PTSD with Dissociative Symptoms: What You Need to Know

Hey there. If you’ve ever wondered whether the “blank‑out” moments you’ve been feeling could be part of PTSD, the answer is a resounding yes. A good chunk of people with PTSD also experience dissociative symptoms—things like feeling detached from their own body or watching the world as if it were a movie. In the next few minutes I’ll walk you through what that looks like, why it matters, and what you can actually do about it.

What Is Dissociation

Definition in Plain English

Dissociation is basically the brain’s way of pressing the “pause” button when something overwhelming happens. When you’re in a dissociative state you might feel like you’re outside of yourself (depersonalization) or that everything around you looks unreal (derealization). It’s not a fancy medical term you need to memorize; it’s just a protective shortcut the mind takes.

How DSM‑5 Calls It

The official manual of mental health disorders (DSM‑5) lists a “dissociative subtype” of PTSD. The label looks technical—PTSD + DS—but it simply means a person meets all the regular PTSD criteria and repeatedly experiences depersonalization or derealization. According to a 2023 update from the National Center for PTSD, this subtype was added after researchers realized the symptoms were distinct enough to deserve their own slot according to the VA research quarterly.

How Common Is It?

Studies vary a bit, but you’ll see numbers in the 12‑30 % range. UpToDate notes that roughly one in every five people with PTSD shows significant dissociative symptoms, while a veteran‑focused study found 32 % of PTSD cases fell into this group. So you’re definitely not alone.

Expert Insight

Dr. Ruth Lanius, a leading PTSD researcher at the VA, describes dissociation as “a double‑edged sword.” It can shield you from immediate overwhelm, yet it often blocks the processing needed for long‑term healing.

Spotting the Symptoms

Core PTSD Symptoms

First, let’s recap the classic PTSD signs: intrusive memories, avoidance of reminders, negative mood shifts, and hyperarousal (think “on‑edge” or “jump‑start” reactions). If you’ve checked any of those boxes, you’re already on the PTSD spectrum.

Dissociative Symptoms Explained

Now add the dissociative layer:

• Depersonalization – feeling like you’re watching yourself from outside, as if you’re a character in a movie.
• Derealization – the world looks foggy, dream‑like, or “not really there.”
• Dissociative amnesia – gaps in memory for the traumatic event or even for everyday moments.
• Dissociative flashbacks – vivid re‑experiences that feel detached from the present.

Quick Self‑Check

Ask yourself these four questions (they come from the Responses to Script‑Driven Imagery Scale used in research):

1. Did what you were experiencing seem unreal, like a dream?
2. Did you feel like a spectator watching yourself?
3. Did you feel disconnected from your body?
4. Did you feel “in a fog” or mentally distant?

If you answered “yes” to two or more, it’s worth bringing up with a mental‑health professional.

Comparison Table

Real‑World Example

Meet Sam (name changed for privacy). After a serious car accident, Sam experiences the usual flashbacks and insomnia. But he also reports that when a siren blares, he “feels like he’s watching his own hands move from a distance.” That out‑of‑body feeling is classic depersonalization, and it pushed Sam to ask his therapist about the dissociative subtype.

Why It Matters

Risks and Challenges

Dissociation isn’t just a quirky side‑effect; it can raise the stakes. Research shows higher rates of suicidality, more chronic symptoms, and greater functional impairment for those with the dissociative subtype. In other words, the “pause button” can keep you stuck in a loop.

The Protective Side

That said, dissociation can be a short‑term lifesaver. When trauma hits hard, the brain’s automatic “shut down” can prevent a flood of terror. Mind, a UK mental‑health charity, points out that occasional dissociation is a normal response—just don’t let it become the default setting.

Balancing Act Graphic (Imagine)

Picture a seesaw: on one side, dissociation protects you from immediate danger; on the other, persistent dissociation blocks processing and healing. The goal is to keep the scales balanced—not let one side dominate.

Expert Quote

“When dissociation is chronic, it interferes with the brain’s ability to integrate memories, which can worsen PTSD,” says Dr. Lanius. “That’s why we treat it explicitly rather than assuming it will resolve on its own.”

Getting Diagnosed

Screening Tools

The first step is a simple questionnaire. Many clinicians use the PTSD Checklist (PCL‑5) together with the Dissociative Experiences Scale (DES). The DES asks about frequency of “spacing out” or feeling disconnected.

Clinical Interview Cues

During a therapy visit, the clinician may ask the four script‑driven questions listed above. They’ll also explore how often the dissociative episodes happen and whether they interfere with daily life.

Assessment Flowchart (Imagine)

1️⃣ Complete PCL‑5 → 2️⃣ If score high, add DES → 3️⃣ Positive DES triggers a deeper interview → 4️⃣ Diagnosis of PTSD + DS confirmed → 5️⃣ Treatment plan built.

When to Seek Help

If you notice any of these red flags, don’t wait:

• Frequent “out‑of‑body” episodes that leave you confused.
• Memory gaps that affect work or relationships.
• Thoughts of self‑harm or feeling hopeless during dissociation.
• Inability to stay present during daily tasks.

Reaching out early can prevent the pattern from solidifying.

Treatment Options

Trauma‑Focused Psychotherapy

Evidence shows that therapy works best when it’s staged:

• Stabilization – building safety, grounding skills, and emotional regulation.
• Trauma processing – EMDR or trauma‑focused CBT, adapted to respect dissociative limits.
• Reintegration – reconnecting fragmented memories and identity.

According to a 2010 study in the American Journal of Psychiatry, EMEMDR (Eye‑Movement Desensitization and Reprocessing) specifically tweaked for dissociation led to significant symptom reduction according to research by Lanius and colleagues.

Medication

Medications treat the core PTSD symptoms but don’t erase dissociation. SSRIs (like sertraline) are first‑line; prazosin can calm nightmares; and low‑dose antipsychotics sometimes help severe depersonalization. Always discuss benefits and side‑effects with a psychiatrist.

Grounding Toolbox

Grounding techniques are the everyday “hand‑rails” that keep you anchored when you start to drift. Here are five quick skills you can try:

1. 5‑5‑5 – name 5 things you see, 5 you hear, 5 you can touch.
2. Temperature shift – hold a cold ice cube or splash cold water on your face.
3. Deep belly breaths – inhale for 4 counts, hold 2, exhale 6.
4. Physical movement – stomp your feet, stretch, or do a quick walk.
5. Safe object – keep a small token (a smooth stone, a bracelet) that reminds you “I’m here.”

When Inpatient Care Is Needed

If dissociative episodes become so frequent that you can’t stay safe (e.g., you’re prone to self‑harm while “checked out”), a short hospital stay may provide the structured environment needed for stabilization.

Supporting Loved Ones

Communication Tips

Talking about dissociation can feel awkward, but a gentle approach helps:

• Use “I” statements: “I notice you seem distant; I’m here if you want to talk.”
• Avoid “just snap out of it” language—dissociation isn’t a choice.
• Validate: “That sounds scary; it makes sense you’d feel that way.”

Creating a Safe Space

Stability is key. Offer predictable routines, reduce sudden sensory overload, and keep a “trigger‑log” handy so you can anticipate moments that might push someone into dissociation.

Resource List (Clickable)

• National Center for PTSD – therapist finder, self‑help guides.
• Mind (UK) – practical tips for families.
• PTSD UK – peer‑support groups.

Quick FAQ

Can PTSD cause depersonalization?

Yes. The dissociative subtype of PTSD specifically includes persistent depersonalization or derealization alongside the usual PTSD symptoms.

How common is the dissociative subtype?

Research ranges from 12‑30 % of PTSD cases, with higher rates in individuals exposed to chronic or early‑life trauma.

Is medication effective for dissociation?

Medication helps core PTSD (flashbacks, anxiety) but does not directly eliminate dissociation; psychotherapy with grounding is essential.

Can I self‑diagnose?

Self‑screening can raise awareness, but a qualified mental‑health professional must confirm a diagnosis.

Find Help

Professional Resources

Look for clinicians who list “dissociative PTSD” or “phase‑based trauma therapy” as specialties. Many VA hospitals, university clinics, and private practices have trained providers.

Self‑Help and Community

Online forums such as Reddit’s r/ptsd, local trauma‑informed support groups, and mindfulness‑based apps (Headspace, Calm) can supplement professional care. Remember: peer groups are great for sharing, but they don’t replace therapy.

Next Steps

If any of the descriptions above resonated with you, consider booking a short intake with a therapist or reaching out to a crisis line if you feel unsafe. You deserve relief, and there are proven paths forward.

Conclusion

Understanding that PTSD can come with dissociative symptoms is the first step toward reclaiming your life. Those “blank‑out” moments aren’t a personal failing—they’re the brain’s way of coping with overload. By spotting the signs, seeking a proper diagnosis, and embracing evidence‑based treatments—therapy, medication, and grounding—you can move from “just surviving” to truly thriving. You’re not alone on this journey; countless people, clinicians, and resources are ready to walk beside you. If you have questions or want to share your story, feel free to comment below. Let’s keep the conversation going and support each other every step of the way.