The experience and role of dissociation in psychosis following developmental trauma: A systematic review
Eirini Aikaterini Melegkovits, Rui Tang, Olivia Pounds, Katie Ashcroft, Paul Jung, Helen Kennerley, Peter Fonagy, Michael Bloomfield
Clinical Psychology Review February 26, 2025 Peer reviewed DOI: 10.1016/j.cpr.2025.102564 via OpenAlex
Summary
Developmental trauma (DT), such as abuse or neglect before age 18, is associated with a moderate increase in dissociative symptoms among individuals experiencing psychosis. The review of 40 studies involving 6941 participants found that DT correlates significantly with dissociation, particularly following sexual and emotional abuse. Dissociation was identified as a mediator between DT and positive psychotic symptoms, such as hallucinations and paranoia. Screening for these symptoms in DT survivors is recommended.
Study at a glance
| Design | systematic review |
|---|---|
| Sample size | 6,941 |
| Population | individuals exhibiting psychosis or psychotic features who experienced developmental trauma |
| Key finding | A significant moderate association was observed between developmental trauma and dissociation, with dissociation mediating the link between developmental trauma and positive psychotic symptoms. |
Abstract
Developmental trauma (DT), defined as abuse or neglect before age 18, is linked with elevated risk and poorer outcomes in psychosis. This systematic review aimed to elucidate the relationship between DT and dissociation in psychosis and discern the potential mediating role of dissociation in the link between DT and psychotic manifestations. Our study protocol was pre-registered with PROSPERO (CRD42022330026). We adopted broad criteria, including a variety of methodologies exploring dissociation post-DT in individuals exhibiting psychosis or psychotic features. Risk of bias was assessed for all included studies. Our review incorporated 40 studies, totalling 6941 participants. A significant moderate association was observed between DT and dissociation ( r = 0.33 (95 %CI: 0.28–0.38)), underscored by dose-response effects. Sexual and emotional abuse demonstrated the most robust associations with dissociation. Individuals with psychosis and DT reported elevated dissociation relative to their non-traumatized counterparts. Dissociation mediated the link between DT and positive psychotic symptoms, notably hallucinations, across clinical and general populations. Five studies pinpointed dissociation's mediating role in tying DT to paranoia and delusional ideation. The review delves into clinical considerations, emphasizing screening for psychotic and dissociative symptoms in DT survivors, and outlining dissociation management strategies. Future research, employing longitudinal, qualitative, and experimental approaches, remains paramount. • Developmental trauma is linked to dissociative symptoms in patients with psychosis. • Dissociation contributes to hallucinations following developmental trauma. • The link between developmental trauma and paranoia may be in part explained by dissociation. • Dissociation may be both a cause and a response to psychotic symptoms. • Qualitative research is needed to understand the phenomenology of dissociation.