The Relationship Between Dissociation and Symptoms of Psychosis: A Meta-analysis

Abstract

Evidence suggests that dissociation is associated with psychotic experiences, particularly hallucinations, but also other symptoms. However, until now, symptom-specific relationships with dissociation have not been comprehensively synthesized. This is the first prospectively registered (CRD42017058214) meta-analysis to quantify the magnitude of association between dissociative experiences and all symptoms of psychosis. MEDLINE, PsycINFO, PubMed, and Scopus databases were searched using exhaustive terms denoting dissociation and psychotic symptoms. We included both nonclinical (58 studies; 16 557 participants) and clinical (46 studies; 3879 patient participants) samples and evaluated study quality. Ninety-three eligible articles considering 20 436 participants were retained for analysis. There was a robust association between dissociation and clinical and nonclinical positive psychotic symptoms (r = .437; 95%CI: .386 −.486), with the observed effect larger in nonclinical studies. Symptom-specific associations were also evident across clinical and nonclinical studies, and included significant summary effects for hallucinations (r = .461; 95%CI: .386 −.531), delusions (r = .418; 95%CI: .370 −.464), paranoia (r = .447; 95%CI: .393 −.499), and disorganization (r = .346; 95%CI: .249 −.436). Associations with negative symptoms were small and, in some cases, not significant. Overall, these findings confirm that dissociative phenomena are not only robustly related to hallucinations but also to multiple positive symptoms, and less robustly related to negative symptoms. Our findings are consistent with proposals that suggest certain psychotic symptoms might be better conceptualized as dissociative in nature and support the development of interventions targeting dissociation in formulating and treating psychotic experiences.

Dissociation in relation to other mental health conditions: An exploration using network analysis

“…Further, dissociation is likely to influence paranoia, grandiosity, and cognitive disorganization. This is consistent with existing models of delusions ( Maher and Ross, 1984 ; Garety et al, 2001 ; Freeman, 2016 ), and a recent meta-analysis of the relationships between dissociation and psychotic symptoms ( Longden et al, 2020 ).…”

Psychotomimetic symptoms after a moderate dose of a synthetic cannabinoid (JWH-018): implications for psychosis

“…positive and negative symptoms, perceptual alterations, euphoria and anxiety) during intoxication (D'Souza et al 2004). Dissociation, which is 'a disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control and behaviour' (American Psychiatric Association 2013), is shown to be an important factor underlying vulnerability to psychotic experiences (Longden et al 2020). Dissociative symptoms have been reported during cannabis intoxication and are known to also occur in psychiatric disorders such as schizophrenia (Hunter et al 2004).…”

Interpersonal Violence and Psychotic-Like Experiences: The Mediation of Ideas of Reference, Childhood Memories, and Dissociation

“…Participation of emotional variables in the genesis of psychosis is a consolidated premise [48], although it was not tested in this study. In this study, a major role in the sequence of mediator variables was given to the known relationship between dissociation (absorption and depersonalization) and the psychotic process [14]. Other authors, however, believe it does not refer as much to dissociation or depersonalization as to the destructuring of the more global personality [49].…”

“…Dissociation might be the response of a maladjusted child, youth, or adult, to their resources being overwhelmed [13]. Recent reviews agree on the relationship between dissociation (e.g., absorption and depersonalization) and positive symptoms, such as hallucination, paranoia, or delusions [14]. This relationship was verified by analyzing PLE with both patients and nonclinical populations [15].…”