Dissociation Subtype of PTSD


Disassociation is a relatively common and normal response to trauma; an instinctive way of mentally blocking out unbearable thoughts or feelings as a result of a trauma, and so is often found alongside PTSD.

Thought to be an automatic defence mechanism when we are faced with overwhelming emotional or physical pain, research shows that up to 50% of adults experience some level of disassociation occasionally, and as a psychiatric condition it might affect up to 3% of the general population. Chronic, and problematic dissociation is most likely to develop where there is repeated threat or trauma (even more so when it starts at a young age).

The term ‘dissociation’ includes those experiencing depersonalization, derealisation or Dissociative Identity Disorder (DID) and can range from mild to severe (and everything in between). It may even last just a few moments or may be ongoing.

General dissociation disorder sufferers may experience:

  • memory loss
  • feel that their body (or the world around them) is not real
  • feel that they have several different identities
  • Sensitivity to light and sound
  • Tunnel vision
  • Feeling as if your body is larger or smaller than it is
  • Stationary objects may appear to move
  • Not being aware of the passage of time


Sufferers of ‘depersonalisation’ experience changes in self awareness and are likely to feel detached from themselves; observing themselves and their feelings, actions and thoughts as if they belong to someone else, perhaps feeling as they are ‘watching themselves from the outside’.

Some of the typical symptoms are:

  • feeling like you are watching a film of yourself
  • feeling ‘this is not happening to me’
  • reduction of the intensity, and a sense of detachment from emotions
  • loss of feeling in parts of your body
  • distorted views of your body
  • unable to recognise yourself in the mirror
  • ‘out-of-body experiences’


Those experiencing ‘derealisation’ may see the environment around them as ‘dream-like.’ They may also perceive objects as unsolid, smaller in size than they actually are, or two-dimensional. Derealisation has been described as ‘peering at the world through a fog, with the world unreachable and meaningless’.

Some of the typical symptoms are:

  • feeling like a normal environment is unfamiliar
  • feeling detached from the world
  • your perception of objects changes: shape, colour, size
  • feeling that people you know are strangers
  • a sense that what is happening is not real

Disassociative Identity Disorder (DID)

Dissociative identity disorder, or ‘multiple personality disorder’, is the most extreme of the three types of disassociation. Sufferers may feel uncertain about who they are, or even feel the presence of other identities.

Some of the typical symptoms are:

  • writing in different handwriting
  • being confused about your sexuality or gender
  • feeling like a stranger to yourself
  • feeling like there are different people within you
  • referring to yourself as ‘we’
  • behaving out of character

The relationship between disassociation and PTSD

One study of PTSD sufferers found that roughly 15 – 30% also reported symptoms of depersonalization and derealization.

Research assessing the relationship between PTSD and dissociation has suggested that there may be a ‘dissociative subtype’ of PTSD.

Studies have shown that those with the dissociative subtype of PTSD generally showed a repeated traumatization and early adverse experience prior to onset of PTSD.

Dissociative disorders are conditions that involve disruptions or breakdowns of memory, awareness, identity, or perception. In the context of severe chronic abuse, the reliance on disassociation is adaptive, as it succeeds in reducing unbearable distress, and warding off the threat of psychological annihilation.

The dissociative disorders a survivor of chronic trauma presents with vary and are inclusive of dissociative identity disorder (formerly known as multiple personality disorder), dissociative amnesia, dissociative fugue, and depersonalization disorder.

Identity confusion is also deemed a by-product of dissociation and is linked to fugue states when the traumatized person loses memory of their past and concomitantly, a tangible sense of their personal identity

Treatment of disassociation alongside PTSD

Disassociation in PTSD sufferers should be considered when looking at treatment options for PTSD.  It’s been found that those with PTSD who displayed symptoms of depersonalization and derealization generally responded better to treatments that included particular cognitive behavioural therapy and exposure therapy (which is desensitization and cognitive restructuring) rather than exposure treatment which can lead to further dissociation.

Depending on the severity of the repetitious traumas, even in progressed stages of recovery a client may find himself grappling with persistent feelings of detachment and derealization.

Given that the brain’s mediation of psychological functions is dramatically compromised by the impact of chronic trauma, this neurobiological impact may be a strong contributing factor regarding lingering dissociative symptoms in survivors of C-PTSD. When a child’s brain is habitually set to a fear response system so as to survive daily threat, brain cells are killed, and the inordinate production of stress hormones interferes with returning to a state of homeostasis.

Turning to dissociative states to relieve the pain of hyperarousal further exacerbates the effective use of one’s executive functions, such as emotional regulation and socialization. Accordingly, neuroimaging findings reveal that cortical processing of emotional material is reduced in those presenting with C-PTSD and an increase in amygdala activity, where anxiety and fear responses persists.

In spite of the harrowing repercussions of prolonged traumatic abuse and neglect, those suffering from C-PTSD and dissociative disorders profit from working through overwhelming material with a caring, seasoned professional.

Treating the sequelae of complex trauma means establishing stabilization, resolving traumatic memory, and achieving personality (re)integration and rehabilitation. Integrating and reclaiming dissociated and disowned aspects of the personality is largely dependent on constructing a cohesive narrative, which allows for the assimilation of emotional, cognitive, and physiological realities.

And finally, when fight/flight responses diminish and an enhanced sense of hope and love for self and others results from years of courageous, painstaking hard work, the survivor reaps the rewards of this capricious and harrowing journey; one’s True Self.

I would love to hear from you so please leave a comment. All feedback is much appreciated. Thank you. Erin

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