The Relationship Between Dissociation and Complex Post-Traumatic Stress Disorder: A Scoping Review

Abstract

Complex post-traumatic stress disorder (CPTSD) has recently been recognized as an official psychiatric diagnosis in ICD-11, after years of research and advocacy in the field. It has been suggested that dissociative symptoms are a major feature of CPTSD. This scoping review aimed to summarize the existing knowledge base on the relationship between dissociation and CPTSD, and to identify relevant research gaps. We searched the two largest and most widely used academic databases (i.e., the Web of Science and Scopus databases) and the ProQuest database and identified original studies published in English relevant to our research questions, namely: (1) Would CPTSD be associated with dissociative symptoms? 2) How common are dissociative symptoms among people with CPTSD? (3) What are the correlates of dissociative symptoms among people with CPTSD? In all, 26 studies were included. We found 10 studies which reported that people with CPTSD scored significantly higher on a dissociation measure than those without CPTSD, and 11 studies reported a positive correlation between CPTSD symptoms and psychoform/somatoform dissociation scores. While very few studies reported the prevalence and correlates of dissociative symptoms among people with CPTSD, there may be a considerable subgroup of people with CPTSD who have clinically significant levels of dissociative symptoms (e.g., 28.6–76.9%). Dissociation may also be associated with other comorbidities (e.g., DSM-IV Axis II features, shame, somatic symptoms) in people with CPTSD. We recommend that more studies are needed to investigate the prevalence of dissociative symptoms among people with CPTSD and examine how these symptoms are associated with other comorbid conditions and clinical needs in this vulnerable group.

Dissociative symptoms among community health service users in Hong Kong: a longitudinal study of clinical course and consequences

“…Although our hypothesis that dissociative symptoms would predict depressive symptoms was not supported by our data, we did find that dissociative symptoms were associated with PTSD and DSO symptoms, as well as poor social and occupational participation in the community. These results are consistent with the notion that dissociation may be a crucial factor leading to post-traumatic psychopathology (Fung, Chien, Lam, et al, 2022b ; Van der Hart et al, 2006 ) and is also a disabling set of symptoms that requires greater public health attention (Loewenstein, 2018 ). These results highlight the importance of early identification and management of dissociative symptoms.…”

“…Dissociative symptoms, which reflect disruptions in the integration of thoughts, feelings, and experiences into consciousness, might engender or worsen a variety of trauma-related symptoms, such as intrusions, affective dysregulation, and relationship difficulties. Thus, our findings highlight the potentially important role of dissociation in post-traumatic psychopathology such as complex PTSD symptoms (Fung, Chien, Lam, et al, 2022b ; Nijenhuis, 2017 ; Van der Hart et al, 2006 ).…”

“…Dalenberg et al, 2012 ; Kate et al, 2020 ). Furthermore, recent studies have provided cross-cultural evidence showing that dissociative symptoms are particularly associated with childhood betrayal trauma (Fung, Chien, et al, 2023 ; Wu et al, 2022 ) and that dissociation is also associated with symptoms of complex post-traumatic stress disorder (PTSD) (Fung, Chien, Lam, et al, 2022b ).…”

Exploring the Interplay between Complex Post-Traumatic Stress Disorder and Obsessive–Compulsive Disorder Severity: Implications for Clinical Practice

“…cPTSD often leads to dissociation, a mental mechanism that can be employed adaptively or maladaptively in response to distressing life experiences [ 67 ]. Studies indicate that among individuals with minimal exposure to trauma, dissociation may serve as a normal and even constructive aspect of the mind, possibly linked to typical self-absorption phenomena and creative coping strategies during distressing events [ 68 ].…”

Unraveling the Complexity: Exploring the Intersection of Panic Disorder, Dissociation, and Complex Post-Traumatic Stress Disorder

“…Traumatic experiences, particularly childhood abuse, should be considered in the etiology of dissociation [ 23 , 24 , 25 ]. A recent review by Fung and colleagues demonstrated that a considerable number of patients with complex post-traumatic stress disorder (cPTSD) exhibited dissociative symptoms, with a clinically relevant dissociation rate of 76.9% [ 26 ]. Dissociation often functions as a defense mechanism to protect an individual’s psychological integrity against trauma [ 27 , 28 , 29 , 30 , 31 , 32 ].…”