Opposite brain emotion-regulation patterns in identity states of dissociative identity disorder: A PET study and neurobiological model

Antje A T S Reinders, Antoon T M Willemsen, Johan A den Boer, Herry P J Vos, Dick J Veltman, Richard J Loewenstein

Research output: Contribution to journalArticlepeer-review

56 Citations (Scopus)
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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.
Original languageEnglish
Pages (from-to)236-243
Number of pages8
JournalPsychiatry Research. Neuroimaging
Volume223
Issue number3
DOIs
Publication statusPublished - 30 Sept 2014

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