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Dissociative aspects of posttraumatic stress disorder: Epidemiology, clinical manifestations, assessment, and diagnosis

Ruth Lanius, MD, PhD
Paul A Frewen, PhD
Bethany Brand, PhD
Section Editor
David Spiegel, MD
Deputy Editor
Richard Hermann, MD


Some patients with posttraumatic stress disorder (PTSD) experience significant dissociative symptoms; this is often the case with patients who have experienced chronic traumatization including sexual, physical, and psychological abuse as well as severe neglect during childhood. This observation and subsequent clinical and neurophysiological research has led to a new dissociative subtype of PTSD.

The dissociative subtype of PTSD, which was added to DSM-5, consists of meeting the full diagnostic criteria for PTSD and, in addition, having depersonalization and/or derealization [1]. Patients with the dissociative subtype often have a history of PTSD earlier in life, more trauma exposure, and higher rates of suicidality [2-10]. “Dissociative PTSD” is an older term, used to describe PTSD with substantial dissociative symptoms.

The epidemiology, pathogenesis, clinical manifestations, and diagnosis of dissociative PTSD are reviewed here. The epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment of acute stress disorder (ASD) and PTSD are discussed elsewhere. (See "Posttraumatic stress disorder in adults: Epidemiology, pathophysiology, clinical manifestations, course, and diagnosis" and "Pharmacotherapy for posttraumatic stress disorder in adults" and "Psychotherapy for posttraumatic stress disorder in adults" and "Acute stress disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis".)


Dissociation — Dissociation is a disruption of the usually integrated functions of consciousness, memory, identity, or awareness of body, self, or environment. When one or more of these functions are disrupted, characteristic symptoms can occur:

Consciousness – Impaired consciousness is characterized by decreased responsiveness to external stimuli.


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