Reality monitoring across disorders of reality: Systematic and narrative reviews of dissociation and psychosis

Summary

Impairment in reality monitoring, the ability to distinguish between internally and externally generated information, is observed in both dissociation and psychosis. A systematic review identified four studies involving 482 participants that showed a small significant negative correlation between reality monitoring and dissociation, indicating impairment in high dissociation. Clinical psychosis was robustly linked to impaired reality monitoring, while findings for non-clinical experiences were mixed. No studies addressed reality monitoring in clinical dissociation.

Study at a glance

Abstract

Reality monitoring is the ability to remember whether information was internally- or externally-generated and is often impaired in clinical populations. Though an altered sense of reality characterizes both dissociation and psychosis, no review has compared reality monitoring between them. This paper compares these fields to inform the relation between dissociation and psychosis and the role of reality monitoring in mental health. First, a systematic review identified four eligible high-quality papers (according to Kmet and Lee’s Quantitative Checklist; n = 482) which measured dissociation directly and tested reality monitoring experimentally. Meta-analysis indicated a small significant negative association between reality monitoring and dissociation (Correlation = -.013, [-0.22, -0.04]), implying reality monitoring impairment in dissociation. Papers were identified from inception to 15 th May 2025 through searching Web of Science, Scopus, PsycINFO, PsycARTICLES, EMBASE, and MEDLINE. Next, a narrative review of psychosis and reality monitoring, covering pre-existing systematic reviews and original articles, indicated variation across the clinical spectrum. While clinical psychosis was robustly associated with impaired reality monitoring ability and externalising bias, results at non-clinical and sub-clinical levels were mixed. Finally, the reviews were compared to understand how reality monitoring and research practices vary across dissociation and psychosis. This indicated that both dissociation and psychosis are associated with impaired reality monitoring. Though this suggests a shared cognitive basis, no papers on dissociation included clinical presentations or bias towards internalising/externalising the item’s source, meaning any comparison is incomplete. Future research should consider clinical dissociation, reality monitoring bias in dissociation, and compare dissociation and psychosis directly. • Reality monitoring is overall slightly impaired in high dissociation • Clinical psychosis is robustly associated with impaired reality monitoring • It is unclear if non-clinical psychotic-like experiences impair reality monitoring • Only clinical psychosis was biased to attributing information to an external source • There were no publications on reality monitoring in clinical dissociation

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