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Biomarkers of Pathological Dissociation: A Systematic Review

Research output: Contribution to journalReview articlepeer-review

Monika I. Roydeva, Antje A. T. S. Reinders

Original languageEnglish
Pages (from-to)120-202
Number of pages83
JournalNeuroscience and Biobehavioral Reviews
Accepted/In press15 Nov 2020
Published1 Apr 2021

Bibliographical note

Funding Information: This paper represents independent research part funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London . The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. We are grateful to Professor Christa Krüger and Professor Dick Veltman for helpful comments and expert advice and Gill Brown for graphical design ( ). Publisher Copyright: © 2020 Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors


Pathological dissociation is a severe, debilitating and transdiagnostic psychiatric symptom. This review identifies biomarkers of pathological dissociation in a transdiagnostic manner to recommend the most promising research and treatment pathways in support of the precision medicine framework. A total of 205 unique studies that met inclusion criteria were included. Studies were divided into four biomarker categories, namely neuroimaging, psychobiological, psychophysiological and genetic biomarkers. 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.

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