title: Opposite brain emotion-regulation patterns in identity states of dissociative identity disorder: a PET study and neurobiological model.
abstract: Imaging studies in posttraumatic stress disorder (PTSD) have shown differing neural network patterns between hypo-aroused/dissociative and hyper-aroused subtypes. Since dissociative identity disorder (DID) involves different emotional states, this study tests whether DID fits aspects of the differing brain-activation patterns in PTSD. While brain activation was monitored using positron emission tomography, DID individuals (n=11) and matched DID-simulating healthy controls (n=16) underwent an autobiographic script-driven imagery paradigm in a hypo-aroused and a hyper-aroused identity state. Results were consistent with those previously found in the two PTSD subtypes for the rostral/dorsal anterior cingulate, the prefrontal cortex, and the amygdala and insula, respectively. Furthermore, the dissociative identity state uniquely activated the posterior association areas and the parahippocampal gyri, whereas the hyper-aroused identity state uniquely activated the caudate nucleus. Therefore, we proposed an extended PTSD-based neurobiological model for emotion modulation in DID: the hypo-aroused identity state activates the prefrontal cortex, cingulate, posterior association areas and parahippocampal gyri, thereby overmodulating emotion regulation; the hyper-aroused identity state activates the amygdala and insula as well as the dorsal striatum, thereby undermodulating emotion regulation. This confirms the notion that DID is related to PTSD as hypo-aroused and hyper-arousal states in DID and PTSD are similar.
authors: Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom; Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: a.a.t.s.reinders@gmail.com.
authors: Antje A T S
authors: AA
authors: Reinders
authors: Department of Nuclear Medicine & Molecular Imaging, University Medical Center Groningen, University of Groningen, The Netherlands.
authors: Antoon T M
authors: AT
authors: Willemsen
authors: Department of Nuclear Medicine & Molecular Imaging, University Medical Center Groningen, University of Groningen, The Netherlands.
authors: Johan A
authors: JA
authors: den Boer
authors: Outpatient Department Addiction Clinic Groningen/Drenthe, The Netherlands.
authors: Herry P J
authors: HP
authors: Vos
authors: Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
authors: Dick J
authors: DJ
authors: Veltman
authors: Sheppard Pratt Health System, Department of Psychiatry, University of Maryland, Baltimore, MD, USA.
authors: Richard J
authors: RJ
authors: Loewenstein
mesh_terms: D000328:Adult; D000679:Amygdala / Q000000981:diagnostic imaging; D001143:Arousal; D001921:Brain / Q000000981:diagnostic imaging*; D009105:Dissociative Identity Disorder / Q000000981:diagnostic imaging* / Q000523:psychology*; D004644:Emotions; D005260:Female; D005625:Frontal Lobe / Q000000981:diagnostic imaging; D006801:Humans; D008875:Middle Aged; D049268:Positron-Emission Tomography; D017397:Prefrontal Cortex / Q000000981:diagnostic imaging; D013313:Stress Disorders, Post-Traumatic / Q000000981:diagnostic imaging / Q000523:psychology
keywords: Dissociative identity disorder (DID); Emotional overmodulation; Emotional undermodulation; Etiology; Neuroimaging; Posttraumatic stress disorder (PTSD)