The experience and role of dissociation in psychosis following developmental trauma: A systematic review

IF 13.7 1区心理学 Q1 PSYCHOLOGY, CLINICAL

Clinical Psychology Review Pub Date : 2025-02-26 DOI:10.1016/j.cpr.2025.102564

Eirini Aikaterini Melegkovits , Rui Tang , Olivia Pounds , Katie Ashcroft , Paul Jung , Helen Kennerley , Peter Fonagy , Michael Bloomfield

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引用次数: 0

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.

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发育性创伤（DT）是指 18 岁以前受到的虐待或忽视，它与精神病的高风险和不良后果有关。本系统性综述旨在阐明 DT 与精神病患者解离之间的关系，并揭示解离在 DT 与精神病表现之间的潜在中介作用。我们的研究方案已在 PROSPERO（CRD42022330026）上预先注册。我们采用了宽泛的标准，包括各种探索 DT 后表现出精神病或精神病特征的个体的解离的方法。我们对所有纳入的研究进行了偏倚风险评估。我们的综述纳入了 40 项研究，共计 6941 名参与者。我们观察到 DT 与解离之间存在明显的中度关联（r = 0.33 (95 %CI: 0.28-0.38)），并强调了剂量反应效应。性虐待和情感虐待与解离之间的关系最为密切。与未受过创伤的人相比，患有精神病和 DT 的人报告的解离程度更高。在临床和普通人群中，解离在 DT 和阳性精神病症状（尤其是幻觉）之间起中介作用。有五项研究指出，解离在将 DT 与偏执狂和妄想症联系在一起时起到了中介作用。综述深入探讨了临床注意事项，强调要筛查 DT 幸存者的精神病和分离症状，并概述了分离管理策略。采用纵向、定性和实验方法进行未来研究仍然至关重要。

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来源期刊

Clinical Psychology Review PSYCHOLOGY, CLINICAL-

CiteScore

23.10

自引率

1.60%

发文量

期刊介绍： Clinical Psychology Review serves as a platform for substantial reviews addressing pertinent topics in clinical psychology. Encompassing a spectrum of issues, from psychopathology to behavior therapy, cognition to cognitive therapies, behavioral medicine to community mental health, assessment, and child development, the journal seeks cutting-edge papers that significantly contribute to advancing the science and/or practice of clinical psychology. While maintaining a primary focus on topics directly related to clinical psychology, the journal occasionally features reviews on psychophysiology, learning therapy, experimental psychopathology, and social psychology, provided they demonstrate a clear connection to research or practice in clinical psychology. Integrative literature reviews and summaries of innovative ongoing clinical research programs find a place within its pages. However, reports on individual research studies and theoretical treatises or clinical guides lacking an empirical base are deemed inappropriate for publication.