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Dissociation

What are dissociation symptoms in PTSD?

Dissociation is a disruption in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, or behaviour. Common dissociative experiences include mild forms of absorption, such as daydreaming. Less common and more severe dissociative experiences include amnesia, derealisation, depersonalisation, and fragmentation of identity. Dissociation is not required for a diagnosis of PTSD.

Trait dissociation is a stable characteristic that may be a vulnerability factor for PTSD. In contrast, state dissociation occurs in response to situations. Peritraumatic dissociation is a form of state dissociation and refers to dissociation that occurs during a trauma. It may be a causal factor for PTSD.

What is the evidence for dissociation symptoms in people with PTSD?

Moderate to low quality evidence found people with PTSD had higher scores on the Dissociative Experiences Scale than people with other psychiatric disorders. These included borderline personality disorder, conversion disorder, schizophrenia, somatic symptom disorder, substance-related and addictive disorders, eating disorders, and affective disorders. People with PTSD had lower dissociation scores than people with dissociative disorders. People with PTSD also report symptoms of depersonalisation. Depersonalisation items endorsed by people with PTSD include; “I felt split into two people and one of me is watching what the other is doing”, “things around me felt unreal or dreamlike”, “I felt like I was in a dream”, “I felt that I was in a daze”, and “I’m not feeling like my actual self”.

Moderate quality evidence found an association between increased state/peritraumatic dissociation and increased self-reported meta-memory fragmentation. Meta-memory involves thinking about or recalling an event and making self-report ratings on the quality of the memory. There was no relationship between state/peritraumatic dissociation and narrative fragmentation, which involves recalling an event that is analysed by a clinician. There were also no relationships between trait dissociation and either meta-memory or narrative fragmentation.

Moderate to low quality evidence finds around 50% of people with PTSD report hearing voices, and there were significant associations between hearing voices and having dissociation symptoms.

August 2021

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Last updated at: 12:22 am, 8th October 2021
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