A 4-D model classifies posttraumatic stress symptoms into those occurring in normal waking consciousness versus those representing dissociative altered states of consciousness. Across four dimensions—time-memory, thought, body, and emotion—the model predicts that dissociative symptoms are less frequent, less intercorrelated as momentary states, more common in people with high dissociative symptoms, and more frequent after repeated trauma, especially early developmental trauma. In a sample of 74 women with PTSD primarily from childhood trauma and 504 undergraduates, the first two predictions were supported; the third held in the PTSD sample. However, childhood trauma severity was not strongly linked to dissociative symptoms, indicating further research is needed.
Trauma-related dissociation can be understood through a 4-dimensional model that distinguishes altered states of consciousness from distress symptoms across time, thought, body, and emotions. In 111 people with trauma-related dissociative disorders receiving in-person psychotherapy plus an online psychoeducational program, intrusive memories were more common than flashbacks, and emotional numbing was more common than other forms of affect dysregulation. Negative thoughts and emotion dysregulation correlated more strongly than did voice hearing and emotional numbing. Distress symptoms were more tied to PTSD symptoms and emotion regulation difficulties, while depersonalization was more linked to dissociative self-states. Distress symptoms also reduced more than altered states during treatment. Results support distinguishing distress from dissociation, though findings varied across dimensions.