What Do You Need To Know About The Dissociative Subtype Of Post-Traumatic Stress Disorder (PTSD)?

Are you familiar with post-traumatic stress disorder? Perhaps you have even been diagnosed with it yourself, or are close to someone with PTSD? Then you'll probably know PTSD as a trauma-related anxiety disorder that causes intrusive memories, flashbacks, a sometimes extreme avoidance of reminders of traumatic experiences, and hypervigilance. 

Not all cases of PTSD are the same, however. Several subtypes of post-traumatic stress disorder have been identified, and PTSD with dissociative features is among them. Even if you were correctly diagnosed with PTSD, there's a chance that your diagnosing psychologist or psychiatrist missed the dissociative symptoms, which extend far beyond the inability to recall important aspects of the trauma or intrusive memories that are typical for "garden-variety PTSD". 

What makes PTSD with dissociative symptoms different? 

People diagnosed with PTSD with dissociative symptoms will meet all the diagnostic criteria for PTSD — but also have additional symptoms. 

That, in short, means, that they'll experience, to varying degrees:

• At least one intrusion symptom. PTSD symptoms that fall under this heading include intrusive memories, nightmares, flashbacks and other experiences that are also considered dissociative because they'll have some "now-ness" quality, and (sometimes extreme) distress when reminded of the trauma. 
• Efforts to avoid reminders of the trauma, whether they are external — like places, people, circumstances, or physical sensations — or internal, in the form of thoughts, feelings, and memories. 
• Changes in mood and thought patterns that can include being unable to remember parts of the trauma, negative beliefs about the world or the self, ultimately logically unwarranted feelings like guilt and shame, and feelings or horror, extreme fear, or anger. A loss of interest in many activities and a persistent feeling of being detached from the world are also part of this cluster of PTSD symptoms.
• Hyperarousal symptoms that can include irritability or anger, risky, destructive behavior, hypervigilance (or always being "on guard"), being quick to startle, sleep dysfunction, and trouble concentrating. 

In this, people with dissociative PTSD are no different. They will also, however, persistently experience dissociation. This can mean two different, though related, things:

• Depersonalization. This is a feeling of being detached from yourself or your body. Many people with PTSD will experience this during a trauma — it may be an "out of body experience", a feeling of whatever is happening not happening to your body, or like you're watching a film of yourself. People with dissociative PTSD will continue to experience these feelings after the trauma. 
• Derealization. If depersonalization is a feeling of detachment from yourself, derealization is a detachment from reality or the world. The world may feel foggy or dream-like, your sensations surrounding it may be distorted (colors, objects, and other aspects of your environment may change), or you may feel like you haven't been somewhere before when you have actually been there many times. 

Dissociation exists on a spectrum. At the far end, you have dissociative identity disorder (formerly called multiple personality disorder), wherein a person becomes so fragmented that the different aspects of their self become distinct identities, and complex systems of different personalities can exist within the same body.

What are the risk factors for PTSD with dissociative symptoms?

Post-traumatic stress disorder with dissociative symptoms is most likely, research has shown, to occur in people who lived through multiple or prolonged traumas, especially during their childhood. This kind of traumatization can cause a kind of PTSD known as complex post-traumatic stress disorder.

People with co-existing or pre-existing mental disorders, like borderline personality disorder, a specific phobia, or avoidant personality disorder, also appear to have a higher risk of dissociative PTSD, especially if they are women. 

Is PTSD with dissociative symptoms treated differently?

While it's clear that the dissociative subtype of post-traumatic stress disorder further decreases a person's quality of life as compared to PTSD alone, by causing a higher level of disability, much is still unknown about dissociative PTSD. It currently appears that prolonged exposure therapy, which is one of the most effective treatments for PTSD, is not suitable for people experiencing dissociation as it can worsen symptoms. Instead, cognitive restructuring therapies seem to be more effective. Medications may also be prescribed specifically to help with dissociative symptoms, but further research is needed. 

How do you know if you are experiencing dissociative symptoms?

Questions doctors ask to determine whether you are dissociating include:

• Do you feel disconnected from your body, like it isn't your body?
• Do you "check out" of your body, like you're not present?
• Do you ever feel like you are on the outside of your body, looking in?
• Do you ever have trouble recognizing yourself in a mirror?
• Do you lose portions of time, with little idea what you did in the missing period of time? (Not caused by substance abuse blackouts.)
• Do you ever feel like you are in an unfamiliar place when you have been there many times before?
• Do things or people around you sometimes feel like they aren't real?
• Do you feel you should be able to remember more about your traumatic experiences than you actually can?