A new instrument, the Clinician Administered Dissociative States Scale (CADSS), was developed to measure present-state dissociative symptoms. Initial analyses showed good interrater reliability and construct validity. CADSS scores successfully discriminated patients with dissociative disorders from patients with other psychiatric disorders and from healthy subjects.
Dissociative symptoms during trauma and afterward in PTSD may be linked to stress-induced glutamate release in the brain. Animal studies show stress stimulates cortico-limbic glutamate release, affecting behavior and neural plasticity, and contributing to neural toxicity. NMDA receptor antagonists also trigger transient glutamate release and produce dissociative-like symptoms in animals and humans. A drug that reduces glutamate release lessens the perceptual effects of the NMDA antagonist ketamine in humans. Because hyperglutamatergic states may contribute to acute and long-term trauma effects, drugs that attenuate glutamate release warrant exploration for treating traumatized individuals with dissociative symptoms.
Combat veterans with post-traumatic stress disorder (PTSD) who completed an eight-session mindfulness-based stress reduction (MBSR) program showed lasting improvement in PTSD symptoms for six months after treatment, along with increased mindfulness. Brain imaging revealed that MBSR increased activity in the anterior cingulate and inferior parietal lobule while decreasing activity in the insula and precuneus when veterans were exposed to traumatic reminders, compared to those who received present-centered group therapy. These brain changes are linked to fear extinction and stress regulation. MBSR appears to be a safe and effective non-pharmacologic treatment for PTSD.