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PTSD and its dissociative subtype through the lens of the insula: Anterior and posterior insula resting-state functional connectivity and its predictive validity using machine learning.

Sherain Harricharan, A. Nicholson, J. Thome, Maria Densmore, Margaret C Mckinnon, Jean Théberge, Paul Frewen, Richard W.J. Neufeld, Ruth A. Lanius

Psychophysiology September 10, 2019 DOI: 10.1111/psyp.13472 (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Observational cross-sectional neuroimaging study Peer reviewed
Sample size 184
Population Adults with PTSD (n = 84), PTSD dissociative subtype (n = 49), and age-matched healthy controls (n = 51)
Topics PTSD
Key findings The authors report that PTSD and its dissociative subtype show distinct insula subregion resting-state connectivity patterns: PTSD had greater posterior insula connectivity with subcortical structures including the periaqueductal gray, while PTSD+DS had greater anterior and posterior insula connectivity with posterior cortices such as the lingual gyrus and precuneus. Machine learning classified the three groups with 80.4% balanced accuracy, which the authors suggest indicates a neurobiological distinction between PTSD and its dissociative subtype.

Abstract

Individuals with post-traumatic stress disorder (PTSD) typically experience states of reliving and hypervigilance; however, the dissociative subtype of PTSD (PTSD+DS) presents with additional symptoms of depersonalization and derealization. Although the insula is critical to emotion processing, its association with these contrasting symptom profiles is yet to be fully delineated. Accordingly, we investigated insula subregion resting-state functional connectivity patterns among individuals with PTSD, PTSD+DS, and healthy controls. Using SPM12 and PRONTO software, we implemented a seed-based resting-state functional connectivity approach, along with multiclass Gaussian process classification machine learning, respectively, in order to evaluate unique patterns and the predictive validity of insula subregion connectivity among individuals with PTSD (n = 84), PTSD+DS (n = 49), and age-matched healthy controls (n = 51). As compared to PTSD and PTSD+DS, healthy controls showed increased right anterior and posterior insula connectivity with frontal lobe structures. By contrast, PTSD showed increased bilateral posterior insula connectivity with subcortical structures, including the periaqueductal gray. Strikingly, as compared to PTSD and controls, PTSD+DS showed increased bilateral anterior and posterior insula connectivity with posterior cortices, including the left lingual gyrus and the left precuneus. Moreover, machine learning analyses were able to classify PTSD, PTSD+DS, and controls using insula subregion connectivity patterns with 80.4% balanced accuracy (p < .01). These findings suggest a neurobiological distinction between PTSD and its dissociative subtype with regard to insula subregion functional connectivity patterns. Furthermore, machine learning algorithms were able to utilize insula resting-state connectivity patterns to discriminate between participant groups with high predictive accuracy.

Comparable studies

Other experimental studies on PTSD, most cited first.

Study Year Design Participants
A PILOT STUDY OF GROUP MINDFULNESS-BASED COGNITIVE THERAPY (MBCT) FOR COMBAT VETERANS WITH POSTTRAUMATIC STRESS DISORDER (PTSD) Veterans with chronic combat posttraumatic stress disorder seeking treatment at a VA... 2013 Quasi-experimental with treatment-as-usual comparison group n = 37
Resting‐state functional connectivity of the bed nucleus of the stria terminalis in post‐traumatic stress disorder and its dissociative subtype Adults with PTSD (n = 70), its dissociative subtype (n = 41), and healthy controls (n =... 2017 Cross-sectional resting-state fMRI study n = 161
Sensory overload and imbalance: Resting-state vestibular connectivity in PTSD and its dissociative subtype. Adults with PTSD, PTSD dissociative subtype, and healthy controls 2017 Cross-sectional, seed-based resting-state fMRI study n = 141
Altered Sense of Body Ownership and Agency in Posttraumatic Stress Disorder and Its Dissociative Subtype: A Rubber Hand Illusion Study Adults with PTSD (n=4), PTSD with dissociative subtype (n=6), and healthy controls (n=7) 2018 Case-control experimental study n = 17
Superior colliculus resting state networks in post‐traumatic stress disorder and its dissociative subtype Adults with PTSD (n = 67), its dissociative subtype (n = 41), and healthy controls (n =... 2017 Observational cross-sectional resting-state fMRI study n = 158

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