Differential Diagnosis

The following differential diagnosis is based on the provided symptoms and history of sexual trauma.

• Single most likely diagnosis:

  • Dissociation: The symptoms described, such as somatic flashbacks, body freezing, and inability to ground despite being mentally aware, are characteristic of dissociative responses. Dissociation is a common coping mechanism for individuals who have experienced trauma, and it can be triggered by various stimuli, including mindfulness practices that encourage internal focus.

• Other Likely diagnoses:

  • Post-Traumatic Stress Disorder (PTSD) exacerbation: The experience of somatic flashbacks and dissociative symptoms during mindfulness practice suggests that the trauma is not fully processed or that the practice triggered a PTSD response. Even if the individual believes they have processed their trauma, certain triggers can cause a resurgence of symptoms.
  • Anxiety or Panic Attack: The freezing and inability to ground could also be symptoms of an anxiety or panic attack, especially if the mindfulness practice unintentionally triggered a state of heightened arousal or fear response.
  • Complex Trauma: Given the history of sexual trauma, complex trauma could be a factor, where the individual experiences a range of symptoms including dissociation, emotional dysregulation, and somatic symptoms due to the trauma's complexity and impact on their life.

• Do Not Miss diagnoses:

  • Seizure Disorder: Although less likely, it's crucial not to miss a seizure disorder, as some seizures can present with dissociative-like symptoms, including a frozen state and altered consciousness. The key distinguishing feature would be the presence of other seizure-like activity or a post-ictal state afterward.
  • Neurological Conditions: Certain neurological conditions, such as conversion disorder (functional neurological symptom disorder), could present with symptoms that mimic dissociation, including frozen states or inability to move. These conditions often have a psychological trigger but manifest as neurological symptoms.

• Rare diagnoses:

  • Depersonalization Disorder: Now more commonly referred to as Depersonalization/Derealization Disorder, this condition involves persistent or recurrent experiences of feeling detached from one's own mental processes or body, which could be mistaken for dissociation triggered by trauma.
  • Traumatic Brain Injury (TBI) Sequelae: If the individual has a history of TBI, some symptoms could be attributed to the aftermath of the injury, including dissociative-like states or freezing, although this would typically be accompanied by other cognitive, emotional, or physical symptoms related to the TBI.