Dissociative subtype of DSM-5 posttraumatic stress disorder in U.S. veterans

• 19% of veterans with lifetime DSM-5 PTSD and 16% with past-month DSM-5 PTSD screened positive for the dissociative subtype.
• Veterans with the dissociative subtype reported greater cumulative trauma and PTSD symptoms than those without the subtype.
• Veterans with the dissociative subtype reported more depression and alcohol problems than those without the subtype.
• Identifying veterans with the dissociative subtype is clinically relevant but further work is needed on operationalization.

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) formally introduced a dissociative subtype of posttraumatic stress disorder (PTSD). This study examined the proportion of U.S. veterans with DSM-5 PTSD that report dissociative symptoms; and compared veterans with PTSD with and without the dissociative subtype and trauma-exposed controls on sociodemographics, clinical characteristics, and quality of life. Multivariable analyses were conducted on a nationally representative sample of 1484 veterans from the National Health and Resilience in Veterans Study (second baseline survey conducted September–October, 2013). Of the 12.0% and 5.2% of veterans who screened positive for lifetime and past-month DSM-5 PTSD, 19.2% and 16.1% screened positive for the dissociative subtype, respectively. Among veterans with PTSD, those with the dissociative subtype reported more severe PTSD symptoms, comorbid depressive and anxiety symptoms, alcohol use problems, and hostility than those without the dissociative subtype. Adjusting for PTSD symptom severity, those with the dissociative subtype continued to report more depression and alcohol use problems. These results underscore the importance of assessing, monitoring, and treating the considerable proportion of veterans with PTSD and dissociative symptoms.