Emotion Modulation in PTSD: Clinical and Neurobiological Evidence for a Dissociative Subtype
Top Cited Papers
- 1 June 2010
- journal article
- review article
- Published by American Psychiatric Association Publishing in American Journal of Psychiatry
- Vol. 167 (6), 640-647
- https://doi.org/10.1176/appi.ajp.2009.09081168
Abstract
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.Keywords
This publication has 45 references indexed in Scilit:
- Quality of Early Care and Childhood TraumaJournal of Nervous & Mental Disease, 2009
- Functional Neuroimaging of Anxiety: A Meta-Analysis of Emotional Processing in PTSD, Social Anxiety Disorder, and Specific PhobiaAmerican Journal of Psychiatry, 2007
- A review of neuroimaging studies in PTSD: Heterogeneity of response to symptom provocationJournal of Psychiatric Research, 2006
- Neural Correlates of Antinociception in Borderline Personality DisorderArchives of General Psychiatry, 2006
- Dissociative Symptomatology in Posttraumatic Stress Disorder and Disorders of Extreme StressJournal of Trauma & Dissociation, 2006
- Skills training in affective and interpersonal regulation followed by exposure: A phase-based treatment for PTSD related to childhood abuse.Journal of Consulting and Clinical Psychology, 2002
- Symptoms of Dissociation in Humans Experiencing Acute, Uncontrollable Stress: A Prospective InvestigationAmerican Journal of Psychiatry, 2001
- Influence of emotional engagement and habituation on exposure therapy for PTSD.Journal of Consulting and Clinical Psychology, 1998
- Disintegrated experience: The dissociative disorders revisited.Journal of Abnormal Psychology, 1991
- Emotional processing of fear: Exposure to corrective information.Psychological Bulletin, 1986