title: The dissociative subtype of posttraumatic stress disorder: rationale, clinical and neurobiological evidence, and implications.
abstract: BACKGROUND
  Clinical and neurobiological evidence for a dissociative subtype of posttraumatic stress disorder (PTSD) has recently been documented. A dissociative subtype of PTSD is being considered for inclusion in the forthcoming Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) to address the symptoms of depersonalization and derealization found among a subset of patients with PTSD. This article reviews research related to the dissociative subtype including antecedent, concurrent, and predictive validators as well as the rationale for recommending the dissociative subtype.
  
  
  METHODS
  The relevant literature pertaining to the dissociative subtype of PTSD was reviewed.
  
  
  RESULTS
  Latent class analyses point toward a specific subtype of PTSD consisting of symptoms of depersonalization and derealization in both veteran and civilian samples of PTSD. Compared to individuals with PTSD, those with the dissociative subtype of PTSD also exhibit a different pattern of neurobiological response to symptom provocation as well as a differential response to current cognitive behavioral treatment designed for PTSD.
  
  
  CONCLUSIONS
  We recommend that consideration be given to adding a dissociative subtype of PTSD in the revision of the DSM. This facilitates more accurate analysis of different phenotypes of PTSD, assist in treatment planning that is informed by considering the degree of patients' dissociativity, will improve treatment outcome, and will lead to much-needed research about the prevalence, symptomatology, neurobiology, and treatment of individuals with the dissociative subtype of PTSD.
authors.affiliation: The University of Western Ontario, London, Ontario, Canada.
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Lanius
authors.forename: Bethany
authors.initials: B
authors.lastname: Brand
authors.forename: Eric
authors.initials: E
authors.lastname: Vermetten
authors.forename: Paul A
authors.initials: PA
authors.lastname: Frewen
authors.forename: David
authors.initials: D
authors.lastname: Spiegel
mesh_terms: D001921:Brain / Q000503:physiopathology*; D015897:Comorbidity; D018450:Disease Progression; D004213:Dissociative Disorders / Q000453:epidemiology / Q000503:physiopathology*; D006801:Humans; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000503:physiopathology*