Post-Traumatic Stress Disorder (PTSD) is a mental health condition that can develop after experiencing or witnessing a traumatic event. Core symptoms include re-experiencing the trauma (e.g., flashbacks, nightmares), avoidance of trauma-related thoughts or reminders, negative alterations in cognitions and mood, and alterations in arousal and reactivity (e.g., hypervigilance, exaggerated startle response).  

Dissociation is a central and direct defense mechanism against overwhelming traumatic experiences, particularly when actual escape is not possible, such as in cases of childhood abuse or war trauma. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) now includes a dissociative subtype of PTSD (D-PTSD), defined primarily by symptoms of derealization (feeling as if the world is not real) and depersonalization (feeling as if oneself is not real). This highlights that dissociation is not merely a co-occurring symptom but a fundamental aspect of the trauma response for a significant subgroup of individuals. While one may believe that they are separate, the are really a part of the same process, particularly if we include addiction as an dissociative processes. 

Many core symptoms of PTSD are, in essence, manifestations of dissociation, where the mind disconnects from or fragments overwhelming traumatic experiences:

• Flashbacks and Intrusive Memories: Flashbacks are vivid re-experiencing of traumatic events, where the individual feels as though the events are recurring. These are inherently dissociative experiences, ranging from distraction to a complete loss of awareness of the current context. Traumatic memories are often retrieved as dissociated mental imprints of sensory and affective elements (visual, olfactory, auditory, kinesthetic) rather than coherent narratives.  
• Emotional Numbing and Detachment: Dissociation involves states of subjective detachment, emotional numbing, and a reduction of conscious awareness of the traumatic event. This can manifest as depersonalization (feeling detached from oneself, as if observing oneself from a distance) and derealization (feeling that the world is unreal, foggy, or dreamlike). This “shut-down” of the arousal system is a passive defense mode in inescapable threat situations.  
• Amnesia and Memory Gaps: PTSD can involve memory impairments, particularly for specific details of traumatic events. Dissociative amnesia, a more severe form of memory loss, can lead to gaps in memory for personal information or significant life events, directly impeding the integration of the trauma. Dissociation interferes with the coherent encoding of salient events, leading to fragmentation or compartmentalization of memory.  

The persistence of dissociative symptoms in PTSD is a significant predictor of poorer long-term treatment outcomes. Dissociation can become maladaptive, interfering with treatment engagement and efficacy. For instance, individuals with high dissociation undergoing exposure therapy for PTSD may show reduced benefits compared to those without significant dissociative symptoms. This highlights that if the underlying dissociative coping mechanism is not addressed, the individual remains stuck in a pattern of avoiding and fragmenting their traumatic experiences, preventing true healing and integration.  

Effective treatment for PTSD, especially the dissociative subtype, requires a trauma-informed approach that directly addresses dissociation. Psychotherapies like Brainspotting, EMDR, Neurofeedback, and exposure methods are crucial, but they must be adapted to help individuals gradually process traumatic memories and emotions in a safe and contained manner, fostering integration rather than perpetuating dissociative avoidance. While one may believe that they are separate, the are really a part of the same process, particularly if we include addiction as an dissociative processes. 

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References

O’Brien, A. (2023a). Addiction as Trauma-Related Dissociation: A Phenomenological Investigation of the Addictive State. International University of Graduate Studies. (Dissertation). Retrieved at woundedhealersinstitute.org/courses/addiction-as-dissociation-model-course/

O’Brien, A. (2023b). Memory Reconsolidation in Psychedelics Therapy. In Path of the Wounded Healer: A Dissociative-Focused Phase Model for Normative and Pathological States of Consciousness: Training Manual and Guide. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/courses/addiction-as-dissociation-model-course/

O’Brien, A. (2023c). Path of the Wounded Healer: A Dissociative-Focused Phase Model for Normative and Pathological States of Consciousness: Training Manual and Guide. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/

O’Brien, A. (2024a). Healer and Healing: The re-education of the healer and healing professions as an advocation. Re-educational and Training Manual and Guide. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/

O’Brien, A. (2024e). Path of the Wounded Healers for Thrivers: Perfectionism, Altruism, and Ambition Addictions; Re-education and training manual for Abusers, Activists, Batterers, Bullies, Enablers, Killers, Narcissists, Offenders, Parents, Perpetrators, and Warriors. Re-Education and Training Manual and Guide. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/

O’Brien, A. (2025). American Made Addiction Recovery: a healer’s journey through professional recovery. Albany, NY: Wounded Healers Institute. Retrieved at woundedhealersinstitute.org/

*This is for informational and educational purposes only. For medical advice or diagnosis, consult a professional.