Negligence of current diagnostic classifications in dissociative phenomena of posttraumatic stress disorder

Abstract

BACKGROUND: In spite of the growing importance of dissociation in post traumatic stress disorder (PTSD), dissociative symptoms are not included in the diagnostic criteria of official classifications (CID-10, DSM-IV). Research in psychophysiology, functional neuroimaging, psycho-endocrinology and opioid systems provides support for a dissociative subtype of PTSD. CASE REPORT: A case study on a PTSD patient with persistent dissociative symptoms since the trauma will show that current criteria are insufficient for detecting dissociative symptoms in PTSD. The patient meets criteria for PTSD and major depressive disorder according to the DSM-IV. He also meets criteria for depersonalization disorder, although this diagnosis is not possible with PTSD. The patient showed peritraumatic conversive symptoms, evaluated by the tonic immobility scale. Further, he obtained significant scores on the Peritraumatic Dissociative Experiences Questionnaire and the Dissociative Experiences Scale, revealing prominent peritraumatic and current dissociative symptoms. There was no improvement in the patients condition after three years of treatment. CONCLUSION: Recognition of the importance of dissociative/conversive phenomena in PTSD will allow practitioners to perfect their diagnoses, as well as improve research on the physiopathology of these phenomena and help develop more effective treatments.