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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
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.
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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“A number of recent studies develop the concept of a dissociative “subtype” of PTSD (Ginzburg et al., 2006; Lanius et al., 2010).”
BackgroundFranzke, I., Wabnitz, P., & Catani, C. (2015) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2015.989646 · Cited by 67
“Moreover, data from neurobiological investigations (Lanius et al., 2010) as well as from taxometric and latent class analysis (e.g., Waelde, Silvern, & Fairbank, 2005) support this thesis.”
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TRANCEFORMATIONS: HYPNOSIS IN BRAIN AND BODY
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“[54] This subgroup can be distinguished as well using fMRI by a pattern of frontal activation and limbic suppression in response to trauma scripts, in contrast to the more comment hyperarousal type of PTSD, with hypofrontality and limbic activation.[55] Hypnosis can be understood as a state of artificially induced dis…”
ResultSelf-citationHerringa, R. J., Phillips, M. L., Fournier, J. C. J., Kronhaus, D. M., & Germain, A. (2012) · Psychological Medicine · doi:10.1017/s0033291712002310 · Cited by 68
“Dissociative symptoms were included in this model given evidence suggesting the opposite pattern of brain activation in dissociative subtypes of PTSD (e.g. increased vmPFC, decreased amygdala activation; Lanius et al. 2010).”
BackgroundPerez, D. L., Matin, N., Williams, B., Tanev, K. S., Makris, N., LaFrance, W. C., Jr., & Dickerson, B. C. (2017) · Human Brain Mapping · doi:10.1002/hbm.23853 · Cited by 67
“…trait dissociation in patients with FND. Based on the existing literature in dissociation and our published models of the neurobiology of FND [Lanius et al., 2010; Perez et al., 2012, 2015], we hypothesized that FND patients with elevated psychological dissociation would exhibit cortical…”
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“…screened positive for clinically significant dissociation, which is consistent with the existence of a less common dissociative subtype of PTSD that is thought to involve emotional overmodulation via inhibition of limbic regions of the brain by the medial prefrontal cortex (Lanius et al., 2010).”
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“’’ Biological findings indicating that the dissociative subtype of PTSD may represent different biological processes (Lanius et al., 2010; Mickleborough et al., 2011) also informed the addition of a dissociative specifier to the DSM-V PTSD diagnosis.”
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“For instance, a dissociative subtype of posttraumatic stress disorder (PTSD) has been defined by the additional symptoms of DEP and/or DER (Lanius et al., 2010).”
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“Further, Lanius’s model of over- and undermodulation (Lanius et al., 2010) suggested that youth who have experienced chronic trauma may use dissociation as a regulatory strategy, and thus may report less emotional distress.”
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“The dissociative subtype of PTSD has been theorized to involve the excessive activation (overmodulation) by the prefrontal cortex to inhibit transiently the amygdala’s response to traumatic stress and its reminders (Hopper et al., 2007; Lanius et al., 2010).”
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“We therefore think that the mechanisms identified for bilateral alternating stimulation in healthy subjects might at least in part mirror effects in patients with PTSD.”
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Self-citationBrand, B. L., & Lanius, R. A. (2014) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/2051-6673-1-13 · Cited by 64
“Two subtypes of acute trauma response have been found in a range of neurobiological studies, one primarily involving dissociative symptoms and the other predominantly intrusive, hyperaroused symptoms; these symptoms may underlie some forms of emotion dysregulation in traumarelated disorders, including PTSD, chronic co…”
BackgroundSelf-citationSchalinski, I., & Teicher, M. H. (2015) · PLoS ONE · doi:10.1371/journal.pone.0127151 · Cited by 56
“These results were interpreted as emotional over-modulation in dissociative PTSD, versus emotional under-modulation in non-dissociative PTSD mediated by less intensive prefrontal inhibition of the limbic system [73].”
BackgroundLongitudinal changes in brain function associated with symptom improvement in youth with PTSD
Garrett, A. S., Cohen, J. A., Zack, S., Carrión, V. G., Jo, B., Blader, J. C., Rodriguez, A., Vanasse, T. J., Reiss, A. L., & Agras, W. S. (2019) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2019.04.021 · Cited by 60
“Neurobiological evidence of a dissociative subtype of PTSD has been presented in several studies by Lanius and colleagues (Lanius et al. 2010; Nicholson et al. 2015; Nicholson et al. 2016; Daniels et al. 2016), suggesting that the dissociative subtype of PTSD involves unique biological abnormalities.”
BackgroundMentalization and dissociation after adverse childhood experiences
Wagner‐Skacel, J., Riedl, D., Kampling, H., & Lampe, A. (2022) · Scientific Reports · doi:10.1038/s41598-022-10787-8 · Cited by 71
The Neural Correlates of Cognitive Reappraisal during Emotional Autobiographical Memory Recall
Holland, A. C., & Kensinger, E. A. (2012) · Journal of Cognitive Neuroscience · doi:10.1162/jocn_a_00289 · Cited by 55
“, in the case of a dissociative subtype of PTSD) of emotional intensity (Lanius et al., 2010), an interesting next step would be to differentiate between individuals with these two subtypes of PTSD as they complete an instructed reappraisal task.”
BackgroundBoyd, J. E., Protopopescu, A., O’Connor, C., Neufeld, R. W. J., Jetly, R., Hood, H. K., Lanius, R. A., & McKinnon, M. C. (2018) · European Journal of Psychotraumatology · doi:10.1080/20008198.2018.1463794 · Cited by 61
Self-citationWinter, D., Krause-Utz, A., Lis, S., Chiu, C.-D., Lanius, R. A., Schriner, F., Bohus, M., & Schmahl, C. (2015) · Psychiatry Research: Neuroimaging · doi:10.1016/j.pscychresns.2015.05.018 · Cited by 54
Self-citationTherapeutic Challenges of Post-traumatic Stress Disorder: Focus on the Dopaminergic System
Torrisi, S. A., Leggio, G. M., Drago, F., & Salomone, S. (2019) · Frontiers in Pharmacology · doi:10.3389/fphar.2019.00404 · Cited by 59
Lotfinia, S., Soorgi, Z., Mertens, Y., & Daniels, J. (2020) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2020.05.006 · Cited by 53
Impaired voluntary control in PTSD: probing self-regulation of the ACC with real-time fMRI
Zweerings, J., Pflieger, E. M., Mathiak, K. A., Zvyagintsev, M., Kacela, A., Flatten, G., & Mathiak, K. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00219 · Cited by 52
“We selectively chose patients who suffered from PTSD after a single trauma that did not encompass prolonged or sexual traumatization to minimize unspecific effects of repeated exposure or successive affective disturbances (39, 40).”
MethodŞar, V. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.00216 · Cited by 52
“This suggestion is consistent with contemporary understanding of the bimodal nature of neurobiological response to traumatic stress, where overmodulation and undermodulation of emotions are operative (Lanius et al., 2010).”
BackgroundInfluentialRabellino, D., Burin, D., Harricharan, S., Lloyd, C., Frewen, P., McKinnon, M. C., & Lanius, R. A. (2018) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2018.00163 · Cited by 62
“…of emotional reaction and to a coping style characterized by active avoidance of trauma reminders and potential triggers, as well as emotional detachment/restricted affect (such as emotional numbing, often associated with alexithymia; Frewen et al., 2008, 2012; Lanius et al., 2010; APA, 2013).”
BackgroundSelf-citationCampbell, M. C., Smakowski, A., Rojas-Aguiluz, M., Goldstein, L. H., Cardeña, E., Nicholson, T. R., Reinders, A. A. T. S., & Pick, S. (2022) · BJPsych Open · doi:10.1192/bjo.2022.597 · Cited by 61
Neural correlates of self‐reflection in post‐traumatic stress disorder
Bluhm, R. L., Frewen, P., Coupland, N., Densmore, M., Schore, A. N., & Lanius, R. A. (2011) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2011.01773.x · Cited by 53
Self-citationvan Dijke, A., Ford Julian, D., van der Hart, O., Van Son Maarten, J. M., van der Heijden, P. G. M., & Bühring, M. E. F. (2011) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v2i0.5628 · Cited by 60
“In posttraumatic stress disorder (PTSD; Lanius, Vermetten, et al., 2010; Lanius, Frewen, et al., 2010), complex PTSD (S¸ar, 2011), and in SoD and BPD (Van Dijke, Ford, et al., 2010), over-regulation of affect may represent a sub-type that is associated with negative symptoms of somatoform and…”
InfluentialNeurodevelopmental origins of abnormal cortical morphology in dissociative identity disorder
Reinders, A. A. T. S., Chalavi, S., Schlumpf, Y. R., Vissia, E. M., Nijenhuis, E. R. S., Jäncke, L., Veltman, D. J., & Ecker, C. (2018) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12839 · Cited by 52
“However, in the latter study, the dACC thickness did not differ between patients and controls, and only 16 patients with PTSD were included.”
BackgroundInfluentialMarkowitz, J. C. (2010) · Depression and Anxiety · doi:10.1002/da.20752 · Cited by 52
“,([18]) and others have argued that chronically traumatized individuals and other PTSD patients who present with prominent dissociative symptoms may respond poorly to EBTs and need a more affectbased approach, at least as an initial treatment step.”
BackgroundKratzer, L., Knefel, M., Haselgruber, A., Heinz, P., Schennach, R., & Karatzias, T. (2021) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-021-01342-z · Cited by 57
Nicholson, A. A., Siegel, M., Wolf, J., Narikuzhy, S., Roth, S. L., Hatchard, T., Lanius, R. A., Schneider, M. A., Lloyd, C., McKinnon, M. C., et al. (2022) · European Journal of Psychotraumatology · doi:10.1080/20008198.2021.2002572 · Cited by 57
“…(i.e. exacerbated prefrontal cortex top-down regulation on hyperactive limbic structures), and have repeatedly been shown to be associated with emotional numbing and dissociation symptom profiles (Lanius et al., 2010; Nicholson et al., 2020; Rabellino, Densmore, Théberge, McKinnon, & Lanius, 2018).”
BackgroundSelf-citationDissociative subtype of DSM-5 posttraumatic stress disorder in U.S. veterans
Tsai, J., Armour, C., Southwick, S. M., & Pietrzak, R. H. (2015) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2015.04.017 · Cited by 53
Harrington, K. M., Miller, M. W., Wolf, E. J., Reardon, A. F., Ryabchenko, K. A., & Ofrat, S. (2012) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2011.12.001 · Cited by 55
“For example, some theories of ADHD postulate that difficulty in regulating arousal or activation levels is a core deficit of the disorder [69-70], and recent neuroimaging studies by Frewen and Lanius [71] and Lanius et al [72] have suggested that a “deficiency in the ability to adaptively regulate levels of affective…”
ResultFragkaki, I., Thomaes, K., & Sijbrandij, M. (2016) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v7.30915 · Cited by 60
“…PTSD is characterized by emotional undermodulation exhibiting low PFC activity and increased amygdala activation as described above, the dissociative subtype of PTSD is characterized by emotional overmodulation and exhibits increased PFC and decreased limbic activity (Lanius et al., 2010).”
BackgroundInfluentialKlabunde, M., Weems, C. F., Raman, M. M., & Carrión, V. G. (2016) · Depression and Anxiety · doi:10.1002/da.22577 · Cited by 54
The Psychobiology of Authentic and Simulated Dissociative Personality States: The Full Monty
Reinders, A. A. T. S., Willemsen, A. T. M., Vissia, E. M., Vos, H. P. J., den Boer, J. A., & Nijenhuis, E. R. S. (2016) · Journal of Nervous & Mental Disease · doi:10.1097/nmd.0000000000000522 · Cited by 51
Boughner, E., Thornley, E., Kharlas, D., & Frewen, P. (2016) · Mindfulness · doi:10.1007/s12671-016-0502-3 · Cited by 51
Gola, H., Engler, H., Schauer, M., Adenauer, H., Riether, C., Kolassa, S., Elbert, T., & Kolassa, I.-T. (2012) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2011.06.005 · Cited by 64
Exploring the mutual regulation between oxytocin and cortisol as a marker of resilience
Li, Y., Hassett, A. L., & Seng, J. S. (2018) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2018.11.008 · Cited by 53
Şar, V., Alioğlu, F., & Akyüz, G. (2013) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2013.849321 · Cited by 51
“However, this hypothesis requires further studies on clinical populations, including studies of the neurobiological consequences of trauma (Lanius et al., 2010).”
BackgroundMcTeague, L. M., Laplante, M.-C., Bulls, H. W., Shumen, J. R., Lang, P. J., & Keil, A. (2017) · Biological Psychiatry · doi:10.1016/j.biopsych.2017.10.004 · Cited by 52
“Similar to posttraumatic stress (62,63), there may be subtypes of social anxiety with different corticolimbic biases, correspondingly different patterns of reentrant modulation of visual cortex, and thus different attentional phenotypes.”
BackgroundStevens, J. S., Reddy, R., Kim, Y. J., van Rooij, S. J. H., Ely, T. D., Hamann, S., Ressler, K. J., & Jovanovic, T. (2018) · NeuroImage: Clinical · doi:10.1016/j.nicl.2017.11.016 · Cited by 49
Use of the Flash Technique in EMDR Therapy: Four Case Examples
Manfield, P. E., Lovett, J., Engel, L. L., & Manfield, D. (2017) · Journal of EMDR Practice and Research · doi:10.1891/1933-3196.11.4.195 · Cited by 55
“Most clients with PTSD reexperience aspects of their traumatic memories when they think of them (Hackmann, Ehlers, Speckens, & Clark, 2004; R. A. Lanius et al., 2010; Shapiro, 2001).”
BackgroundBrand, B. L., Schielke, H. J., Brams, J. S., & DiComo, R. A. (2017) · Psychological Injury and Law · doi:10.1007/s12207-017-9305-7 · Cited by 53
Self-citationHébert, M., Langevin, R., & Charest, F. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.02.032 · Cited by 48
Yang, R., Gautam, A., Getnet, D., Daigle, B. J., Miller, S., Misganaw, B., Dean, K. R., Kumar, R., Muhie, S., Wang, K., et al. (2021) · Molecular Psychiatry · doi:10.1038/s41380-020-00966-2 · Cited by 48
Fruchtman-Steinbok, T., Keynan, J. N., Cohen, A., Jaljuli, I., Mermelstein, S., Drori, G., Routledge, E., Krasnoshtein, M., Playle, R., Linden, D. E. J., et al. (2021) · NeuroImage: Clinical · doi:10.1016/j.nicl.2021.102859 · Cited by 42
The distinctive neural circuitry of complex posttraumatic stress disorder during threat processing
Bryant, R. A., Felmingham, K. L., Malhi, G., Andrew, E., & Korgaonkar, M. S. (2021) · Psychological Medicine · doi:10.1017/s0033291719003921 · Cited by 46
Parlar, M., Frewen, P. A., Oremus, C., Lanius, R. A., & McKinnon, M. C. (2016) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v7.29061 · Cited by 56
“…dissociation is thought to stem primarily from exposure to traumatic events or disruptions in attachment, serving to overmodulate affect and protect the individual from experiencing overwhelming distress during and/or after a traumatic event (Dalenberg et al., 2012; Lanius et al., 2010).”
BackgroundSelf-citationPsychogenic amnesia – A malady of the constricted self
Staniloiu, A., Markowitsch, H. J., & Brand, M. (2010) · Consciousness and Cognition · doi:10.1016/j.concog.2010.06.024 · Cited by 49
“…brain region that has recently been receiving increased attention (A.D. Craig, 2010) in stress-related disturbances of self and consciousness (Lanius et al., 2005, 2010), including the ones accompanying the psychogenic memory loss (Brand et al., 2009; Thomas-Anterion, Guedj, Decousus, &…”
BackgroundOcisková, M., Praško, J. P., Kamarádová, D., Grambal, A., & Sigmundova, Z. (2015) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s87737 · Cited by 52
Tambelli, R., Cimino, S., Cerniglia, L., & Ballarotto, G. (2015) · Scientific Reports · doi:10.1038/srep13984 · Cited by 54
Trauma-Related Dissociation Is Linked With Maladaptive Personality Functioning
Granieri, A., Guglielmucci, F., Costanzo, A., Caretti, V., & Schimmenti, A. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00206 · Cited by 54
When the body becomes the enemy: Disownership toward the Body
Ataria, Y. (2016) · Philosophy, psychiatry & psychology · doi:10.1353/ppp.2016.0002 · Cited by 46
“…be further generalized: “subjects with both PTSD and disorders of extreme stress not otherwise specified exhibited chronic symptoms of dissociation as evidenced by higher scores on the Dissociative Experiences Scale than participants who were suffering from PTSD only” (Lanius et al. 2010, p. 644).”
BackgroundTrauma-related dissociation: An analysis of two conflicting models
van der Hart, O. (2021) · European Journal of Trauma & Dissociation · doi:10.1016/j.ejtd.2021.100210 · Cited by 49
Al-Shamali, H. F., Winkler, O., Talarico, F., Greenshaw, A. J., Forner, C. C., Zhang, Y., Vermetten, E. H. G. J. M., & Burback, L. (2022) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/00048674221077029 · Cited by 48
“This reduced response has been explained by data demonstrating prefrontal inhibition of limbic regions, leading to emotional overmodulation in response to emotional or traumatic cues (Lanius et al., 2010; Lyssenko et al., 2018).”
BackgroundSelf-citationXiao, S., Yang, Z., Su, T., Gong, J., Huang, L., & Wang, Y. (2022) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2022.08.010 · Cited by 49
Lieberman, J. M., Rabellino, D., Densmore, M., Frewen, P., Steyrl, D., Scharnowski, F., Théberge, J., Neufeld, R. W. J., Schmahl, C. G., Jetly, R., et al. (2023) · Brain and Behavior · doi:10.1002/brb3.2883 · Cited by 49
“…within large-scale functional brain networks, that is, intrinsic connectivity networks (ICNs) (Akiki et al., 2018; Breukelaar et al., 2021; Daniels et al., 2010; Fenster et al., 2018; Lanius et al., 2010; Nicholson et al., 2020; Sripada et al., 2012; Tursich et al., 2015; Weng et al., 2019).”
BackgroundInfluentialSelf-citationAcute dissociation and cardiac reactivity to script-driven imagery in trauma-related disorders
Sack, M., Cillien, M., & Hopper, J. W. (2012) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v3i0.17419 · Cited by 46
“One possible explanation for such ‘‘non-responding’’ to trauma-related stimuli is that acute dissociative reactions lead to disengagement of emotional reactivity and associated overmodulation of autonomic arousal (Lanius et al., 2010).”
BackgroundResultZhang, Q., Wu, Q., Zhu, H., He, L. T., Huang, H., Zhang, J., & Zhang, W. (2016) · Frontiers in Neuroscience · doi:10.3389/fnins.2016.00292 · Cited by 46
Kratzer, L., Heinz, P., Pfitzer, F., Padberg, F., Jobst, A., & Schennach, R. (2017) · European Journal of Trauma & Dissociation · doi:10.1016/j.ejtd.2017.06.004 · Cited by 55
Ben‐Zion, Z., Zeevi, Y., Keynan, J. N., Admon, R., Kozlovski, T., Sharon, H., Halpern, P., Liberzon, I., Shalev, A. Y., Benjamini, Y., et al. (2020) · Translational Psychiatry · doi:10.1038/s41398-020-00898-z · Cited by 47
Biological and clinical framework for posttraumatic stress disorder
Vermetten, E. H. G. J. M., & Lanius, R. A. (2012) · Handbook of clinical neurology · doi:10.1016/b978-0-444-52002-9.00018-8 · Cited by 50
Self-citationBrand, B. L., Schielke, H. J., & Brams, J. S. (2017) · Psychological Injury and Law · doi:10.1007/s12207-017-9304-8 · Cited by 50
Self-citationBrand, B. L., & Stadnik, R. (2013) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2012.736929 · Cited by 44
Self-citationInterpersonal psychotherapy for PTSD: Treating trauma without exposure.
Bleiberg, K. L., & Markowitz, J. C. (2019) · Journal of Psychotherapy Integration · doi:10.1037/int0000113 · Cited by 44
Marshall‐Berenz, E. C., Morrison, J. A., Schumacher, J. A., & Coffey, S. F. (2011) · Depression and Anxiety · doi:10.1002/da.20798 · Cited by 44
“This pattern of findings extends past work suggesting that certain PTSD symptom clusters may correspond to distinct deficits in emotion regulation, such that re-experiencing/hyperarousal symptoms may be particularly relevant for emotion under-modulation.[23,24] Taken together, the current findings suggest that PTSD sy…”
BackgroundResultPsychogenic non-epileptic seizures and functional motor symptoms: A common phenomenology?
Demartini, B., Goeta, D., Barbieri, V., Ricciardi, L., Canevini, M. P., Turner, K., D’Agostino, A., Romito, L. M., & Gambini, O. (2016) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2016.06.045 · Cited by 45
Predicting and Managing Treatment Non-response in Posttraumatic Stress Disorder
Fonzo, G. A., Federchenco, V., & Lara, A. E. (2020) · Current Treatment Options in Psychiatry · doi:10.1007/s40501-020-00203-1 · Cited by 49
Dissociation, trauma, and borderline personality disorder
Krause-Utz, A. (2022) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-022-00184-y · Cited by 58
“This may point to an increased recruitment of brain regions implicated in arousal modulation [21, 40].”
BackgroundDalenberg, C. J., Glaser, D., & Alhassoon, O. M. (2012) · Depression and Anxiety · doi:10.1002/da.21926 · Cited by 50
“The distinctions that have garnered the most research support have been the complex PTSD subtype,[4, 5] the externalizing– internalizing subtypes,[6, 7] and the dissociative PTSD subtype.[8] The present paper will briefly present an argument for the minimum criteria necessary for justifying a subtype, will attempt to…”
BackgroundMethodInfluentialPost-traumatic Stress Disorder: Focus on Neuroinflammation
Li, J., Tong, L., Schock, B. C., & Ji, L.-L. (2023) · Molecular Neurobiology · doi:10.1007/s12035-023-03320-z · Cited by 47
“suggest PTSD-DS is due to increased activation of prefrontal regions and over-inhibition of limbic regions [80].”
BackgroundPosttraumatic stress disorder in DSM‐5: New criteria and controversies.
Miller, M. W., Wolf, E. J., & Keane, T. M. (2014) · Clinical Psychology Science and Practice · doi:10.1111/cpsp.12070 · Cited by 43
“On the basis of these findings, Lanius et al. (2010, 2012) suggested that those with the dissociative subtype show an over-modulated response to trauma cues such that frontal brain regions actively inhibit the limbic brain regions that are heavily implicated in emotional, and particularly fear,…”
BackgroundChou, C., Marca, R. L., Steptoe, A., & Brewin, C. R. (2014) · Biological Psychology · doi:10.1016/j.biopsycho.2014.08.002 · Cited by 49
“We also investigated the influence of pre-existing traits, such as dissociation, which have been linked with decreased physiological activation in response to traumatic stimuli (Lanius et al., 2010).”
Wöller, W., Leichsenring, F., Leweke, F., & Kruse, J. (2012) · Bulletin of the Menninger Clinic · doi:10.1521/bumc.2012.76.1.69 · Cited by 39
“…has been proposed to be mediated by failure of prefrontal inhibition of limbic regions, whereas 74 Bulletin of the Menninger Clinic emotional overmodulation may be mediated by prefrontal inhibition of the same limbic regions (Lanius, Frewen, Vermetten, & Yehuda, 2010; Lanius et al., 2010).”
Mutluer, T., Şar, V., Koşe-Demiray, Ç., Arslan, H., Tamer, S., İnal, S., & Kaçar, A. Ş. (2017) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2017.1304489 · Cited by 43
“In a meta-analysis, hippocampus was bilaterally smaller in adults with childhood maltreatment-related PTSD compared to healthy controls, but not in children with maltreatment-related PTSD, suggesting that these deficits may not be apparent until adulthood (Woon & Hedges, 2008).”
BackgroundInfluential
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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