mental health disorders
Dissociative Subtype of Posttraumatic Stress Disorder
Introduction
A person with the dissociative subtype of posttraumatic stress disorder (PTSD) experiences all the symptoms of PTSD as well as depersonalization (detachment from the self) and derealization (detachment from the environment). Depersonalization and derealization are the two most prominent dissociative symptoms associated with this subtype of PTSD. Doctors diagnose this disorder in people with PTSD who have persistent or recurrent symptoms of either depersonalization or derealization. Psychotherapy includes gradual exposure to the stressor or trigger and other strategies. (See also Overview of Dissociative Disorders and refers to a mental process in which the mind's ability to automatically and fully integrate all aspects of identity, memory, and consciousness fails under the stress of trauma. As a result, a person experiencing dissociation may feel disconnected from the self, and the surrounding environment may seem unreal. Some people with PTSD experience dissociative symptoms (for example, amnesia, flashbacks, numbing, and/or Depersonalization/Derealization Disorder ), which commonly occur after exposure to trauma. Dissociation is linked to a history of experiencing abusive or neglectful parenting, psychologic trauma, and PTSD. Complex trauma, which typically begins early in life and involves a close relationship (for example, one with a caregiver), increases the likelihood that a person will develop dissociative symptoms with PTSD. Other factors associated later in life with dissociative symptoms include physical violence, shame, and guilt. In complex trauma, a child is exposed to multiple traumatic events, often in the form of child abuse or neglect. It differs from PTSD, which can result from one exceptionally traumatic event. Because a trusted caregiver is usually involved in complex traumas, the child’s neurocognitive development, sense of self, and ability to form secure attachments is disrupted, which often has consequences into adulthood. Almost 15% of people with PTSD also experience depersonalization and derealization. As a result, these people Experience PTSD symptoms more frequently Have onset of PTSD in childhood Have high exposure to trauma and more childhood adversities (for example, mental illness in a parent, divorce, and poverty) Experience severe role impairment (for example, they have difficulties in performing job responsibilities and completing work around the house) Have more suicidal thoughts and make more suicidal gestures, plans, and attempts Sudden physical injury (as from a serious illness or accident, physical violence, war, or a natural disaster), or even the threat of such injury, dysregulates emotion and normal development. This, in turn, disrupts the person's experience, alters his or her expectations for the future, and interferes with the ability to cope. Brain scans of people with PTSD show alterations in the brain structures that help control thinking and regulate emotion. In the dissociative subtype of PTSD, emotions are suppressed to such a degree that depersonalization (a disconnection from the self) and derealization (a disconnection from the surrounding environment) take place. 