A 32-year-old soldier with PTSD reports flashbacks and nightmares. In addition, he describes repeated episodes in which he feels detached from his own body, as if watching himself from outside, and states that people around him seem unreal or robotic. Which DSM-5 specifier best captures these additional phenomena?

• A With delayed expression
• B With restricted affect
• C With dissociative symptoms: derealisation
• D With dissociative symptoms: depersonalisation ✓

Explanation

The DSM-5 dissociative subtype of PTSD is diagnosed when either depersonalisation or derealisation is present. Depersonalisation is the experience of detachment from one's own body or mental processes, exactly as described here. Derealisation refers to unreality of the external world, so option C alone is incomplete because both features coexist in this patient. Restricted affect is part of the negative alterations in cognition and mood cluster, not a specifier.

Reference: Diagnostic and Statistical Manual of Mental Disorders, DSM-5, 5th ed.

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