PTSD and Dissociation

Dissociation is a mental health term used to describe an abnormal sense of psychological, emotional, or physical detachment. Prominent forms of this detachment include a sense of unusual separation from the body and a sense of unusual separation from the surrounding physical environment. Generally speaking, people experience dissociation as part of a psychological defense mechanism against overwhelming events or circumstances. Some affected individuals develop any one of several diagnosable conditions known collectively as dissociative disorders. However, others develop dissociation-related symptoms in the context of post-traumatic stress disorder (PTSD). In 2013, the American Psychiatric Association officially acknowledged dissociative PTSD as a diagnosable mental health condition.

Dissociation Basics

People who develop an abnormal sense of separation from their own bodies have a form of dissociation called depersonalization, the National Center for PTSD reports. Experiences commonly associated with this sensation include being “outside” of the body, looking down at the body from a distance, and a partial disconnection of the body-mind link that forms the basis for emotional responses. People who develop an abnormal sense of separation from their surrounding environments have a form of dissociation called derealization. Experiences commonly associated with this sensation include a feeling of being stuck within a dream, a perception of objects in the environment as “unreal,” and a more generalized feeling of distance or separation from people or things.

The three distinct dissociative disorders recognized by the American Psychiatric Association are depersonalization/derealization disorder, dissociative identity disorder (once known as multiple personality disorder) and dissociative amnesia. Two other conditions in this category—called other specified dissociative disorder and unspecified dissociative disorder—have less detailed definitions and may contain any one of a number of combined dissociation-related symptoms.

PTSD Basics

As of 2013, the American Psychiatric Association places post-traumatic stress disorder in a category of conditions called trauma- and stressor-related disorders. As this name implies, all of the included disorders feature some sort of dysfunctional reaction to an unusually traumatic event or a series of more ordinary daily stresses. PTSD, in particular, produces symptoms that include avoidance of situations that literally or symbolically resemble an original traumatic event, a reliving of an original traumatic event in dreams or in waking mental events called flashbacks, amnesia regarding certain aspects of a traumatic event, and a state of unusual mental agitation or exaggerated awareness that mental health professionals term hyperarousal. In order to receive a diagnosis, affected individuals must manifest these symptoms 30 days or longer after a traumatic event takes place.

Dissociative PTSD

Anywhere from 15 to 30 percent of all people diagnosed with PTSD display signs of the classic dissociative symptoms of derealization and/or depersonalization, according to the National Center for PTSD. These figures hold true for civilian and military populations. While depersonalization and derealization symptoms in a PTSD patient sometimes superficially resemble the symptoms of hyperarousal and reliving of a traumatic event, they actually differ in important ways and involve separate processes inside the brain. For this reason, the presence of dissociation-related symptoms can significantly alter the course of PTSD, as well as the course of PTSD treatment.

In recognition of the unique impact of dissociation on people with PTSD, the American Psychiatric Association includes dissociative PTSD as a distinct PTSD subtype in the new fifth edition of its widely distributed and referenced Diagnostic and Statistical Manual of Mental Disorders. Doctors can detect the presence of this subtype with the help of a standardized testing procedure called the Clinician Administered PTSD Scale. Additional information used to make a diagnosis of dissociative PTSD includes patient interviews and self-administered tests that allow patients to list their perceived symptoms, as well as the perceived severity of those symptoms.

Considerations

Certain factors tend to emphasize the difference between people with general PTSD and people with dissociative PTSD. For instance, people with dissociative PTSD (who are frequently male) have a greater chance of experiencing significant, recurring traumatic events long before they develop PTSD symptoms. They also suffer more everyday impairment related to their PTSD symptoms, have a higher chance of experiencing other simultaneous mental health issues, and have higher risks for suicide-related thoughts and behaviors.

Two symptoms that commonly appear in people with PTSD—namely, waking flashbacks and amnesia—are actually forms of dissociation themselves. However, doctors don’t typically characterize them as such when they appear in a PTSD context, and affected individuals must also experience symptoms of depersonalization and/or derealization in order to receive a diagnosis of dissociative PTSD.