Archives for : Onno van der Hart

Are PTSD and C-PTSD dissociative disorders? Does it matter?

art-1699977_1920Are PTSD and C-PTSD dissociative disorders?  Yes, but it’s more important to remember that they are first of all about terror.

It appears that PTSD and C-PTSD may be grouped under the dissociative disorders in the next edition of the DSM (Diagnostic and Statistical Manual of Mental Disorders).  As Matthew Friedman points out, the new DSM-5 category of trauma and stress related disorders was intentionally placed next to the dissociative disorders in order to suggest their similarity (p. 549).  Whether this is a good direction to be heading is another question. 

A quick definition: dissociation is the division of parts of the self.  Dissociation occurs when the parts of the self that know and feel traumatic experience no longer communicate with the rest of the self.  Dissociation is generally seen on a continuum, more or less.   

What’s dissociative about PTSD and C-PTSD?  

I’ll get to C-PTSD (complex PTSD) in a minute. 

It’s easy enough to interpret the leading symptoms of PTSD in terms of dissociation.  The flashback is a dissociative symptom, a failure to prevent intrusion of unwanted and painful experience.

PTSD criteria read like a short laundry list of dissociative isolative and exclusionary processes (intrusion, numbing, and avoidance). (Chefetz, p. 28)

The dissociation associated with PTSD is characterized by an alteration between hyperarousal and numbing or constriction.  The dialectic of trauma moves between intrusion and numbing.   

Judith Herman (pp. 47-49) and others have argued that the experience of trauma generally moves from early hyperarousal to later numbing and constriction.  Others, such as Richard Chefetz see no progression, just the dominance of one position or another. 

Some people with PTSD present with flooding, and others are so emotionally shutdown that they present as emotionally flat, detached, with active dissociative process.  (p. 80)

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