Dissociation in patients with non-affective psychosis: prevalence, symptom associations, and maintenance factors

Emma Černis; Andrew Molodynski; Anke Ehlers; Daniel Freeman

doi:10.1016/j.schres.2021.11.008

Dissociation in patients with non-affective psychosis: prevalence, symptom associations, and maintenance factors

Emma Černis^*, Andrew Molodynski, Anke Ehlers, Daniel Freeman

^*Corresponding author for this work

Psychology

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

29 Downloads (Pure)

Abstract

Dissociation is problematic in its own right for patients with psychosis but may also contribute to the occurrence of psychotic experiences. We therefore set out to estimate in a large cohort of patients with psychosis the prevalence of dissociative experiences, and assess using network models the relationships between dissociation, its potential maintenance mechanisms, and mental health symptoms. 902 patients with non-affective psychosis attending UK mental health services participated. Both an undirected model and a partially directed network model were estimated to identify potential relationships between ‘felt sense of anomaly’ dissociative experiences, paranoia, hallucinations, psychological wellbeing, sleep, and six potential maintenance mechanisms (affect intolerance, perseverative thinking, general self-efficacy, alexithymia, cognitive appraisals, and cognitive-behavioural responses to dissociation). 617 patients (65.4%) had experienced at least one dissociative symptom regularly over the past fortnight, with the average number experienced being 8.9 (SD = 8.0). Dissociation had direct relationships with paranoia, hallucinations, low psychological wellbeing, cognitive appraisals, cognitive-behavioural responses to dissociation, perseverative thinking, and low alexithymia. Dissociation was a probable cause of hallucinations (94.21% of 50,000 sampled directed acyclic graphs), with a trend towards also being a cause of paranoia (86.25% of 50,000 sampled directed acyclic graphs). Approximately two-thirds of patients with psychosis experience regular dissociative experiences. Dissociation is associated with low psychological wellbeing, and it is likely to have a direct causal influence on psychotic symptoms. Catastrophic cognitive appraisals, cognitive-behavioural responses to dissociation, factors related to affect sensitivity, and perseverative thinking may contribute to the occurrence of dissociation.

Original language	English
Pages (from-to)	11-18
Number of pages	8
Journal	Schizophrenia Research
Volume	239
Early online date	17 Nov 2021
DOIs	https://doi.org/10.1016/j.schres.2021.11.008
Publication status	Published - Jan 2022

Bibliographical note

Funding Information:
The work was supported by the Wellcome Trust via a Clinical Doctoral Fellowship to EČ (grant number 102176/B/13/Z ). DF was supported during this work by an NIHR Research Professorship ( NIHR-RP-2014-05-003 ) and is an NIHR Senior Investigator. AE is funded by the Wellcome Trust ( 200796 ) and supported by the NIHR Oxford Health Biomedical Research Centre and a NIHR Senior Investigator Award. The views expressed are those of the authors and not necessarily those of the National Health Service, NIHR, or Department of Health.

Publisher Copyright:
© 2021 The Authors

Keywords

Depersonalization
Dissociation
Network analysis
Prevalence
Psychological mechanisms
Psychosis

ASJC Scopus subject areas

Psychiatry and Mental health
Biological Psychiatry

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.schres.2021.11.008Licence: Creative Commons: Attribution (CC BY)

ČernisE2021DissociationFinal published version, 768 KBLicence: Creative Commons: Attribution (CC BY)

Cite this

@article{c4054267ad404f608dc152d3366d417c,

title = "Dissociation in patients with non-affective psychosis: prevalence, symptom associations, and maintenance factors",

abstract = "Dissociation is problematic in its own right for patients with psychosis but may also contribute to the occurrence of psychotic experiences. We therefore set out to estimate in a large cohort of patients with psychosis the prevalence of dissociative experiences, and assess using network models the relationships between dissociation, its potential maintenance mechanisms, and mental health symptoms. 902 patients with non-affective psychosis attending UK mental health services participated. Both an undirected model and a partially directed network model were estimated to identify potential relationships between {\textquoteleft}felt sense of anomaly{\textquoteright} dissociative experiences, paranoia, hallucinations, psychological wellbeing, sleep, and six potential maintenance mechanisms (affect intolerance, perseverative thinking, general self-efficacy, alexithymia, cognitive appraisals, and cognitive-behavioural responses to dissociation). 617 patients (65.4%) had experienced at least one dissociative symptom regularly over the past fortnight, with the average number experienced being 8.9 (SD = 8.0). Dissociation had direct relationships with paranoia, hallucinations, low psychological wellbeing, cognitive appraisals, cognitive-behavioural responses to dissociation, perseverative thinking, and low alexithymia. Dissociation was a probable cause of hallucinations (94.21% of 50,000 sampled directed acyclic graphs), with a trend towards also being a cause of paranoia (86.25% of 50,000 sampled directed acyclic graphs). Approximately two-thirds of patients with psychosis experience regular dissociative experiences. Dissociation is associated with low psychological wellbeing, and it is likely to have a direct causal influence on psychotic symptoms. Catastrophic cognitive appraisals, cognitive-behavioural responses to dissociation, factors related to affect sensitivity, and perseverative thinking may contribute to the occurrence of dissociation.",

keywords = "Depersonalization, Dissociation, Network analysis, Prevalence, Psychological mechanisms, Psychosis",

author = "Emma {\v C}ernis and Andrew Molodynski and Anke Ehlers and Daniel Freeman",

note = "Funding Information: The work was supported by the Wellcome Trust via a Clinical Doctoral Fellowship to E{\v C} (grant number 102176/B/13/Z ). DF was supported during this work by an NIHR Research Professorship ( NIHR-RP-2014-05-003 ) and is an NIHR Senior Investigator. AE is funded by the Wellcome Trust ( 200796 ) and supported by the NIHR Oxford Health Biomedical Research Centre and a NIHR Senior Investigator Award. The views expressed are those of the authors and not necessarily those of the National Health Service, NIHR, or Department of Health. Publisher Copyright: {\textcopyright} 2021 The Authors",

year = "2022",

month = jan,

doi = "10.1016/j.schres.2021.11.008",

language = "English",

volume = "239",

pages = "11--18",

journal = "Schizophrenia Research",

issn = "0920-9964",

publisher = "Elsevier",

}

TY - JOUR

T1 - Dissociation in patients with non-affective psychosis

T2 - prevalence, symptom associations, and maintenance factors

AU - Černis, Emma

AU - Molodynski, Andrew

AU - Ehlers, Anke

AU - Freeman, Daniel

N1 - Funding Information: The work was supported by the Wellcome Trust via a Clinical Doctoral Fellowship to EČ (grant number 102176/B/13/Z ). DF was supported during this work by an NIHR Research Professorship ( NIHR-RP-2014-05-003 ) and is an NIHR Senior Investigator. AE is funded by the Wellcome Trust ( 200796 ) and supported by the NIHR Oxford Health Biomedical Research Centre and a NIHR Senior Investigator Award. The views expressed are those of the authors and not necessarily those of the National Health Service, NIHR, or Department of Health. Publisher Copyright: © 2021 The Authors

PY - 2022/1

Y1 - 2022/1

N2 - Dissociation is problematic in its own right for patients with psychosis but may also contribute to the occurrence of psychotic experiences. We therefore set out to estimate in a large cohort of patients with psychosis the prevalence of dissociative experiences, and assess using network models the relationships between dissociation, its potential maintenance mechanisms, and mental health symptoms. 902 patients with non-affective psychosis attending UK mental health services participated. Both an undirected model and a partially directed network model were estimated to identify potential relationships between ‘felt sense of anomaly’ dissociative experiences, paranoia, hallucinations, psychological wellbeing, sleep, and six potential maintenance mechanisms (affect intolerance, perseverative thinking, general self-efficacy, alexithymia, cognitive appraisals, and cognitive-behavioural responses to dissociation). 617 patients (65.4%) had experienced at least one dissociative symptom regularly over the past fortnight, with the average number experienced being 8.9 (SD = 8.0). Dissociation had direct relationships with paranoia, hallucinations, low psychological wellbeing, cognitive appraisals, cognitive-behavioural responses to dissociation, perseverative thinking, and low alexithymia. Dissociation was a probable cause of hallucinations (94.21% of 50,000 sampled directed acyclic graphs), with a trend towards also being a cause of paranoia (86.25% of 50,000 sampled directed acyclic graphs). Approximately two-thirds of patients with psychosis experience regular dissociative experiences. Dissociation is associated with low psychological wellbeing, and it is likely to have a direct causal influence on psychotic symptoms. Catastrophic cognitive appraisals, cognitive-behavioural responses to dissociation, factors related to affect sensitivity, and perseverative thinking may contribute to the occurrence of dissociation.

AB - Dissociation is problematic in its own right for patients with psychosis but may also contribute to the occurrence of psychotic experiences. We therefore set out to estimate in a large cohort of patients with psychosis the prevalence of dissociative experiences, and assess using network models the relationships between dissociation, its potential maintenance mechanisms, and mental health symptoms. 902 patients with non-affective psychosis attending UK mental health services participated. Both an undirected model and a partially directed network model were estimated to identify potential relationships between ‘felt sense of anomaly’ dissociative experiences, paranoia, hallucinations, psychological wellbeing, sleep, and six potential maintenance mechanisms (affect intolerance, perseverative thinking, general self-efficacy, alexithymia, cognitive appraisals, and cognitive-behavioural responses to dissociation). 617 patients (65.4%) had experienced at least one dissociative symptom regularly over the past fortnight, with the average number experienced being 8.9 (SD = 8.0). Dissociation had direct relationships with paranoia, hallucinations, low psychological wellbeing, cognitive appraisals, cognitive-behavioural responses to dissociation, perseverative thinking, and low alexithymia. Dissociation was a probable cause of hallucinations (94.21% of 50,000 sampled directed acyclic graphs), with a trend towards also being a cause of paranoia (86.25% of 50,000 sampled directed acyclic graphs). Approximately two-thirds of patients with psychosis experience regular dissociative experiences. Dissociation is associated with low psychological wellbeing, and it is likely to have a direct causal influence on psychotic symptoms. Catastrophic cognitive appraisals, cognitive-behavioural responses to dissociation, factors related to affect sensitivity, and perseverative thinking may contribute to the occurrence of dissociation.

KW - Depersonalization

KW - Dissociation

KW - Network analysis

KW - Prevalence

KW - Psychological mechanisms

KW - Psychosis

UR - http://www.scopus.com/inward/record.url?scp=85119198618&partnerID=8YFLogxK

U2 - 10.1016/j.schres.2021.11.008

DO - 10.1016/j.schres.2021.11.008

M3 - Article

C2 - 34800911

AN - SCOPUS:85119198618

SN - 0920-9964

VL - 239

SP - 11

EP - 18

JO - Schizophrenia Research

JF - Schizophrenia Research

ER -

Dissociation in patients with non-affective psychosis: prevalence, symptom associations, and maintenance factors

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

Fingerprint

Cite this