The Dissociative Subtype of Posttraumatic Stress Disorder: Forensic Considerations and Recent Controversies

Abstract

This article provides an overview of the evidence concerning the dissociative subtype of posttraumatic stress disorder (PTSD) and its relevance in forensic contexts. We discuss best practices for the assessment of the subtype in forensic settings, including consideration of malingering, and the impact of the subtype on witness presentation and potential award determinations. We review recent debate concerning the definition of the subtype and how multivariate analyses can be used to inform the understanding of the relationship between PTSD and dissociation. Altering the definition of the subtype (or of the core PTSD criteria), such as by including additional types of dissociative symptoms, would likely hold major implications for diagnostic prevalence and comorbidity and could substantially affect forensic cases involving the dissociative subtype of PTSD. We suggest that for DSM-6, it would be best to use structural evidence to decide how best to revise the subtype and accurately capture its relationship with the core PTSD symptoms. It is important for forensic experts to be well-versed in the state of the science concerning this condition so as to reliably and validly assess clients and inform triers of fact of the strengths and weaknesses of this body of work.