Pathological dissociation is a severe, debilitating and transdiagnostic psychiatric symptom. This presentation aims to inform on biomarkers of pathological dissociation in a transdiagnostic manner in support of the precision medicine framework (part 1) and on the basis of a brain imaging study in individuals with DID (part 2).
In part 1 a systematic review will present a systematic review that includes a total of 205 unique studies. The terms ‘biomarker’ and ‘precision medicine’ will be explained. Studies that met inclusion criteria were divided into four biomarker categories, namely neuroimaging, psychobiological, psychophysiological and genetic biomarkers. Two tables per category were created, namely one to list the studies by biomarker measure and first author, and a second one listing the biomarker findings and the directionality of response. For every biomarker finding, e.g. the hippocampus, a counter was created to calculate the frequency of this biomarker finding across studies. Bar graphs were created on the basis of these counters. A biomarker finding that was most frequent was proposed as an important biomarker for pathological dissociation. The dorsomedial and dorsolateral prefrontal cortex, bilateral superior frontal regions, (anterior) cingulate, posterior association areas and basal ganglia are identified as neurofunctional biomarkers of pathological dissociation and decreased hippocampal, basal ganglia and thalamic volumes as neurostructural biomarkers. Increased oxytocin and prolactin and decreased tumor necrosis factor alpha (TNF-α) are identified as psychobiological markers. Psychophysiological biomarkers, including blood pressure, heart rate and skin conductance, were inconclusive. For the genetic biomarker category studies related to dissociation were limited and no clear directionality of effect was found to warrant identification of a genetic biomarker. Recommendations for future research pathways and possible clinical applicability are provided.
Part 2 presents a novel study in individuals with DID and reveals a hippocampal subfield as neurostructural biomarker of dissociative amnesia.
This course is based on the recorded webinar, Biomarkers of Pathological Dissociation created by Simone Reinders, PhD and Lora Dimitrova, MSC, AKC in 2021.
First Jul 2021
Course Material Authors
Course Material Authors authored the material only, and were not involved in creating this CE course. They are identified here for your own evaluation of the relevancy of the material this course is based on.
Simone Reinders, PhD
Dr A.A.T. Simone Reinders is a leading neuroscientist and international expert in the neurobiology of trauma-related dissociation and the brain imaging correlates of dissociative identity disorder (DID). Simone studied Applied Physics and Artificial Intelligence and obtained her doctorate in Medical Sciences with the highest Dutch distinction Cum Laude at the University of Groningen, Netherlands. She received the most prestigious grant for young investigators, only awarded to the top 5% most promising researchers in the Netherlands, which allowed her to successfully lead a multi-centre neuroimaging project. Simone’s pioneering research showed identity-state-dependent blood-flow patters in the brain of individuals with DID. Follow-up research showed that these patterns cannot be simulated and that DID and PTSD share trauma related neurobiomarkers. This significantly advanced understanding of brain function and structural brain abnormalities in DID. Simone has an H-index of 23 and is currently working as a Senior Research associate at the IoPPN of King’s College London, UK. Her most recent work addresses DID-dismissive perspectives using brain imaging and a review of 205 studies identified biomarkers of pathological dissociation in a transdiagnostic manner. Simone is Chair of the ENIGMA-Dissociation Working Group and Lead Trustee for the Clinic of Dissociative Studies' Academic Programme. Her work has been honoured with multiple awards from the ISSTD, including a Morton Prince Award for Scientific Achievement in 2017.
Lora Dimitrova, MSC, AKC
Lora Dimitrova is a PhD student affiliated with both King’s College London (UK) and the VU University Amsterdam (NL). For her thesis she is interested in the aetiology of dissociative identity disorder and in the neurofunctional l and neurostructural biomarkers of pathological dissociation and traumatization. Lora completed her bachelor’s degree in Psychology at Kingston University with a distinction. She completed her master’s in Mental Health Studies at King’s College London under the supervision of Dr A T S Reinders and received a distinction as well. As part of her PhD Lora has published her first paper “Sleep, trauma, fantasy and cognition in dissociative identity disorder, post-traumatic stress disorder and healthy controls: a replication and extension study” in the European Journal of Psychotraumatology (2020). She is currently also working as a research assistant at Tavistock Relationships
Counselors, marriage and family therapists, psychologists and social workers. This course is appropriate for all levels of knowledge.
After taking this course, you should be able to:
Define "Precision Medicine"
Explain a "Biomarker for pathological dissociation”
Describe what is proposed as neuroimaging, psychobiological, psychophysiological and genetic biomarkers of pathological dissociation
List three current research possibilities and challenges.
Discuss what a neurostructural biomarker of dissociative amnesia is for DID.
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