| Dissociative subtype PTSD | Schizophrenia and psychotic disorders | Bipolar disorder | Borderline personality disorder | |
| Trauma | Typically report early onset, severe, chronic childhood trauma. | Less likely to have severe, chronic childhood trauma. | Less likely to have severe, chronic childhood trauma. | Although may report a history of childhood trauma, it may be less severe or chronic than with dissociative disorders. |
| Dissociative symptoms | Typically endorse high levels (eg, DES average score high 20s or more) with intact reality testing. Often prefer to feel numb than to have strong feelings. May self-harm to induce a state of dissociation from traumatic experiences. | Endorse mildly high symptoms (eg, DES average score 17.6) with poor reality testing. | Lower dissociation scores expected. | Moderate symptoms (eg, DES average in the low 20s) but significantly lower than DID with intact reality testing; may not be different from dPTSD on derealization and depersonalization, but usually lower on amnesia. Often find it distressing to feel numb and may self-harm to end an episode of dissociation. |
| Hallucinatory experiences | In severe cases, may endorse hearing voice(s) but aware of the "as if" quality ("I know they're not real but I hear a child crying as she gets yelled at"); may experience brief periods of "seeing" past traumatic events in flashback; reality testing otherwise intact; auditory and visual hallucinations relate to high dissociativity/hypnotizability. | May endorse voices without awareness of the hallucinatory quality; may have visual hallucinations without recognition they are not real; hallucinations are due to psychotic process. | Experiences hallucinations only during episodes of psychotic mania- or depression; in psychotic depression, any voices are typically solely persecutory. | If experiences hallucinatory experiences, they are brief, distressing and occur during stress; if endorses voices, they express patient's polarized thoughts. |
| Affect | Typically experience a range of affective states including numbed and detached; severe cases may have inexplicable, rapid mood changes that may be triggered by internal or external precipitants (eg, sad to angry to helpless and afraid). Many mood shifts can occur per day; rarely complain of "emptiness". | Flat and/or inappropriate affect. | Shifts in mood state occur more slowly (take at least 12 hours to shift mood state and usually much longer than that). | Affect is typically less modulated than in dPTSD and shifts according to external precipitants; often the most frequent affects are emptiness and intense anger. |
| Ability to perceive accurately and think logically | Perceptions are generally accurate; thinking is usually logical and organized except for brief periods following traumatic intrusions or periods of intense flooding of traumatic symptoms. | Perception may be less accurate than in dPTSD; thinking tends to be less logical and organized. | Disturbed only during mood episodes. | Perception tends to be distorted and thinking is less logical, particularly when stressed. |
| Working alliance | Generally capable of developing a working alliance with therapist; interested in others despite fear of being hurt; usually capable of self-reflection; may have long-standing relationships and/or be avoidant and prefer to be alone because it feels "safer". | Less capable of developing a working alliance; generally less interested in others; less capacity for self-reflection. | Capable of developing a working alliance. | Often less capable of developing a working alliance; pattern of overvaluing/devaluing therapist, provocations and fear of abandonment; may expect others to be less cooperative than dPTSD; often have about the same level of interest in others as in DID; less capacity for self-reflection than in DID; history of tumultuous, chaotic relationships and difficulty tolerating being alone. |
| Comorbidity | Usually meet criteria for multiple comorbid disorders including mood disorders, PTSD and other anxiety disorders, substance disorders, mixed personality disorders, somatoform disorders as well as multiple medical illnesses such as headaches, fibromyalgia, gastrointestinal, and gynecological problems. Usually meet BPD criteria when severely decompensated/having overwhelming PTSD/dissociative disorder symptoms; most do not meet BPD criteria once stabilized. | Typically meet criteria for fewer comorbid conditions although substance disorders are common. | Typically meet criteria for fewer comorbid conditions, but comorbid substance abuse is common. | Often have a variety of comorbid disorders, but less prevalence of PTSD, somatoform disorders. |
