Reactive and Dissociative Psychosis Re-visited: Trauma, Identity, and the Phenomenology of Collapse: Case Report with a Narrative Review and Conceptual Framework

Mykhaylo  Pustovoyt; Ivan  Romash; Yuliia  Medynska; Roman  Kechur; Oxana  Shevchuk; Iryna  Romash; Vasyl  Neyko; Volodymyr  Paliichuk; Liubov  Lutska; Olexander  Myronenko; Berger  Hartmut

doi:10.56508/mhgcj.v9i1.368

Authors

Mykhaylo Pustovoyt Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine https://orcid.org/0000-0001-8689-6220
Ivan Romash Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine https://orcid.org/0000-0002-6591-6613
Yuliia Medynska Lviv Psychoanalytic Institute of Mental Health, Lviv, Ukraine https://orcid.org/0000-0002-5688-0903
Roman Kechur Ukrainian Catholic University, Lviv, Ukraine https://orcid.org/0000-0002-9489-7351
Oxana Shevchuk Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine https://orcid.org/0009-0006-4345-2949
Iryna Romash Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine https://orcid.org/0000-0002-9749-7783
Vasyl Neyko Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine https://orcid.org/0000-0002-6033-2387
Volodymyr Paliichuk Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine https://orcid.org/0000-0002-6773-8996
Liubov Lutska Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine https://orcid.org/0009-0002-0574-9443
Olexander Myronenko Ukrainian Catholic University, Lviv, Ukraine https://orcid.org/0000-0003-0700-9393
Berger Hartmut Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany https://orcid.org/0009-0008-4813-4119

DOI:

https://doi.org/10.56508/mhgcj.v9i1.368

Keywords:

Mental Health, Dissociation, Schizo-Dissociative Reactive Disorder, Phenomenology, Differential Diagnosis, Psychosis, Trauma, Reactive Psychosis

Abstract

To read the full-text Open Access article and download the PDFs, please visit our Issue portal at Paradigm (Walter de Gruyter): https://reference-global.com/article/10.56508/mhgcj.v9i1.368

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.

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