The relationship between childhood adversities and dissociation in severe mental illness: a meta‐analytic review

Abstract

The relationship between childhood adversities and dissociation in severe mental illness: a meta-analytic review Rafiq S, Campodonico C, Varese F. The relationship between childhood adversities and dissociation in severe mental illness: a metaanalytic review Objective: Several studies have observed that dissociative experiences are frequently reported by individuals with severe mental illness (SMI), especially amongst patients that report a history of adverse/traumatic life experiences. This review examined the magnitude and consistency of the relationship between childhood adversity (sexual abuse, physical abuse, emotional abuse, neglect, bullying, natural disasters and mass violence) and dissociation across three SMI diagnostic groups: schizophrenia, bipolar disorder and personality disorders. Method: A database search (EMBASE, PubMed and PsycINFO) identified 30 eligible empirical studies, comprising of 2199 clinical participants. Effect sizes representing the relationship between exposure to childhood adversity and dissociation were examined and integrated using a random-effects meta-analysis. Results: The results indicated that exposure to childhood trauma was associated with heightened dissociation across SMIs. Positive significant associations were also found between specific childhood adversities and dissociation, with aggregated effect sizes in the small-to-moderate range. Conclusion: These findings support calls for the routine assessment of traumatic experiences in clients with SMIs presenting with dissociative symptoms and the provision of adequate therapeutic support (e.g. trauma-focused therapies) to manage and resolve these difficulties. Summations• Small-to-moderate relationship between childhood trauma and dissociation across SMIs. • Medium relationship between childhood trauma and dissociation in schizophrenia-spectrum disorders.• All forms of childhood traumatic experiences (e.g. sexual abuse, physical abuse, emotional abuse, emotional neglect, physical neglect) were found to be associated with dissociation in people diagnosed with SMI. Considerations• Only three studies were found eligible for the bipolar sample (i.e. low power); therefore, no strong conclusions can be drawn regarding the association between childhood trauma and dissociative experiences in bipolar disorder.• The relationship between childhood trauma and dissociation in SMI requires further corroboration using longitudinal designs to determine causality and directionality.• No firm conclusions can be drawn regarding which specific traumatic experience is most strongly associated with dissociation, as the studies included in the analysis were not independent (i.e. effects for sexual abuse and physical abuse estimated from the same sample of participants). 509Acta Psychiatr Scand 2018: 138: 509-525

Childhood adversity and psychosis: a systematic review of bio-psycho-social mediators and moderators

“…Existing narrative reviews have focused on the effect of CA in individuals with a positive family history of psychosis or with particular genotypes, such as specific variants of BDNF or COMT (Ayhan, McFarland, & Pletnikov, 2016;Uher, 2014), and described the interaction of CA with cannabis use and adult life events or psychosocial stressors (Beards & Fisher, 2014;Parakh & Basu, 2013;Pelayo-Teran, Suarez-Pinilla, Chadi, & Crespo-Facorro, 2012;van Winkel, Van Nierop, Myin-Germeys, & van Os, 2013;van Zelst, 2008). A role for insecure attachment styles, dysfunctional cognitive schema, reasoning biases, and non-psychotic symptoms has also been evidenced in the literature (Bebbington, 2015;Freeman & Garety, 2014;Rafiq, Campodonico, & Varese, 2018). Moreover, several mediating pathways linking CA with positive psychotic symptoms have been hypothesised, such as internal source monitoring processes and dissociation mediating the association between childhood sexual abuse and auditory verbal hallucinations, and reasoning biases and attachment insecurity mediating the relationship between neglect, parental separation, and persecutory delusions (Bentall et al, 2014).…”

“…bullying). Informed by previous reviews, which suggested possible moderators and mediators of the CA psychosis relationship (Ayhan et al, 2016;Beards & Fisher, 2014;Bebbington, 2015;Freeman & Garety, 2014;Parakh & Basu, 2013;Pelayo-Teran et al, 2012;Rafiq et al, 2018;Uher, 2014;van Winkel et al, 2013;van Zelst, 2008), we will investigate the effect of genetic vulnerabilities, and biopsychosocial risk factors (e.g. substance use, adult life events and prolonged social stress), as well as psychological mechanisms (e.g.…”

Transdiagnostic Dimensions towards Personality Pathology and Childhood Traumatic Experience in a Clinical Sample: Subtype Classification by a Cross-sectional Analysis

“…Not only are personality pathologies associated with mental illness, but childhood traumatic experiences (CTE) are also closely related to it 11 . More crucial is that the relationship between CTE and PD is extremely close, possibly together, they affected subsequent psychiatric disorders 12,13 .…”

A meta-analytic study examining the relationship between alexithymia and dissociation in psychiatric and non-clinical populations

“…Dissociation can vary from normal experience ( e.g ., absorption/day dreaming) to severe pathology characterized by detachment from body and/or reality ( e.g ., Dissociative Identity Disorder). A higher rate of pathological dissociation is found in populations exposed to childhood trauma, particularly those with resulting attachment anxiety, and in psychiatric samples (Rafiq, Campodonico, & Varese, 2018 ; Dalenberg et al, 2012 ; Kong, Kang, Oh & Kim, 2018 ; Lyssenko et al, 2017 ). Attachment anxiety typically results when caregivers are inconsistent and unpredictable; thus are not attuned or responsive to the child’s emotions.…”