Psychological mechanisms connected to dissociation: Generating hypotheses using network analyses

Dissociative experiences in individuals with subclinical psychosis and a history of developmental trauma: a qualitative study

Background: Among individuals with psychotic experiences, those with a history of developmental trauma face greater symptom severity and worse clinical outcomes compared to those without. Dissociation constitutes a prominent, characteristic of this group's clinical presentation, whose nuances and associated characteristics remain however understudied in psychosis research. We aimed to address this gap by conducting a qualitative study to investigate the phenomenology, context, and impact of dissociative experiences in individuals with subclinical psychosis and a history of developmental trauma.Methods: 25 UK-based participants with a history of developmental trauma and meeting criteria for subclinical psychosis, based on the CAPE-15, were recruited via social media. Participants attended semi-structured interviews online, which were transcribed verbatim and analysed with thematic analysis by two researchers.Results: Thematic analysis yielded the following themes: (1) Phenomenology of Dissociation; (2) Context of Dissociation; (3) Impact of Dissociation; (4) Dissociation and Psychotic-like Phenomena. Participants described experiences of detachment and compartmentalisation, which when experienced were confusing and often distressing. Dissociation was linked to affective experiences, their history of developmental trauma and psychotic-like experiences.Conclusion: This study elucidates the complex and varied nature of dissociative experiences in individuals with subclinical psychosis with a history of developmental trauma. These findings highlight the need for further research to understand the manifestation of dissociation in this population and the links with distress and other aspects of psychopathology. Importantly, it is essential to use this understanding to inform the development of interventions and improve clinical recognition and management.

Unravelling the associations between dissociation and emotion (dys)regulation: A multidimensional meta-analytic review

BACKGROUND

The relationship between dissociation features, maladaptive regulation strategies, and emotional dysregulation is a controversial issue. This meta-analytic review provides a comprehensive and multidimensional overview of the association between aspects of dissociation and emotional (dys)regulation.

METHODS

We conducted systematic research on the main databases (Psycinfo, PsycARTICLES, Pubmed, MEDLINE, Scopus), collecting the literature of the last 20 years. A total of 120 studies were included in the meta-analytic review. The analyses were based on the Pearson coefficient as a measure of the size of the effect, using the random effect model and performing moderation analysis.

RESULTS

Results showed significant relationships between emotion (dys)regulation and the different facets of dissociation. Overall, we observed stronger associations between deficits in emotion regulation/maladaptive regulating strategies, rather than alexithymia, and dissociation, supporting the prior involvement of emotional dimensions in dissociative experiences.

CONCLUSIONS

This work confirms the connection between emotion (dys)regulation and dissociation, revealing differential patterns according to the specific assessed dimensions and, thus, providing a systematization of the associations between specific aspects of the examined constructs.

The role of trauma, attachment, dissociation, and alexithymia in pathways to negative symptoms in psychosis

OBJECTIVES

Emerging models of trauma and psychosis highlight the role of attachment, dissociation, and emotion regulation processes in pathways to positive symptoms, yet little is known about the relevance of these processes to negative symptoms. The primary aim of this study was to examine trauma, attachment, dissociation, and alexithymia as predictors of negative symptoms in psychosis. A secondary, exploratory aim was to delineate pathways by which trauma may lead to negative symptoms (via attachment, dissociative or alexithymic processes).

METHOD

This was a cross-sectional study of people attending mental health services for a psychosis-related diagnosis (N = 71). Measures of trauma, negative symptoms, attachment, alexithymia, dissociation, and depression were completed.

RESULTS

Regression analyses indicated that recurrent trauma, disorganized attachment, difficulty identifying feelings (DIF), and depression accounted for a significant portion of the variance in negative symptoms, though only DIF and depression were significant independent predictors. Subsequent serial mediation analyses indicated that recurrent trauma exerted its influence on negative symptoms through a sequence of disorganized attachment and DIF, while controlling for depression. As avoidant attachment was not associated with trauma and dissociation was not associated with total negative symptoms, hypothesized models related to these variables were not examined.

CONCLUSIONS

These exploratory findings highlight the relevance of trauma-related variables in our formulation and treatment of negative symptoms. Future research should focus on replication studies with larger clinical samples and longitudinal designs to establish causality.

"Big chunks of blank memory": complex trauma and dissociative body memory

Research into traumatic memory has focused heavily upon re-experiencing symptoms (e.g. flashbacks). Features predominantly associated with complex trauma, such as gaps in the recollection of traumatic events, remain comparatively underexplored. In this article, I draw on the testimonies of survivors of complex trauma who participated in a survey informed by Phenomenologically Grounded Qualitative Research (Køster and Fernandez in Phenomenol Cogn Sci 22:149, 2023). I provide a phenomenological account of how survivors often experience memory blanks as inchoately disturbing, despite being unable to recount 'missing' events. Although challenging and equivocal, the notion of body memory offers one way of articulating this phenomenon. Specifically, I suggest that the troubling feelings accompanying perceived gaps in recollection arise alongside a form of non-conceptual body memory, which, lacking in propositional content, fails to be meaningfully contextualised. Drawing on the literature on body memory, dissociation, and Husserl's (Collected works. Kluwer, Dordrecht, 1991 [1893-1917]) internal time consciousness, I distinguish this as dissociative body memory and describe two central, non-exhaustive, features: (1) habitual dissociation, and (2) protentive salience. What is taken to be a gap in traumatic memory is in fact only a partial gap, involving a kind of pre-reflective remembering that is not recognised as such. Dissociative body memory additionally prevents the narrative integration required for minimising these perceived gaps, leading to an ongoing sense of foreboding concerning one's past. This has significant clinical implications, highlighting that what survivors experience as forgotten must not be disregarded. At the theoretical level, the phenomenon may be a hitherto unrecognised characteristic of complex posttraumatic stress disorder and related conditions.

Depersonalisation-derealisation as a transdiagnostic treatment target: a scoping review of the evidence in anxiety, depression, and psychosis

Introduction

Depersonalisation and derealisation (DPDR) describe dissociative experiences involving distressing feelings of disconnection from oneself or one's surroundings. Such experiences are common transdiagnostically across the range of mental health presentations, with evidence to suggest they may even play an active role in the development and maintenance of other mental health concerns. If substantiated, DPDR could present a plausible novel transdiagnostic treatment target. The objective of this scoping review was to therefore to synthesise the evidence-base regarding DPDR as a transdiagnostic target for the treatment of anxiety, depression, and psychosis, in order to evaluate this proposal for each.

Methods

Embase, Ovid MEDLINE, APA PsychInfo, Scopus, and PubMed were searched for empirical published research and "grey" literature addressing transdiagnostic DPDR and primary anxiety, depression, or psychotic disorders (time range: 1993 to 12th October 2023). Extracted data were summarised and provided to the Lived Experience Advisory Panel for interpretation and analysis.

Results

We screened 3,740 records, resulting in 42 studies addressing DPDR in the context of psychosis, 28 in anxiety, and 24 in depression. The results indicate that transdiagnostic DPDR is highly likely to be a viable treatment target in psychosis, and that it may share common cognitive processes with anxiety disorders. Evidence for the feasibility of DPDR as a treatment target in depression was sparse, and thus inconclusive.

Discussion

Whilst no established interventions targeting transdiagnostic DPDR were identified by this review, its findings highlight many viable options for treatment development. Given the difficulty drawing clinically meaningful conclusions from the current evidence-base, we strongly recommend that this work actively involves people with lived experience of DPDR.

Systematic review registration

https://osf.io/ufbkn/.

Identifying Preliminary Risk Profiles for Dissociation in 16- to 25-Year-Olds Using Machine Learning

INTRODUCTION

Dissociation is associated with clinical severity, increased risk of suicide and self-harm, and disproportionately affects adolescents and young adults. Whilst evidence indicates multiple factors contribute to dissociative experiences, a multi-factorial explanation of increased risk for dissociation has yet to be achieved.

METHODS

We used multiple regression to investigate the relative influence of five plausible risk factors (childhood trauma, loneliness, marginalisation, socio-economic status, and everyday stress), and machine learning to generate tentative high-risk profiles for 'felt sense of anomaly' dissociation (FSA-dissociation) using cross-sectional online survey data from 2384 UK-based 16- to 25-year-olds.

RESULTS

Multiple regression indicated that four risk factors significantly contributed to FSA-dissociation, with relative order of contribution: everyday stress, childhood trauma, loneliness and marginalisation. Exploratory analysis using machine learning suggested dissociation results from a complex interplay between interpersonal, contextual, and intrapersonal pressures: alongside marginalisation and childhood trauma, negative self-concept and depression were important in younger (16-20 years), and anxiety and maladaptive emotion regulation in older (21-25 years) respondents.

CONCLUSIONS

Validation of these findings could inform clinical assessment, and prevention and outreach efforts, improving the under-recognition of dissociation in mainstream services.

The analysis of generative adversarial network in sports education based on deep learning

The importance of mental health is increasingly emphasized in modern society. The assessment of mental health qualities among college and university students as the future workforce holds significant significance. Therefore, this study, aiming to streamline the process of writing quality evaluations and enhance the fairness of assessment comments, explores the use of Generative Adversarial Network (GAN) technology in deep learning to evaluate the mental health qualities of college and university students through the unique avenue of sports. Firstly, GAN and Sequence Generative Adversarial Network (SeqGAN) models are introduced. Secondly, GAN is employed to construct a model for generating evaluation texts, encompassing the construction of a generator and discriminator, along with the introduction of a reward function. Finally, the constructed model is utilized to train on evaluation texts related to the mental health qualities of college and university students engaged in sports, validating the effectiveness of the model. The results indicate: (1) The pre-training of the generator in the constructed text generation model stabilizes after the 10th epoch. In contrast, the pre-training of the discriminator gradually stabilizes after the 35th epoch, demonstrating overall good training effectiveness. (2) When the generator's update speed surpasses that of the discriminator, the model's loss does not converge. However, with a reduction in the ratio of rounds between the two, there is a noticeable improvement in the convergence of the model. (3) The mean score of adaptability quality is the highest among the four indicators, suggesting a strong correlation between comment generation and adaptability quality. The results validate the effectiveness of the proposed text generation model in semantic control. This study aims to advance the level of mental health education among college and university students in the sports domain, providing theoretical references for enhancing the effectiveness of quality education assessments in other subjects as well.

Dissociative Symptoms and Interoceptive Integration

Dissociative symptoms and disorders of dissociation are characterised by disturbances in the experience of the self and the surrounding world, manifesting as a breakdown in the normal integration of consciousness, memory, identity, emotion, and perception. This paper aims to provide insights into dissociative symptoms from the perspective of interoception, the sense of the body's internal physiological state, adopting a transdiagnostic framework.Dissociative symptoms are associated with a blunting of autonomic reactivity and a reduction in interoceptive precision. In addition to the central function of interoception in homeostasis, afferent visceral signals and their neural and mental representation have been shown to shape emotional feeling states, support memory encoding, and contribute to self-representation. Changes in interoceptive processing and disrupted integration of interoceptive signals into wider cognition may contribute to detachment from the body and the world, blunted emotional experience, and altered subjective recall, as experienced by individuals who suffer from dissociation.A better understanding of the role of altered interoceptive integration across the symptom areas of dissociation could thus provide insights into the neurophysiological mechanisms underlying dissociative disorders. As new therapeutic approaches targeting interoceptive processing emerge, recognising the significance of interoceptive mechanisms in dissociation holds potential implications for future treatment targets.

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

BACKGROUND

Dissociation may be important across many mental health disorders, but has been variously conceptualised and measured. We introduced a conceptualisation of a common type of dissociative experience, 'felt sense of anomaly' (FSA), and developed a corresponding measure, the Černis Felt Sense of Anomaly (ČEFSA) scale.

AIMS

We aimed to develop a short-form version of the ČEFSA that is valid for adolescent and adult respondents.

METHOD

Data were collected from 1031 adult NHS patients with psychosis and 932 adult and 1233 adolescent non-clinical online survey respondents. Local structural equation modelling (LSEM) was used to establish measurement invariance of items across the age range. Ant colony optimisation (ACO) was used to produce a 14-item short-form measure. Finally, the expected test score function derived from item response theory modelling guided the establishment of interpretive scoring ranges.

RESULTS

LSEM indicated 25 items of the original 35-item ČEFSA were age invariant. They were also invariant across gender and clinical status. ACO of these items produced a 14-item short-form (ČEFSA-14) with excellent psychometric properties (CFI=0.992; TLI=0.987; RMSEA=0.034; SRMR=0.017; Cronbach's alpha=0.92). Score ranges were established based on the expected test scores at approximately 0.7, 1.25 and 2.0 theta (equivalent to standard deviations above the mean). Scores of 29 and above may indicate elevated levels of FSA-dissociation.

CONCLUSIONS

The ČEFSA-14 is a psychometrically valid measure of FSA-dissociation for adolescents and adults. It can be used with clinical and non-clinical respondents. It could be used by clinicians as an initial tool to explore dissociation with their clients.

The relationship between dissociation and panic symptoms in adolescence and the exploration of potential mediators

Background

Dissociative experiences have been linked to panic symptoms in adolescents, yet the nature of the association remains unclear.

Methods

In the present study, we investigated the longitudinal relationship between dissociative experiences (focusing on the felt sense of anomaly subtype) and panic, as well as the potential mediating roles of emotion regulation strategies (expressive suppression and cognitive reappraisal), alexithymia, and cognitive appraisals of dissociation. Four thousand five hundred one adolescents aged 13-18 years were recruited via social media advertising to take part in an online survey at two timepoints, 1 month apart.

Results

Analysis of 421 datasets found a significant positive relationship between initial dissociative experiences and panic symptoms reported 1 month later. This was mediated by the emotion regulation strategy of cognitive reappraisal, and cognitive appraisals of dissociation. These two variables were no longer significant mediators when controlling for panic symptoms at the first time point, likely due to the stability of panic symptoms across both assessments. Neither alexithymia nor expressive suppression were significant mediators.

Conclusions

Thus, dissociative experiences that are persistently misinterpreted in a catastrophic manner may lead to escalating anxiety and panic symptoms, which could in turn heighten and maintain the feared dissociation sensation. These results indicate that dissociative experiences are associated with panic symptoms in adolescence, with cognitive appraisals of dissociation and cognitive reappraisal playing a role in this relationship.

Neural correlates of perceptual switching and their association with empathy and alexithymia in individuals with and without autism spectrum disorder

Individuals with autism spectrum disorder (ASD) often show limited empathy (poor recognition of others' emotions) and high alexithymia (poor recognition of own emotions and external thinking), which can negatively impact their social functioning. Previous experimental studies suggest that alterations in cognitive flexibility play key roles in the development of these characteristics in ASD. However, the underlying neural mechanisms that link cognitive flexibility and empathy/alexithymia are still largely unknown. In this study, we examined the neural correlates of cognitive flexibility via functional magnetic resonance imaging during perceptual task-switching in typical development (TD) adults and adults with ASD. We also investigated associations between regional neural activity and psychometric empathy and alexithymia scores among these populations. In the TD group, stronger activation of the left middle frontal gyrus was associated with better perceptual switching and greater empathic concern. Among individuals with ASD, stronger activation of the left inferior frontal gyrus was associated with better perceptual switching, greater empathy, and lower alexithymia. These findings will contribute to develop a better understanding of social cognition, and could be informative for the development of new ASD therapies.

Developing an understanding of the relationship between anxiety and dissociation in adolescence

Anxiety is a common problem in adolescence which is hypothesised to be associated with dissociation, a range of distressing symptoms linked to reduced psychosocial functioning. Yet, to date, research into the mechanisms of dissociation in adolescents has been limited. The present study investigated the link between trait anxiety and dissociative experiences (depersonalisation and 'felt sense of anomaly') using an online survey. Cognitive appraisals of dissociation, perseverative thinking, and body vigilance were assessed as potential mediating factors of this relationship. 1211 adolescents aged 13-18 years were recruited via social media advertisements and local schools. Linear regression showed a moderate positive relationship between trait anxiety and both dissociation constructs. Hierarchical regression indicated that cognitive appraisals of dissociation and perseverative thinking mediated the relationship between trait anxiety and both dissociation constructs, but trait anxiety was a significant predictor for felt sense of anomaly but not depersonalisation after including the mediators. The final models accounted for 58.7% of variance in depersonalisation and 68.4% of variance in felt sense of anomaly. These results support the hypothesis that dissociation is associated with anxiety in adolescence. They also demonstrate that cognitive-behavioural conceptualisations may be valid for understanding dissociation in adolescence.