Prevalence of the dissociative subtype of post-traumatic stress disorder: a systematic review and meta-analysis

Abstract

The dissociative subtype of post-traumatic stress disorder (PTSD-DS) was introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and is characterised by symptoms of either depersonalisation or derealisation, in addition to a diagnosis of post-traumatic stress disorder (PTSD). This systematic review and meta-analysis sought to estimate the point prevalence of current PTSD-DS, and the extent to which method of assessment, demographic and trauma variables moderate this estimate, across different methods of prevalence estimation. Studies included were identified by searching MEDLINE (EBSCO), PsycInfo, CINAHL, Academic Search Complete and PTSDpubs, yielding 49 studies that met the inclusion criteria (N = 8214 participants). A random-effects meta-analysis estimated the prevalence of PTSD-DS as 38.1% (95% CI 31.5–45.0%) across all samples, 45.5% (95% CI 37.7–53.4%) across all diagnosis-based and clinical cut-off samples, 22.8% (95% CI 14.8–32.0%) across all latent class analysis (LCA) and latent profile analysis (LPA) samples and 48.1% (95% CI 35.0–61.3%) across samples which strictly used the DSM-5 PTSD criteria; all as a proportion of those already with a diagnosis of PTSD. All results were characterised by high levels of heterogeneity, limiting generalisability. Moderator analyses mostly failed to identify sources of heterogeneity. PTSD-DS was more prevalent in children compared to adults, and in diagnosis-based and clinical cut-off samples compared to LCA and LPA samples. Risk of bias was not significantly related to prevalence estimates. The implications of these results are discussed further.

The brain-body disconnect: A somatic sensory basis for trauma-related disorders

“…Symptoms include flashbacks or dissociative re-experiencing, hypervigilance, increased startle responses, behavioral avoidance of potential triggers, and pervasive negative cognitions ( American Psychiatric Association [APA], 2013 ). Additionally, PTSD + DS occurs in up to 44% of individuals with PTSD and is characterized by additional symptoms of derealization and depersonalization ( Lanius et al, 2010b ; Steuwe et al, 2012 ; Wolf et al, 2012b ; Stein et al, 2013 ; Armour et al, 2014 ; Blevins et al, 2014 ; for a review, see Hansen et al, 2017 ; White et al, 2022 ). In derealization, an individual feels as though their external environment is slowed down, foggy, dream-like, or otherwise unreal, while in depersonalization the individual feels as if they are detached from or even floating above their physical body.…”

Four reasons why we should screen for dissociation in competitive sports

“…Dissociative disorders often develop in the context of traumatic life events with a special focus on adverse childhood experiences (ACE) [16]. A recent meta-analysis estimated the prevalence of the dissociative subtype of PTSD at 38.1% across all samples [17].…”

Cannabis-assisted psychotherapy for complex dissociative posttraumatic stress disorder: A case report

“…It contains cannabinoids and several other chemicals acting on cannabinoid type-1 (CB 1 ) and type-2 (CB 2 ) receptors in neurons and immune cells (20). This includes 9 -tetrahydrocannabinol (THC), the main psychoactive ingredient of cannabis known to produce alterations in perception, awareness, and insight; or the "high" commonly reported by users. THC also has analgesic, antiinflammatory, and antioxidant properties (21).…”

“…Other complaints include memory disturbance, gaps in awareness, and sensory illusions ( 7 , 8 ). A recent meta-analysis estimated the prevalence of D-PTSD as 38.1% in patients with PTSD ( 9 ). The phenotype is further linked to increased role impairment, psychiatric comorbidity, and suicide risk compared to PTSD alone ( 10 , 11 ).…”