Feeling of detachment after trauma has worse impact on mental health: Study | Health

The presence of dissociation, a deep sense of detachment from one’s sense of self or environment, may indicate a high risk of developing severe post-traumatic stress disorder, anxiety, physical pain, depression and social limitations for people who have experienced trauma, according to findings from the largest prospective study of its kind.

The study, which was led by researchers at McLean Hospital, and its findings are published in the journal American Journal of Psychiatry.

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“Dissociation can help a person cope with the aftermath of trauma by providing some psychological distance from the experience, but at a high cost — dissociation often accompanies more severe psychiatric symptoms,” said lead author Lauren AM Lebois, PhD, director from the Dissociative Disorders and Trauma Research Program at McLean Hospital and an assistant professor of psychiatry at Harvard Medical School. “Despite this, dissociative symptoms remain understudied and underdiagnosed due to a relative lack of understanding in medical and clinical practice.”

To provide insights, Lebois and her colleagues examined information from the Advancing Understanding of RecOvery after TraumA (AURORA) Study. The data involved 1,464 adults who were treated at 22 different emergency departments in the United States and reported whether they had experienced a severe form of dissociation called derealization. Also, 145 of the patients underwent brain imaging during an emotional task. Three months later, researchers collected follow-up reports of post-traumatic stress, depression, pain, anxiety symptoms, and functional impairment.

The research team found that patients who reported experiencing derealization had more post-traumatic stress, anxiety, depression, pain and functional impairment at the 3-month follow-up. In addition, both self-reported study results and brain imaging results indicative of derealization predicted worse post-traumatic stress symptoms at follow-up, even after taking post-traumatic stress symptoms into account at study entry and childhood trauma histories.

The results indicate the importance of screening patients for dissociation-related symptoms after trauma to identify at-risk individuals who may benefit from early interventions.

The scientists found that derealization was related to altered activity in certain brain regions detected through brain imaging.

“Therefore, sustained derealization is both an early psychological marker and a biological marker of worse psychiatric outcomes later, and the 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 professor of psychiatry at Harvard Medical School.

The researchers hope their findings will increase awareness of these symptoms and their potential aftereffects.

“With luck, this will allow more clinicians to connect empathically and thoughtfully communicate with patients to help them understand their symptoms and available treatments,” Lebois said. “Unfortunately, omitting dissociation from the conversation increases patients’ vulnerability to more serious psychiatric problems after trauma.”

The study is an example of how patient care could be impacted by analyzing data from the AURORA study – a large national initiative headquartered at the University of North Carolina that aims to provide information on the development and testing of preventive and treatment interventions for individuals who experienced traumatic events.

“These latest findings add to AURORA’s growing list of discoveries to help improve understanding of how to better prevent and manage 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 create a huge global burden of suffering, yet historically there have been very few large-scale longitudinal studies evaluating the underlying neurobiology of these conditions,” he added. .

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