Multimodal Approaches to Neurobiology of Traumatic Dissociation

精神创伤患者的分离症状很常见，使人虚弱，而且代价高昂；然而，很少有这种症状。 了解其生物学机制如何与创伤后应激障碍的治疗相互作用。创伤性广泛分离 包括一系列截然不同但临床上相互关联的症状：去人格化，去人格化， 健忘、麻木、倒叙、消极影响现象和身份认同障碍。一个人或在里面 不同的组合，这些症状可作为诊断标准和常见的相关特征 多发性精神障碍。创伤性分离也与重要的个人和社会联系在一起 负担。有分离症状的精神创伤患者通常会同时出现精神疾病， 自毁行为和自杀率高，是不成比例的治疗使用者。此外, 在治疗干预后，他们面临更高的自然减员、无反应和复发的风险。尽管 创伤性分离症状的显著和致残性，对其神经生物学知之甚少。 这些进程和有针对性的干预措施并不存在。 创伤后应激障碍的治疗研究既没有关注神经中间的分离表型，也没有研究它是如何 这些与心理生理学和数字表型有关。与临床症状比较 这些生物的和即时的数字解离标记可能会更有力地映射到 儿童和成人后区分分离亚型的障碍的潜在核心方面 精神创伤。我们建议在之前的探索性R21的基础上，现在捕获纵向多模式表型 与解离、创伤后应激障碍治疗前、创伤后应激障碍后和创伤后应激障碍治疗过程相关的数据包括经验性的、 基于曝光的组件。 这项研究的目标将是1)了解映射到离解的差异生物标志物 症状，以及2)了解这些生物标记物如何最好地预测经验性的 以标准护理为基础的治疗。对于这些目标中的每一个，我们将收集神经成像、生理学和 数字表型数据，应用具有多模式数据的计算建模来提供机器学习 基于基线和纵向的分离中间表型的无偏预测模型。这 自然主义研究将使我们能够绘制出解离的生物学图谱，更重要的是，解离的变化 130例PTSD患者随时间推移的症状和潜在生物标志物的自然主义循证治疗 寻求治疗的创伤后应激障碍患者，以及一系列分离症状。 这些目标的成功实现将提供对生物学的新的和强有力的理解 创伤暴露后解离亚型的标志物，并将确定 解离对创伤后应激障碍的认识和治疗。

Dissociative symptoms in traumatized individuals are common, debilitating, and costly; however, little is known about how its biological mechanisms interact with PTSD treatment. Traumatic dissociation broadly encompasses a range of distinct, yet clinically interrelated symptoms: depersonalization, derealization, amnesia, numbing, flashbacks, passive influence phenomena, and identity disturbances. Either alone or in various combinations, these symptoms serve as diagnostic criteria and commonly associated features across multiple psychiatric disorders. Traumatic dissociation is also associated with significant personal and societal burden. Traumatized individuals with dissociative symptoms typically have co-occurring psychiatric conditions, high rates of self-destructive behaviors and suicidality, and are disproportionate treatment utilizers. In addition, they are at increased risk for attrition, non-response and relapse following treatment interventions. Despite the significant and disabling nature of traumatic dissociative symptoms, little is known about the neurobiology of these processes and targeted interventions do not exist. PTSD treatment studies have neither looked at neural intermediate phenotypes of dissociation, nor how these are associated with psychophysiological and digital phenotypes. Compared to clinical symptom measures, these biological and in-the-moment digital markers of dissociation may more robustly map onto the underlying core aspects of the disorder differentiating dissociation subtypes following childhood and adult trauma. We propose to build upon our prior Exploratory R21 to now capture longitudinal multimodal phenotype data related to dissociation, pre-, post- and during PTSD treatment modalities that include empirically-derived, exposure-based components. The goals of this study will be 1) to understand the differential biomarkers that map onto dissociative symptoms, and 2) to understand how these biomarkers may best predict trajectory of response to empirically based standard-of-care treatments. For each of these Aims, we will collect Neuroimaging, Physiology, and Digital Phenotyping data, applying computational modeling with multimodal data to provide machine-learning based, unbiased predictive models of dissociative intermediate phenotypes at baseline and longitudinally. This naturalistic study will allow us to map the biology of dissociation, and importantly, the change in dissociative symptoms and underlying biomarkers over time, using naturalistic evidenced-based treatment for PTSD in 130 treatment-seeking patients with PTSD, and a range of dissociative symptoms. Successful completion of these Aims will provide a novel and powerful understanding of the biological markers of dissociation subtypes following trauma exposure, and will identify biological mechanisms for understanding and treating PTSD with dissociation.