Dissociative experiences as mediators between childhood trauma and auditory hallucinations

Abstract

The purpose of this work was to study the relationship between reported traumatic experiences in childhood and positive psychotic symptoms. We hypothesized that dissociative experiences were potential mediators between childhood trauma and hallucinations, but not delusions. The sample comprised 71 patients diagnosed with psychoses. They were assessed with the Dissociative Experiences Scale (DES-II; Carlson & Putnam, 1993), a questionnaire on trauma (TQ; Davidson, Hughes, & Blazer, 1990), and the Positive and Negative Syndrome Scale (PANSS; Kay, Opler, & Lindenmayer, 1988) delusions and hallucinations items. The results showed that childhood trauma was positively associated with the dissociation scale scores (r = .40) and also the hallucination (r = .36) and delusions scale scores (r = .32). Furthermore, it was demonstrated that the dissociation variable was a potential mediator between childhood trauma and hallucinations, but not between childhood trauma and delusions. Of the 3 DES-II factors, only depersonalization showed a mediating relationship between childhood trauma and hallucinations. The main conclusion is that the impact of childhood trauma on hallucinations may not simply be direct, but mediated by dissociative experiences, especially depersonalization. Clinical implications are also briefly discussed.

The relationship between dissociation and voices: A systematic literature review and meta-analysis

“…The between-group studies all reported significant effects between dissociative experiences and voice-hearing. The remaining five correlational studies similarly showed significant bivariate associations for the dissociationvoices relationship (Kilcommons & Morrison, 2005;Lysaker & LaRocco, 2008;Offen et al, 2003a;Perona-Garcelán et al, 2012a;Varese et al, 2012), with two studies also employing multiple regression analysis showed that dissociation variables predicted voices when accounting for the effect of other possible predictors (Perona-Garcelán et al, 2008;2012b& Kilcommons & Morrison, 2005. In addition to the above investigations, one study used an experience sampling design to examine the relationship between voices and dissociation in a voice-hearing sample only (Varese et al, 2011b), and found that instances of voices in the daily life of voice-hearers are associated with increased dissociation even after controlling for the effect of comorbid symptoms (paranoia).…”

“…Twelve studies investigated the relationship between voice-hearing and dissociation in a psychosis sample (Kilcommons & Morrison, 2005;Lysaker & LaRocco, 2008;Maggini, et al, 2002;Offen et al, 2003a;Offen et al, 2003b;Perona-Garcelán et al, 2008;PeronaGarcelán et al, 2010;Perona-Garcelán et al, 2012a;Perona-Garcelán et al, 2012b;Spitzer, 1997;Varese et al, 2011;Varese et al, 2012). Seven studies employed a between-group design.…”

The relationship between different types of dissociation and psychosis-like experiences in a non-clinical sample

“…Previous studies on patients with psychosis have suggested that dissociative experiences associated with (typically childhood) trauma mediate the presence of psychotic symptoms in adulthood (e.g. Vogel et al, 2013;Sar et al, 2010;Perona-Garcelán et al, 2012c;Schäfer et al, 2012;Varese et al, 2012;Braehler et al, 2013).…”

“…More recently, studies have suggested that dissociation associated with childhood trauma may play a specific causal role in the development of psychotic symptoms (e.g. Vogel et al, 2013;Sar et al, 2010;Perona-Garcelán et al, 2012c;Schäfer et al, 2012;Varese et al, 2012;Braehler et al, 2013). However, the term 'dissociation' can refer to different types of symptoms and psychological processes that traditionally have been linked but are functionally and theoretically distinct (Brown, 2006) making it unclear as to which form of dissociation may be key in mediating psychotic symptoms.…”

The journey to psychosis: an exploration of specific psychological pathways

“…There appears to be most evidence for the role of dissociation as a potential mediator between childhood trauma and AVHs [10,11], and also for current attachment style as a mediator between childhood neglect and later paranoia [12]. However, the evidence for a specific risk pathway between parental miscommunication and later thought disorder in offspring, and also for source monitoring biases as a mediator between childhood sexual abuse and AVHs, is reasonably sparse [7,10].…”