PTSD Isn’t Just Hyperarousal: The Hidden Science of Dissociation
In this video, psychiatrist Dr Sanil Rege breaks down the neuroscience of dissociation — a crucial yet often misunderstood dimension of trauma and PTSD.
While most clinicians associate PTSD with hyperarousal, Dr Rege explains the other half of the picture: dissociation — emotional numbing, detachment, and shutdown driven by the brain’s defensive circuitry.
You’ll learn how to recognise dissociation in your patients, understand the underlying brain circuits and neurotransmitters, and apply evidence-based treatment strategies that prevent retraumatisation.
Dr Rege is a consultant psychiatrist, educator, and founder of The Academy by Psych Scene, where he’s trained over 10,000 mental-health professionals globally.
🕒 CHAPTERS
0:00 – What Is Dissociation?
2:24 – Two Faces of Trauma: Hyperarousal vs Dissociation
3:28 – The Brain’s Defence Cascade and the Role of the PAG
4:13 – Neurotransmitters in Dissociation: Mu & Kappa Opioids, Endocannabinoids
5:03 – Clinical Pitfalls: When Therapy Reinforces Dissociation
5:38 – How to Recognise Dissociation in Practice
6:05 – Treatment Strategies: Matching Interventions to Brain State
7:01 – Role of Medication in Dissociation: Naltrexone, SSRIs, and Clonidine
8:02 – Phase-Oriented Trauma Therapy Explained
🔍 Key Insights for Clinicians & Learners
1. Dissociation ≠ Weakness — it’s the brain’s survival mechanism when escape feels impossible.
2. Hyperarousal and dissociation represent opposite ends of trauma circuitry: emotional under-modulation vs over-modulation.
3. Neural drivers: Prefrontal-limbic inhibition, periaqueductal grey (PAG) activation, and opioid-endocannabinoid systems.
4. Clinical red flag: Flat affect, detachment, or “blankness” during trauma exposure may indicate in-session shutdown.
5. Therapeutic principle: Match intervention to arousal state — down-regulate hyperarousal, up-regulate dissociation.
6. Avoid pitfalls: Relaxation or benzodiazepines can deepen dissociative shutdown.
7. Best practice: Phase-oriented therapy → (1) Safety & Stabilisation (2) Processing (3) Integration.
#Trauma #Dissociation #PTSD #Neuroscience #PsychiatrySimplified #PsychScene #DrSanilRege #MentalHealthEducation #Neurobiology #Psychotherapy #BrainScience #CPTSD
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