Format

Send to

Choose Destination
Curr Psychiatry Rep. 2018 Nov 7;20(12):118. doi: 10.1007/s11920-018-0983-y.

A Review of the Neurobiological Basis of Trauma-Related Dissociation and Its Relation to Cannabinoid- and Opioid-Mediated Stress Response: a Transdiagnostic, Translational Approach.

Lanius RA1,2,3,4, Boyd JE5,6,7, McKinnon MC5,6,8, Nicholson AA9,10,11, Frewen P12, Vermetten E13,14, Jetly R15, Spiegel D16.

Author information

1
Department of Neuroscience, Western University, London, ON, Canada. Ruth.lanius@lhsc.on.ca.
2
Department of Psychiatry, Western University, London, ON, Canada. Ruth.lanius@lhsc.on.ca.
3
Lawson Health Research Institute, London, ON, Canada. Ruth.lanius@lhsc.on.ca.
4
Homewood Research Institute, Guelph, ON, Canada. Ruth.lanius@lhsc.on.ca.
5
Homewood Research Institute, Guelph, ON, Canada.
6
Mood Disorders Program, St. Joseph's Healthcare, Hamilton, ON, Canada.
7
Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, ON, Canada.
8
Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, ON, Canada.
9
Department of Neuroscience, Western University, London, ON, Canada.
10
Department of Psychiatry, Western University, London, ON, Canada.
11
Lawson Health Research Institute, London, ON, Canada.
12
Department of Psychology, Western University, London, ON, Canada.
13
Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands.
14
Military Mental Health Research, Ministry of Defense, Utrecht, Netherlands.
15
Canadian Forces, Health Services, Ottawa, ON, Canada.
16
Stanford University School of Medicine, Stanford, CA, USA.

Abstract

Dissociative experiences have been associated with increased disease severity, chronicity, and, in some cases, reduced treatment response across trauma-related and other psychiatric disorders. A better understanding of the neurobiological mechanisms through which dissociative experiences occur may assist in identifying novel pharmacological and non-pharmacological treatment approaches. Here, we review emerging work on the dissociative subtype of posttraumatic stress disorder (PTSD), and other trauma-related disorders providing evidence for two related overarching neurobiological models of dissociation, the defense cascade model of dissociation and Mobb's threat detection model. In particular, we review neuroimaging studies highlighting alterations in functional connectivity of key brain regions associated with these models, including connectivity between the prefrontal cortex, the amygdala and its complexes, the insula, and the periaqueductal gray. Work implicating the kappa-opioid and endocannabinoid systems in trauma-related dissociative experiences is also reviewed. Finally, we hypothesize mechanisms by which pharmacological modulation of these neurochemical systems may serve as promising transdiagnostic treatment modalities for individuals experiencing clinically significant levels of dissociation. Specifically, whereas kappa-opioid receptor antagonists may serve as a pharmacological vehicle for the selective targeting of dissociative symptoms and associated emotion overmodulation in the dissociative subtype of posttraumatic stress disorder and transdiagnostically, modulation of the endocannabinoid system may reduce symptoms associated with emotional undermodulation of the fight or flight components of the defense cascade model.

KEYWORDS:

Amygdala; Dissociation; Endocannabinoids; Opioids; PTSD; Periaqueductal grey; Prefrontal cortex; Stress response

PMID:
30402683
DOI:
10.1007/s11920-018-0983-y

Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center