Dissociative Symptoms in traumatized treatment-seeking Refugees: Prevalence of the dissociative Subtype of Posttraumatic Stress Disorder and Associations with complex PTSD Symptoms

The DSM-5 and the ICD-11 differ regarding their conceptualization of dissociation in relation to Posttraumatic Stress Disorder (PTSD). The DSM-5 defines a subtype of PTSD characterized by dissociative symptoms (PTSD-DS), whereas the ICD-11 comprises some specific dissociative symptoms (flashbacks; dissociation as one variant of problems in affect regulation) in their diagnosis of (complex) PTSD. Research on the relation of trauma and dissociation in refugees is very limited. The prevalence of PTSD-DS and the association of cPTSD symptoms and dissociation severity was investigated using the baseline data of treatment-seeking traumatized refugees participating in a multi-center randomized controlled clinical trial (registration: DRKS00019876). In a sample of N =104, we found a prevalence of 36.53% for PTSD-DS. In an exploratory multiple regression analysis of dissociation severity, in which all cPTSD symptoms were entered as predictors, only re-experiencing and affective dysregulation emerged as significant contributors. Our results support the notion that there is a subgroup of individuals with additional dissociative symptoms while re-experiencing and affective dysregulation are associated with dissociation. This could be explained by perceiving dissociation as a form of avoidance in response to flashbacks or strong emotions. Another explanation could be that the definition of these criteria confounds the association since dissociative reactions are explicitly mentioned in flashbacks and affective dysregulations. We recommend to add a culturally sensitive assessment of dissociative symptoms to standard practices in clinical care of refugees so that appropriate interventions can be selected.