The dissociative post-traumatic stress disorder (PTSD) subtype : A treatment outcome cohort study in veterans with PTSD



Dissociation is a prevalent phenomenon among veterans with post-traumatic stress disorder (PTSD) that may interfere with the effectiveness of treatment. This study aimed to replicate findings of a dissociative PTSD subtype, to identify corresponding patterns in coping style, symptom type, and symptom severity, and to investigate its impact on post-traumatic symptom improvement.


Latent profile analysis (LPA) was applied to baseline data from 330 predominantly (97%) male treatment-seeking veterans (mean age 39.5 years) with a probable PTSD. Multinomial logistic models were used to identify predictors of dissociative PTSD. Eighty veterans with PTSD that commenced with psychotherapy were invited for a follow-up measure after 6 months. The majority (= 64, 80% response rate) completed the follow-up measure. Changes in post-traumatic stress between baseline and follow-up were explored as a continuous distal outcome.


Latent profile analysis revealed four distinct patient profiles: ‘low’ (12.9%), ‘moderate’ (33.2%), ‘severe’ (45.1%), and ‘dissociative’ (8.8%) PTSD. The dissociative PTSD profile was characterized by more severe pathology levels, though not post-traumatic reactions symptom severity. Veterans with dissociative PTSD benefitted equally from PTSD treatment as veterans with non-dissociative PTSD with similar symptom severity.


Within a sample of veterans with PTSD, a subsample of severely dissociative veterans was identified, characterized by elevated severity levels on pathology dimensions. The dissociative PTSD subtype did not negatively impact PTSD treatment.

Practitioner points

  • The present findings confirmed the existence of a distinct subgroup veterans that fit the description of dissociative PTSD.
  • Patients with dissociative PTSD subtype symptoms uniquely differed from patients with non-dissociative PTSD in the severity of several psychopathology dimensions.
  • Dissociative and non-dissociative PTSD patients with similar post-traumatic severity levels showed similar levels of improvement after PTSD treatment.
  • The observational design and small sample size caution interpretation of the treatment outcome data.
  • The IES-R questionnaire does not assess all PTSD DSM-IV diagnostic criteria (14 of 17), although it is considered a valid measure for an indication of PTSD.

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Joris F. G. Haagen, Allison van Rijn, Jeroen W. Knipscheer, Niels van der Aa, Rolf J. Kleber | 2018
In: British Journal of Clinical Psychology, ISSN 0144-6657; eISSN 2044-8260 | 57 | 2 | June | 203-222
Dissociative Disorders, PTSD (DSM-5), Treatment, Veterans