One of the experiential aspects of post-traumatic stress for those who have Complex PTSD (often associated with repeated childhood or adult sexual trauma) is the experience of depersonalization (feeling that one’s body is unfamiliar or strange) and/or derealization (feeling that one’s surroundings are unreal or unfamiliar), both of which are types of dissociation.

A third experience, known as structural dissociation, is the experience of different "selves" taking over the personality. This can range from the experience of one's wounded "inner child" acting out all the way to distinct personalities with names and characterological differences (dissociative identity disorder). Often the experience is somewhere in the middle - the primary self experiences lost time, "absent mindedness," and may told s/he acts like different people sometimes. This is usually the experience of different "stuck" parts of the self taking over, but it can also be specific subpersonalities or parts [mangers] whose job it is to manage stress and anxiety.

This recent study form the Archives of General Psychiatry identified a subgroup of highly dissociative survivors (about 12% of individuals with a current diagnosis of PTSD), as well as a low-severity group and high-severity group. 

The [dissociative] group was characterized by severe PTSD symptoms combined with marked elevations on items assessing flashbacks, derealization, and depersonalization. Individuals in this subgroup also endorsed greater exposure to childhood and adult sexual trauma compared with the other 2 groups, suggesting a possible etiologic link with the experience of repeated sexual trauma.

The researchers suggest that this finding may be sufficient for a dissociative PTSD subtype in the DSM-5, but that is hardly what is needed, in my opinion.

Rather, in my opinion we need:

(1) A developmental trauma criteria, since the experience of trauma during development creates whole different kind of wounding than later trauma [which may also be seen in those who develop structural dissociation];

(2) A Complex PTSD criteria for those who experience repeated and/or on-going trauma, which, again, creates a different collection of symptoms when the wounding manifests in the personality; and

(3) A single-episode PTSD criteria for those who experience a unique traumatic event (natural disaster, terrorist attack, etc.) and experience some of the various symptoms of PTSD, such as hyper-vigilance, hyperarousal, acute anxiety, depression, and nightmares/flashbacks. This final category is unlikely to experience the dissociation with which survivors in the first two categories generally have to deal.

In fact, in my opinion, nearly all "mental illness" is the result of physical, emotional, and/or psychological trauma - i.e., it's all relational (aside from the very few organic issues). This should be the basis for our "diagnostic manual."

But for now, at least psychiatrists believe dissociation is real (for a while, the majority opinion was that patients were only seeking secondary gain).

New ‘Unreal’ Subtype of PTSD Proposed

By Rick Nauert PhD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on July 4, 2012 

 

A provocative new study suggests that dissociation is associated with one form of post-traumatic stress disorder (PTSD).

Dissociation typically reflects problems in consciousness and awareness. Understanding that the course of PTSD may take alternative paths is an important discovery for treatment of the disorder.

Researchers discovered dissociation is often associated with unique PTSD symptoms of derealization, the feeling that one’s surroundings are unreal or unfamiliar, and depersonalization, or the feeling that one’s body is unfamiliar or strange.

Researchers studied PTSD and dissociative symptoms in 492 veterans and their intimate partners, all of whom had histories of trauma.

Participants reported exposure to a variety of traumatic events including combat, childhood physical and sexual abuse, partner abuse, motor vehicle accidents and natural disasters with most participants reporting exposure to multiple types of traumatic events.

Clinicians interviewed participants with the Clinician Administered PTSD Scale (CAPS), a diagnostic instrument that measures the frequency and severity of PTSD and dissociation symptoms.

Analysis revealed a small but distinct subset of participants characterized by high symptoms of dissociation and PTSD along with high rates of sexual assault history.

Researchers believe the findings contribute to a growing body of research, which could provide a basis for adding the new dissociative subtype distinction to the PTSD diagnosis in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

The study was led by Erika J. Wolf, Ph.D., and Mark W. Miller, Ph.D., both from the National Center for PTSD at the VA Boston Healthcare System and Department of Psychiatry at Boston University School of Medicine.

“This study helps to identify a small group of individuals who show a unique pattern of post-traumatic symptoms marked by derealization, or feeling that one’s surroundings are unreal or unfamiliar, and depersonalization, or feeling that one’s body is unfamiliar or strange,” said Wolf.

“The results clarify that these symptoms are not a core part of PTSD for most people with the disorder. However, identification of this group of individuals is important for maximizing PTSD treatment effectiveness.”

The study findings are published in the journal Archives of General Psychiatry.

Source: Boston University Medical Center

Full Citation:
Wolf EJ, Miller MW, Reardon AF, Ryabchenko KA, Castillo D, Freund R. (2012, Jul). A Latent Class Analysis of Dissociation and Posttraumatic Stress Disorder: Evidence for a Dissociative Subtype. Arch Gen Psychiatry; 69(7):698-705. doi:10.1001/archgenpsychiatry.2011.1574.

Here is the abstract for the study:

ABSTRACT

Context  The nature of the relationship of dissociation to posttraumatic stress disorder (PTSD) is controversial and of considerable clinical and nosologic importance.

 

Objectives  To examine evidence for a dissociative subtype of PTSD and to examine its association with different types of trauma.

Design  A latent profile analysis of cross-sectional data from structured clinical interviews indexing DSM-IV symptoms of current PTSD and dissociation.

Settings  The VA Boston Healthcare System and the New Mexico VA Health Care System.

Participants  A total of 492 veterans and their intimate partners, all of whom had a history of trauma. Participants reported exposure to a variety of traumatic events, including combat, childhood physical and sexual abuse, partner abuse, motor vehicle accidents, and natural disasters, with most participants reporting exposure to multiple types of traumatic events. Forty-two percent of the sample met the criteria for a current diagnosis of PTSD.

Main Outcome Measures  Item-level scores on the Clinician-Administered PTSD Scale.

Results  A latent profile analysis suggested a 3-class solution: a low PTSD severity subgroup, a high PTSD severity subgroup characterized by elevations across the 17 core symptoms of the disorder, and a small but distinctly dissociative subgroup that composed 12% of individuals with a current diagnosis of PTSD. The latter group was characterized by severe PTSD symptoms combined with marked elevations on items assessing flashbacks, derealization, and depersonalization. Individuals in this subgroup also endorsed greater exposure to childhood and adult sexual trauma compared with the other 2 groups, suggesting a possible etiologic link with the experience of repeated sexual trauma.

Conclusions  These results support the subtype hypothesis of the association between PTSD and dissociation and suggest that dissociation is a highly salient facet of posttraumatic psychopathology in a subset of individuals with the disorder.