The Dissociative Subtype of Post-Traumatic Stress Disorder: Understanding Prevalence, Course, Prognosis, Characteristics, Severity, and Functional Impairment

A separate dissociative subtype of post-traumatic stress disorder (PTSD-DS) has been described in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. It has been suggested that PTSD-DS represents a small proportion of individuals with PTSD and may be a more pathological and severe subtype, however, there has been limited investigation of this subtype, especially in children, following various forms of traumatic experience. A systematic review and meta-analysis were conducted, synthesising the current evidence relating to point prevalence of a PTSD-DS in children and adults (as a proportion of those with PTSD). In addition, empirical analysis was conducted of pre-existing data from two longitudinal studies of children and adolescents; one in which they had experienced a single-event trauma, the second in which they were under the care of a local authority and had experience of abuse or neglect. Meta-analysis of 49 studies (53 samples; N = 8214) estimated the point prevalence of PTSD-DS in children and adults to be 38.1% (95% CI 31.5–45.0%). Prevalence of PTSD-DS was significantly higher for children compared to adults, and when prevalence was determined by diagnostic or clinical cut-off methods compared to latent class and profile analyses (exploratory methods that determine hidden groups based on the means of categorical and continuous variables respectively). Results of the empirical study found that: PTSD-DS was common in children with PTSD, early PTSD-DS showed similar natural recovery to early PTSD, and PTSD-DS was predictive of later PTSD following single-event trauma. Dissociation did not appear to be an important factor in post-traumatic stress symptoms or functional impairment following single- or multi-event trauma. The results of both studies suggest that PTSD-DS is relatively common, especially in children. PTSD-DS may offer little clinical utility to the extant PTSD diagnosis, and dissociation may simply be a typical part of the PTSD presentation in children. Further research is warranted into PTSD-DS following different forms of trauma and in larger samples of participants with this subtype