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Although the insula is critical to emotion processing, its association with these contrasting symptom profiles is yet to be fully delineated. Accordingly, we investigated insula subregion resting\u2010state functional connectivity patterns among individuals with PTSD, PTSD+DS, and healthy controls. Using SPM12 and PRONTO software, we implemented a seed\u2010based resting\u2010state functional connectivity approach, along with multiclass Gaussian process classification machine learning, respectively, in order to evaluate unique patterns and the predictive validity of insula subregion connectivity among individuals with PTSD (\n                    <jats:italic>n<\/jats:italic>\n                    \u00a0=\u00a084), PTSD+DS (\n                    <jats:italic>n<\/jats:italic>\n                    \u00a0=\u00a049), and age\u2010matched healthy controls (\n                    <jats:italic>n<\/jats:italic>\n                    \u00a0=\u00a051). As\u00a0compared to PTSD and PTSD+DS, healthy controls showed increased right anterior and posterior insula connectivity with frontal lobe structures. By contrast, PTSD showed increased bilateral posterior insula connectivity with subcortical structures, including the periaqueductal gray. Strikingly, as\u00a0compared to PTSD and controls, PTSD+DS showed increased bilateral anterior and posterior insula connectivity with posterior cortices, including the left lingual gyrus and the left precuneus. Moreover, machine learning analyses were able to classify PTSD, PTSD+DS, and controls using insula subregion connectivity patterns with 80.4% balanced accuracy (\n                    <jats:italic>p &lt;<\/jats:italic>\n                    .01). These findings suggest a neurobiological distinction between PTSD and its dissociative subtype with regard to insula subregion functional connectivity patterns. Furthermore, machine learning algorithms were able to utilize insula resting\u2010state connectivity patterns to discriminate between participant groups with high predictive accuracy.\n                  <\/jats:p>","DOI":"10.1111\/psyp.13472","type":"journal-article","created":{"date-parts":[[2019,9,10]],"date-time":"2019-09-10T03:24:40Z","timestamp":1568085880000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":83,"title":["PTSD and its dissociative subtype through the lens of the insula: Anterior and posterior insula resting\u2010state functional connectivity and its predictive validity using machine learning"],"prefix":"10.1111","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6421-7995","authenticated-orcid":false,"given":"Sherain","family":"Harricharan","sequence":"first","affiliation":[{"name":"Department of Neuroscience Western University London Ontario Canada"},{"name":"Department of Psychiatry Western University London Ontario Canada"},{"name":"Imaging Division Lawson Health Research Institute London Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew A.","family":"Nicholson","sequence":"additional","affiliation":[{"name":"Department of Psychological Research and Research Methods University of Vienna Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janine","family":"Thome","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Western University London Ontario Canada"},{"name":"Imaging Division Lawson Health Research Institute London Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Densmore","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Western University London Ontario Canada"},{"name":"Imaging Division Lawson Health Research Institute London Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret C.","family":"McKinnon","sequence":"additional","affiliation":[{"name":"Mood Disorders Program St. Joseph's Healthcare Hamilton Ontario Canada"},{"name":"Department of Psychiatry and Behavioural Neurosciences McMaster University Hamilton Ontario Canada"},{"name":"Homewood Research Institute Guelph Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean","family":"Th\u00e9berge","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Western University London Ontario Canada"},{"name":"Imaging Division Lawson Health Research Institute London Ontario Canada"},{"name":"Department of Medical Imaging Western University London Ontario Canada"},{"name":"Department of Medical Biophysics Western University London Ontario Canada"},{"name":"Department of Diagnostic Imaging St. Joseph's Healthcare London Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul A.","family":"Frewen","sequence":"additional","affiliation":[{"name":"Department of Neuroscience Western University London Ontario Canada"},{"name":"Department of Psychiatry Western University London Ontario Canada"},{"name":"Department of Psychology Western University London Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard W. 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