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For some people the condition can feel as though the world around them is like a movie that they are watching rather than specifically being a part of it. It is one way that the mind copes during periods of high levels of stress, and usually develops as a way to cope with trauma. It is a phenomenon characterised by a disruption in self-awareness and emotional numbness, where many people feel that they are disconnected or estranged form one’s self. The researchers say that patients' dissociative symptoms may be directly related to these alterations in the brain's functional circuitry.Depersonalisation-Derealisation Disorder is a dissociative disorder and is the experience of feeling unreal, detached, and often, unable to feel emotion. They found that in the brains of patients with the dissociative subtype of PTSD, the amygdala was more strongly connected to brain regions involved in consciousness, awareness, emotional regulation, and proprioception (the sense of body position) than it was in PTSD patients without the dissociative subtype. They examined connections to two parts of the amygdala: the basolateral amygdala, which evaluates sensory information and helps integrate emotions, and the centromedial amygdala, which helps execute fear responses. The researchers focused their analysis on parts of the brain that connect to the amygdala, a small structure deep in the brain that is involved in emotion and fear processing. Their study also included 40 people without PTSD.
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The scientists used functional magnetic resonance imaging to compare activity in the brains of 49 people with PTSD, 13 of whom had been diagnosed with the dissociative subtype of the disorder. Senior author Ruth Lanius, M.D., Ph.D., of the University of Western Ontario led a team of scientists that included two-time (20) NARSAD Young Investigator grantee Margaret McKinnon, Ph.D., of McMaster University in Ontario. In people with the dissociative subtype of PTSD, in contrast, emotional responses are overmodulated (over-regulated) by the brain, leading to emotional detachment and the subtype's characteristic feelings of depersonalization and derealization. Emotional responses are undermodulated (under-regulated, or controlled) by the brain in most people with PTSD, causing them to relive traumatic events and experience hyperarousal symptoms such as being easily startled. In both groups, emotion-regulating brain circuits are thought to be disrupted.
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Studies have found that reminders of traumatic events trigger different patterns of neural activity in patients with dissociative PTSD than they do in people who have PTSD without dissociation. Genetic factors can also increase the risk of developing PTSD with dissociation. It is most common among people whose PTSD developed after repeated traumas or childhood adversity. PTSD with dissociation is recognized as a distinct subtype of the disorder.
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The findings, reported in Neuropsychopharmacology, suggest that such patients need different treatment options. New research now reveals that brain circuits involved in fear processing are wired differently in these people than in others diagnosed with PTSD. These disturbances to awareness and consciousness are known as dissociation. Up to 30 percent of people with PTSD also suffer from symptoms known as depersonalization and de-realization––that is, they experience “out-of-body” episodes or feelings that the world is not real. For some people with post-traumatic stress disorder (PTSD), symptoms go beyond the flashbacks, nightmares, sleeplessness, and tense feelings that trouble many.