Triple Network Theory applied to Dissociative Disorders

 

See also: Triple Network model of psychopathology

AND Triple Network Model

Triple Network Theory applied to Dissociative Disorders

“Deconstructing dissociation: a triple network model of trauma-related dissociation and its subtypes” by Lauren A. M. Lebois and colleagues, published in Neuropsychopharmacology in 2022. 

Deconstructing dissociation: a triple network model of trauma-related dissociation and its subtypes | Neuropsychopharmacology

The three networks

The model uses Vinod Menon's Triple Network Model, involving:

1. Default Mode Network (DMN/DN)

 Broadly involved in:

• autobiographical memory
• internally directed attention
• self-referential processing
• constructing a coherent sense of "me"
• integrating experience across time

2. Salience Network (SN)

 Broadly involved in:

• detecting what is important
• interoception/body signals
• emotional relevance
• threat detection
• shifting attention between internal and external experience
• helping coordinate switching between DMN and executive systems

3. Central Executive Network (CEN)

 Broadly involved in:

• working memory
• cognitive control
• attention
• planning
• goal-directed behavior
• maintaining information online

This basic triple-network framework was originally proposed as a transdiagnostic model of psychopathology rather than specifically a dissociation model.

Journal of Integrative Neuroscience | Controlling the Triple Network Model: Salience Network Modulatory Roles, Default Mode Dynamic Functions, and Central Executive Network Heterogeneity

What gets especially interesting with dissociation

Lebois and colleagues studied 91 women with varying histories of childhood trauma, PTSD, and dissociation using resting-state fMRI. Importantly, they didn't treat "dissociation" as one homogeneous phenomenon. They examined:

1. Depersonalization/derealization
2. Partially dissociated intrusions
3. Dissociative Identity Disorder (DID)

They controlled statistically for age, childhood maltreatment, and PTSD severity.  

Across dissociation generally, they found:

greater connectivity within the CEN, DMN, and SN, combined with reduced connectivity between portions of the CEN/SN and other brain regions.

Even more interestingly, different forms of dissociation showed somewhat different network signatures:

Dissociative phenomenon	Particularly implicated network findings
Depersonalization / derealization	CEN + DMN
Partially dissociated intrusions	CEN
DID	CEN

 

A way to conceptualize this clinically

SALience

What requires my attention right now?

↓

EXECUTIVE

What mental state, information, behavioral response, or action do I need online right now?

↕

DEFAULT/SELF

How does this experience belong to "me," my autobiographical past, and my continuous identity?

In ordinary functioning, these systems coordinate dynamically.

In pathological dissociation, the problem may be less "one network is broken" and more abnormal segregation and coordination between systems responsible for salience, cognitive control, and self-related/autobiographical processing. That interpretation fits the authors' finding of increased within-network connectivity alongside altered integration between networks. 

And this becomes especially intriguing for DID

From a Structural Dissociation/parts perspective, this is a possible conceptual bridge rather than evidence proving the theory.

For example, imagine that a trauma-associated cue suddenly acquires very high salience:

cue / interoceptive state

 ↓

 Salience Network

 "THIS matters."

 ↓

 changes large-scale network configuration

 ↓

 Central Executive Network

 different memories, action tendencies, attentional priorities, behavioral programs become accessible

 ↓

 Default Mode / autobiographical systems

 the currently accessible experience may not integrate normally with the person's broader autobiographical sense of self.

That gives us a surprisingly plausible neuroscience vocabulary for something clinicians working with DID have described phenomenologically for decades:

state-dependent access to memory, identity, emotion, perception, and executive control.

But importantly, the Lebois study does not demonstrate that chain of causation. It's a useful working interpretation of their connectivity findings, not yet a demonstrated mechanism. 

And it also gives us a potentially useful way of understanding why executive dysfunction in DID can look superficially ADHD-like while arising from a very different mechanism. ADHD may involve relatively persistent difficulties with executive regulation, whereas severe dissociation could produce more state-dependent access to executive resources.