The Role of the Insula in Classical and Dissociative PTSD: A Double Case Study
Abstract: Two service members were diagnosed with PTSD due to military trauma exposure. Patient A (26, M) presented with the classical manifestation of PTSD without any motor disorder, while Patient B (29, F) suffered from the dissociative subtype accompanied by dystonia. Functional MRI scans of their brains demonstrated significantly different patterns of activity in the anterior cingulate, amygdala, and insula, consistent with their diagnoses. A statistical map of insula activation also revealed that Patient A had more connectivity in the anterior insula, while Patient B had more posterior connectivity. These differences in connectivity suggest that dissociative PTSD may be identified, understood, and treated as a disorder related to increased posterior insula activity. This double case study provides preliminary evidence for a concrete neuroanatomical discrepancy between insula function in classical and dissociative PTSD that may help explain the emergence of different coping strategies. Further investigation is needed to substantiate these findings and develop treatments that target this potential focal area of dysfunction.