Trauma-related dissociation and the autonomic nervous system: a systematic literature review of psychophysiological correlates of dissociative experiencing in PTSD patients

Background: Neurophysiological models link dissociation (e.g. feeling detached during or after a traumatic event) to hypoarousal. It is currently assumed that the initial passive reaction to a threat may coincide with a blunted autonomic response, which constitutes the dissociative subtype of post-traumatic stress disorder (PTSD). Objective: Within this systematic review we summarize research which evaluates autonomic nervous system activation (e.g. heart rate, blood pressure) and dissociation in PTSD patients to discern the validity of current neurophysiological models of trauma-related hypoarousal. Method: Of 553 screened articles, 28 studies (N = 1300 subjects) investigating the physiological response to stress provocation or trauma-related interventions were included in the final analysis. Results: No clear trend exists across all measured physiological markers in trauma-related dissociation. Extracted results are inconsistent, in part due to high heterogeneity in experimental methodology. Conclusion: The current review is unable to provide robust evidence that peri- and post-traumatic dissociation are associated with hypoarousal, questioning the validity of distinct psychophysiological profiles in PTSD. There is no consensus on physiological biomarkers of trauma-related dissociation.Peri- and post-traumatic dissociation are physiologically distinct from stress reactions in chronic states.Standardized methodologies may increase the reproducibility and specificity of psychophysiological biomarkers of dissociation. There is no consensus on physiological biomarkers of trauma-related dissociation. Peri- and post-traumatic dissociation are physiologically distinct from stress reactions in chronic states. Standardized methodologies may increase the reproducibility and specificity of psychophysiological biomarkers of dissociation.