Page 26 - PIECES OF THE PUZZLE Eline Vissia

CHAPTER 1
main components underlying impaired extinction or under-modulation of affect. A review (Aupperle et al. 2012) reported subtle impairments in response inhibition and attention regulation in PTSD that may be exacerbated within emotional or trauma-related contexts, and may relate to dorsal prefrontal dysfunction. Rolls (2013) reviews evidence suggesting that the maintenance of a regulatory goal in emotion regulation highly depends on working memory (Okon-Singer et al. 2015). Research examining working memory and attentional mechanisms has attempted to build a cognitive profile of several other psychiatric conditions (Nigg 2000), but results regarding the relation between dissociation and working memory have been ambiguous. Inconsistent results regarding dissociation and working memory require clarification (Giesbrecht et al. 2008).
One multi-subject functional magnetic resonance imaging (fMRI) study has been conducted in dissociative disorders (Elzinga et al. 2007). This study assessed working memory performance in patients with dissociative disorders (DID and DD-NOS) as compared with healthy controls. Dissociative patients showed enhanced working memory performance together with greater activation in the left anterior PFC, dorsolateral PFC and parietal cortex compared with controls. Unfortunately, it remains unclear which type of personality state (NPS or TPS) was tested. Since it is known from previous studies that different types of personality states display distinct patterns of neural activation (for example (Reinders et al. 2003, Reinders et al. 2006)), personality state differences (NPS/TPS) need to be examined for working memory functioning as compared with multiple control groups, testing both the trauma and fantasy model.
Neuroimaging DID
Over the past few decades a variety of methods have been developed to study the brain (Matthews, Jezzard 2004). Neuroimaging includes the use of various techniques to either directly or indirectly image the structure, pharmacology or function of the brain. Structural MRI is a neuroimaging technique for performing volumetric measurements of the brain tissue classes, with a spatial resolution on a millimeter scale. Tissue classes include white matter, gray matter and cerebrospinal fluid. Pathological conditions related to trauma may affect the gray and white matter of the brain (Bremner et al. 1997, Carrion
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