Toward dimensional body consciousness impairments in post-traumatic stress disorder and its dissociative subtype: A predictive processing approach.

Summary

A review proposes that post-traumatic stress disorder (PTSD) involves disrupted body awareness, specifically the sense of body ownership and sense of agency, which current models overlook. Using predictive processing theory, it distinguishes two PTSD subtypes. In non-dissociative PTSD, hyperprecise trauma-related prior beliefs and heightened interoceptive signals (due to amygdala and anterior insula hyperactivity) produce rigid self-representations, with cognitive processing ranked as prior, interoception, then exteroception. In the dissociative subtype, emotional over-inhibition and anterior insula hypoactivity weaken priors and interoception, while exteroception dominates (exteroception, interoception, prior). Sense of agency impairments are specific to the dissociative subtype, linked to angular gyrus hyperactivity and glutamate hypofunction. The framework suggests a dimensional model of body consciousness disruption across the PTSD spectrum and discusses therapeutic implications for top-down and bottom-up interventions.

Study at a glance

Abstract

Current models of post-traumatic stress disorder (PTSD) predominantly focus on emotional dysregulation, avoidance behaviors, and intrusive symptoms, with limited attention to disturbances in bodily self-consciousness. These frameworks do not fully account for how trauma may disrupt the integration of interoceptive and exteroceptive signals underlying the sense of embodied self. Building on recent advances in computational psychiatry, this review introduces a novel theoretical framework that differentiates between dissociative and non-dissociative forms of PTSD using the predictive processing paradigm. Body awareness, including the sense of body ownership (SBO) and the sense of agency (SoA), is framed within a Bayesian inference framework, where perception results from the interaction between prior beliefs and incoming sensory information. In non-dissociative PTSD, we suggest that hyperprecise trauma-related priors, coupled with increased interoceptive weighting due to amygdala and anterior insula hyperactivity, result in rigid self-representations and a diminished capacity for perceptual updating. Thus, we may consider PTSD as a state in which accuracy and reliability of cognitive processes are ranked as follows: [Prior > Interoception > Exteroception]. Conversely, in the dissociative PTSD subtype, emotional over-inhibition and anterior insula hypoactivity weaken priors and interoception, while exteroceptive inputs dominate. Therefore, we consider ranked cognitive processes in PTSD dissociative subtype as follows: [Exteroception > Interoception > Prior]. SoA impairements is specific to the dissociative subtype involving hyperactivity of the angular gyrus and glutamate hypofunction. On this basis, we propose an original dimensional model of body consciousness disruption across PTSD spectra. Therapeutic implications are explored, including top-down and bottom-up interventions.