Exploring a novel perspective on dissociative symptoms in PTSD: A habit-goal framework

Dissociative symptoms are common in nearly all psychiatric disorders, especially in posttraumatic stress disorder (PTSD). Yet, our understanding of its working mechanisms remains limited. This study presents a new theoretical framework, the habit-goal framework of dissociation, which conceptualizes dissociative symptoms as habitual experiential avoidance. We propose that, due to repetition and negative reinforcement, dissociative symptoms transform into mental habits that are automatically elicited by negative emotions. Using self-report measures, we investigated two core assumptions of this framework in 55 individuals (46 women, six men, three otherwise identified; M age = 42.55 (14.59)) with PTSD and long-term dissociative symptoms, currently receiving PTSD treatment. Firstly, we examined whether dissociation is a form of experiential avoidance, by assessing participants’ beliefs about the positive (e.g., relief) and negative consequences of dissociation. Secondly, we investigated whether dissociative symptoms are more under habitual than goal-directed control, by assessing the subjective automaticity and goal-directedness of the initiation of dissociation. In line with our expectations, most participants identified negative emotions as their primary trigger to dissociate, and experienced dissociation as a way of emotional avoidance. However, dissociation frequency was associated with beliefs about negative, but not positive consequences of dissociation. Furthermore, consistent with the habit-goal framework, participants experienced dissociative symptoms as being initiated automatically rather than being under goal-directed control, and increasingly so over time. To conclude, we found partial support of the habit-goal framework of dissociation. This study marks a first step to test this promising model of the persistence of dissociative symptoms and its implications for treatment.