F43 vs F44
F44 — Dissociative [conversion] disorders
Distinguish a stress reaction in which dissociative symptoms are one feature among several from a dissociative disorder in which dissociative symptoms are the predominant presentation.
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Show overlap — what both share
Both can occur in close relationship to a stressful or traumatic event, and PTSD can include dissociative symptoms such as emotional numbing or a sense of unreality.
Show decisive evidence
- F43 (particularly PTSD) requires the broader characteristic symptom cluster of re-experiencing, avoidance, and hyperarousal, with any dissociative features occurring as part of that broader picture.
- F44 applies when dissociative symptoms (memory loss, altered identity, loss of movement or sensation) become the predominant, defining feature of the presentation, rather than one feature among the fuller PTSD symptom cluster.
- Checking whether the full re-experiencing/avoidance/hyperarousal cluster is present (favouring F43) or whether a specific dissociative symptom dominates the picture (favouring F44) is the decisive step.
What weakens F43: Evidence of the full re-experiencing/avoidance/hyperarousal symptom cluster weakens a primary F44 classification and favours F43; evidence that a specific dissociative symptom (e.g. amnesia, loss of movement) is the predominant, isolated feature, without the fuller PTSD cluster, weakens F43 and favours F44.
Show duration / course
Both can arise in relationship to a stressful event; the decisive factor is which symptom cluster predominates, not which occurs first or lasts longer.
Show exclusions / context
A vignette's overall symptom pattern — the fuller PTSD cluster versus an isolated, predominant dissociative symptom — is what should be checked.
Show information still needed
Whether the fuller re-experiencing/avoidance/hyperarousal symptom cluster is present, or whether a specific dissociative symptom is the predominant, defining feature of the presentation.
Show the common trap
Classifying any dissociative feature occurring after a stressful event as F44, without checking whether it is actually one feature within a broader PTSD symptom cluster.
Mini challenge — practise this distinction
Apply the discriminating evidence above to a fresh case before checking the full feedback.