The dissociative subtype of post-traumatic stress disorder (PTSD) is a distinct PTSD phenotype characterized by trauma-related dissociation, alongside unique patterns of functional connectivity. However, disparate findings across multiple scales of investigation have highlighted the need for a cohesive understanding of dissociative neurobiology. We took a step towards this goal by conducting one of the broadest region of interest (ROI)-to-ROI analyses performed on a PTSD population to date. In this retrospective study, we investigated resting-state functional MRI data collected from a total of 192 participants, 134 of whom were diagnosed with PTSD. Small functional connectivity differences (maximum effect size 0.27) were found between participants with PTSD and controls in the temporal regions and the right frontoparietal network. Participants with the dissociative subtype showed a markedly different pattern of widespread functional hyperconnectivity compared with controls (maximum effect size 0.46), spanning subcortical regions, sensorimotor and other intrinsic connectivity networks. Furthermore, analysis of latent dimensions underlying both ROI-to-ROI brain results and a range of behavioral and clinical measures identified three clinically relevant latent dimensions—two linked to dissociation and one linked to PTSD symptoms. These results advance our understanding of dissociative neurobiology, characterizing it as a divergence from normative small-world organization. These patterns of hyperconnectivity are thought to serve a compensatory function to preserve global brain functioning in participants experiencing trauma-related dissociation.
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The data supporting the results in this study are available within the paper and the accompanying Supplementary Information. The data use agreement governing the dataset used in this study restricts public sharing, and hence the dataset is not publicly available.
The analyses used the standard SPM12 and CONN (version 21a) analysis pipelines and algorithms (for example, hierarchical clustering algorithm), and the standard MATLAB R2022a implementation of CCA, as described in the detailed Methods. No further custom code or algorithm was used in this study.
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We thank all the individuals who participated, as well as Homewood Health in Guelph, Ontario, Canada, who facilitated referrals. We are also grateful to our dedicated research and clinical team, without whom we could not have done this work. This work was supported by infrastructure funds from the Canada Foundation for Innovation Grant (J.T.; grant number 31724) and Lawson Health Research Institute, as well as operating funds from the Canadian Institute of Military and Veteran Health Research, Green Shield Canada, the Centre of Excellence on PTSD, and the Canadian Institutes of Health Research (M.C.M. and R.A.L.; grant number 148784). R.A.L. is supported by the Harris-Woodman Chair in Psyche and Soma at Western University, and M.C.M. is supported by the Homewood Chair in Mental Health and Trauma at McMaster University. S.B.S. and B.A.T. are supported by Mitacs Elevate funding, partnered generously by the Homewood Research Institute in Guelph, Ontario, Canada.
The authors declare no competing interests.
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Statistical source data containing unprocessed two-sided contrast between the PTSD group and controls, used for the visualization in Figs. 1a and 2a; statistical source data containing unprocessed two-sided contrast between the PTSD + DS group and controls, used for the visualization in Figs. 1b and 2b.
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Shaw, S.B., Terpou, B.A., Densmore, M. et al. Large-scale functional hyperconnectivity patterns in trauma-related dissociation: an rs-fMRI study of PTSD and its dissociative subtype. Nat. Mental Health 1, 711–721 (2023). https://doi.org/10.1038/s44220-023-00115-y
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