment (Jaycox & Foa, 1996; Lanius et al., 2010), including premature dropout and exacerbation of symptoms (Cloitre, Koenen, Cohen, & Han, 2002; McDonagh et al., 2005; Scott &…”
BackgroundHarricharan, S., Nicholson, A. A., Thome, J., Densmore, M., McKinnon, M. C., Théberge, J., Frewen, P. A., Neufeld, R. W. J., & Lanius, R. A. (2020) · Psychophysiology · doi:10.1111/psyp.13472 · Cited by 94
Self-citationThomaes, K., Dorrepaal, E., Draijer, N., de Ruiter, M. B., Elzinga, B. M., Sjoerds, Z., van Balkom, A. J., Smit, J. H., & Veltman, D. J. (2013) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nsr084 · Cited by 103
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“25 To elucidate the specific role that these brain regions play during pain perception in clinical populations, future studies should”
BackgroundKleindienst, N., Priebe, K., Görg, N., Dyer, A., Steil, R., Lyssenko, L., Winter, D., Schmahl, C., & Bohus, M. (2016) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v7.30375 · Cited by 105
“On the other hand, current neurobiological models of dissociation suggest increased activity in prefrontal brain areas associated with executive functioning and emotion regulation (Lanius et al., 2010).”
BackgroundSelf-citationBoden, M. T., Bonn-Miller, M. O., Kashdan, T. B., Alvarez, J., & Gross, J. J. (2012) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2011.11.007 · Cited by 104
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Chalavi, S., Vissia, E. M., Giesen, M. E., Nijenhuis, E. R. S., Draijer, N., Cole, J. H., Dazzan, P., Pariante, C. M., Madsen, S. K., Rajagopalan, P., et al. (2015) · Human Brain Mapping · doi:10.1002/hbm.22730 · Cited by 100
“This has led to the recent nosological inclusion of a dissociative subtype of Post-traumatic Stress Disorder (PTSD) [Lanius et al., 2010] in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [American Psychiatric Association, 2013].”
BackgroundTrauma and Dissociation: Implications for Borderline Personality Disorder
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“Howmay these findings contribute to the interpretation of mPFC– limbic NCI dips, coinciding with highly emotional events in Sophie? A recent review on post-traumatic stress disorder (PTSD)-related pathologies of emotion modulation (Lanius et al., 2010) may provide a clue.”
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“…at both underregulation, a core symptom found in the majority of BPD patients (Ford, 2010; van Dijke, 2008; van Dijke et al., 2010; Zanarini et al., 2002), as well as overregulation such as numbing and dissociation, reported by 1 in 5 BPD patients (Lanius et al., 2010; van Dijke et al., 2010).”
BackgroundMcKinnon, M. C., Boyd, J. E., Frewen, P. A., Lanius, U. F., Jetly, R., Richardson, J. D., & Lanius, R. A. (2016) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2016.07.017 · Cited by 94
Self-citationReinders, A. A. T. S., Willemsen, A. T. M., den Boer, J. A., Vos, H. P. J., Veltman, D. J., & Loewenstein, R. J. (2014) · Psychiatry Research: Neuroimaging · doi:10.1016/j.pscychresns.2014.05.005 · Cited by 96
“The latter pattern has been termed “undermodulation” of emotional response to trauma cues (Hopper et al., 2007; Felmingham et al., 5 2008; Lanius et al., 2002, 2010, 2012) and is generally accompanied by hyper-arousal and increases in heart rate and blood pressure, consistent with the more…”
InfluentialSelf-citationTrauma-related reactivity and regulation of emotion: Associations with posttraumatic stress symptoms
Badour, C. L., & Feldner, M. T. (2012) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2012.07.007 · Cited by 97
“Dissociation or emotional numbing as means to disengage from the traumatic memory has been offered as one possibility to account for dampened physiological responding among some individuals with PTSD (see Lanius, Bluhm, Lanius, & Pain, 2006; Lanius et al., 2010 for reviews).”
BackgroundCoping With COVID-19: Mindfulness-Based Approaches for Mitigating Mental Health Crisis
Antonova, E., Schlosser, K., Pandey, R., & Kumari, V. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.563417 · Cited by 89
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“…including re-experiencing symptoms and a detachment from emotional experience that occurs during emotional numbing and states of depersonalization and derealization, respectively [Etkin and Wager, 2007; Lanius et al., 2010; Nicholson et al., 2015; Reinders et al., 2014; Wolf et al., 2014].”
BackgroundInfluentialSelf-citationLaboratory models of post-traumatic stress disorder: The elusive bridge to translation
Dunsmoor, J. E., Cisler, J. M., Fonzo, G. A., Creech, S. K., & Nemeroff, C. B. (2022) · Neuron · doi:10.1016/j.neuron.2022.03.001 · Cited by 101
Dissociation and emotion regulation in borderline personality disorder
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“In brief, the model suggests that during dissociation the medial prefrontal cortex inhibits processing of external emotional stimuli in the amygdala, thus dampening emotional responses to these stimuli (Sierra & Berrios, 1998 ; Sierra et al. 2002 ; Lanius et al. 2010).”
BackgroundRitov, G., Boltyansky, B., & Richter-Levin, G. (2016) · Molecular Psychiatry · doi:10.1038/mp.2015.169 · Cited by 92
Bohus, M., Schmahl, C. G., Fydrich, T., Steil, R., Müller‐Engelmann, M., Herzog, J., Ludäscher, P., Kleindienst, N., & Priebe, K. (2019) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-019-0099-y · Cited by 103
Self-citationNicholson, A. A., Harricharan, S., Densmore, M., Neufeld, R. W. J., Ros, T., McKinnon, M. C., Frewen, P., Théberge, J., Jetly, R., Pedlar, D., et al. (2020) · NeuroImage Clinical · doi:10.1016/j.nicl.2020.102262 · Cited by 100
“Indeed, functional connectivity patterns of ICNs may further polarize during emotion induction paradigms when comparing PTSD versus PTSD+DS patients, where these patient groups are known to exhibit unique symptoms in response to such paradigms (Hopper et al., 2007b; Lanius et al., 2010).”
InfluentialSelf-citationEvren, C., Sar, V., Dalbudak, E., Cetin, R., Durkaya, M., Evren, B., & Celik, S. (2011) · Psychiatry Research · doi:10.1016/j.psychres.2010.07.004 · Cited by 92
“Interestingly, a dissociative subtype of PTSD has also been proposed that was associated with a history of childhood abuse and/or neglect as a co-factor alongside the index traumatic event leading to PTSD in adulthood (Waelde et al., 2005; Ginzburg et al., 2006; Lanius et al., 2010).”
BackgroundOzdemir, O., Boysan, M., Özdemir, P. G., & Yılmaz, E. (2015) · Psychiatry Research · doi:10.1016/j.psychres.2015.05.045 · Cited by 97
“On the contrary, individuals with dissociative PTSD were more prone to emotional overmodulation marked by hypo responsiveness in amygdala and preponderance of prefrontal control over temporal lobe structures that is implicated in detachment and compartmentalization symptoms during reminders of the original traumatic e…”
BackgroundZoet, H. A., Wagenmans, A., van Minnen, A., & de Jongh, A. (2018) · European Journal of Psychotraumatology · doi:10.1080/20008198.2018.1468707 · Cited by 96
“…(Lanius, Brand, Vermetten, Frewen, & Spiegel, 2012; Wolf et al., 2012; Wolf, Miller, Harrington, & Reardon, 2012) and empirical evidence suggesting that individuals with DS show increased activation in the rostral anterior cingulate cortex and the medial prefrontal cortex (Lanius et al., 2010).”
BackgroundResultInfluentialThe co-occurrence of PTSD and dissociation: differentiating severe PTSD from dissociative-PTSD
Armour, C., Karstoft, K.-I., & Richardson, J. D. (2014) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-014-0819-y · Cited by 90
“Recent research on trauma and dissociation has focused on identifying a dissociativePTSD subtype by classifying individuals with PTSD into groups based on their level of dissociation [7-12].”
BackgroundRabinak, C. A., MacNamara, A., Kennedy, A. E., Angstadt, M., Stein, M. B., Liberzon, I., & Phan, K. L. (2014) · Depression and Anxiety · doi:10.1002/da.22243 · Cited by 89
“Alternatively, given the subjective ratings, diminished reappraisal-related prefrontal brain activity in the PTSD group might also have been related to dissociation,[69] numbing or blunted emotional responses reported by some patients with PTSD.[70, 71] Of note, these subjective rating differences occurred in the cont…”
BackgroundRoberts, N. A., & Reuber, M. (2013) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2013.09.035 · Cited by 91
MacNamara, A., Rabinak, C. A., Kennedy, A. E., Fitzgerald, D. A., Liberzon, I., Stein, M. B., & Phan, K. L. (2015) · Neuropsychopharmacology · doi:10.1038/npp.2015.190 · Cited by 90
Brand, B. L., Myrick, A. C., Loewenstein, R. J., Classen, C. C., Lanius, R. A., McNary, S. W., Pain, C., & Putnam, F. W. (2011) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/a0026487 · Cited by 94
Self-citationCRITICAL REVIEW OF OUTCOME RESEARCH ON INTERPERSONAL PSYCHOTHERAPY FOR ANXIETY DISORDERS
Markowitz, J. C., Lipsitz, J. D., & Milrod, B. L. (2014) · Depression and Anxiety · doi:10.1002/da.22238 · Cited by 92
“Research has suggested that affect-focused therapy may particularly benefit PTSD patients with high levels of dissociative symptoms.[58, 59]”
BackgroundSchlumpf, Y. R., Reinders, A. A. T. S., Nijenhuis, E. R. S., Luechinger, R., van Osch, M. J. P., & Jäncke, L. (2014) · PLoS ONE · doi:10.1371/journal.pone.0098795 · Cited by 87
“Emotional and mnemonic functions are disturbed in trauma stressor-related disorders such as dissociative disorders [100,101,102,103].”
BackgroundNiedtfeld I, I., Schulze, L., Krause-Utz, A., Demirakca, T., Bohus, M., & Schmahl, C. (2013) · PLoS ONE · doi:10.1371/journal.pone.0065824 · Cited by 84
“The subgroup of patients with BPD and PTSD showed increased volumes in DLPFC (BA9), and superior temporal gyrus (BA22) compared to BPD patients without PTSD.”
BackgroundInfluentialSelf-citationDissociative depression among women in the community
Sar, V., Akyüz, G., Öztürk, E., & Alioğlu, F. (2013) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2012.753654 · Cited by 86
“Such research may benefit from insights collected in studies of the psychiatric consequences of chronic traumatization, including its neurobiological effects (Lanius et al., 2010).”
BackgroundPrimitive mechanisms of trauma response: an evolutionary perspective on trauma-related disorders.
Baldwin, D. V. (2013) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2013.06.004 · Cited by 85
Dissociation and posttraumatic stress disorder: a latent profile analysis
Blevins, C. A., Weathers, F. W., & Witte, T. K. (2014) · Journal of Traumatic Stress · doi:10.1002/jts.21933 · Cited by 85
“Several studies by Lanius and colleagues (e.g., Lanius et al., 2001; 2002; 2010) found that PTSD patients who experienced 4 self-reported dissociative reactions in response to trauma-related imagery had a neurological and psychophysiological pattern distinct from those who self-reported…”
BackgroundInfluentialDispelling Myths About Dissociative Identity Disorder Treatment: An Empirically Based Approach
Brand, B. L., Loewenstein, R. J., & Spiegel, D. (2014) · Psychiatry: Interpersonal and Biological Processes · doi:10.1521/psyc.2014.77.2.169 · Cited by 85
“The importance of improving emotion awareness and regulation is supported by neurobiological research which shows that high dissociation involves difficulty modulating affect due to excessive limbic inhibition (e.g., Brand, Lanius, Vermetten, Loewenstein, & Spiegel, 2012; Lanius et al., 2010).”
BackgroundSelf-citationDalenberg, C., & Carlson, E. B. (2012) · Psychological Trauma: Theory, Research, Practice, and Policy · doi:10.1037/a0027900 · Cited by 108
Nicholson, A. A., Ros, T., Frewen, P., Densmore, M., Théberge, J., Kluetsch, R. C., Jetly, R., & Lanius, R. A. (2016) · NeuroImage Clinical · doi:10.1016/j.nicl.2016.07.006 · Cited by 85
“Consistent with neurocognitive models of PTSD (Lanius et al., 2010), this shift in amygdala complex connectivity was positively associated with reduced hyperarousal among patients, together with a stronger “rebound” of alpha synchronization, and negatively correlated to PTSD symptom severity.”
InfluentialSelf-citationThe effects of trauma on brain and body: A unifying role for the midbrain periaqueductal gray
Terpou, B. A., Harricharan, S., McKinnon, M. C., Frewen, P., Jetly, R., & Lanius, R. A. (2019) · Journal of Neuroscience Research · doi:10.1002/jnr.24447 · Cited by 82
“Critically, the etiology of dissociation has been linked predominantly to chronic and repeated traumas as opposed to acute and single‐event traumas (Cloitre et al., 2009; Cook et al., 2005; Dalenberg et al., 2012; Karam et al., 2014; Lanius et al., 2010; Stein et al., 2013).”
BackgroundResultInfluentialSelf-citationDorrepaal, E., Thomaes, K., Smit, J. H., van Balkom, A. J. L. M., Veltman, D. J., Hoogendoorn, A. W., & Draijer, N. (2012) · Psychotherapy and Psychosomatics · doi:10.1159/000335044 · Cited by 82
Fonzo, G. A., Flagan, T., Sullivan, S. A., Allard, C. B., Grimes, E. M., Simmons, A. N., Paulus, M. P., & Stein, M. B. (2012) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2012.08.006 · Cited by 89
“, 2009) as well as predominantly dissociative or reexperiencing responses to trauma-related stimuli (Felmingham et al., 2008; Lanius et al., 2010), suggesting variability in this brain region may be particularly important in contributing to heterogeneity in symptom manifestations.”
BackgroundCavicchioli, M., Tobia, V., & Ogliari, A. L. (2022) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-022-00980-8 · Cited by 89
“Departing from these findings together with evidence from clinical and neurobiological studies (Lanius et al., 2010; Schore, 2009) concerning the role of dissociation on emotion functioning, Cavicchioli et al.”
BackgroundDefrin, R., Schreiber, S., & Ginzburg, K. (2015) · Journal of Pain · doi:10.1016/j.jpain.2015.06.010 · Cited by 82
van Dijke, A., Hopman, J. A. B., & Ford, J. D. (2018) · European Journal of Psychotraumatology · doi:10.1080/20008198.2017.1400878 · Cited by 80
“…suggests that research is needed to clarify the relationship of the DESNOS formulation of CPTSD with the DSM-5 dissociative sub-type of PTSD (Lanius et al., 2010), particularly to determine if there are forms of negative psychoform dissociation that are shared or distinct in the two…”
BackgroundMethodPsilocybin and MDMA for the treatment of trauma-related psychopathology
Bird, C., Modlin, N. L., & Rucker, J. (2021) · International Review of Psychiatry · doi:10.1080/09540261.2021.1919062 · Cited by 94
“Those with dissociative symptoms, severe affect dysregulation, increased suicidal ideation and disturbances in learning, memory, attention, and concentration may struggle to engage in trauma-focused therapies (Bisson et al., 2013; Lanius et al., 2010; Raines et al., 2017).”
BackgroundThe Psychedelic Future of Post-Traumatic Stress Disorder Treatment
Zaretsky, T. G., Jagodnik, K. M., Barsic, R., Antonio, J. H., Bonanno, P. A., MacLeod, C., Pierce, C., Carney, H., Morrison, M. T., Saylor, C. F., et al. (2024) · Current Neuropharmacology · doi:10.2174/1570159x22666231027111147 · Cited by 92
Reality versus fantasy: Reply to Lynn et al. (2014).
Dalenberg, C. J., Brand, B. L., Loewenstein, R. J., Gleaves, D. H., Dorahy, M. J., Cardeña, E., Frewen, P., Carlson, E. B., & Spiegel, D. (2014) · Psychological Bulletin · doi:10.1037/a0036685 · Cited by 81
Self-citationDissociation as a disorder of integration – On the footsteps of Pierre Janet
Scalabrini, A., Mucci, C., Esposito, R., Damiani, S., & Northoff, G. (2020) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2020.109928 · Cited by 90
Nicholson, A. A., Densmore, M., McKinnon, M. C., Neufeld, R. W. J., Frewen, P. A., Théberge, J., Jetly, R., Richardson, J. D., & Lanius, R. A. (2019) · Psychological Medicine · doi:10.1017/s0033291718002866 · Cited by 79
“the medial prefrontal cortex (mPFC) and increased bottom-up activation of the amygdala/limbic system, with concomitant hyperarousal and emotion undermodulation (Lanius et al., 2010; Hayes et al., 2012; Stevens et al., 2013; Reinders et al., 2014; Sadeh et al., 2014; Nicholson et al., 2017; Pitman, 2012).”
BackgroundResultInfluentialSelf-citationPrice, M., Kearns, M., Houry, D., & Rothbaum, B. O. (2014) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0035537 · Cited by 77
“Last, increased peritraumatic dissociation, which involves a disruption of consciousness, memory, body awareness, and perception of the environment in response to intense emotional distress, is associated with increased PTSD symptoms (Lanius et al., 2010).”
Wolf, E. J., Lunney, C. A., & Schnurr, P. P. (2016) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000036 · Cited by 78
“…into the pathophysiology and treatment of PTSD. Dissociation is thought to negatively influence the efficacy of exposurebased PTSD therapies (Lanius et al., 2010), such as Prolonged Exposure (PE), because it may prevent activation of the fear network (i.e., processing of trauma-related…”
BackgroundLatent profile analysis and principal axis factoring of the DSM-5 dissociative subtype
Frewen, P. A., Brown, M. F. D., Steuwe, C., & Lanius, R. A. (2015) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v6.26406 · Cited by 78
“Within Wave 1 participants, there were no differences between classes for CTQ measures of emotional abuse and emotional neglect.”
BackgroundSelf-citationRabellino, D., Tursich, M., Frewen, P. A., Daniels, J. K., Densmore, M., Théberge, J., & Lanius, R. A. (2015) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12418 · Cited by 78
Self-citationCerebellar and Prefrontal Cortical Alterations in PTSD: Structural and Functional Evidence
Holmes, S. E., Scheinost, D., DellaGioia, N., Davis, M. T., Matuskey, D., Pietrzak, R. H., Hampson, M., Krystal, J. H., & Esterlis, I. (2018) · Chronic Stress · doi:10.1177/2470547018786390 · Cited by 78
Considering PTSD from the perspective of brain processes: A psychological construction approach
Suvak, M. K., & Barrett, L. F. (2011) · Journal of Traumatic Stress · doi:10.1002/jts.20618 · Cited by 78
Krause-Utz, A., Veer, I. M., Rombouts, S. A. R. B., Bohus, M., Schmahl, C. G., & Elzinga, B. M. (2014) · Psychological Medicine · doi:10.1017/s0033291714000324 · Cited by 79
“For example, it has been proposed that limbic activation is dampened during states of dissociation (Sierra & Berrios, 1998; Lanius et al. 2010b), a core feature of BPD (APA, 2000).”
BackgroundResultSelf-citationAtypical visual processing in posttraumatic stress disorder
Mueller‐Pfeiffer, C., Schick, M., Schulte-Vels, T., Tuura, R., Michels, L., Martin-Söelch, C., Blair, J., Rufer, M., Schnyder, U., Zeffiro, T. A., et al. (2013) · NeuroImage Clinical · doi:10.1016/j.nicl.2013.08.009 · Cited by 79
“However, we neither found a significant correlation between dissociation levels and neural activity, nor higher activity in medial prefrontal areas in PTSD participants, as has been postulated in the corticolimbic inhibition model for dissociative PTSD [73].”
ResultThome, J., Terpou, B. A., McKinnon, M. C., & Lanius, R. A. (2019) · Depression and Anxiety · doi:10.1002/da.22977 · Cited by 80
“This is in contrast to the undermodulation associated more strongly with the traditional symptom pattern of PTSD (Fenster, Lebois, Ressler, & Suh, 2018; Lanius et al., 2010, 2014, 2018).”
ResultSelf-citationLueger‐Schuster, B., Knefel, M., Glück, T. M., Jagsch, R., Kantor, V., & Weindl, D. (2017) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2017.12.009 · Cited by 78
Wolf, E. J., Rasmusson, A. M., Mitchell, K. S., Logue, M. W., Baldwin, C. T., & Miller, M. W. (2014) · Depression and Anxiety · doi:10.1002/da.22260 · Cited by 75
“, hypoactivation of limbic brain regions and increased activation in prefrontal regions) during exposure to traumatic memories than individuals with PTSD who do not dissociate.[1, 2] Although severity of trauma exposure is a predictor of the dissociative subtype of PTSD,[3, 4, 6] it is also possible that the capacity…”
BackgroundVissia, E. M., Giesen, M. E., Chalavi, S., Nijenhuis, E. R. S., Draijer, N., Brand, B. L., & Reinders, A. A. T. S. (2016) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12590 · Cited by 85
“This placement is based on the discovery of a dissociative subtype of posttraumatic stress disorder (PTSD)[3-6].”
BackgroundInfluentialSelf-citationYildirim, B. O., & Derksen, J. J. L. (2013) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2013.04.009 · Cited by 81
“experiences (Lanius et al., 2010).”
Hoeboer, C. M., de Kleine, R. A., Molendijk, M. L., Schoorl, M., Oprel, D. A. C., Mouthaan, J., van der Does, W. A. J., & van Minnen, A. (2020) · BJPsych Open · doi:10.1192/bjo.2020.30 · Cited by 75
The memory and identity theory of ICD-11 complex posttraumatic stress disorder.
Hyland, P., Shevlin, M. E., & Brewin, C. R. (2023) · Psychological Review · doi:10.1037/rev0000418 · Cited by 95
Reinders, A. A. T. S., Marquand, A. F., Schlumpf, Y. R., Chalavi, S., Vissia, E. M., Nijenhuis, E. R. S., Dazzan, P., Jäncke, L., & Veltman, D. J. (2019) · British Journal of Psychiatry · doi:10.1192/bjp.2018.255 · Cited by 73
Bączkowski, B. M., van Zutphen, L., Siep, N., Jacob, G. A., Domes, G., Maier, S. J., Sprenger, A., Senft, A., Willenborg, B., Tüscher, O., et al. (2016) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-016-0760-z · Cited by 78
“To overcome this deficit, BPD patients might employ a compensatory but maladaptive strategy, such as dissociation, which typically occur due to overwhelming emotions in stressful situations 1 3 [61].”
Emotion regulation profiles in psychogenic non-epileptic seizures
Uliaszek, A. A., Prensky, E. H., & Baslet, G. C. (2012) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2012.01.009 · Cited by 74
“Affective disengagement from the emotional content of traumatic memories in PTSD results from overmodulation of affect whereas re-experiencing symptoms result from undermodulation of affect, and the neurobiological mechanisms of these alternating profiles have been identified [41].”
Brain stimulation in posttraumatic stress disorder
Novakovic, V., Sher, L., Lapidus, K. A. B., Mindes, J., Golier, J. A., & Yehuda, R. (2011) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v2i0.5609 · Cited by 73
“These variable results may be explained by a model including separate PTSD subtypes, with either emotional overmodulation (dissociative, with elevated cortical activity) or undermodulation (hyperaroused, with decreased cortical activity) (Lanius et al., 2010).”
BackgroundInfluentialDifferential predictors of DSM-5 PTSD and ICD-11 complex PTSD among African American women
Powers, A. D., Fani, N., Carter, S. E., Cross, D., Cloître, M., & Bradley, B. (2017) · European Journal of Psychotraumatology · doi:10.1080/20008198.2017.1338914 · Cited by 73
“Despite these criticisms, however, there is empirical and neurobiological evidence suggesting distinctions between CPTSD and DSM-IV defined PTSD (Lanius, Frewen, Vermetten, & Yehuda, 2010; Lanius et al., 2010; van der Kolk et al., 2005).”
BackgroundHass‐Cohen, N., Findlay, J. C., Carr, R., & Vanderlan, J. R. (2014) · Art Therapy · doi:10.1080/07421656.2014.903825 · Cited by 89
Gray matter volume alterations related to trait dissociation in PTSD and traumatized controls
Nardo, D., Högberg, G., Lanius, R. A., Jacobsson, H., Jonsson, C., Hällström, T., & Pagani, M. (2012) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12026 · Cited by 71
“Our results are consistent with the neurobiological model proposed by Lanius and colleagues (7, 8), according to which hyperaroused PTSD subjects exhibit a functional reduction in the mPFC and a functional increase in the amygdala (emotional undermodulation), while dissociative subjects exhibit the opposite pattern (o…”
BackgroundResultSelf-citationWhite matter integrity alterations in post‐traumatic stress disorder
O'Doherty, D. C. M., Ryder, W., Paquola, C., Tickell, A. M., Chan, C., Hermens, D. F., Bennett, M. R., & Lagopoulos, J. (2017) · Human Brain Mapping · doi:10.1002/hbm.23920 · Cited by 75
“No participant diagnosed with PTSD reported above threshold depersonalization or derealization (Lanius et al., 2010).”
BackgroundTrauma-specific grey matter alterations in PTSD
Meng, L., Jiang, J., Jin, C., Liu, J., Zhao, Y., Wang, W., Li, K., & Gong, Q. (2016) · Scientific Reports · doi:10.1038/srep33748 · Cited by 71
Trauma-Focused Art Therapy in the Treatment of Posttraumatic Stress Disorder: A Pilot Study
Schouten, K. A., van Hooren, S., Knipscheer, J. W., Kleber, R. J., & Hutschemaekers, G. J. M. (2019) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2018.1502712 · Cited by 71
“These are frequently patients with prolonged and multiple traumatization (Robertson, Humphreys, & Rey, 2004; Spinazzola, Blaustein, & van der Kolk, 2005), poor verbal memory (Wild & Gur, 2008), and/or emotional over-modulation, such as dissociative and numbing symptoms (Lanius et al., 2010).”
BackgroundFrontal and subcortical grey matter reductions in PTSD
O'Doherty, D. C. M., Tickell, A. M., Ryder, W., Chan, C., Hermens, D. F., Bennett, M. R., & Lagopoulos, J. (2017) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2017.05.008 · Cited by 74
“The insula is reported to contribute to memory processes, emotional self-awareness and dissociative states (Chalavi et al., 2015b; Chen et al., 2006; Craig, 2009; Critchley, 2005; Lanius et al., 2010).”
BackgroundBeutler, S., Mertens, Y. L., Ladner, L., Schellong, J., Croy, I., & Daniels, J. K. (2022) · European Journal of Psychotraumatology · doi:10.1080/20008066.2022.2132599 · Cited by 64
“…concomitant with altered brain activity in fronto-limbic circuits were labeled ‘physiological non-responders’ and would later fall into the dissociative subtype of PTSD (American Psychiatric Association, 2013; Lanius et al., 2010; Lanius et al., 2012; Spiegel et al., 2011; Terpou et al., 2019).”
BackgroundMethodTraumatic dissociation: Theory, research, and treatment.
Bailey, T. D., & Brand, B. L. (2017) · Clinical Psychology Science and Practice · doi:10.1111/cpsp.12195 · Cited by 79
Self-citationBorderline Personality Disorder (BPD): In the Midst of Vulnerability, Chaos, and Awe
Kulacaoğlu, F., & Köse, S. (2018) · Brain Sciences · doi:10.3390/brainsci8110201 · Cited by 71
“Research in the dissociative subtype of PTSD and depersonalization suggested that dissociation might be a form of emotional over-modulation, promoting trauma-related stressful emotions [70].”
BackgroundHalvorsen, J. Ø., Stenmark, H. I., Neuner, F., & Nordahl, H. M. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.03.010 · Cited by 70
“…emphasise that this dissociative subtype of PTSD might be associated with treatment outcomes (Feeny & Danielson, 2004; Ginzburg & Neria, 2011; Lanius et al., 2010; Lanius et al., 2012; Steuwe et al., 2012; Wolf, Lunney, et al., 2012; Wolf, Miller, et al., 2012), notably with a poor response…”
BackgroundNeural activity related to cognitive and emotional empathy in post-traumatic stress disorder
Mazza, M., Tempesta, D., Pino, M. C., Nigri, A., Catalucci, A., Guadagni, V., Gallucci, M., Iaria, G., & Ferrara, M. (2015) · Behavioural Brain Research · doi:10.1016/j.bbr.2014.12.049 · Cited by 69
Rabellino, D., Frewen, P. A., McKinnon, M. C., & Lanius, R. A. (2020) · Frontiers in Neuroscience · doi:10.3389/fnins.2020.586605 · Cited by 69
Self-citationDSM–5’s Posttraumatic Stress Disorder with Dissociative Symptoms: Challenges and Future Directions
Dorahy, M. J., & van der Hart, O. (2014) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2014.908806 · Cited by 79
“This is consistent with other data showing that individuals with a more severe trauma history report more complex symptoms, including more complex dissociative symptoms (e.g., Carlson et al., 2012; Ginzburg et al., 2006, 2009; Herman, 1992a; Lanius et al., 2010; Stein et al., 2013).”
BackgroundResultInfluentialThe impact of the therapeutic alliance on treatment outcome in patients with dissociative disorders
Cronin, E., Brand, B. L., & Mattanah, J. F. (2014) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v5.22676 · Cited by 76
“Dissociative disorders (DD) have an underlying neurobiological basis that includes excessive limbic inhibition and alterations involving the endogenous opioid system, among others (Brand, Lanius, Loewenstein, Vermetten, & Spiegel, 2012; Lanius et al., 2010).”
BackgroundSelf-citationComplex mental health sequelae of psychological trauma among women in prenatal care.
Seng, J. S., D'Andrea, W. M., & Ford, J. D. (2013) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/a0031467 · Cited by 77
“In contrast to a recently proposed dissociative sub-type of PTSD (Lanius et al., 2010), however, dissociation and somatization represented distinct clusters that were characterized only by non-abuse trauma and adult abuse trauma, respectively.”
ResultFrom Childhood Trauma to Adult Dissociation: The Role of PTSD and Alexithymia
Terock, J., der Auwera, S. V., Janowitz, D., Spitzer, C., Barnow, S., Miertsch, M., Freyberger, H. J., & Grabe, H. J. (2016) · Psychopathology · doi:10.1159/000449004 · Cited by 70
van Huijstee, J., & Vermetten, E. H. G. J. M. (2017) · Current topics in behavioral neurosciences · doi:10.1007/7854_2017_33 · Cited by 69
Self-citationHarricharan, S., Nicholson, A. A., Densmore, M., Théberge, J., McKinnon, M. C., Neufeld, R. W. J., & Lanius, R. A. (2017) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2017.09.010 · Cited by 64
“…2007; Yehuda and McFarlane, 1995), or alternatively, hypoarousal symptoms associated with emotional detachment, including symptoms of depersonalization/derealization in patients with its dissociative subtype (Frewen and Lanius, 2006; Lanius et al., 2010; Pain et al., 2010; Van Der Kolk, 2006).”
BackgroundSelf-citation
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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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