Dissociative episodes and concurrent heart rate in patients with PTSD - An ecological momentary assessment.
Sarah Beutler-Traktovenko, Marcel Franz, Judith Daniels, J. Schellong, Kerstin Weidner, Ilona Croy
Psychiatry Research 2025 DOI: 10.1016/j.psychres.2024.116345 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Observational study using ecological momentary assessment Peer reviewed |
|---|---|
| Sample size | 47 |
| Population | Female inpatients diagnosed with posttraumatic stress disorder and dissociative symptoms |
| Duration | 5 to 10 days of continuous heart rate monitoring |
| Measures | mobile ECG, smartphone app self-report of dissociative events, conventional self-reports for depersonalization and derealization |
| Topics | PTSD |
| Key findings | Heart rate during spontaneously occurring dissociative symptoms was on average not different from baseline and showed no significant relation to dissociation intensity, despite theoretical predictions of physiological hypoarousal. The authors argue this challenges the reactive hypoarousal theory of chronic dissociation and supports the view that physiological adaptation occurs during posttraumatic chronification, while highlighting large individual variability in dissociative symptoms. |
Abstract
Dissociative symptoms are a frequent complication in posttraumatic stress disorders affecting about a third of all PTSD patients. While theoretical models predict a physiological hypoarousal during posttraumatic dissociations, empirical evidence is lacking. We addressed this by studying spontaneously occurring dissociative symptoms and related heart rate changes in an ecological momentary assessment. Therefore, we continuously measured heart rate for five to ten days with mobile ECG in 47 female inpatients diagnosed with posttraumatic stress disorder and dissociative symptoms. During this observation period, patients tracked each dissociative event on a smartphone app and reported on symptom characteristics. Patients reported a total of 164 dissociative events. Those typically lasted <30 min and involved co-occuring depersonalization and derealization of moderate to severe intensity. Tracked symptoms correlated positively with some conventional self-reports for depersonalization and derealization. Heart rate during dissociative symptoms varied greatly between and within individuals and was on average not different from baseline assessment. There was also no significant relation between dissociation intensity and heart rate change. These results challenge the theory of reactive hypoarousal during chronic dissociation and support the view that physiological adaptation modifies in the course of posttraumatic chronification. They also highlight the individual variability of dissociative symptoms and underscore the necessity of detailed assessment for targeted therapeutic approaches.
Comparable studies
Other observational and cohort studies on PTSD, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| MDMA-Assisted Psychotherapy Using Low Doses in a Small Sample of Women with Chronic Posttraumatic Stress Disorder Women with chronic PTSD secondary to sexual assault | 2008 | Observational cohort | n = 6 |
| An Ambulatory Polysomnography Study of the Post-traumatic Nightmares of Post-traumatic Stress Disorder Treatment-seeking veterans, current serving military members, and emergency service... | 2017 | Observational study using ambulatory polysomnography | n = 35 |
| Increased Mastery Elements Associated With Imagery Rehearsal Treatment for Nightmares in Sexual Assault Survivors With PTSD. Female sexual assault survivors with chronic nightmares | 2004 | Observational cohort | n = 44 |
| Posttraumatic stress symptoms following near-death experiences. Persons who report near-death experiences and those who came close to death without NDEs | 2001 | Observational study | |
| Impact of oral ketamine augmentation on hospital admissions in treatment-resistant depression and PTSD: a retrospective study. Outpatients with treatment-resistant depression and PTSD | 2018 | Retrospective review | n = 37 |
Citations in the library
Cites 3
- Neurobiological and Genetic Correlates of the Dissociative Subtype of PTSD Journal of Psychopathology and Clinical Science April 6, 2023
- A review of the relation between dissociation, memory, executive functioning and social cognition in military members and civilians with neuropsychiatric conditions. Neuropsychologia September 2016
- Tracking Potentiating States of Dissociation: An Intensive Clinical Case Study of Sleep, Daydreaming, Mood, and Depersonalization/Derealization. Frontiers in Psychology August 17, 2016