The suitable diagnostic class of sleep-related dissociative problems

Sleep-related dissociative disorder (SRDD) should be included in the field of sleep medicine and should be included in the Parasomnias section according to study results published in the Journal of Clinical Sleep Medicine.

While SRDD was previously included in the Parasomnias section of the International Classification of Sleep Disorders (ICSD), 2nd Edition 2005, this category has not been included since. The aim of this study was to summarize the clinical profile of SRDD cases and to provide data to support the reintegration of SRDD into the Parasomnias section of future editions of the ICSD.

The study researchers conducted a systematic literature search for SRDD, nocturnal dissociative disorders, and nocturnal dissociation in PubMed, PsycINFO, PsycLIT, Embase, Scopus and other databases.

In addition to the previous 11 SRDD cases reported in ICSD-2, study researchers identified 9 cases with available clinical and video polysomnography data. There were 26 additional SRDD cases, which were not considered due to lack of data.

Video polysomnography monitoring, which documents episodes resulting from electroencephalogram vigilance, was an objective finding that confirmed the diagnosis of SRDD was reported in over half of the patients in the study. Dissociative episodes during the day were an almost universal finding.

In addition, in most cases, a history of repeated trauma, including physical or emotional, was documented along with a diverse range of psychopathology.

Treatment with clonazepam resulted in no response and there have even been reports of worsening SRDD with use of clonazepam.

The study’s researchers presented several reasons for SRDD reintegration in the section on parasomnias in the next issue of ICSD. These reasons included claiming that while SRDD is technically a psychiatric disorder, it is in fact a sleep-related behavioral disorder that occurs both day and night. Because sleep clinicians are expected to refer to the Parasomnias section of ICSD when evaluating a patient with SRDD, the disorder should be included in this section. While SRDD is relatively rare, other cases are diagnosed, including cases of parasomnia overlap disorder. The inclusion of SRDD in the ICSD will improve reporting on additional cases of SRDD.

There is evidence of parasomnia border areas that include sleep behavior disorders related to post-traumatic stress disorder. Since a trauma history is common in patients with SRDD and can serve as a triggering factor, this condition should be included in the parasomnia borderline spectrum.

“Given the cases, data, and considerations just presented, it should be obvious that sleep-related dissociative disorders are embedded in the field of sleep medicine and should be included in their official nosology in the Parasomnias section,” the study’s researchers concluded.


Schenck CH, Bornemann MC, Kaplish N., Eiser AS. Sleep-Related (Psychogenic) Dissociative Disorders as Parasomnias Associated with a Psychiatric Disorder: Update of reported cases. J Clin Sleep Med. Published online December 31, 2020. doi: 10.5664 / jcsm.9048

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