Managing Dissociation and Somatic Symptoms in Complex PTSD Using a Structural Dissociation-informed Approach: A Case Report

Abstract

Chronic interpersonal trauma can lead to complex clinical presentations characterized by dissociation, somatic symptoms, and disturbances in self-organization, particularly when psychosocial stressors remain active. This case report describes a 32-year-old female with prolonged interpersonal trauma who presented with dissociative episodes, somatic symptoms including fainting and jaw locking, recurrent suicidal ideation, and significant functional impairment. Symptoms intensified amid ongoing interpersonal conflict and financial stress.  Assessment findings supported a diagnosis of complex post-traumatic stress disorder (CPTSD) with prominent dissociative and somatic features. Treatment followed a phase-oriented approach informed by the structural dissociation model developed by Onno van der Hart, Ellert Nijenhuis, and Kathy Steele. Intervention progressed through stabilization, trauma-focused work, and integration, incorporating psychoeducation, grounding, body-based interventions, affect regulation, and bottom-up approaches including titration and pendulation.  Over the course of therapy, improvements were observed in awareness of dissociative experiences, emotional regulation, sleep, and daily functioning. Anxiety, depressive, and dissociative symptoms showed partial reduction, and suicidal behaviors decreased, although suicidal ideation remained intermittently present. Somatic dissociative symptoms, including fainting episodes, persisted but became more predictable and manageable. Given the concurrent psychotropic medication and single-case design, these changes cannot be attributed to psychotherapy alone.  This case illustrates the application of a phase-oriented, structural dissociation-informed approach in CPTSD with prominent dissociative and somatic symptoms, while highlighting the challenges of treatment amid ongoing psychosocial adversity.