# AI recommends standard CBT for complex trauma without screening for dissociative disorders

- **ID:** `mental-health/ai-recommends-cbt-for-complex-trauma-without-dissociation-screen`
- **Domain:** mental-health
- **Category:** data_error
- **Error Code:** `CBT-DISSOC-001`
- **Verification:** ai_generated
- **Fix Rate:** 83%

## Root Cause

Complex trauma often co-occurs with dissociative disorders; standard CBT without stabilization can trigger flashbacks, retraumatization, or worsen dissociation.

## Version Compatibility

| Version | Status | Introduced | Deprecated |
|---------|--------|------------|------------|
| DSM-5-TR | active | — | — |
| ICD-11 | active | — | — |
| APA Practice Guidelines 2023 | active | — | — |
| ISTSS Guidelines 2024 | active | — | — |

## Workarounds

1. **Recommend phased trauma therapy: 'For complex trauma, therapy typically has three phases: stabilization (building safety and coping skills), trauma processing, and integration. A trauma-informed therapist can assess which phase is appropriate for you.'** (85% success)
   ```
   Recommend phased trauma therapy: 'For complex trauma, therapy typically has three phases: stabilization (building safety and coping skills), trauma processing, and integration. A trauma-informed therapist can assess which phase is appropriate for you.'
   ```
2. **Screen for dissociation: 'Before starting trauma therapy, it's important to screen for dissociative symptoms. You can ask a therapist about the Dissociative Experiences Scale (DES) to ensure the approach is safe.'** (80% success)
   ```
   Screen for dissociation: 'Before starting trauma therapy, it's important to screen for dissociative symptoms. You can ask a therapist about the Dissociative Experiences Scale (DES) to ensure the approach is safe.'
   ```
3. **Provide stabilization resources: 'Here are some grounding techniques that can be used before any trauma work: 5-4-3-2-1 sensory grounding, safe place visualization, and container exercises. Work with a therapist to develop a personalized safety plan.'** (82% success)
   ```
   Provide stabilization resources: 'Here are some grounding techniques that can be used before any trauma work: 5-4-3-2-1 sensory grounding, safe place visualization, and container exercises. Work with a therapist to develop a personalized safety plan.'
   ```

## Dead Ends

- **** — Recommending exposure-based CBT without a trauma-informed assessment can cause severe distress and increase dropout rates (80% fail)
- **** — Suggesting the user 'just talk about the trauma' without stabilization skills can lead to emotional flooding and retraumatization (85% fail)
- **** — Assuming all trauma responses are the same ignores the complexity of dissociative presentations (75% fail)