Panic attack or psychotic break2/15/2024 ![]() 9 Considerable evidence further suggests that psychosis, like dissociative experiences, exists on a continuum with normal functioning and that its presentation cuts across diagnostic boundaries without being necessarily pathognomonic for any specific disorder. 8 In turn, the concept of psychiatric disorders as discrete “disease entities” linked to distinct biological or genetic etiologies only present in those who meet criteria for specific conditions is increasingly contested. 3, 7 The frequency with which the so-called first rank or Schneiderian symptoms are found in dissociative disorders lends weight to this argument. 6 Indeed, some have gone so far to suggest that certain psychotic symptoms, particularly auditory hallucinations and delusions of control or passive influence experiences, are better classified as dissociative than psychotic. 5 As trauma is increasingly seen as a causal risk factor in the development of psychosis, the relevance of dissociative experiences to psychosis is being explored with more vigor. 4 The latter domain is the focus of this meta-analysis.ĭissociation has been defined by DSM-5 as “a disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behaviour.” 5 (p291) Dissociation, and the dissociative disorders, are generally seen as resulting from traumatizing experiences in recognition of this, dissociative symptoms are now formally recognized in other disorders typically seen as trauma-related, including borderline personality disorder and posttraumatic stress disorder. The concept of dissociation has become a focus of considerable interest for the psychosis field over the past few years, with research examining its importance for the historical concept of schizophrenia, 1 the prevalence of undiagnosed dissociative disorders in psychotic populations, 2 the possibility of hybrid dissociative/psychotic disorders, 3 and the role of dissociation in psychotic 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. 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. Associations with negative symptoms were small and, in some cases, not significant. Symptom-specific associations were also evident across clinical and nonclinical studies, and included significant summary effects for hallucinations ( r =. 386 −.486), with the observed effect larger in nonclinical studies. There was a robust association between dissociation and clinical and nonclinical positive psychotic symptoms ( r =. Ninety-three eligible articles considering 20 436 participants were retained for analysis. We included both nonclinical (58 studies 16 557 participants) and clinical (46 studies 3879 patient participants) samples and evaluated study quality. MEDLINE, PsycINFO, PubMed, and Scopus databases were searched using exhaustive terms denoting dissociation and psychotic symptoms. This is the first prospectively registered (CRD42017058214) meta-analysis to quantify the magnitude of association between dissociative experiences and all symptoms of psychosis. However, until now, symptom-specific relationships with dissociation have not been comprehensively synthesized. Evidence suggests that dissociation is associated with psychotic experiences, particularly hallucinations, but also other symptoms.
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