Research Directory
Complex PTSD & Dissociation
Longitudinal Interrelations Between Complex PTSD and Dissociation
Post-traumatic stress disorder (PTSD) and dissociation are common responses to trauma, especially interpersonal and betrayal trauma. Dissociation is recognized as a subtype of PTSD in DSM-5, while ICD-11 includes Complex PTSD (CPTSD)—defined by the core PTSD triad alongside disturbances in self-organization (DSO: affective dysregulation, negative self-concept, and relational disturbances)—as an independent diagnostic category. This longitudinal multi-cohort investigation evaluates the prospective relationship between CPTSD symptom dimensions and dissociative symptoms across Western and South Asian female samples.
Key Empirical Findings
Cross-lagged panel models and longitudinal analyses reveal bidirectional associations between DSO features and dissociative processes over time. Specifically, negative self-concept and affective dysregulation significantly predict subsequent dissociative severity, supporting the conceptualization of dissociation as an experiential defense mechanism when emotional overwhelm exceeds integrative capacity.
Citation: Fung, H. W., Lay, C. M., Yuan, G. F., Chau, A. K. C., Reyes, M. E. S., Jaya, E. S., Mukhtar, F., Lian, A. E. Z., Derin, G., Bengwasan, P. D., Kuriala, G. K. K., Uludag, K., Hartanto, S., Dewantary, N. I., Novrianto, R., Zhang, Z. J., Huang, C. H. O., Wang, S.-C., & Lam, S. K. K. (2026). The relationship between complex PTSD and dissociation: Longitudinal findings across Western and South Asian female samples. Social Psychiatry and Psychiatric Epidemiology, 1–11.
Self-Compassion in ICD-11 Complex PTSD: Cross-Cultural Evidence
Complex posttraumatic stress disorder (CPTSD) is a newly recognized trauma-related condition in the ICD-11 characterized by PTSD symptoms alongside severe disturbances in self-organization (DSO)—most prominently pervasive negative self-concept and profound feelings of worthlessness, defeat, or guilt. While self-compassion is theorized to protect against trauma-related distress, empirical cross-cultural evidence regarding whether low self-compassion represents a core hallmark of CPTSD has been limited.
Cross-Cultural Multi-Sample Findings
Analyzing extensive international cohorts spanning Indonesia, Hong Kong, Turkey, the Philippines, and Western settings, the findings confirm that individuals meeting diagnostic criteria for ICD-11 CPTSD exhibit substantially lower self-compassion across multiple cultural contexts compared to trauma-exposed individuals without CPTSD. Low self-compassion specifically accounts for unique variance in DSO severity, underscoring compassionate mind training and compassion-focused interventions as essential clinical ingredients in trauma recovery.
Citation: Fung, H. W., Cheung, C. T. Y., Chau, A. K. C., Huang, C. H. O., Reyes, M. E. S., Jaya, E. S., Mukhtar, F., Lian, A. E. Z., Derin, G., Bengwasan, P. D., Kuriala, G. K. K., Uludag, K., Hartanto, S., Dewantary, N. I., Novrianto, R., Lam, S. K. K., & Yuan, G. F. (2026). Is low self-compassion characteristic of ICD-11 complex PTSD? Further investigation using cross-cultural samples. Journal of Psychiatric Research, 193, 15–18.
Preference to Avoid Self-Experiences (PASE): Cross-Cultural Scale Validation
Individuals exposed to chronic interpersonal or developmental trauma frequently experience distressing intrusive memories, overwhelming negative emotions, and bodily tension. Consequently, many develop a pronounced preference to avoid self-experiences—a psychological coping strategy focused on suppressing or evading self-awareness, internal states, and bodily sensations to prevent emotional re-traumatization.
Psychometric Structure and Clinical Correlates
The Preference to Avoid Self-Experiences (PASE) scale was validated across diverse international samples including Indonesian participants. Confirmatory factor analysis demonstrated robust cross-cultural measurement invariance and convergent validity. Elevated PASE scores correlated strongly with Complex PTSD symptom severity, dissociative tendencies, and impaired emotional regulation, highlighting experiential avoidance as a pivotal target for acceptance and exposure-based trauma therapies.
Citation: Lay, C. M., Yuan, G. F., Lam, S. K. K., Reyes, M. E. S., Jaya, E. S., Mukhtar, F., Lian, A. E. Z., Derin, G., Bengwasan, P. D., Kuriala, G. K. K., Uludag, K., Hartanto, S., Dewantary, N. I., Novrianto, R., Leung, C. S. Y., & Fung, H. W. (2025). Psychometric evaluation of the preference to avoid self-experiences (PASE) scale: Cross-cultural validity and associations with complex PTSD and dissociation in an international female sample. Journal of Psychiatric Research, 194, 259–270.
Somatic Symptom Burden and Dissociative Experiences
Somatic symptoms—such as chronic musculoskeletal pain, gastrointestinal distress, headaches, and profound physical exhaustion—frequently co-occur with trauma exposure, yet the exact mechanistic pathways connecting post-traumatic stress, disturbances in self-organization (DSO), and dissociative states to somatic symptom burden have remained poorly differentiated in international mental health cohorts.
Cross-Sectional Findings from 995 Service Users
In a large cross-sectional study of 995 international female mental health service users across 6 countries (including Indonesia), researchers found that both PTSD symptom severity and dissociative experiences accounted for substantial independent variance in somatic symptom burden. Dissociation emerged as a crucial mediating bridge between developmental trauma and unexplained bodily pain, pointing toward the imperative of somatic-informed, bottom-up psychotherapeutic stabilization alongside cognitive trauma processing.
Citation: Lay, C. M., Yuan, G. F., Wang, E. K. S., Şar, V., Lam, S. K. K., Reyes, M. E. S., Jaya, E. S., Mukhtar, F., Lian, A. E. Z., Derin, G., Bengwasan, P. D., Kuriala, G. K. K., Uludag, K., Hartanto, S., Dewantary, N. I., Novrianto, R., Po, S. K., Huang, C. H. O., & Fung, H. W. (2025). Somatic symptom burden, PTSD, and dissociation: Cross-sectional findings from 995 international female mental health service users. Journal of Psychosomatic Research, 195, 112181.
