Reactive and Dissociative Psychosis Revisited: Trauma, Identity, and the Phenomenology of Collapse
Abstract
Introduction
Diagnostic differentiation between dissociative, reactive, and psychotic disorders remains conceptually and clinically challenging due to overlapping phenomenology and insufficiently specified psychopathological criteria. Existing classification systems often fail to adequately capture the dynamic and phenomenological complexity of trauma.
Purpose
This article identifies key diagnostic gaps in the field of dissociative and reactive disorders and proposes a refined conceptual framework for their differentiation, including a novel diagnostic construct.
Methodology
A conceptual and clinical-theoretical analysis was conducted based on accumulated clinical experience and integration of relevant psychopathological and phenomenological perspectives. Particular attention was given to the analysis of symptom structure, developmental dynamics, and differential diagnostic boundaries.
Results
The analysis highlights persistent limitations in the current differentiation of dissociative and reactive conditions, particularly regarding their overlap with psychotic disorganization processes. In response, a novel hypothetical diagnostic category - schizo-dissociative reactive disorder - is proposed. This construct is defined as a clinical entity emerging at the intersection of dissociative fragmentation, trauma-related reactive mechanisms, and psychotic disorganization. Phenomenologically oriented diagnostic criteria are outlined to improve the identification of core features, including identity fragmentation, affective-cognitive disintegration, and dynamic trauma-related symptom modulation.
Conclusion
The proposed model emphasizes the need for a trauma-informed, phenomenologically grounded, and dimensionally oriented approach to diagnostic classification. Introducing the concept of schizo-dissociative reactive disorder may contribute to improved diagnostic clarity and more precise clinical stratification of complex trauma-related psychopathology.
© 2026 Mykhaylo Pustovoyt, Ivan Romash, Yuliia Medynska, Roman Kechur, Oxana Shevchuk, Iryna Romash, Vasyl Neyko, Volodymyr Paliichuk, Liubov Lutska, Olexander Myronenko, Berger Hartmut, published by International Platform on Mental Health
This work is licensed under the Creative Commons Attribution 4.0 License.