![]() ![]() ![]() In addition, there are several self-report rating scales that assess dissociative symptomatology. The Clinician-Administered PTSD Scale (CAPS) includes items assessing depersonalization ("Have there been times when you felt as if you were outside of your body, watching yourself as if you were another person?") and derealization ("Have there been times when things going on around you seemed unreal or very strange and unfamiliar?"). Additional research is needed to more fully evaluate the effects of depersonalization and derealization on treatment response. Individuals with PTSD who exhibited symptoms of depersonalization and derealization tended to respond better to treatments that included cognitive restructuring and skills training in affective and interpersonal regulation in addition to exposure-based therapies (7,8). Effects of depersonalization and derealization on treatment responseĮarly evidence suggests that symptoms of depersonalization and derealization in PTSD are relevant to treatment decisions in PTSD (reviewed in Lanius et al., 2012 5). Depersonalization/derealization responses are suggested to be mediated by midline prefrontal inhibition of the limbic regions (5,6). In contrast, the group who exhibited symptoms of depersonalization and derealization showed increased activation in the rostral anterior cingulate cortex and the medial prefrontal cortex. Reliving responses are, therefore, thought to be mediated by failure of prefrontal inhibition or top-down control of limbic regions. Neurobiological evidence suggests depersonalization and derealization responses in PTSD are distinct from re-experiencing/hyperarousal reactivity. Individuals who re-experienced their traumatic memory and showed concomitant psychophysiological hyperarousal exhibited reduced activation in the medial prefrontal- and the rostral anterior cingulate cortex and increased amygdala reactivity. The subtype also replicated cross-culturally. Individuals with the dissociative subtype were more likely: a) to be male, b) have experienced repeated traumatization and early adverse experiences, c) have comorbid psychiatric disorders, and d) evidenced greater suicidality and functional impairment (4). Several studies using latent class, taxometric, epidemiological, and confirmatory factor analyses conducted on PTSD symptom endorsements collected from Veteran and civilian PTSD samples indicated that a subgroup of individuals (roughly 15 - 30%) suffering from PTSD reported symptoms of depersonalization and derealization (1-3). Symptoms of depersonalization and derealization The addition of a dissociative subtype of PTSD in DSM-5 was based on these lines of evidence. Recognizing a dissociative subtype of PTSD has the potential to improve the assessment and treatment outcome of PTSD.  Even though dissociative symptoms such as flashbacks and psychogenic amnesia are included as part of the core PTSD symptoms, evidence suggests that a subgroup of PTSD patients exhibits additional symptoms of dissociation, including depersonalization and derealization, thus warranting a subtype of PTSD specifically focusing on these two symptoms. The recognition of a dissociative subtype of PTSD as part of the DSM-5 PTSD diagnosis was based on three converging lines of research: (1) symptom assessments, (2) treatment outcomes, and (3) psychobiological studies. The addition of a dissociative subtype to the PTSD diagnosis is expected to further advance research examining the etiology, epidemiology, neurobiology, and treatment response of this subtype and facilitate the search for biomarkers of PTSD. Similarly, states of derealization during which individuals experience that 'things are not real it is just a dream' create the perception that 'this is not really happening to me' and are often associated with the experience of decreased emotional intensity.An 'out-of-body' or depersonalization experience during which individuals often see themselves observing their own body from above has the capacity to create the perception that 'this is not happening to me' and is typically accompanied by an attenuation of the emotional experience.States of depersonalization and derealization provide striking examples of how consciousness can be altered to accommodate overwhelming experience that allows the person to continue functioning under fierce conditions. Rationale Evidence Assessment Associated features and risks of the dissociative subtype Treatment concerns ReferencesĬonfrontation with overwhelming experience from which actual escape is not possible, such as childhood abuse, torture, as well as war trauma challenges the individual to find an escape from the external environment as well as their internal distress and arousal when no escape is possible. VA Software Documentation Library (VDL).Clinical Trainees (Academic Affiliations).War Related Illness & Injury Study Center. ![]()
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