DSM-5 introduced a specifier for PTSD applied when the predominant clinical picture includes persistent or recurrent experiences of depersonalisation, in which the patient feels like an outside observer of their own mental processes, or derealisation. What is this specifier called?
- A Delayed expression subtype
- B Dissociative subtype ✓
- C Complex post-traumatic subtype
- D Depersonalised-derealised variant
Correct answer: B. Dissociative subtype
Explanation
The DSM-5 dissociative specifier is added when depersonalisation or derealisation predominates in PTSD, reflecting a distinct neurobiological profile with cortical inhibition over limbic activity rather than simple hyperarousal. Delayed expression refers to full criteria appearing at least six months after the trauma, which is a different concept entirely. Complex PTSD remains an ICD-11 construct and is not a DSM-5 specifier.
Reference: Diagnostic and Statistical Manual of Mental Disorders, DSM-5, 5th ed.
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