Several mental health disorders, like post-traumatic stress disorder (PTSD), often result from trauma. Various symptoms are associated with PTSD, including nightmares, anxiety, and flashbacks. Subtypes of this disorder can sometimes be distinguished based on specific groups of symptoms. The symptoms of PTSD with dissociative symptoms are similar to those of dissociative disorders, which are also trauma-related mental health problems.
What is PTSD with dissociative symptoms, and how is it diagnosed and treated?
How Does Dissociation Work?
Dissociation is a psychological experience that involves feeling disconnected from your surroundings or yourself. Some have described it as
an out-of-body experience. Dissociation can be defined as an overall feeling of distance from your environment. It’s sometimes described as looking at it through a pane of glass or observing yourself. There is a separation between you and your identity or your immediate surroundings.
It may sound bizarre, but dissociation isn’t a psychotic break. Your brain is designed to respond to psychological trauma by doing this naturally. When someone experiences a traumatic event like a car accident or assault, they often experience a dissociative episode. It is believed that dissociation is your brain’s defense against psychological trauma. Normal dissociation, however, lasts only a short time after a traumatic event ends.
But in some cases, dissociative episodes can return at random, even when no trauma or danger is around. These random dissociative episodes are associated with dissociative disorders. People with dissociative disorders experience an involuntary disconnection from themselves and the world around them. Post-traumatic stress disorder can also be associated with dissociative episodes. Symptoms of both disorders may overlap and are closely related to trauma in your past.
A person often develops dissociative disorders after experiencing a traumatic event in their lives, similar to PTSD. It is possible to experience amnesia, loss of identity, and catatonic states as symptoms of dissociative disorders. When you suffer from dissociative PTSD, you may experience intense flashbacks in which you feel remote from the world around you. Symptoms can sometimes be worsened by stress and triggers.
What Are PTSD’s Effects on the Brain?
Post-traumatic stress disorder involves the fight-or-flight response, which is your body’s physical reaction to stress and danger. Danger, and reminders of past trauma, can trigger extreme mental and emotional responses in people with PTSD. Your brain prepares you to react quickly when you experience a traumatic event, and you become more vigilant and ready for action. Once the dangerous situation is over, the stress response diminishes.
When you are triggered by something, you experience the fight-or-flight response to the traumatic event all over again. The hippocampus is believed to be affected by PTSD. In this part of the brain, short-term memory is turned into long-term memory. When you encounter dangerous events again, the hippocampus reminds you that it is dangerous and that you should escape.
Hippocampus can become convinced that the traumatic event is happening again when you are reminded of triggers, memories, and emotions from the past. As a result, you may experience flashbacks, which are dissociative experiences in which you relive the traumatic event. Traumatic memories may also cause severe anxiety and nightmares.
What Causes PTSD?
PTSD is caused by traumatizing events. First responders and military personnel are at high risk of developing PTSD, though civilians can develop it as well. PTSD can be caused by traumatic events such as:
- Facing combat or exposure to war
- Losing a loved one
- Domestic or childhood abuse
- Witnessing a violent act or accident
- Major injuries or health problems
- Natural disasters
- Being physically or sexually assaulted
- Hearing about a traumatizing situation that a loved one experienced
Of everyone who experiences traumatic events, it’s estimated that one-third of them will experience PTSD. However, it’s unknown why some develop PTSD while others don’t. In fact, it’s common that people who experience the same traumatizing event don’t experience the same emotions and symptoms afterward.
Like other mental health issues, there are multiple factors that can increase the risk of developing PTSD, including your environment, genetics, and how you process what you experienced. For example, talking about the event right after it happens with a mental health professional or someone you trust can help decrease the risk of developing PTSD. Those with high-stress occupations, such as first responders, can take preventative steps to cope with the traumatizing situations they deal with and reduce their chances of developing PTSD.
Surrounding yourself with a strong support system can also help you to avoid PTSD. However, that alone doesn’t guarantee you will never experience it.
What Are the Dissociation Symptoms?
People with dissociative disorders can experience a range of symptoms. You may feel only a few or all of them. The three major types of dissociation include:
Dissociative Amnesia
Dissociative disorders can sometimes cause memory loss that is more severe than normal forgetfulness. There may be gaps in your memory in which you can’t remember places, people, or events. Usually, these memory gaps are due to traumatic events or periods of high stress, such as a combat tour or experiencing a natural disaster. In rare cases, amnesia can be so intense that it causes complete memory loss about yourself.
Some people experience dissociative fugue. They suddenly become lost in a state of confusion and amnesia that could last a few minutes or years.
Dissociative Identity Disorder
Once referred to as multiple personality disorder, dissociative identity disorder (DID) is characterized by a separation between several simultaneous personalities in the same person. Rather than several distinct identities, the disorder is more accurately described as a single identity that has been “fractured” into several personalities. You may feel like multiple people share your body.
Like other dissociative disorders, DID is often triggered by a traumatic event that causes your mind to fragment into separate personas. It’s thought that this happens because your mind is shielding you from a painful psychological experience.
When other personalities are in control, people with DID may experience dissociative fugue symptoms. The research on dissociative identity disorder is still ongoing, and there is still a need for more research.
Depersonalization Derealization Disorder
Dissociative disorders can cause depersonalization and derealization, which are two distinct but similar symptoms. When you feel depersonalized, you feel disconnected from yourself. The term out-of-body experience often refers to this type of experience. In derealization, you may feel like an outside observer watching the way you act, feel, or think.
As a result of derealization, you feel less connected to the world around you. It may feel as if you are living in a fog or dream world. There may also be a feeling that time is slowed or that the world isn’t real.
Depersonalization and derealization can occur at the same time. It is possible for symptoms to be persistent or to come and go for a long period of time—even years. Even though episodes usually last only a few minutes, they can be extremely distressing and uncomfortable. It’s important to note that derealization and depersonalization are not delusional thinking.
Despite feeling as if their world is not real, people with dissociative disorders know the difference between what they are feeling and reality. It is this recognition of reality that sets these symptoms apart from those that are associated with psychosis.
What Is PTSD With Dissociative Symptoms?
There are different subtypes of post-traumatic stress disorder. The subtypes of mental health disorders can often be differentiated by clusters of symptoms. These clusters create unique experiences among people with the same disorder. The dissociative symptoms of PTSD are one of many possible symptom clusters, but they can sometimes be classified as a subtype.
Recent updates to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) have included the dissociative subtype of PTSD. Mental health disorders are diagnosed using the DSM-5, which is the latest edition of this diagnostic tool.
When PTSD is accompanied by dissociative symptoms, it is referred to as PTSD with dissociative symptoms. PTSD with dissociative symptoms is diagnosed if you meet the DSM criteria for PTSD but also show signs of derealization or depersonalization.
It is necessary for these symptoms to persist or recur to meet the diagnostic criteria. Additionally, these symptoms cannot be attributed to psychoactive substances. You may lose your sense of self or individuality temporarily when taking certain drugs, which is called ego death.
In combination with PTSD, dissociative symptoms may involve flashbacks or memories of trauma. Dreams and flashbacks related to past trauma can be caused by PTSD. Flashbacks can cause you to lose touch with yourself or the environment around you. Symptoms of dissociation may be triggered by flashbacks, retraumatization, and reliving trauma that feels very real.
How Is PTSD With Dissociative Symptoms Treated?
Even though PTSD is a chronic condition, it can be treated safely and effectively. However, PTSD, like most mental health issues, is extremely complex, and your treatment plan will depend on your specific needs.
It may be helpful to use various medications and therapies that your doctor or therapist suggests. Several medications are available to treat PTSD with dissociative symptoms, including selective serotonin reuptake inhibitors (SSRIs). Insomnia and sleep disturbances may also be managed with sleep aids. EMDR (eye movement desensitization and reprocessing) is also an effective way of treating trauma, along with several kinds of behavioral therapy.
