The conceptualization and assessment of dissociation: An umbrella review of synthesis studies

IF 11.2 1区心理学 Q1 PSYCHOLOGY, CLINICAL

Clinical Psychology Review Pub Date : 2026-03-01 Epub Date: 2026-01-23 DOI:10.1016/j.cpr.2026.102702

Carlo Garofalo , Irene Severi , Gianluca Bruno , Elisa Delvecchio , Adriano Schimmenti , Claudia Mazzeschi

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引用次数: 0

Abstract

Dissociation is a central yet controversial topic in psychopathology, eliciting interest from diverse areas of mental health research and clinical practice. Fundamental debates persist regarding its conceptualization and measurement. The present umbrella review synthesizes findings from all existing systematic reviews (n = 44), meta-analyses (n = 27), and mixed works (i.e., both systematic reviews and meta-analyses; n = 4) on dissociation, published between 1996 and 2025, encompassing 3864 primary studies and over 1,596,432 participants. We addressed three foundational questions: (1) Is dissociation conceptualized and measured as a categorical or dimensional construct? (2) Is it conceptualized and measured as unidimensional or multidimensional? (3) Do synthesis studies account for sample-specific factors such as culture, language, or environment? Regarding (1), findings revealed an almost equal split in the conceptualization of dissociation as categorical versus dimensional. However, measurement predominantly employs continuous scales, revealing inconsistencies between theoretical framing and empirical methods. Regarding (2), most studies endorse a multidimensional understanding of dissociation. Yet, most studies rely on total scores rather than subscale-level analyses. This suggests divergence in how multidimensionality is operationalized. Regarding (3), despite frequent use of group comparisons, few reviews systematically address cross-cultural or contextual comparability. This raises concerns about measurement validity across diverse populations. Overall, this review highlights a hybrid and sometimes inconsistent approach to dissociation in the literature. Advancing the field requires greater alignment between conceptual models and methods of operationalization, as well as systematic attention to cultural and contextual influences on dissociation assessment. Establishing consensus in these areas will strengthen theoretical clarity and improve the rigor and relevance of future research on dissociation.

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解离的概念化和评估：综合研究的概括性回顾

在精神病理学中，分离是一个中心但有争议的话题，引起了心理健康研究和临床实践各个领域的兴趣。关于其概念化和测量的基本争论仍然存在。本综述综合了1996年至2025年间发表的关于分离的所有现有系统综述（n = 44）、荟萃分析（n = 27）和混合研究（即系统综述和荟萃分析；n = 4）的研究结果，包括3864项主要研究和超过1,596,432名参与者。我们解决了三个基本问题：(1)解离是作为分类结构还是维度结构来概念化和测量的？(2)它是单维的还是多维的？(3)综合研究是否考虑了样本的特定因素，如文化、语言或环境？关于(1)，研究结果显示，在分类与维度分离的概念化中，分裂几乎相等。然而，测量主要采用连续尺度，揭示理论框架和经验方法之间的不一致。关于(2)，大多数研究支持对解离的多维理解。然而，大多数研究依赖于总分，而不是亚量表水平的分析。这表明多维度是如何运作的分歧。关于(3)，尽管经常使用群体比较，但很少有综述系统地讨论跨文化或上下文可比性。这引起了对不同人群测量有效性的关注。总的来说，这篇综述强调了文献中分离的混合和有时不一致的方法。推进这一领域需要在概念模型和操作方法之间取得更大的一致，以及系统地注意对分离评估的文化和背景影响。在这些领域建立共识将加强理论的清晰度，提高未来离解研究的严谨性和相关性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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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.