ABSTRACT
Inclusion of the dissociative subtype of posttraumatic stress disorder (PTSD) in the DSM-5 has resulted in both a recognition of dissociation and its nature in assessment, therapy and research, and also, at times, a lack thereof. In this chapter, we review current theoretical frameworks of dissociative phenomena in psychotrauma and outline research supporting inclusion of a dissociative PTSD subtype in the DSM. We also discuss challenges with narrowly confining dissociation to the dissociative subtype of PTSD, assert that the boundaries of what we consider dissociative in PTSD may need to be widened, and propose to frame dissociation in PTSD within a larger trauma spectrum. We illustrate this with current perspectives and some clinical vignettes. An approach to Research Domain Criteria (RDoC) is taken in which stress, emotional regulation and maintenance of consciousness are highlighted as novel domains for PTSD that also yield dissociation. In reviewing the current state of affairs in psychotraumatology, it is evident that recognition of dissociation and its intersection with PTSD is needed, as is the ongoing education of healthcare professionals and research on dissociation. We recommend early career researchers and therapists build on current knowledge and apply learnings to inform trauma care.
