The presence of dissociation, a profound sense of detachment from one’s sense of self or surroundings, may indicate a high risk of later developing severe post-traumatic stress disorder, depression, anxiety, physical pain, and social impairment for people who experience trauma, according to the findings of the largest prospective study of its kind.
The research, which was led by investigators at McLean Hospital, is published in the American Journal of Psychiatry.
“Dissociation may help someone cope in the aftermath of trauma by providing some psychological distance from the experience, but at a high cost dissociation is often linked with more severe psychiatric symptoms,” said lead author Lauren A. M. Lebois, PhD, director of the Dissociative Disorders and Trauma Research Program at McLean Hospital and an assistant professor in psychiatry at Harvard Medical School. “Despite this, dissociative symptoms remain under-studied and under-diagnosed due to a relative lack of understanding in medical and clinical practice.”
Lebois and her coworkers looked at data from the Advancing Understanding of RecOvery After Trauma (AURORA) Study to draw conclusions. The information referred to 1,464 persons who were seen in 22 different emergency rooms across the country and who stated whether they had ever experienced derealization, a severe form of dissociation.
Also, 145 of the patients had brain imaging done while performing an emotional activity. Researchers gathered updates on post-traumatic stress disorder, sadness, pain, anxiety symptoms, and functional impairment three months later.
The study team discovered that during the 3-month follow-up, individuals who had reported experiencing derealization typically had greater levels of post-traumatic stress disorder, anxiety, sadness, pain, and functional impairment.
Dissociation may help someone cope in the aftermath of trauma by providing some psychological distance from the experience, but at a high cost dissociation is often linked with more severe psychiatric symptoms. Despite this, dissociative symptoms remain under-studied and under-diagnosed due to a relative lack of understanding in medical and clinical practice.
Lauren A. M. Lebois
Even after taking into account post-traumatic stress symptoms at the beginning of the trial and histories of childhood trauma, both self-reported survey findings and brain imaging results that were suggestive of derealization predicted greater post-traumatic stress symptoms at the follow-up exam.
The findings highlight the significance of screening patients for dissociation-related symptoms after trauma to identify at-risk people who might benefit from early interventions.
The researchers found a connection between derealization and abnormal brain activity in certain areas that could be seen through brain imaging.
“Therefore, persistent derealization is both an early psychological marker and a biological marker of worse psychiatric outcomes later, and its neural correlates in the brain may serve as potential future targets for treatments to prevent PTSD,” said senior author Kerry J. Ressler, MD, PhD, chief scientific officer at McLean Hospital and a professor in psychiatry at Harvard Medical School.
The researchers anticipate that the public will become more aware of these symptoms and any potential side effects as a result of their research.
“With any luck this will enable more clinicians to connect empathically and communicate thoughtfully with patients to help them understand their symptoms and available treatments,” said Lebois. “Sadly, omitting dissociation from the conversation increases patients’ vulnerability to more severe psychiatric problems following trauma.”
The study is an illustration of how analyses of data from the AURORA Study, a significant national initiative with its headquarters at the University of North Carolina, may have an impact on patient care. The study aims to inform the development and testing of preventive and treatment interventions for people who have experienced traumatic events.
“These latest findings add to the growing list of discoveries from AURORA to help improve understanding about how to better prevent and treat adverse mental health outcomes after trauma,” said Samuel McLean, MD, the organizing principal investigator of the AURORA Study and a professor of anesthesiology, emergency medicine, and psychiatry at the University of North Carolina School of Medicine.
“Studies such as AURORA are critical because adverse post-traumatic mental health outcomes cause a tremendous global burden of suffering, and yet historically there have been very few large-scale longitudinal studies evaluating the underpinning neurobiology of these conditions.”
The National Institutes of Health, private foundations, and collaborations with top technological firms have contributed more than $30 million to the AURORA Project. Prediction tools, presentations, and publications resulting from the study can be found at https://www.med.unc.edu/itr/aurora-study/.
“We are committed to helping the AURORA initiative and its investigators like Dr. Ressler make important discoveries and bridge the gaps that exist in mental health research funding and patient support,” said Brandon Staglin, President of One Mind, a leading brain health nonprofit that has given more than $5 million in funding to the AURORA Study.
