Dissociation in patients with non-affective psychosis: Prevalence, symptom associations, and maintenance factors

Abstract

Dissociation is problematic in its own right for patients with psychosis but may also contribute to the occurrence of psychotic experiences. We therefore set out to estimate in a large cohort of patients with psychosis the prevalence of dissociative experiences, and assess using network models the relationships between dissociation, its potential maintenance mechanisms, and mental health symptoms. 902 patients with non-affective psychosis attending UK mental health services participated. Both an undirected model and a partially directed network model were estimated to identify potential relationships between ‘felt sense of anomaly’ dissociative experiences, paranoia, hallucinations, psychological wellbeing, sleep, and six potential maintenance mechanisms (affect intolerance, perseverative thinking, general self-efficacy, alexithymia, cognitive appraisals, and cognitive-behavioural responses to dissociation). 617 patients (65.4%) had experienced at least one dissociative symptom regularly over the past fortnight, with the average number experienced being 8.9 (SD = 8.0). Dissociation had direct relationships with paranoia, hallucinations, low psychological wellbeing, cognitive appraisals, cognitive-behavioural responses to dissociation, perseverative thinking, and low alexithymia. Dissociation was a probable cause of hallucinations (94.21% of 50,000 sampled directed acyclic graphs), with a trend towards also being a cause of paranoia (86.25% of 50,000 sampled directed acyclic graphs). Approximately two-thirds of patients with psychosis experience regular dissociative experiences. Dissociation is associated with low psychological wellbeing, and it is likely to have a direct causal influence on psychotic symptoms. Catastrophic cognitive appraisals, cognitive-behavioural responses to dissociation, factors related to affect sensitivity, and perseverative thinking may contribute to the occurrence of dissociation.

Psychological mechanisms connected to dissociation: Generating hypotheses using network analyses

“…The results have informed a subsequent clinical study of dissociation in a large cohort of patients diagnosed with non-affective psychosis ( Černis et al, 2022 ). The findings of this new clinical study are consistent with the results reported with the non-clinical study.…”

The Relationship Between Dissociation and Panic Symptoms in Adolescence and the Exploration of Potential Mediators

“…Greater dissociative symptoms at the first time point related to less use of cognitive reappraisal (e.g., 'When I'm worried about something, I make myself think about it in a way that helps me feel better'), which in turn was associated with more severe panic symptoms at the second time point. Thus, it could be that when individuals prone to dissociation fail to reappraise their symptoms in a way that reduces their negative impact, the resulting escalation of anxiety may heighten both the feared dissociation sensation (Hunter et al, 2003;Černis et al, 2022a;Černis et al, 2022b) and panic symptoms. Although this study provides tentative preliminary evidence in support of this interpretation, experimental evidence is needed to confirm whether the combination of catastrophic misinterpretations of dissociation and a lack of reappraisal is not only co-morbid with panic symptoms but plays a causal role in their occurrence.…”

Measuring dissociation across adolescence and adulthood: developing the short-form Černis Felt Sense of Anomaly scale (ČEFSA-14)

“…Clinical participants were recruited by Clinical Research Network (CRN) research assistants and clinical studies officers embedded in clinical and research teams across 36 NHS trusts in England to participate in a cross-sectional self-report questionnaire study ( Černis, Molodynski, et al, 2022 ). Informed consent was obtained by CRN staff.…”