psychiatric disorders
Dissociative Subtype of Posttraumatic Stress Disorder
Treatment of Dissociative Subtype of PTSD
Modified approach to psychotherapy used for PTSD Treatment should be modified from the common and effective therapies typically used for hyperarousal PTSD (prolonged exposure and cognitive processing); direct exposure may provoke further dissociation. The recommended therapeutic approach is staged psychotherapy involving gradual exposure; identifying dissociative symptomatology; stabilization, clarification, and discussion of dissociative symptoms; exploration of stressors that may lead to dissociative episodes; and controlling risk of revictimization ( Treatment references ). However, the data are mixed and subsequent studies have suggested that the essential elements of exposure-based and cognitive reprocessing psychotherapies that are effective for PTSD may also work well with those who have prominent dissociative symptoms ( Hypnotherapy may also be useful to help patients contain and reprocess traumatic memories. It may help patients maintain physical comfort, thereby using dissociation to protect them from unwanted arousal while altering their perspective on the traumatic experiences (eg, helping them recognize what they did to protect themselves or others during the trauma). This technique may enable them to both restructure their depersonalization and derealization experiences and learn control over their need for dissociation ( 1.Cloitre M, Petkova E, Wang J, et al: An examination of the influence of a sequential treatment on the course and impact of dissociation among women with PTSD related to childhood abuse.Depress Anxiety29(8):709-717, 2012. doi: 10.1002/da.21920 2.Resick PA, Suvak MK, Johnides BD, et al: The impact of dissociation on PTSD treatment with cognitive processing therapy.Depress Anxiety29(8):718-730, 2012. doi: 10.1002/da.21938 3.Burton MS, Feeny NC, Connell AM, et al: Exploring evidence of a dissociative subtype in PTSD: Baseline symptom structure, etiology, and treatment efficacy for those who dissociate.J Consult Clin Psychol;86(5):439-451, 2018. doi: 10.1037/ccp0000297 4.Zoet HA, Wagenmans A, van Minnen A, et al: Presence of the dissociative subtype of PTSD does not moderate the outcome of intensive trauma-focused treatment for PTSD.Eur J Psychotraumatol9(1):1468707, 2018. doi: 10.1080/20008198.2018.1468707 5.D Brom, R J Kleber, P B Defares: Brief psychotherapy for posttraumatic stress disorders.J Consult Clin Psychol57(5):607-612, 1989. doi: 10.1037//0022-006x.57.5.607 6.Spiegel D: The use of hypnosis in the treatment of PTSD.Psychiatr Med10(4):21-30, 1992. PMID: 1289959 