Clinical patterns in a neuroimaging-based predictive model of self-reported dissociation

Affiliations

¹ Division of Depression and Anxiety Disorders, McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA. Electronic address: jpurcell1@mclean.harvard.edu.
² Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA; Laboratory for Psychiatric Biostatistics, McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA. Electronic address: bren@mgb.org.
³ Division of Depression and Anxiety Disorders, McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA. Electronic address: cpalermo@mclean.harvard.edu.
⁴ Division of Depression and Anxiety Disorders, McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA. Electronic address: zbair@mclean.harvard.edu.
⁵ Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA; Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA; Department of Psychiatry, McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA. Electronic address: mmarr@mgb.org.
⁶ Division of Depression and Anxiety Disorders, McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA. Electronic address: rmodell@mclean.harvard.edu.
⁷ Division of Depression and Anxiety Disorders, McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA; Teacher's College, Columbia University, 525 West 120th Street, New York City, NY, 10027, USA. Electronic address: xpan@mclean.harvard.edu.
⁸ Division of Depression and Anxiety Disorders, McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA. Electronic address: mrobinson@mclean.harvard.edu.
⁹ Division of Depression and Anxiety Disorders, McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA. Electronic address: meshanahan@mclean.harvard.edu.
¹⁰ Division of Depression and Anxiety Disorders, McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA. Electronic address: mswee@mclean.harvard.edu.
¹¹ Division of Depression and Anxiety Disorders, McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA. Electronic address: mlkaufman@mclean.harvard.edu.
¹² Division of Depression and Anxiety Disorders, McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA. Electronic address: llebois@mclean.harvard.edu.

PMID: 41175563
DOI: 10.1016/j.jpsychires.2025.10.045

Clinical patterns in a neuroimaging-based predictive model of self-reported dissociation

Juliann B Purcell et al. J Psychiatr Res. 2025.

. 2025 Oct 22:192:251-260.

doi: 10.1016/j.jpsychires.2025.10.045. Online ahead of print.

Authors

Affiliations

¹ Division of Depression and Anxiety Disorders, McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA. Electronic address: jpurcell1@mclean.harvard.edu.
² Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA; Laboratory for Psychiatric Biostatistics, McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA. Electronic address: bren@mgb.org.
³ Division of Depression and Anxiety Disorders, McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA. Electronic address: cpalermo@mclean.harvard.edu.
⁴ Division of Depression and Anxiety Disorders, McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA. Electronic address: zbair@mclean.harvard.edu.
⁵ Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA; Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA; Department of Psychiatry, McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA. Electronic address: mmarr@mgb.org.
⁶ Division of Depression and Anxiety Disorders, McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA. Electronic address: rmodell@mclean.harvard.edu.
⁷ Division of Depression and Anxiety Disorders, McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA; Teacher's College, Columbia University, 525 West 120th Street, New York City, NY, 10027, USA. Electronic address: xpan@mclean.harvard.edu.
⁸ Division of Depression and Anxiety Disorders, McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA. Electronic address: mrobinson@mclean.harvard.edu.
⁹ Division of Depression and Anxiety Disorders, McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA. Electronic address: meshanahan@mclean.harvard.edu.
¹⁰ Division of Depression and Anxiety Disorders, McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA. Electronic address: mswee@mclean.harvard.edu.
¹¹ Division of Depression and Anxiety Disorders, McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA. Electronic address: mlkaufman@mclean.harvard.edu.
¹² Division of Depression and Anxiety Disorders, McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA. Electronic address: llebois@mclean.harvard.edu.

PMID: 41175563
DOI: 10.1016/j.jpsychires.2025.10.045

Abstract

Assessment of trauma-related dissociation has been historically challenging given its subjective nature and the lack of provider education around this topic. Recent work identified a promising neural biomarker of trauma-related dissociation, representing a significant step toward improved assessment and identification of dissociation. However, it is necessary to better understand clinical factors that may be associated with this biomarker. Participants were 65 women with histories of childhood maltreatment, posttraumatic stress disorder (PTSD), and varying levels of dissociation (e.g., co-occurring dissociative identity disorder, DID). Data were drawn from previously published work that identified a model predicting Multidimensional Inventory of Dissociation severe pathological dissociation scores on the basis of neural functional connectivity. Here, we conducted a k-means cluster analysis to explore model performance patterns in the original prediction model. We then investigated differences among the clusters in a range of clinically-relevant variables. Our clustering analysis identified four distinct groups. The original model best predicted those at the low (cluster 1, 82 % PTSD) and high (cluster 3, 86 % DID) ends of self-reported dissociation. Cluster 2 also largely included participants with DID (67 %), but the predictive model was less accurate for these individuals. Follow up analyses revealed that DID participants in cluster 2 reported lower levels of self-state intrusions, a type of DID-specific dissociation, compared to those in cluster 3. Thus, the identified model performance patterns suggest that the original prediction model may be linked to DID-specific dissociation. Our findings indicate that patterns of functional connectivity may be valuable to improve accurate assessment of DID.

Keywords: Dissociation; Functional connectivity; K-means clustering; Neural biomarker; Posttraumatic stress.

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Conflict of interest statement

Declaration of competing interest ML Kaufman, CA Palermo and LAM Lebois report funding by the Julia Kasparian Fund for Neuroscience Research. ML Kaufman, LAM Lebois, and MC Marr report funding from the National Institute of Mental Health (R01 MH119227, K01 MH118467, R25 MH13587). ML Kaufman, CA Palermo, M Robinson, and LAM Lebois report unpaid membership on the Scientific Committee for the International Society for the Study of Trauma and Dissociation (ISSTD). This work was also conducted with support from UM1TR004408 award through Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health) and financial contributions from Harvard University and its affiliated academic healthcare centers. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic healthcare centers, or the National Institutes of Health. Neither ISSTD nor any funding sources were involved in the analysis or preparation of the paper. LAM Lebois also reports spousal IP payments from Vanderbilt University for technology licensed to Acadia Pharmaceuticals and spousal equity/ownership interest in Violet Therapeutics unrelated to the present work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Update of

Clinical patterns in a neuroimaging-based predictive model of self-reported dissociation.
Purcell JB, Ren B, Palermo CA, Bair ZA, Marr MC, Modell RL, Pan X, Robinson MA, Shanahan ME, Swee MB, Kaufman ML, Lebois LAM. Purcell JB, et al. medRxiv [Preprint]. 2025 Feb 28:2025.02.27.25323014. doi: 10.1101/2025.02.27.25323014. medRxiv. 2025. Update in: J Psychiatr Res. 2025 Oct 22;192:251-260. doi: 10.1016/j.jpsychires.2025.10.045. PMID: 40061334 Free PMC article. Updated. Preprint.

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Clinical patterns in a neuroimaging-based predictive model of self-reported dissociation

Affiliations

Clinical patterns in a neuroimaging-based predictive model of self-reported dissociation

Authors

Affiliations

Abstract

Conflict of interest statement

Update of

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