According to the results of the largest prospective study, dissociation is a deep sense of separation from one’s self or environment. This could indicate a high chance of suffering from severe post-traumatic stress disorder (STP), anxiety, depression and social impairment in people who have suffered trauma.
McLean Hospital researchers led the study. The research findings were published in American Journal of Psychiatry.
“Dissociation can help someone cope with trauma by providing some psychological separation from the experience,” stated Lauren A. M. Lebois PhD, lead author and director of McLean Hospital’s Dissociative Disorders & Trauma Research Program. She is also an assistant professor of psychiatry at Harvard Medical School. “Despite all this, dissociative symptoms still remain under-studied. This is due to a relative lack in clinical and medical practice.
Lebois and her coworkers analyzed information from the Advancing Understanding of RecOvery afteR traumA Study (AURORA). To gain insight, Lebois examined data from this study. This data was compiled from 1,464 adult patients who were treated in 22 emergency departments across the United States. They reported whether or not they had experienced severe dissociation, also known as derealization. 145 patients had brain imaging done during an emotional task. Researchers collected three months later follow-up reports on depression, anxiety, post-traumatic stress and functional impairment.
Research team discovered that patients who had experienced derealization reported higher levels post-traumatic stress, anxiety and depression at 3-month follow up. They also had greater pain, functional impairment, and depression. Both self-reported surveys and brain imaging results that indicated derealization predicted worse symptoms of post-traumatic stress at the follow up exam. This was even after accounting for childhood trauma histories and post-traumatic symptoms.
These results show that it is important to screen patients for symptoms related to dissociation following trauma in order to identify individuals at risk and provide early intervention.
Researchers discovered that brain imaging revealed that there was a link between derealization and altered activity in certain brain areas.
“Persistent derealization is therefore both a psychological and a biomarker of worse psychiatric outcomes. Its neural correlates in brain may serve as potential targets for future treatments to prevent PTSD,” stated senior author Kerry J. Ressler MD, PhD, chief scientist at McLean Hospital, and a professor of psychiatry at Harvard Medical School.
Investigators hope to raise awareness of these symptoms as well as their possible effects.
Lebois said, “With any luck this will allow more clinicians to communicate empathically with patients to help their symptoms and possible treatments.” Dissociation should not be left out of the conversation as it increases vulnerability to more serious psychiatric problems after trauma.
This research shows how the AURORA Study data can impact patient care. It is a large national initiative based at the University of North Carolina. The AURORA Study seeks to provide information that will help in the development and testing of treatment and preventive interventions for people who have suffered traumatic events.
“These findings are part of the growing list of discoveries by AURORA to help increase understanding about how to treat adverse mental health outcomes following trauma,” said Samuel McLean MD. He is also the principal investigator of AURORA and a professor of psychiatry and emergency medicine at University of North Carolina School of Medicine.
He said that studies such as AURORA are crucial because adverse post-traumatic mental outcomes can cause a huge global burden of suffering and that there have been very few longitudinal studies examining the neurobiology underpinning these conditions.