Study: Dissociation Predicts Worse Mental Health Outcomes After Trauma

New results from a large, prospective study suggest that the presence of dissociation in individuals who experience trauma may indicate a high risk of developing severe post-traumatic stress disorder (PTSD), depression, anxiety, physical pain, and social impairment.

Dissociation is a profound feeling of detachment from one’s sense of self or surroundings, according to the study. Based on these findings, researchers said it is essential to screen for feelings of detachment to identify individuals who may benefit from preventive care.

“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 Labois, PhD, in a press release. “Despite this, dissociative symptoms remain under-studied and under-diagnosed due to a relative lack of understanding in medical and clinical practice.”

To understand dissociative reactions, investigators examined data from the Advancing Understanding of Recovery After Trauma (AURORA) Study. The data pertained to 1464 adults treated at 22 different emergency departments across the United States who reported whether they experienced a severe type of dissociation called derealization. Furthermore, 145 of the patients underwent brain imaging during an emotional task. Three months after the survey, the researchers collected follow-up reports of post-traumatic stress, depression, pain, anxiety symptoms, and functional impairment.

The researchers found that patients who reported experiencing derealization tended to have higher levels of post-traumatic stress, anxiety, depression, pain, and functional impairment at the 3-month follow-up. Furthermore, both self-reported survey results and brain imaging results that were indicative of derealization predicted worse PTSD symptoms at the follow-up exam, even after accounting for PTSD symptoms at the start of the study and histories of childhood trauma.

Derealization was also associated with altered activity in certain brain regions detected through brain imaging. These findings underline the importance of screening patients for dissociation-related symptoms following trauma.

“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, in the press release.

These findings could help increase awareness of these symptoms and their potential impacts, according to the study. Lebois said this knowledge could also help clinicians connect more empathetically and communicate thoughtfully with patients.

“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,” Samuel McLean, MD, organizing principal investigator of the AURORA Study, in the press release. “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.”

REFERENCE

Feelings of Detachment Predict Worse Mental Health Outcomes After Trauma. News release. McLean; June 22, 2022. Accessed July 7, 2022. https://www.mcleanhospital.org/news/feelings-detachment-predict-worse-mental-health-outcomes-after-trauma