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Review
THE DISSOCIATIVE SUBTYPE OF POSTTRAUMATIC STRESS DISORDER: RATIONALE, CLINICAL AND NEUROBIOLOGICAL EVIDENCE, AND IMPLICATIONS
Article first published online: 16 MAR 2012
DOI: 10.1002/da.21889
© 2012 Wiley Periodicals, Inc.
Additional Information
How to Cite
Lanius, R. A., Brand, B., Vermetten, E., Frewen, P. A. and Spiegel, D. (2012), THE DISSOCIATIVE SUBTYPE OF POSTTRAUMATIC STRESS DISORDER: RATIONALE, CLINICAL AND NEUROBIOLOGICAL EVIDENCE, AND IMPLICATIONS. Depress. Anxiety, 29: 701–708. doi: 10.1002/da.21889
Publication History
- Issue published online: 1 AUG 2012
- Article first published online: 16 MAR 2012
- Manuscript Accepted: 25 NOV 2011
- Manuscript Revised: 19 NOV 2011
- Manuscript Received: 27 SEP 2011
- Abstract
- Article
- References
- Cited By
Keywords:
- PTSD;
- dissociative subtype;
- depersonalization;
- derealization;
- medial prefrontal cortex;
- amygdala;
- treatment outcome
Background
Clinical and neurobiological evidence for a dissociative subtype of posttraumatic stress disorder (PTSD) has recently been documented. A dissociative subtype of PTSD is being considered for inclusion in the forthcoming Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) to address the symptoms of depersonalization and derealization found among a subset of patients with PTSD. This article reviews research related to the dissociative subtype including antecedent, concurrent, and predictive validators as well as the rationale for recommending the dissociative subtype.
Methods
The relevant literature pertaining to the dissociative subtype of PTSD was reviewed.
Results
Latent class analyses point toward a specific subtype of PTSD consisting of symptoms of depersonalization and derealization in both veteran and civilian samples of PTSD. Compared to individuals with PTSD, those with the dissociative subtype of PTSD also exhibit a different pattern of neurobiological response to symptom provocation as well as a differential response to current cognitive behavioral treatment designed for PTSD.
Conclusions
We recommend that consideration be given to adding a dissociative subtype of PTSD in the revision of the DSM. This facilitates more accurate analysis of different phenotypes of PTSD, assist in treatment planning that is informed by considering the degree of patients’ dissociativity, will improve treatment outcome, and will lead to much-needed research about the prevalence, symptomatology, neurobiology, and treatment of individuals with the dissociative subtype of PTSD.