Posttraumatic Stress Disorder (PTSD)
The patient's clinical presentation of peritraumatic dissociation (out-of-body experience, emotional numbing, and memory gaps during the traumatic event) is most strongly correlated with the subsequent development of Posttraumatic Stress Disorder (PTSD), making option B the correct answer. 1, 2
Understanding Peritraumatic Dissociation as a Predictor
Peritraumatic dissociation—the dissociative symptoms occurring during or immediately after the trauma—is one of the strongest predictors for developing PTSD. 1, 2 The American Academy of Pediatrics specifically identifies dissociative symptoms such as numbness and derealization as core PTSD symptom clusters that are strongly correlated with PTSD development, especially when peritraumatic dissociation is present. 1
The patient's specific symptoms are classic peritraumatic dissociative features:
- Out-of-body experience (depersonalization/derealization) 1
- Emotional "blank" state (emotional numbing) 1
- Difficulty recalling events (dissociative amnesia) 2
Why Other Options Are Incorrect
Option A: Resilience and Functional Outcome
This is the opposite of what the evidence shows. Peritraumatic dissociation predicts worse outcomes, not resilience. 1, 2
Option C: Dissociative Identity Disorder
This is a chronic, complex dissociative disorder involving multiple distinct personality states—not an acute trauma response. The patient's symptoms are time-limited and trauma-specific. 1
Option D: Pretraumatic Dissociative Disorders
While pre-existing conditions can increase PTSD risk, the question asks what is correlated with this patient's clinical presentation—which describes peritraumatic (during-trauma) dissociation, not pre-existing pathology. 3
Option E: Pretraumatic Major Depressive Disorder
Although pre-existing depression increases PTSD risk, it doesn't explain the specific dissociative presentation described. 3 The patient's symptoms are dissociative, not depressive.
Clinical Trajectory and Management Implications
The American Academy of Pediatrics notes that peritraumatic response and related cognitions confer the greatest risk for PTSD development. 4 This patient is at high risk for:
- Acute Stress Disorder (ASD) if symptoms persist 3 days to 1 month post-trauma 1, 2
- PTSD if symptoms persist beyond 1 month 1, 2
Critical management point: The American Psychological Association guidelines emphasize that trauma-focused psychotherapy should not be delayed even in patients with dissociative symptoms, as evidence does not support that trauma-focused treatments pose significant risks. 1 Early intervention during the acute phase can prevent progression to chronic PTSD. 2
Common Pitfall to Avoid
Do not dismiss peritraumatic dissociation as a "normal" stress response. While many people experience some dissociation during trauma, the intensity and combination of symptoms described (out-of-body experience, complete emotional numbing, memory gaps) represent significant peritraumatic dissociation that warrants active monitoring and early intervention rather than passive observation. 2